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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.
Pharmacologic: ace inhibitors
Time/action profile (antihypertensive effect)
|PO||within 1 hr*||1–2 wks†||24 hr†|
Adverse Reactions/Side Effects
Central nervous system
- cough (most frequent)
- hypotension (most frequent)
- impaired renal function
Fluid and Electrolyte
- angioedema (life-threatening)
Drug-Drug interactionExcessive 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.
Renal ImpairmentOral (Adults) CCr <30 mL/min—Initiate therapy with 5 mg once daily.
Renal ImpairmentOral (Children ≥ 6 yr) CCr <30 mL/min——Contraindicated.
Availability (generic available)
- 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 DiagnosesDecreased cardiac output (Indications, Side Effects)
Noncompliance (Patient/Family Teaching)
- 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.
- 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.
- Decrease in BP without appearance of excessive side effects.
benazeprilA 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.
Headache, cough, anaphylaxis, angioedema, hyperkalemia.