Lotensin


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benazepril hydrochloride

Apo-Benazepril (CA), Lotensin

Pharmacologic class: Angiotensin-converting enzyme (ACE) inhibitor

Therapeutic class: Antihypertensive

Pregnancy risk category C (first trimester), D (second and third trimesters)

FDA Box Warning

• When used during second or third trimester of pregnancy, drug may cause fetal injury and death. Discontinue as soon as possible when pregnancy is detected.

Action

Inhibits conversion of angiotensin I to angiotensin II, a vasoconstrictor that stimulates adrenal glands and promotes aldosterone secretion, thereby reducing sodium and water reabsorption and ultimately decreasing blood pressure. Decreased angiotensin also causes increased potassium level and fluid loss.

Availability

Tablets: 5 mg, 10 mg, 20 mg, 40 mg

Indications and dosages

Hypertension

Adults: Initially, 5 to 10 mg/day P.O. as a single dose. Increase gradually to a maintenance dosage of 20 to 40 mg/day as a single dose or in two divided doses. (Start with 5 mg/day in patients receiving diuretics.)

Dosage adjustment

• Renal impairment

Off-label uses

• Myocardial infarction

• Nephropathy

Contraindications

• Hypersensitivity to drug or to other ACE inhibitors

• Angioedema with or without previous ACE inhibitor treatment

Precautions

Use cautiously in:

• renal or hepatic impairment, hypovolemia, hyponatremia, aortic stenosis, hypertrophic cardiomyopathy, cerebrovascular or cardiac insufficiency

• patients receiving concurrent diuretics

• black patients

• elderly patients

• pregnant patients (use not recommended, particularly in second and third trimesters)

• breastfeeding patients

• children.

Administration

Use extreme caution if patient has family history of angioedema.

• When giving concurrently with diuretics, know that drug may cause excessive hypotension. If possible, stop diuretic therapy 2 to 3 days before starting benazepril.

• Give with or without food.

• Know that drug may be used alone or in conjunction with other antihypertensives.

Adverse reactions

CNS: dizziness, drowsiness, fatigue, syncope, light-headedness, headache, insomnia

CV: angina pectoris, hypotension, tachycardia

EENT: sinusitis

GI: diarrhea, nausea, anorexia

GU: proteinuria, erectile dysfunction, decreased libido, renal failure

Hematologic: agranulocytosis

Metabolic: hyperkalemia

Respiratory: cough, dyspnea, bronchitis, asthma, eosinophilic pneumonitis

Skin: rash, angioedema

Other: fever, altered taste

Interactions

Drug-drug. Allopurinol: increased risk of hypersensitivity reaction

Antacids: decreased benazepril absorption

Antihypertensives, diuretics, general anesthetics, nitrates, phenothiazines: excessive hypotension

Cyclosporine, indomethacin, potassium-sparing diuretics, potassium supplements: hyperkalemia

Lithium: increased lithium blood level, greater risk of lithium toxicity

Nonsteroidal anti-inflammatory drugs: blunting of antihypertensive response

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, potassium: increased levels

Antinuclear antibodies: positive result

Sodium: decreased level

Drug-food. Salt substitutes containing potassium: hyperkalemia

Drug-herbs. Capsaicin: cough

Drug-behaviors. Acute alcohol ingestion: increased hypotension

Patient monitoring

Monitor for signs and symptoms of angioedema, including laryngeal edema and shock.

• Measure blood pressure regularly.

• Monitor CBC, electrolyte levels, kidney and liver function test results, and urinary protein level.

Patient teaching

Tell patient to immediately report change in urination pattern, difficulty breathing, or swelling of throat or lips.

• Instruct patient to record blood pressure at various intervals daily.

• Tell patient to report dizziness, fainting, or light-headedness during initial therapy.

• Advise patient to increase fluid intake during exercise and in hot weather.

• Caution patient to avoid salt substitutes, which may cause hyperkalemia.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.

benazepril

(ben-aye-ze-pril) ,

Lotensin

(trade name)

Classification

Therapeutic: antihypertensives
Pharmacologic: ace inhibitors
Pregnancy Category: D

Indications

Alone or with other agents in the management of hypertension.

Action

Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of bradykinin and other vasodilatory prostaglandins. ACE inhibitors also ↑ plasma renin levels and ↓ aldosterone levels. Net result is systemic vasodilation.

Therapeutic effects

Lowering of BP in patients with hypertension.

