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Captopril
CHF and arrhythmias
Diabetes
Hypertension
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Drug Name:

Captopril Rx

Generic Name and Formulations:
Captopril 12.5mg, 25mg, 50mg, 100mg; scored tabs.

Company:
Various generic manufacturers

Therapeutic Use:

Indications for Captopril:

Congestive heart failure inadequately controlled by digitalis and diuretics. To reduce mortality in stable post-MI patients with left ventricular dysfunction (ejection fraction ≤40%).

Adult:

Take 1hr before meals. Heart failure: initially 25mg 3 times daily (generally with diuretic and digitalis regimen). Increase, if needed, to 50mg 3 times daily. After 2 wks, may increase; max 450mg/day. Salt/volume depleted, or if systolic BP <100mmHg: initially 6.25mg or 12.5mg 3 times daily. Titrate to usual dose after several days. Post-MI: first dose 6.25mg 3 days post-MI, then increase to 12.5mg 3 times daily. Increase to 25mg 3 times daily over several days; maintenance 50mg 3 times daily. Renal impairment: see full labeling.

Children:

Not established.

Contraindications:

History of ACEI-associated or other angioedema. Concomitant aliskiren in patients with diabetes. Concomitant neprilysin inhibitor (eg, sacubitril); do not give within 36 hours of switching to or from sacubitril/valsartan.

Warnings/Precautions:

Fetal toxicity may develop: discontinue if pregnancy is detected. Renal impairment. Severe renal artery stenosis. Salt/volume depletion. Dialysis (esp. high-flux membrane). CHF. Aortic stenosis. Surgery. Diabetes. Monitor WBCs and renal function in renal and collagen vascular disease. Monitor BP, electrolytes, and renal function. Discontinue if neutropenia, agranulocytosis, angioedema, laryngeal edema, elevated liver enzymes, or jaundice occurs. Black patients may have higher risk of angioedema than non-black patients. Neonates. Pregnancy (Cat.D); avoid. Nursing mothers: not recommended.

Interactions:

See Contraindications. Increased risk of angioedema with concomitant neprilysin inhibitor or mTOR inhibitor (eg, temsirolimus, sirolimus, everolimus). Dual inhibition of the renin-angiotensin system with ARBs, ACEIs, or aliskiren may increase risk of hypotension, hyperkalemia, renal function changes; monitor closely. Avoid concomitant aliskiren in renal impairment (CrCl <60mL/min). Hyperkalemia with K+-sparing diuretics, K+ supplements and K+-containing salt substitutes. May be antagonized by, and renal toxicity potentiated by NSAIDs, including selective COX-2 inhibitors (monitor renal function in elderly and/or volume depleted). Potentiated by, and hypotension with diuretics, β-blockers, adrenergic antagonists. Discontinue nitroglycerin, other nitrates, or other vasodilators before starting therapy; if resumed, reduce dose and give cautiously. May increase lithium levels. May produce false (+) urinary acetone. Nitritoid reactions with injectable gold (eg, sodium aurothiomalate); rare.

Pharmacological Class:

ACE inhibitor.

Adverse Reactions:

Hypotension, dysgeusia, rash, pruritus, cough, proteinuria, tachycardia, neutropenia/agranulocytosis, hyperkalemia, hyponatremia, jaundice, angioedema.

Note:

Formerly known under the brand name Capoten.

Elimination:

Renal.

How Supplied:

Contact supplier.

Indications for Captopril:

Diabetic nephropathy (proteinuria >500mg/day) in type 1 diabetes with retinopathy.

Adult:

Take 1 hr before meals. 25mg 3 times daily. Renal impairment: see full labeling.

Children:

Not established.

Contraindications:

History of ACEI-associated or other angioedema. Concomitant aliskiren in patients with diabetes. Concomitant neprilysin inhibitor (eg, sacubitril); do not give within 36 hours of switching to or from sacubitril/valsartan.

Warnings/Precautions:

Fetal toxicity may develop: discontinue if pregnancy is detected. Renal impairment. Severe renal artery stenosis. Salt/volume depletion. Dialysis (esp. high-flux membrane). CHF. Aortic stenosis. Surgery. Diabetes. Monitor WBCs and renal function in renal and collagen vascular disease. Monitor BP, electrolytes, and renal function. Discontinue if neutropenia, agranulocytosis, angioedema, laryngeal edema, elevated liver enzymes, or jaundice occurs. Black patients may have higher risk of angioedema than non-black patients. Neonates. Pregnancy (Cat.D); avoid. Nursing mothers: not recommended.

