CAPTOPRIL (kap'toe-pril) Capoten Classifications: cardiovascular agent; angiotensin-converting enzyme (ace) inhibitor; antihypertensive agent Prototype: Enalapril Pregnancy Category: D |
12.5 mg, 25 mg, 50 mg, 100 mg tablets
Lowers blood pressure by specific inhibition of the angiotensin-converting enzyme (ACE). This interrupts conversion sequences initiated by renin that lead to formation of angiotensin II, a potent endogenous vasoconstrictor. ACE inhibition alters hemodynamics without compensatory reflex tachycardia or changes in cardiac output (except in patients with CHF). Peripheral vascular resistance is lowered by vasodilation. Inhibition of ACE also leads to decreased circulating aldosterone. Reduced circulating aldosterone is associated with a potassium-sparing effect. In heart failure, captopril administration is followed by a fall in CVP and pulmonary wedge pressure; hypotensive action appears to be unrelated to plasma renin levels.
Effective in stepped protocol management of hypertension to convert to normotensive range, and in congestive heart failure with resulting decreases in dyspnea and improved exercise tolerance.
Hypertension; in conjunction with digitalis and diuretics in CHF, diabetic nephropathy, left ventricular dysfunction post MI.
Idiopathic edema.
Angioedema, hypersensitivity to captopril or ACE inhibitors; hypotension; pregnancy (category D), lactation.
Impaired renal function, patient with solitary kidney; collagen-vascular diseases (scleroderma, SLE); patients receiving IMMUNOSUPPRESSANTS or other drugs that cause leukopenia or agranulocytosis; autoimmune disease, bone marrow suppression, coronary or cerebrovascular disease; cardiomyopathy, aortic stenosis; severe salt/volume depletion; heart failure, renal artery stenosis, renal disease, renal failure, renal impairment; hyperkalemia, children, elderly.
Hypertension Adult: PO 6.2525 mg t.i.d., may increase to 50 mg t.i.d. (max: 450 mg/d) Child: PO 0.312.5 mg/kg q1224h, may titrate up to max of 6 mg/kg/d in 24 divided doses Infant: PO 0.150.3 mg/kg, may titrate up to 6 mg/kg/d in 14 divided doses Neonate: PO 0.050.1 mg/kg q824 h, may titrate up to 0.5 mg/kg q624 h Premature infant: PO 0.01 mg/kg q812h Congestive Heart Failure Adult: PO 6.2512.5 mg t.i.d., may increase to 100 mg t.i.d. (max: 450 mg/d) Renal Insufficiency Clcr 1050 mL/min = 75% of dose, Clcr <10 mL/min = 50% of dose |
In some patients, elevated urine protein levels may persist even after captopril has been discontinued. Possibility of transient elevations of BUN and serum creatinine, slight increase in serum potassium, and serum prolactin, increases in liver enzymes, and false-positive urine acetone (using sodium nitroprusside reagent). Captopril may decrease fasting blood sugar in the nondiabetic and cause hypoglycemia in the diabetic patient controlled with antidiabetic drug therapy.
Assessment & Drug Effects
Patient & Family Education