Pharmacokinetics

Absorption: 37% absorbed after oral administration.
Distribution: Crosses the placenta; enters breast milk in small amounts.
Protein Binding: 95%.
Metabolism and Excretion: Converted by the liver to benazeprilat, the active metabolite; 20% excreted in urine; 11–12% nonrenal (biliary) elimination.
Half-life: Benazeprilat: 10–11 hr.

Time/action profile (antihypertensive effect)

ROUTE ONSETPEAKDURATION
POwithin 1 hr*1–2 wks†24 hr†
*After single dose†Chronic dosing

Contraindications/Precautions

Contraindicated in: Hypersensitivity; History of angioedema with or without previous use of ACE inhibitors; Concurrent use with aliskiren in patients with diabetes or moderate-to-severe renal impairment (CCr <60 mL/min) Obstetric: Can cause injury or death of fetus—if pregnancy occurs, discontinue immediately; Lactation: Discontinue drug or use formula.
Use Cautiously in: Patients with renal impairment, hypovolemia, hyponatremia, and concurrent diuretic therapy; genetic implication Black patients (monotherapy for hypertension less effective, may require additional therapy; higher risk of angioedema); Surgery/anesthesia (hypotension may be exaggerated); Pediatric: Children <6 yr (safety not established); Geriatric: Initial dose ↓ recommended.
Exercise Extreme Caution in: Family history of angioedema.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • drowsiness
  • fatigue
  • headache

Respiratory

  • cough (most frequent)

Cardiovascular

  • hypotension (most frequent)

Gastrointestinal

  • nausea

Genitourinary

  • impaired renal function

Dermatologic

  • rash

Fluid and Electrolyte

  • hyperkalemia

Miscellaneous

  • angioedema (life-threatening)

Interactions

Drug-Drug interaction

Excessive hypotension may occur with concurrent use of diuretics.Additive hypotension with other antihypertensives.↑ risk of hyperkalemia with concurrent use of potassium supplements, potassium-sharing diuretics, or potassium-containing salt substitutes.↑ risk of hyperkalemia, renal dysfunction, hypotension, and syncope with concurrent use of angiotensin II receptor antagonists or aliskiren ; avoid concurrent use with aliskiren in patients with diabetes or CCr <60 mL/min.NSAIDs and selective COX-2 inhibitors may blunt the antihypertensive effect and ↑ the risk of renal dysfunction.↑ levels and may ↑ risk of lithium toxicity.

Route/Dosage

Oral (Adults) 10 mg once daily, ↑ gradually to maintenance dose of 20–40 mg/day in 1–2 divided doses (initiate therapy at 5 mg once daily in patients receiving diuretics).
Oral (Children ≥ 6 yr) 0.2 mg/kg once daily; may be titrated up to 0.6 mg/kg/day (or 40 mg/day).

Renal Impairment

Oral (Adults) CCr <30 mL/min—Initiate therapy with 5 mg once daily.

Renal Impairment

Oral (Children ≥ 6 yr) CCr <30 mL/min——Contraindicated.

Availability (generic available)

Tablets: 5 mg, 10 mg, 20 mg, 40 mg
In combination with: amlodipine (Lotrel) and hydrochlorothiazide (Lotensin HCT). See combination drugs.

Nursing implications

Nursing assessment

  • Monitor BP and pulse frequently during initial dose adjustment and periodically during therapy. Notify health care professional of significant changes.
  • Monitor frequency of prescription refills to determine adherence.
  • Assess patient for signs of angioedema (dyspnea, facial swelling).
  • Lab Test Considerations: Monitor renal function. May cause ↑ BUN and serum creatinine.
    • May cause hyperkalemia.
    • Monitor CBC periodically during therapy in patients with collagen vascular disease and/or renal disease. May rarely cause slight ↓ in hemoglobin as well as leukopenia and eosinophilia.
    • May cause ↑ AST, ALT, alkaline phosphatase, serum bilirubin, uric acid, and glucose.

Potential Nursing Diagnoses

Decreased cardiac output (Indications,  Side Effects)
Noncompliance (Patient/Family Teaching)

Implementation

  • Do not confuse benazepril with Benadryl.
  • Correct volume depletion, if possible, before initiation of therapy. Precipitous drop in BP during first 1–3 hr after first dose may require volume expansion with normal saline but is not normally considered an indication for stopping therapy. Discontinuing diuretic therapy or cautiously increasing salt intake 2–3 days before initiation may decrease risk of hypotension. Monitor closely for at least 1 hr after BP has stabilized. Resume diuretics if BP is not controlled.
  • Oral: For patients with difficulty swallowing tablets, pharmacist can compound an oral suspension; stable for 30 days if refrigerated. Shake suspension before each use.

