Names and pronunciation
(kap′toe-pril)
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Individual generic drug information
Extracted information for captopril only.
(kap′toe-pril)
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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: captopril/carvedilol
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ACTION: Selectively suppresses renin- angiotensin-aldosterone system; inhibits ACE; prevents conversion of angiotensin I to angiotensin II
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USES: Hypertension, HF, left ventricu- lar dysfunction after MI, diabetic nephropathy, proteinuria
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Unlabeled uses: Acute MI, hypertensive emergency/urgency, scleroderma renal crisis (SRC)
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Extracted information for captopril only.
CONTRAINDICATIONS: Breast- feeding, children, hypersensitivity, heart block, potassium-sparing diuretics, bilat- eral renal artery stenosis, ACE inhibitors, ACE inhibitor–induced angioedema
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Black Box Warning: Pregnancy Precautions: Dialysis patients, hypovo- lemia, leukemia, scleroderma, SLE, blood dyscrasias, HF, diabetes mellitus, thyroid/renal/hepatic disease, African descent, pregnancy first trimester, colla- gen vascular disease, hyperkalemia, hyponatremia Black Box Warning: Pregnancy/breast- feeding: Discontinue ACE inhibitors when pregnancy is detected; monitor fetal de- velopment regularly; do not breastfeed Black Box Warning: Pregnancy/breast- feeding: to notify if pregnancy is planned or suspected; not to breastfeed, contra- ception should be used, if pregnancy occurs, discontinue medication See Appendix B
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SIDE EFFECTS CNS: Fever, chills, dizziness, drowsiness, fatigue, headache, insomnia, weakness CV: Hypotension, postural hypotension, tachycardia, angina GI: Loss of taste, increased LFTs GU: Impotence, dysuria, nocturia, pro- teinuria, nephrotic syndrome, acute reversible renal failure, polyuria, oliguria, urinary frequency HEMA: Neutropenia, agranulocytosis, pancytopenia, thrombocytopenia, anemia INTEG: Rash, pruritus MISC: Angioedema, hyperkalemia RESP: Bronchospasm, dyspnea, cough
Source pages 230, 231
INTERACTIONS • Do not use with potassium-sparing di- uretics, sympathomimetics, potassium supplements Increase: possible toxicity—lithium, digoxin; monitor individual drug levels Increase: hyperkalemia—aliskiren Increase: hypoglycemia—insulin, oral antidiabetics; monitor blood glucose Increase: hypotension—diuretics, other antihypertensives, acute alcohol inges- tion, MAOIs Decrease: captopril effect—antacids, COX-2 inhibitors, NSAIDs, salicylates Drug/Herb Increase: antihypertensive effect—hawthorn Decrease: antihypertensive effect— black licorice, ephedra Drug/Food Decrease: absorption of captopril Drug/Lab Test Increase: AST, ALT, alkaline phosphatase, bilirubin, uric acid, potassium Decrease: platelets, WBC, RBC, HB/Hct False positive: urine acetone Positive: ANA titer
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Extracted information for captopril only.
DOSAGE AND ROUTES Hypertension • Adult: PO initial dose: 12.5-25 mg bid-tid; may increase to 50 mg bid-tid at 1-2 wk intervals; usual range: 25-150 mg bid-tid; max 450 mg/day • Child (unlabeled): PO 0.3-0.5 mg/kg/ dose, may titrate up to 6 mg/kg/day in 2-4 divided doses • Infant (unlabeled): PO 0.15-0.3 mg/ kg/dose initially, max 6 mg/kg/day • Neonate (unlabeled): PO 0.01-0.1 mg/kg/dose, may increase as needed Heart failure • Adult: PO 25 mg bid; may increase to 50 mg tid; after 14 days, may increase to 150 mg tid if needed • Adolescent (unlabeled): PO 6.25- 12.5 mg q8-12hr titrated up to max 50- 75 mg/dose • Child (unlabeled): PO 0.1-2 mg/kg/ dose q6-12hr, max 6 mg/kg/day • Infant (unlabeled): PO 0.15-0.3 mg/ kg/dose, max 6 mg/kg/day in 1-4 divided doses • Neonate (unlabeled): PO 0.05-0.1 mg/kg q8-24hr titrate to 0.5 mg/kg q6- 24hr, max 2 mg/kg/day Diabetic nephropathy • Adult: PO 25 mg tid Renal dose • Adult: PO CCr 10-50 mL/min, decrease dose by 25%; CCr <10 mL/min, decrease dose by 50% Left ventricular dysfunction/acute MI (unlabeled) or post-MI • Adult: PO 6.25-12.5 mg tid, increase to 25 mg tid gradually Hypertensive emergency/urgency (unlabeled) • Adult: PO 25 mg, may repeat q30min
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Available forms: Tablets 12.5, 25, 50, 100 mg
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Administer: • Store in tight container at 86°F (30°C) or less • 1 hr prior to or 2 hr after meals • Correct volume depletion before start- ing treatment • Oral solution: May crush 25-mg tablet, dissolve in 50-100 mL water; give within ½ hr; make sure tablet completely dissolved
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Extracted information for captopril only.
