Cilazapril


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO HTN Initial: 1 mg once daily, 1st dose preferably at bedtime. Maintenance: 2.5-5 mg/day. Heart failure Initial: 0.5 mg once daily. Maintenance: 1-2.5 mg once daily. Max: 5 mg/day.
Dosage Details
Oral
Heart failure
Adult: Initially, 0.5 mg once daily increased to a maintenance dose of 1-2.5 mg once daily. Max: 5 mg/day.
Elderly: Initially, 0.5 mg/day.

Oral
Hypertension
Adult: Initially, 1 mg once daily. 1st dose preferably at bedtime to avoid precipitous fall in BP. Maintenance: 2.5-5 mg/day. Patients on diuretics: Initially, 0.5 mg/day.
Elderly: Initially, 0.5 mg/day.
Renal Impairment
Mild to moderate: Initially, 0.5 mg/day. Max: 2.5 mg once daily. Severe (CrCl <10 mL/min): Avoid.
Hepatic Impairment
Hypertension:
Cirrhosis: Initially, 0.5 mg/day.
Administration
May be taken with or without food.
Contraindications
History of angioedema w/ previous ACE inhibitor therapy. Hereditary and idiopathic angioedema. Ascites. Severe renal impairment. Coadministration w/ aliskiren in patients w/ DM or renal impairment. Pregnancy.
Special Precautions
Patients w/ aortic stenosis or outflow tract obstruction, ishaemic heart or cerebrovascular disease, unilateral or bilateral renal artery stenosis, and collagen vascular disease. Hepatic and renal impairment. Elderly, lactation.
Adverse Reactions
Dizziness, headache, fatigue, persistent dry cough, skin rash, nausea, hyperkalaemia, symptomatic hypotension.
Potentially Fatal: Anaphylactic reactions, fulminant hepatic necrosis.
Patient Counseling Information
May impair ability to drive and operate machineries.
MonitoringParameters
Monitor serum creatinine, BUN, electrolytes, CBC w/ differential and BP.
Overdosage
Symptoms: Tachycardia, palpitations, bradycardia, hypotension, hyperventilation, circulatory shock, dizziness, electrolyte disturbances, anxiety and cough. Management: IV infusion of NaCl 0.9% 9 mg/mL soln. Consider the use of angiotensin II infusion and/or IV catecholamines if available. Cilazaprilat can also be removed by haemodialysis.
Drug Interactions
Additive hyperkalaemic effects w/ K-sparing diuretics, K supplements, other drugs that can cause hyperkalaemia. May increase lithium concentration and toxicity. Concomitant use w/ TCAs and antipsychotics may further reduce BP. Reduced antihypertensive effects w/ sympathomimetics.
Potentially Fatal: Increased risk of hyperkalaemia, hypotension and changes in renal function w/ concomitant aliskiren in patients w/ DM and renal impairment.
Food Interaction
Avoid licorice as it may worsen HTN.
Action
Description: Cilazapril, a prodrug of cilazaprilat, a competitive inhibitor of ACE, which prevents the conversion of angiotensin I to angiotensin II that causes vasodilation and reduces peripheral resistance. It may also reduce degradation of bradykinin and affect enzymes involved in the generation of prostaglandins. Reduces both preload and afterload, and left ventricular remodelling.
Onset: Approx 1-2 hr.
Duration: 24 hr.
Pharmacokinetics:
Absorption: Rapidly absorbed. Bioavailability: Approx 60% (cilazaprilat). Time to peak plasma concentration: W/in 2 hr.
Metabolism: Undergoes hepatic hydrolysis and converted to its active metabolite (cilazaprilat).
Excretion: Via urine (53% as unchanged cilazaprilat). Effective half-life: 9 hr.
Storage
Store at 25°C.
References
Anon. Cilazapril. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 25/11/2013.

Buckingham R (ed). Cilazapril. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 25/11/2013.

Joint Formulary Committee. Cilazapril. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 25/11/2013.

Disclaimer: This information is independently developed by MIMS based on Cilazapril from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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