Pregnancy A recent medical history of using ACEI and ARB drugs, fludrocortisone, spironolactone, eplerenone, TCA antidepressant, Simvastatin, MAO inhibitors, serotonin inhibitors such as sertraline and citalopram, Triptamins, Alcoholism Heart Failure (EF<25%) Hepatic failure (Child Pugh score ≥ C ,AST> 5 times of the upper limit normal) Severe renal dysfunction (GFR less than 30cc per min) Any drug side-effects including: Patients’ intolerance, Diarrhea, Gastrointestinal problems Active peptic ulcer Active Bleeding

Pregnancy A recent medical history of using ACEI and ARB drugs, fludrocortisone, spironolactone, eplerenone, TCA antidepressant, Simvastatin, MAO inhibitors, serotonin inhibitors such as sertraline and citalopram, Triptamins, Alcoholism Heart Failure (EF<25%) Hepatic failure (Child Pugh score ≥ C ,AST> 5 times of the upper limit normal) Severe renal dysfunction (GFR less than 30cc per min) Any drug side-effects including: Patients’ intolerance, Diarrhea, Gastrointestinal problems Active peptic ulcer Active Bleeding