Category:

• Antihypertensive

Description:

• Angiotensin-converting enzyme (ACE) inhibitor

Indications:

• Hypertension, heart failure, left ventricular dysfunction after MI

• Diabetic nephropathy in Type 1 patients (proteinuria > 500mg/daily)

Contraindications:

• Heart block

• Bilateral renal artery stenosis

Precautions:

• Pregnancy category C (1^st trimester) and D (3^rd trimester)

• Dialysis patients, hypovolemia, leukemia, scleroderma, lupus erythematosus

• Blood dyscrasias, thyroid disease, COPD, asthma, CHF, hyperkalemia

• Potassium sparing diruretics, cough, aortic stenosis, pediatric use

Adverse Reactions (Side Effects):

• CNS: chills, fever

• CV: chest pain, hypotension, palpitations, postural hypotension, tachycardia

• GI: loss of taste

• GU: acute reversible renal failure, dysuria, frequency, impotence, nephrotic syndrome, oliguria, polyuria, proteinuria

• HEME: agranulocytosis, neutropenia

• METAB: hyperkalemia, hyponatremia

• RESP: angioedema, bronchospasm, cough, dyspnea

• SKIN: rash

Dosage:

Administered orally

• Adult:            

  • Hypertensive crisis: PO 25mg, increasing every 2 hours until desired response; do not exceed 450mg daily

  • Hypertension: PO initial dose 12.5mg 2-3 times daily; may increase to 50mg 2-3 times daily at 1-2 week intervals; usual range 25-150mg 2-3 times daily; max 450mg daily

  • Diabetic nephropathy: PO 25mg 3 times daily

  • Congestive heart failure: PO 12.5mg 2-3 times daily; may increase to 50mg 2-3 times daily; after 14 days, may increase to 150mg 3 times daily if needed

• Child:            

  • Hypertension: PO initiate 0.15 mg/kg/dose; double at intervals of approximately 2 hours until blood pressure controlled; max 6 mg/kg/day

Drug Interactions:

• Allopurinol: increased risk of hypersensitivity reactions including Stevens-Johnson syndrome, skin eruptions, fever, and arthralgias

• NSAIDS: inhibits the antihypertensive response to ACE inhibition

• Lithium: increased risk of lithium toxicity