Names and pronunciation
(ben-aze′uh-pril) Lotensin
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Drug reference
(ben-aze′uh-pril) Lotensin
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Func. class.: Antihypertensive
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Chem. class.: Angiotensin-converting enzyme (ACE) inhibitor
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Do not confuse: benazepril/Benadryl Lotensin/lovastatin
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ACTION: Selectively suppresses renin- angiotensin-aldosterone system; inhibits ACE, thus preventing conversion of angiotensin I to angiotensin II
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USES: Hypertension, alone or in com- bination with thiazide diuretics
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CONTRAINDICATIONS: Breast- feeding, children, hypersensitivity to ACE inhibitors, hereditary angioedema
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Black Box Warning: Pregnancy Precautions: Geriatric patients, impaired renal/hepatic function, dialysis patients, hypovolemia, blood dyscrasias, HF, asthma, bilateral renal artery stenosis, Black patients Black Box Warning: To notify prescriber of pregnancy; product will need to be dis- continued immediately; do not breastfeed • To rise slowly to sitting or standing po- sition to minimize orthostatic hypotension • To notify prescriber of mouth sores, sore throat, fever, swelling of hands or feet, ir- regular heartbeat, chest pain, bruising, bleeding, swelling of face, tongue, lips, dif- ficulty breathing, signs of infection, cough • To report excessive perspiration, de- hydration, vomiting, diarrhea; may lead to fall in B/P; to use caution in hot weather, strenuous exercise; to consume adequate fluids • That product may cause dizziness, fainting, light headedness; that this may occur during first few days of therapy • That product may cause skin rash or impaired perspiration • Diabetes: blood glucose, glucose may be decreased, especially during early treatment • Hypertension: how to take B/P and normal readings for age group • Pregnancy/breastfeeding: to notify prescriber if pregnancy is planned or suspected or if breastfeeding, not to use in pregnancy, breastfeeding
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SIDE EFFECTS CNS: Insomnia, headache, dizziness, fatigue CV: Hypotension, postural hypotension GI: Nausea, constipation, vomiting, diarrhea GU: Increased BUN, creatinine, decreased libido, impotence, renal insufficiency INTEG: Rash, flushing, sweating MISC: Angioedema, Stevens-Johnson syndrome, hypersensitivity, dry cough
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INTERACTIONS Increase: hypotension—phenothiazines, nitrates, acute alcohol ingestion, diuret- ics, other antihypertensives; may need to reduce dose, monitor B/P Increase: hyperkalemia—potassium- sparing diuretics, potassium supplements; monitor potassium, BUN, creatinine Increase: hypotension, hyperkalemia in diabetes, renal disease—aliskiren; do not use in diabetes, avoid use in GFR <60 mL/min Increase: myelosuppression—azaTHIO- prine Increase: serum levels of lithium, digoxin; may cause toxicity; monitor lithium or digoxin levels Decrease: hypotensive effects—NSAIDs, COX-2 inhibitors; monitor B/P Drug/Herb Increase: antihypertensive effect—haw thorn Decrease: antihypertensive effect—ephe- dra (ma huang); avoid concurrent use Drug/Lab Test Increase: AST, ALT, alkaline phosphatase, bilirubin, uric acid, blood glucose, potas- sium, BUN, creatinine
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TREATMENT OF OVERDOSE: 0.9% NaCl IV infusion, hemodialysis HIGH ALERT
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DOSAGE AND ROUTES Hypertension • Adult: PO 10 mg/day initially, then 20-40 mg/day divided bid or daily (with- out a diuretic); reduce initial dose to 5 mg PO daily (with a diuretic); increase as needed, max 80 mg/day • Child ≥6 yr: PO 0.2 mg/kg/day, in- crease as needed; max 0.6 mg/kg/day or 40 mg/day, whichever is lower. Renal dose • Adult: PO CCr <30 mL/min or CCr >3 mg/dL, use 5 mg daily, max 40 mg/day • Child ≥6 yr: PO CCr <30 mL/min, do not use
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Available forms: Tablets 5, 10, 20, 40 mg
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Administer: • May give without regard to food • Do not discontinue product abruptly • Black patients’ response to this drug is less, may need to be combined with other products • Store in a tight container at 86°F (30°C) or less
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Assess: • Hypertension: B/P, pulse at baseline, periodically; orthostatic hypotension, syncope when used with diuretic; notify prescriber of changes; monitor compli- ance • Renal studies: protein, BUN, creatinine; increased levels may indicate nephrotic syndrome; monitor urine for protein; LFTs, uric acid, glucose may be increased; diuretic should be discontinued 3 days before use; if hypertension is not con- trolled, a diuretic can be added; measure B/P at peak 2-4 hr and trough (before this product is less effec- next dose); tive in patients of African descent; CBC, ALT/AST, alkaline phosphatase • Potassium levels, although hyperkale- mia rarely occurs • Allergic reactions: rash, fever, pruri- tus, urticaria; product should be discon- tinued if antihistamines fail to help; Stevens-Johnson syndrome; angio- edema is more common in patients of African descent • Renal symptoms: polyuria, oliguria, frequency, dysuria
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Evaluate: • Therapeutic response: decrease in B/P; decreased HF (unlabeled)
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Not to use OTC products (cough, cold, allergy) unless directed by prescriber; not to use salt substitutes that contain potassium without consulting prescriber • The importance of complying with dosage schedule, even if feeling better
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PHARMACOKINETICS Onset 1 hr, peak 1-2 hr fasting, 2-4 hr after food, duration 24 hr; protein bind- ing 89%-95%; half-life 10-11 hr; metabo- lized by liver (metabolites); excreted in urine 33%
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• Child ≥6 yr: PO 0.2 mg/kg/day, in- crease as needed; max 0.6 mg/kg/day or 40 mg/day, whichever is lower. Renal dose
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• Child ≥6 yr: PO CCr <30 mL/min, do not use
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