captopril


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captopril

 [kap´to-pril]
an angiotensin-converting enzyme inhibitor used, usually with a diuretic, for treatment of hypertension or congestive heart failure in patients who have failed to respond to or developed unacceptable side effects with multiple drug regimens that usually include an adrenergic blocking agent, diuretic, and vasodilator. The most serious adverse reactions associated with its use include proteinuria, neutropenia, and agranulocytosis.

captopril

Acepril (UK), Apo-Capto (CA), Dom-Captopril, Gen-Captopril (CA), Med-Captopril

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

Prevents conversion of angiotensin I to angiotensin II, which leads to decreased vasoconstriction and, ultimately, to lower blood pressure. Also decreases blood pressure by increasing plasma renin secretion from kidney and reducing aldosterone secretion from adrenal cortex. Decreased aldosterone secretion prevents sodium and water retention.

Availability

Tablets: 12.5 mg, 25 mg, 50 mg, 100 mg

Indications and dosages

Hypertension

Adults: 12.5 to 25 mg P.O. two to three times daily; may be increased up to 150/mg/day at 1- to 2-week intervals. Usual dosage is 50 mg t.i.d. If patient is receiving diuretics, start with 6.25 to 12.5 mg P.O. two to three times daily. If blood pressure isn't adequately controlled after 1 to 2 weeks, add diuretic, as prescribed. If further blood pressure decrease is needed, dosage may be raised to 150 mg P.O. t.i.d. while patient continues on diuretic. Maximum dosage is 450 mg/day.

Heart failure

Adults: Usual initial dosage is 25 mg P.O. t.i.d. After increasing to 50 mg P.O. t.i.d. (if indicated), do not increase dosage further for 2 weeks, to determine satisfactory response. Don't exceed 450 mg/day.

Left ventricular dysfunction after myocardial infarction

Adults: 6.25 mg P.O. as a test dose, followed by 12.5 mg t.i.d. May increase up to 50 mg t.i.d.

Diabetic nephropathy

Adults: 25 mg P.O. t.i.d.

Dosage adjustment

• Renal impairment

Off-label uses

• Bartter's syndrome

• Hypertension associated with scleroderma

• Management of hypertensive crisis

• Raynaud's syndrome

• Rheumatoid arthritis

• Severe childhood hypertension

Contraindications

• Hypersensitivity to drug or other ACE inhibitors

• Angioedema (hereditary or idiopathic)

• Pregnancy

Precautions

Use cautiously in:

• renal or hepatic impairment, hypovolemia, hyponatremia, aortic stenosis and hypertrophic cardiomyopathy, cardiac or cerebrovascular insufficiency, systemic lupus erythematous

• family history of angioedema

• black patients with hypertension

• elderly patients

• breastfeeding patients

• children.

Administration

• Discontinue other antihypertensives 1 week before starting captopril, if possible.

• Give 1 hour before meals on empty stomach.

Adverse reactions

CNS: headache, dizziness, drowsiness, fatigue, weakness, insomnia

CV: angina pectoris, tachycardia, hypotension

EENT: sinusitis

GI: nausea, diarrhea, anorexia

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

Hematologic: anemia, agranulocytosis, leukopenia, pancytopenia, thrombocytopenia

Metabolic: hyperkalemia

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

Skin: rash, angioedema

Other: altered taste, fever

Interactions

Drug-drug. Allopurinol: increased risk of hypersensitivity reaction

Antacids: decreased captopril absorption Antihypertensives, general anesthetics that lower blood pressure, nitrates, phenothiazines: additive hypotension

Cyclosporine: hyperkalemia

Digoxin, lithium: increased blood levels of these drugs, increased risk of toxicity

Epoetin alfa: additive hyperkalemia

Indomethacin: reduced antihypertensive effect of captopril

Nonsteroidal anti-inflammatory drugs: decreased antihypertensive response

Potassium-sparing diuretics, potassium supplements: hyperkalemia

Probenecid: decreased elimination and increased blood level of captopril

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

Granulocytes, hemoglobin, platelets, red blood cells, sodium, white blood cells: decreased levels

Urine acetone: false-positive result

Drug-food. Any food: decreased captopril absorption

Salt substitutes containing potassium: hyperkalemia

Drug-herbs. Capsaicin, yohimbine: cough

Drug-behaviors. Acute alcohol ingestion: additive hypotension

Patient monitoring

Monitor for sudden blood pressure drop within 3 hours of initial dose if patient is receiving concurrent diuretics and on a low-sodium diet.

