Captopril

Listed in Dosage.

Adult: PO Hypertension Initially, 25-75 mg daily in 2-3 divided doses. Dosage is individualised according to clinical response and may be increased after at least 2 weeks, to 100-150 mg daily in 2-3 divided doses as needed to reach target BP. Patients on diuretics or with cardiac decompensation: Initially, 6.25 mg or 12.5 mg bid. Congestive heart failure Initial: 6.25-12.5 mg bid or tid. Dosage is individualised according to clinical response and may be increased incrementally, with at least 2 weeks intervals. Maintenance: 75-150 mg/day in divided doses. Post myocardial infarction Acute treatment: Initial: 6.25 mg as test dose, followed by 12.5 mg after 2 hours, and 25 mg after 12 hours. If tolerated, 50 mg bid for 4 weeks. Re-evaluate patient state according to clinical response. Chronic treatment: Initial: 6.25 mg within 3-16 days post-infarction, followed by 12.5 mg tid for 2 days, then 25 mg tid depending on patient response. Maintenance: 75-150 mg/day in 2 or 3 divided doses. Diabetic nephropathy 75-100 mg/day in divided doses.

Should be taken on an empty stomach. Take on an empty stomach 1 hr before or 2 hr after meals.

History of angioedema related to ACE treatment, hereditary or idiopathic angioneurotic oedema. Concomitant use with aliskiren esp in patients with diabetes mellitus or renal impairment (GFR <60 mL/min/1.73m²) and with neprilysin inhibitor (e.g. sacubitril). Pregnancy.

Patient with volume and/or Na depletion, ischaemic cardiovascular or cerebrovascular disease, aortic stenosis, unstented unilateral/bilateral renal artery stenosis, hypertrophic and outflow tract obstruction, collagen vascular disease. Patient undergoing major surgery or during anaesthetics. Desensitisation treatment (e.g. hymenoptera venom). Black race. Renal impairment. Children and elderly. Lactation. Patient Counselling May impair ability to drive or operate machinery. Monitoring Parameters Monitor blood pressure, BUN, serum creatinine, CBC with differentials, and electrolytes. Monitor for signs of angioedema and assess pregnancy status.

Significant: Hypotension, intestinal or peripheral angioedema, non-productive and persistent cough; cholestatic jaundice, proteinuria, neutropenia, agranulocytosis, thrombocytopenia, renal impairment or failure and hyperkalaemia. Cardiac disorders: Dyspnoea. Gastrointestinal disorders: Nausea, vomiting, diarrhea, constipation, dry mouth, epigastric discomfort, abdominal pain, peptic ulcer, dyspepsia. General disorders and administration site conditions: Asthenia. Metabolism and nutrition disorders: Anorexia, symptomatic hyponatremia, hypoglycaemia. Nervous system disorders: Taste impairment, dizziness. Psychiatric disorders: Sleep disorders, rarely, confusion, depression. Renal and urinary disorders: Rarely, polyuria, oliguria, pollakiuria. Reproductive system and breast disorders: Rarely, gynaecomastia. Skin and subcutaneous tissue disorders: Rash, pruritus with or without rash, alopecia.
Potentially Fatal: Angioedema involving the tongue, glottis or larynx; rarely, fulminant hepatic necrosis.

Increases lithium concentration and toxicity. Increased risk of leucopenia with procainamide and immunosuppresants. Decreased renal clearance with probenecid. Enhances hypotensive effect of TCA and antipsychotics. Decreased antihypertensive effects with sympathomimetic agents. Increased hypotensive effect with adrenergic blocking agents and NSAIDs (e.g. indomethacin, ibuprofen). Potentiates blood glucose-lowering effects of insulin and oral antidiabetics (e.g. sulphonylureas). May result in volume depletion and risk of hypotension with thiazide or loop diuretics (except furosemide and hydrochlorothiazide). May increase serum K with K-sparing diuretics (e.g. amiloride, spironolactone, triamterene), K-containing salt substitutes or supplements. Increased risk of low renal function due to serum K increase with NSAIDs. Increased risk of angioedema with neprilysin inhibitor and mammalian target of rapamycin inhibitor (e.g. temsirolimus, everolimus).

ACE Inhibitors/Direct Renin Inhibitors

C09AA01 - captopril ; Belongs to the class of ACE inhibitors. Used in the treatment of cardiovascular disease.