Adult Dosing
Hypertension
- If not on diuretic
- Initiate: 10 mg PO Daily
- Titrate: Adjust dosage as needed and tolerated
- Usual maintenance: 20-40 mg PO daily in 1-2 equally divided doses; usual max 80 mg/day
- If on diuretic
- Discontinue diuretic, if possible, 2-3 days before starting; resume diuretic if blood pressure is not controlled with benazepril alone
- If diuretic cannot be discontinued
Heart failure (Non-FDA Approved)
- Note that similar dosing to that used for hypertension is typically used for this indication
Pediatric Dosing
Hypertension
- Child >6 yrs: Start 0.2 mg/kg PO Daily as monotherapy
- Max: 0.6 mg/kg/day; 40 mg/day
Note:
- Make suspension from tablets for patients who cannot swallow tablets, or for whom the calculated dosage (mg/kg) does not correspond to the available tablet strengths
- Safety and efficacy in children <6 yrs of age have not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
- CrCl <30 mL/min/1.73 m2 (serum creatinine >3 mg/dL): 5 mg PO qd. Max: 40 mg/day
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined
See Supplemental Patient Information
- ACE inhibitors can cause fetal/neonatal morbidity and death when administered to pregnant women [US Black Box Warning]
- Neonates with history of in utero exposure to benazepril may incur risk of oliguria or hypotension; in the case of such an event, exchange transfusions or dialysis may be required to reverse hypotension and/or substitute renal function. Long-term effects of benazepril on growth and development have not been studied. infants < 1 yr of age should not be treated with benazepril due to risk of effects on kidney development
- ACE inhibitors may cause angioedema of the head and neck, including the tongue, lips, eyes, or throat
- Black patients are at an increased risk of angioedema as compared to non blacks
- Assess heart failure patient for evidence of worsening failure (eg, daily weights, evaluation of peripheral edema, shortness of breath)
- Severely salt- or volume-depleted patients or those with heart failure may experience significant decreases in BP especially after first dose. Monitor closely for 2 hrs or more after initial dose and during first 2 wks of therapy
- Rarely, ACE inhibitors have been associated with a syndrome that starts with cholestatic jaundice and progresses to fulminant hepatic necrosis and sometimes death
- Patients with a history of airway surgery may have a higher risk of airway obstruction
- Assess renal and hepatic function prior and periodically throughout therapy
- Monitor serum potassium levels
- Evaluation of patients with HTN or heart failure should always include assessment of renal function
- Monitor WBC if collagen vascular disease, especially if renal impairment
- Monitor BUN/Cr at baseline, then periodically, or more frequently if CHF, renal artery stenosis
- A persistent dry cough may occur and usually does not subside unless drug is stopped
Cautions: Use cautiously in
- Surgery or anesthesia (risk of hypotension)
- Diabetes
- Renal impairment
- Renal artery stenosis
- Aortic stenosis
- Cerebrovascular disease
- Collagen vascular disease (risk of agranulocytosis and bone marrow suppression)
- Potassium sparing diuretics and potassium supplements
- Hypotension
- Hyponatremia
- Volume depletion
- Severe CHF
- Hypertrophic cardiomyopathy
- Elderly patients
- Black patients
- Surgery/anesthesia (hypotension may be exaggerated)
- Dialysis with high-flux membranes
- CAD
- Insect venom allergy, hymenoptera venom immunotherapy
Supplemental Patient Information
- Instruct patient to inform physician if they develop a persistent cough while taking this medication
- Instruct patient to discontinue drug and immediately report any of the following symptoms to physician: sore throat, fever, swelling of the hands or feet, irregular heartbeat, chest pains, fainting, swelling of the face, lips, eyelids, or tongue, difficulty breathing, persistent abdominal pain
Pregnancy Category:C (D in second and third trimesters)
Breastfeeding: Benazepril is excreted in breast milk in low levels; hence it would not be expected to cause any adverse effects in breastfed infants. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 17 February 2011).
Pricing data from www.DrugStore.com in U.S.A.
- Lotensin 5 MG TABS [Bottle] (NOVARTIS)
30 mg = $62.8
90 mg = $163.34 - Lotensin 40 MG TABS [Bottle] (NOVARTIS)
30 mg = $67.99
90 mg = $177.98 - Lotensin 20 MG TABS [Bottle] (NOVARTIS)
30 mg = $64.99
90 mg = $185.96 - Lotensin 10 MG TABS [Bottle] (NOVARTIS)
30 mg = $67.99
90 mg = $177.98
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