Patient/Family Teaching

  • Instruct patient to take medication as directed at the same time each day, even if feeling well. Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses. Warn patient not to discontinue benazepril unless directed by health care professional.
  • Encourage patient to comply with additional interventions for hypertension (weight reduction, low sodium diet, discontinuation of smoking, moderation of alcohol consumption, regular exercise, and stress management). Medication controls but does not cure hypertension.
  • Instruct patient and family on correct technique for monitoring BP. Advise them to check BP at least weekly and to report significant changes to health care professional.
  • Caution patient to avoid salt substitutes containing potassium, or foods containing high levels of potassium or sodium unless directed by health care professional. See.
  • Caution patient to change positions slowly to minimize hypotension. Use of alcohol, standing for long periods, exercising, and hot weather may increase orthostatic hypotension.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially cough, cold, or allergy remedies.
  • May cause dizziness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
  • Advise patient to inform health care professional of medication regimen before treatment or surgery.
  • Instruct patient to notify health care professional if rash; mouth sores; sore throat; fever; swelling of hands or feet; irregular heartbeat; chest pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue; or if difficulty swallowing or breathing occurs. Persistent dry cough may occur and may not subside until medication is discontinued. Consult health care professional if cough becomes bothersome. Also notify health care professional if nausea, vomiting, or diarrhea occurs and continues.
  • Advise women of childbearing age to use contraception and notify health care professional of pregnancy is planned or suspected.
  • Emphasize the importance of follow-up examinations to evaluate effectiveness of medication.

Evaluation/Desired Outcomes

  • Decrease in BP without appearance of excessive side effects.

Lotensin

(lō-tĕn′sĭn)
A trademark for the drug benazepril hydrochloride.

benazepril

A nonsulfhydryl ACE inhibitor and antihypertensive used to manage congestive heart failure and chronic renal failure in patients with renal disease—e.g., glomerulopathies, interstitial nephritis, nephrosclerosis, polycystic kidney disease, diabetic nephropathy, etc.

Adverse effects
Headache, cough, anaphylaxis, angioedema, hyperkalemia.
References in periodicals archive ?
Benazepril HCl and Andrx Pharmaceuticals Lotensin HCT
Combination drugs include Aldoril, Atacand HCT, Avalide, Benicar HCT, Diovan HCT, Dyazide, Hyzaar, Lotensin HCT, Maxzide, Micardis HCT.
has received final approval for benazepril HC1 tablets and benazepril HCI/HCTZ tablets in the same strength as Lotensin and Lotensin HCT, the brand products marketed by Novartis Pharmaceuticals Corp.
The reduced price program will cover Diovan, a high blood pressure medication, as well as a number of other other key Novartis prescription products, including Exelon (Alzheimer's disease), Lamisil Oral (fungal infections), Lescol (high cholesterol), Miacalcin nasal spray (osteoporosis) and Lotensin and Lotril (both high blood pressure).
Commonly used ACE inhibitors include Vasotec, Captopril, Zestril, Accupril, Lotensin.
Several key products - including Lescol, LoTensin, Lamisil and Miacalcin - have generated impressive sales increases in 1996.
Accupril - Agrylin - Axid - Biaxin - Celexa - Cipro - Difl ucan - Duragesic - Effexor - Flonase - Floxin/Occufl ox - Glucophage XR - Glucotrol XL - Glucovance - Lotensin - Metaglip - Mobic - Monopril - Novantrone - Paraplatin - Paxil - Pravachol - Proscar - Retrovir - Rocephin - Romazicon - Tambocor - Ultram - Zaditor - Zestril/Prinivil - Zithromax - Zocor - Zofran - Zoloft
Increases of note among Ciba's top-selling products in 1995 came from Triamterene/HCTZ, Cataflam, Lotensin, Lopressor, Ritalin and Habitrol.
The Company also launched its bioequivalent versions of Lotensin(R) and Lotensin HCT(R) in February 2004, along with numerous other competitors.
s Lotensin and Merck's Plendil (all blood pressure drugs)--as well as American Home Products' Lodine arthritis treatment, Syntex Laboratories Inc.
sales of Lotensin in the 5, 10, 20 and 40 mg dosage strengths were over $330 million in 2003.
is introducing Lotensin, a new hypertension drug, at a price that would remain fixed for the lifetime of customers who begin using it during the next year.