Hyperkalemia may occur (risk factors include renal dysfunction, diabetes mellitus, concomitant use of potassium-sparing diuretics, potassium supplements and/or potassium-containing salts). May be associated with deterioration of renal function and/or increases in serum creatinine, particularly in low renal blood flow (e.g. renal artery stenosis, heart failure) where glomerular filtration rate is dependent on efferent arteriolar vasoconstriction by angiotensin II. Deterioration may result in oliguria, acute renal failure, and progressive azotemia. Small increases in serum creatinine may occur following initiation. Use with caution in significant aortic/mitral stenosis, and in biliary obstructive disorders or hepatic dysfunction. Avoid use or use smaller dose in volume-depleted patients. Use with caution in unstented unilateral/bilateral renal artery stenosis. When unstented bilateral renal artery stenosis is present, use is generally avoided due to elevated risk of deterioration in renal function unless possible benefits outweigh risks. Use with caution with pre-existing renal insufficiency and severe renal impairment.