Category:

• Anytihypertensive

Description:

• Angiotensin-converting enzyme (ACE) inhibitor

Indications:

• Hypertension

• CHF

• Acute MI

• Diabetic nephropathy (non FDA approved)

Precautions:

• Pregnancy category C (1^st trimester), D (2^nd and 3^rd trimester); ACE inhibitors can cause fetal and neonatal morbidity and death when administered to pregnant women

• Impaired renal function, dialysis patients, hypovolemia

• Diuretic therapy, collagen-vascular diseases, elderly, bilateral renal artery stenosis

Adverse Reactions (Side Effects):

• CNS: anxiety, dizziness, fatigue, headache, insomnia, paresthesia

• CV: angina, hypotension, palpitations, postural hypotension, syncope (especially with 1^st dose)

• GI: abdominal pain, constipation, melena, nausea, vomiting

• GU: acute renal failure, decreased libido, impotence, increased BUN, creatinine

• HEME: agranulocytosis, neutropenia

• METAB: hyperkalemia, hyponatremia

• MS: arthralgia, arthritis, myalgia

• RESP: asthma, bronchitis, cough, dyspnea, sinusitis

• SKIN: angioedema, flushing, rash, sweating

Dosage:

Administered orally

• Adult:            

  • Hypertension: PO 10mg daily; usual dose 20-40mg daily

  • CHF: PO 5mg daily; usual range 5-20mg daily

  • Acute MI: PO in hemodynamically stable patients within 24 hours of acute MI, 5mg followed by 5mg after 24 hours, 10mg after 48 hours, then 10mg daily; continue 6 weeks (or longer if concurrent hypertension or CHF)

  • Renal impairment: PO initial dose 5mg daily (serum creatinine > or = to 3 mg/dl); initial dose 2.5mg daily (dialysis patients)

Drug interactions:

• Allopurinol: predisposition to hypersensitivity reactions to ACE inhibitors

• Aspirin, NSAIDs: inhibition of the antihypertensive response to ACE inhibitors

• Prazosin, terazosin, doxazosin: exaggerated first-dose hypotensive response to a-blockers