Trade Names:Capoten- Tablets 12.5 mg- Tablets 25 mg- Tablets 50 mg- Tablets 100 mgAPO-Capto (Canada)Gen-Captopril (Canada)PMS-Captopril (Canada)
Competitively inhibits angiotensin I-converting enzyme, preventing conversion of angiotensin I to angiotensin II, a potent vasoconstrictor that also stimulates aldosterone secretion. Results in decreased BP, potassium retention, and reduced sodium reabsorption.
T max is about 1 h. Food reduces absorption 30% to 40%.
About 25% to 30% protein bound.
More than 90% of a dose is eliminated in the urine; 40% to 50% is unchanged drug. The t ½ is less than 3 h.
60 to 90 min.
Excretion is reduced. Dosage reduction may be needed.
Treatment of hypertension, CHF, left ventricular dysfunction after MI, diabetic nephropathy.
Treatment of hypertensive crisis, neonatal and childhood hypertension, rheumatoid arthritis, diagnosis of anatomic renal artery stenosis and primary aldosteronism, treatment of hypertension related to scleroderma renal crisis and Takayasu disease, idiopathic edema, Bartter and Raynaud syndromes, asymptomatic left ventricular dysfunction after MI.
Hypersensitivity to ACE inhibitors.
PO 25 mg 3 times daily.Heart FailureAdults Initial dose
PO 6.25 to 12.5 mg 3 times daily; then titrate to usual daily dosage within next several days. Generally to be used in conjunction with a diuretic and digitalis.HypertensionAdults Initial dose
PO 25 mg twice daily to 3 times daily; gradually increase every 1 to 2 wk if satisfactory effect is not achieved. Usual dose: 25 to 150 mg twice daily to 3 times daily. Usual dose does not exceed 50 mg 3 times daily. Max daily dose is 450 mg.Left Ventricular Dysfunction after MIAdults
PO 6.25 mg 3 days after MI; then 12.5 mg 3 times daily and 25 mg 3 times daily for next several days.Target dose
50 mg 3 times daily over next several wk.
Give prescribed dose 1 h before or 2 h after meals.
Store tablets at controlled room temperature (59° to 89°F). Protect from moisture.
Reduces bioavailability of captopril.Indomethacin, salicylates (eg, aspirin)
Hypotensive effects may be reduced, especially in low-renin or volume-dependent hypertensive patients.Lithium
Increased lithium levels and symptoms of lithium toxicity may occur.Potassium preparations, potassium-sparing diuretics
May increase serum potassium levels.
False-positive urine acetone test may occur.
Chest pain; palpitations; tachycardia; orthostatic hypotension.
Headache; sleep disturbances; paresthesias; dizziness; fatigue; malaise; ataxia; confusion; depression; nervousness.
Rash; pruritus; alopecia.
Nausea; abdominal pain; vomiting; gastric irritation; aphthous ulcers; peptic ulcer; jaundice; cholestasis; diarrhea; dysgeusia; anorexia; constipation; dry mouth.
Elevated liver enzymes and serum bilirubin.
Neutropenia; agranulocytosis; thrombocytopenia; pancytopenia.
Hyperkalemia; hyponatremia; elevated uric acid and blood glucose.
Chronic dry cough; dyspnea; eosinophilic pneumonitis.
When used in pregnancy during the second and third trimesters, ACE inhibitors can cause injury and even death to the developing fetus. When pregnancy is detected, discontinue therapy as soon as possible.
Monitor and record BP and pulse. If symptomatic hypotension occurs, hold medication and notify health care provider.CBC
Ensure that CBC with differential are evaluated prior to starting therapy, at 2 wk intervals for 3 mo, and periodically thereafter in patient with renal function impairment or CHF.Heart failure patient
Assess heart failure patient for evidence of worsening failure (eg, daily weights, evaluation of peripheral edema, shortness of breath). Inform health care provider if rapid weight gain (eg, 2 pounds in 1 day or 5 pounds in 1 wk) is noted or if patient is experiencing worsening edema or other symptoms of heart failure (eg, worsening shortness of breath).
Category D (second and third trimester); Category C (first trimester). ACE inhibitors can cause injury or death to fetus if used during second or third trimester. When pregnancy is detected, discontinue ACE inhibitors as soon as possible.
Excreted in breast milk.
Safety and efficacy not established.
Because captopril is excreted primarily by the kidneys, patients with renal function impairment may require smaller or less frequent doses.
Use with extreme caution in patients with hereditary angioedema.
Rarely, ACE inhibitors have been associated with a syndrome that starts with cholestatic jaundice and progresses to fulminant hepatic necrosis and sometimes death.
Significant decreases in BP may occur after first dose, especially in patients with severe salt or volume depletion or those with CHF.
Risk appears greater with renal function impairment, CHF.
May occur, especially in patients with prior renal disease or those receiving high doses of drug (more than 150 mg/day); generally resolves within 6 mo.
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