Sulfa antibiotic allergy/Prescribing ACE with ARB

[Ruthiejb]

My doctor recently switched me from Lotrel to Valturna for my high blood pressure, however, it's not working for me.  In fact my BP went  from 138/88 to 160/100 while taking Valturna.  I asked my doctor to add HCT, however, because I developed a rash from taking a sulfa antiobiotic 10 years ago, he doesn't want to take the chance.  So he put me back on Lotrel along with the Valturna.  He said as my BP comes down, he'll adjust the meds.  My questions are:  (1) I've read that having a rash deveop from a sulfa antiobiotic doesn't necessary mean I'll have an allergic reaction to HCT.  Is it safe to try the diuretic to see what happens?  Also, (2)  Is it safe to take Valturna and Lotrel  together?  I know the ACE and ARB drugs are similar.  Thank you for your assistance.

[CCF HeartMD-1]

1.  Yes, it is true that you will not necessarily have a reaction to HCTZ if you have a sulfa allergy.  A small percentage of people (< 15%) do have cross-reactivity to HCTZ when they have a sulfa allergy.  If you have had a severe reaction to sulfa antibiotics then we would probably recommend avoiding HCTZ.  If you have just had a rash, I think it would be ok to try HCTZ if needed in the future but just be observed closely by your physician such as visiting his clinic a day or two after starting the medication.

2.  It is ok to take both an ACE and ARB and there have been some trials using both for blood pressure management.  We just have to be very careful and watch your kidney function because both medications can affect the kidney funtion so make sure your physician checks your kidney function 1-2 weeks after being on both medications.  


Hope this helps.  

[Ruthiejb]

Thank you for your very quick and thorough response.  I will follow up with my doctor.