Interactions:

See Contraindications. Increased risk of angioedema with concomitant neprilysin inhibitor or mTOR inhibitor (eg, temsirolimus, sirolimus, everolimus). Dual inhibition of the renin-angiotensin system with ARBs, ACEIs, or aliskiren may increase risk of hypotension, hyperkalemia, renal function changes; monitor closely. Avoid concomitant aliskiren in renal impairment (CrCl <60mL/min). Hyperkalemia with K+-sparing diuretics, K+ supplements and K+-containing salt substitutes. May be antagonized by, and renal toxicity potentiated by NSAIDs, including selective COX-2 inhibitors (monitor renal function in elderly and/or volume depleted). Potentiated by, and hypotension with diuretics, β-blockers, adrenergic antagonists. Discontinue nitroglycerin, other nitrates, or other vasodilators before starting therapy; if resumed, reduce dose and give cautiously. May increase lithium levels. May produce false (+) urinary acetone. Nitritoid reactions with injectable gold (eg, sodium aurothiomalate); rare.

Pharmacological Class:

ACE inhibitor.

Adverse Reactions:

Hypotension, dysgeusia, rash, pruritus, cough, proteinuria, tachycardia, neutropenia/agranulocytosis, hyperkalemia, hyponatremia, jaundice, angioedema.

Note:

Formerly known under the brand name Capoten.

Elimination:

Renal.

How Supplied:

Contact supplier.

Indications for Captopril:

Hypertension.

Adult:

Take 1 hr before meals. Initially 25mg 2–3 times daily. After 1–2 wks may increase to 50mg 2–3 times daily. If control unsatisfactory, see literature. Titrate to usual dose after several days. Monitor closely for 1st 2 wks and if dose increased; max 450mg/day. Renal impairment: see full labeling.

Children:

Not established.

Contraindications:

History of ACEI-associated or other angioedema. Concomitant aliskiren in patients with diabetes. Concomitant neprilysin inhibitor (eg, sacubitril); do not give within 36 hours of switching to or from sacubitril/valsartan.

Warnings/Precautions:

Fetal toxicity may develop: discontinue if pregnancy is detected. Renal impairment. Severe renal artery stenosis. Salt/volume depletion. Dialysis (esp. high-flux membrane). CHF. Aortic stenosis. Surgery. Diabetes. Monitor WBCs and renal function in renal and collagen vascular disease. Monitor BP, electrolytes, and renal function. Discontinue if neutropenia, agranulocytosis, angioedema, laryngeal edema, elevated liver enzymes, or jaundice occurs. Black patients may have higher risk of angioedema than non-black patients. Neonates. Pregnancy (Cat.D); avoid. Nursing mothers: not recommended.

Interactions:

See Contraindications. Increased risk of angioedema with concomitant neprilysin inhibitor or mTOR inhibitor (eg, temsirolimus, sirolimus, everolimus). Dual inhibition of the renin-angiotensin system with ARBs, ACEIs, or aliskiren may increase risk of hypotension, hyperkalemia, renal function changes; monitor closely. Avoid concomitant aliskiren in renal impairment (CrCl <60mL/min). Hyperkalemia with K+-sparing diuretics, K+ supplements and K+-containing salt substitutes. May be antagonized by, and renal toxicity potentiated by NSAIDs, including selective COX-2 inhibitors (monitor renal function in elderly and/or volume depleted). Potentiated by, and hypotension with diuretics, β-blockers, adrenergic antagonists. Discontinue nitroglycerin, other nitrates, or other vasodilators before starting therapy; if resumed, reduce dose and give cautiously. May increase lithium levels. May produce false (+) urinary acetone. Nitritoid reactions with injectable gold (eg, sodium aurothiomalate); rare.

Pharmacological Class:

ACE inhibitor.

Adverse Reactions:

Hypotension, dysgeusia, rash, pruritus, cough, proteinuria, tachycardia, neutropenia/agranulocytosis, hyperkalemia, hyponatremia, jaundice, angioedema.

Note:

Formerly known under the brand name Capoten.

Elimination:

Renal.

How Supplied:

Contact supplier.

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