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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.
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.
Tablets: 5 mg, 10 mg, 20 mg, 40 mg
Indications and dosages
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.)
• Renal impairment
• Myocardial infarction
• Hypersensitivity to drug or to other ACE inhibitors
• Angioedema with or without previous ACE inhibitor treatment
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
☞ 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.
CNS: dizziness, drowsiness, fatigue, syncope, light-headedness, headache, insomnia
CV: angina pectoris, hypotension, tachycardia
GI: diarrhea, nausea, anorexia
GU: proteinuria, erectile dysfunction, decreased libido, renal failure
Respiratory: cough, dyspnea, bronchitis, asthma, eosinophilic pneumonitis
Skin: rash, angioedema
Other: fever, altered taste
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
☞ 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.
☞ 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.