• Monitor hematologic, kidney, and liver function test results.

• Check for proteinuria monthly and after first 9 months of therapy.

Patient teaching

• Tell patient to take drug 1 hour before meals on empty stomach.

• Advise patient to report fever, rash, sore throat, mouth sores, fast or irregular heartbeat, chest pain, or cough.

• Inform patient that dizziness, fainting, and light-headedness usually disappear once his body adjusts to drug.

• Tell patient his ability to taste may decrease during first 2 to 3 months of therapy.

• Caution patient to avoid over-the-counter medications unless approved by prescriber.

• 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.

captopril

(kăp′tə-prĭl′)
n.
An ACE inhibitor drug used in the treatment of hypertension, congestive heart failure, and other cardiovascular disorders.

Captopril

Capoten® Cardiology A short-acting ACE inhibitor used for HTN, in type 1 DM, heart failure, and post-MI Pts with left ventricular dysfunction; long-term administration of captopril is associated with ↑ survival, and ↓ cardiovascular M&M, possibly attenuating ventricular dilatation and remodeling Warning Angioedema of upper airways Adverse effects Neutropenia, agranulocytosis, proteinuria, rash, pruritus, hypotension, dysgeusia. See ACE inhibitor.

captopril

An angiotensin converting enzyme inhibitor (ACE INHIBITOR) drug used in the treatment of HEART FAILURE and high blood pressure (HYPERTENSION). The drug is on the WHO official list. Brand names are Acepril and Capoten and, with the addition of a thiazide DIURETIC drug, Acezide, Capozide.
References in periodicals archive ?
After treatment with captopril or distilled water for 6 or 13 weeks, the rats were placed in metabolic cages.
Captopril as an antioxidant in lead-exposed Fischer 344 rats.
Tais pacientes foram tratados com captopril via sublingual (SL) ou via oral (VO), sendo a escolha por uma ou outra via conforme a preferencia do paciente, buscando-se perfazer um numero aproximado de pacientes tratados atraves de uma ou outra via de administracao, bem como entre o sexo masculino e feminino.
In the second part of the analysis, we used interrupted time series (ITS) segmented linear regression models of the monthly market share for captopril, enalapril, losartan and MNC.
The 30 SHR were randomly divided into 3 groups (model group, captopril group, and QGQS group) in ten (five male and five female in each group) for each group according to body weight; there was no difference in rats' body weight and rat's blood pressure (RBP) for each group of rats.
We added captopril to the drinking water on the fifth day (see Table S1).
The implementation of sensors produced in this research resulted in appropriate and desirable results in the measurement of captopril in real samples, including human blood serum and tablet.
After surgical operation, the abdominal aortic constriction (AAC) rats were randomly divided into five groups: model control group, three angoroside C treated groups (7.5, 15 and 30 mg x [kg.sup.-1]) and captopril treated group (40 mg x [kg.sup.-1]).
The use of long-term anti-thrombotics and intracardiac defibrillation is also advisable.[10] Our patient was stabilised and continued treatment with captopril and frusemide.
It will deliver the required quality, safety and effectiveness data needed for a future licence of captopril for children throughout Europe.
During in vitro study, 40 [micro]L of plasma was incubated (3 min, 37[degrees]C) with 10 [micro]L of chokeberry extract dissolved in distilled water (1-300 [micro]g/mL), or 10 [micro]L of water solution of captopril (0.0022-22 [micro]g/mL), or 10 of distilled water (control sample).