Assess: • Blood dyscrasias: blood studies: de- creased platelets; CBC with differential at baseline, q2wk and periodically during 1 yr; if neutrophils <1000/mm3, discontinue treatment (recommended with collagen- vascular or renal disease) • Hypertension: B/P, pulse rates at base- line, frequently; notify prescriber of sig- nificant changes • Heart failure: dyspnea, jugular venous distention, weight gain, edema, rales/ crackles in lungs, increased B/P • Renal studies: protein, BUN, creati- nine electrolytes, watch for raised levels, if increased dose may need to be reduced • Angioedema/allergic reaction: rash, fever, pruritus, urticaria; discontinue C product if antihistamines fail to help; swelling of lips, mouth, face; difficulty breathing/swallowing (angioedema); pro- vide supportive care; discontinue product • Monitor AST, ALT, alkaline phosphatase, glucose, urine protein, bilirubin, uric acid baseline and periodically • Cough: monitor for development of dry cough unexplained by other illness; notify prescriber • Black patients may require higher dose and have higher incidence of angio- edema Renal disease/collagen vascular disor- der (SLE, scleroderma): leukocytes, dif- ferential baseline and q2wk × 3 mo and periodically thereafter
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Evaluate: • Therapeutic response: decrease in B/P with hypertension; decreased edema, moist crackles (HF); decreased diabetic nephropathy symptoms
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To take 1 hr prior to or 2 hr after meals; not to discontinue product abruptly; if dose is missed, take as soon as remembered but not if almost time for next dose; not to double doses, advise patient to tell all persons associated with care that product is being used • Not to use OTC products (cough, cold, or allergy) unless directed by prescriber; to avoid salt substitutes, high-potassium or high-sodium foods • To adhere to dosage schedule, even if feeling better • To use cautiously in hot weather, make sure fluids are adequate • To rise slowly to sitting or standing po- sition to minimize orthostatic hypotension • To notify prescriber of fever, swelling of hands or feet, irregular heartbeat, chest pain, signs of angioedema, rash, hoarseness, difficulty breathing • Infection: to report fever, sore throat, flulike symptoms, other signs of infection • That excessive perspiration, dehydra- tion, vomiting, diarrhea may lead to fall in B/P; to consult prescriber if these occur • That dizziness, fainting, light headed- ness may occur during first few days of therapy; to avoid activities that require concentration • How to take B/P and when to notify prescriber • Diabetes: to monitor blood glucose often, hypoglycemia
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Extracted information for captopril only.
PHARMACOKINETICS Peak 1 hr; duration 2-6 hr; half-life <2 hr, increased in renal disease; metabolized by liver (metabolites); excreted in urine; crosses placenta; excreted in breast milk, small amounts; protein binding 25%-30%
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Filter the extracted dose blocks for this individual drug.
Hypertension
• Neonate (unlabeled): PO 0.01-0.1 mg/kg/dose, may increase as needed Heart failure
Candidate age grouping · source page 230
Hypertension
• Neonate (unlabeled): PO 0.05-0.1 mg/kg q8-24hr titrate to 0.5 mg/kg q6- 24hr, max 2 mg/kg/day Diabetic nephropathy
Candidate age grouping · source page 230