Category:

• Antihypertensive

Description:

• ACE inhibitor

Indications:

• Hypertension

• Heart failure

• Left ventricular dysfunction (clinically stable asymptomatic patients, decreases rate of overt heart failure)

Precautions:

• Pregnancy category C (1^st trimester), category D (2^nd and 3^rd trimesters); 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, CHF, elderly, bilateral renal artery stenosis

Adverse Reactions (Side Effects):

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

• CV: angina, hypotension, palpitations, postural hypotension, syncope

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

• GU: decreased libido, impotence, increased BUN/creatinine, UTI

• METAB: hyperkalemia, hyponatremia

• MS: arthralgia, arthritis, myalgia

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

• SKIN: angioedema, flushing, rash, sweating

Dosage:

Administered orally, intravenously

• Adult:   PO 2.5-5mg daily, increase as needed, usually 10-40mg daily divided 1-2 times; IV (enalaprilat) 0.625-1.25 mg/dose given over 5 minutes every 6 hours; dosing adjustment in renal impairment: CrCl 10-50 ml/min, 75%-100% of normal dose; CrCl <10 ml/min, 50% of normal dose

• Child:   PO 0.1 mg/kg/day initially, increase as needed over 2 weeks to max of 0.5 mg/kg/day; IV (enalaprilat) 5-10 mcg/kg/dose every 8-24 hours

Drug interactions:

• Allopurinal: 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