Adult: 75-100 mg daily in divided doses. Child: Neonates and infants: 0.15 mg/kg. Children and adolescents: 0.3 mg/kg. All doses are given tid according to response or based on patient response. Elderly: Initially, 6.25 mg bid.
Oral Post-myocardial infarction
Adult: Acute treatment (within 24 hours of the onset of symptoms): 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 (>24 hours of the onset of symptoms): Initially, 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 daily in 2 or 3 divided doses. Child: Neonates and infants: 0.15 mg/kg. Children and adolescents: 0.3 mg/kg. All doses are given tid according to response or based on patient response. Elderly: Initially, 6.25 mg bid.
Adult: 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. Child: Neonates and infants: 0.15 mg/kg. Children and adolescents: 0.3 mg/kg. All doses are given tid according to response or based on patient response. Elderly: Initially, 6.25 mg bid.
Oral Congestive heart failure
Adult: Initially, 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 daily in divided doses. Child: Neonates and infants: 0.15 mg/kg. Children and adolescents: 0.3 mg/kg. All doses are given tid according to response or based on patient response. Elderly: Initially, 6.25 mg bid.
6.25 mg daily. Max 37.5 mg daily.
12.5 mg daily. Max: 75 mg daily.
25 mg daily. Max: 100 mg daily.
25-50 mg daily. Max: 150 mg daily.
Should be taken on an empty stomach. Take 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 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.
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 admin 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.
Monitor blood pressure, BUN, serum creatinine, CBC with differentials, and electrolytes. Monitor for signs of angioedema and assess pregnancy status.
Symptoms: Severe hypotension, shock, stupor, bradycardia, electrolyte disturbances, and renal failure. Management: Prevent absorption of recent ingestion by employing gastric lavage, administration of adsorbents and Na sulphate within 30 minutes post intake. For hypotension, place in shock position and rapidly initiate salt and volume supplementations. Administer atropine and consider the use of pacemaker for pacemaker and bradycardia.
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). Potentially Fatal: Increased risk of hypotension, hyperkalaemia and impaired renal function with aliskiren. Increased risk of angioedema with neprilysin inhibitors (e.g. sacubitril). May cause anaphylactoid reactions with dextran sulfate in LDL apheresis.
Decreased serum concentration with food.
May cause false-positive urine test for acetone determination using nitroprusside reagent. May result to false-negative aldosterone/renin ratio (ARR).
Description: Captopril is a sulfhydryl-containing ACE inhibitor which competitively inhibits ACE to prevent conversion of angiotensin I to angiotensin II, thereby increasing plasma renin activity and reducing aldosterone secretion. Onset: Within 15 minutes. Pharmacokinetics: Absorption: Rapidly absorbed from the gastrointestinal tract (approx. 60-75%). Decreased serum concentration with food. Bioavailability: Approx 60-75%. Time to peak plasma concentration: Within 1-2 hours. Distribution: Crosses placenta and enters breast milk (small amounts). Volume of distribution at steady state: 0.7 L/kg. Plasma protein binding: 25%-30%. Excretion: Via urine (>95%; 40-50% as unchanged drug). Elimination half-life: 2-3 hours.
C09AA01 - captopril ; Belongs to the class of ACE inhibitors. Used in the treatment of cardiovascular disease.
Anon. Captopril. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 21/11/2013.Anon. Captopril. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 21/11/2013.Buckingham R (ed). Captopril. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 21/11/2013.Capoten Tablets. U.S. FDA. https://www.fda.gov/. Accessed 21/11/2013.Captopril (Apotex Corp.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 21/11/2013.