OBJECT DRUGS

• Benazepril (Lotensin)
• Captopril (Capoten)
• Enalapril (Vasotec, etc.)
• Fosinopril (Monopril)
• Lisinopril (Prinivil, etc.)
• Moexipril (Univasc)
• Perindopril (Aceon)
• Quinapril (Accupril)
• Ramipril (Altace)
• Trandolapril (Mavik)

PRECIPITANT DRUGS

• Tizanidine (Zanaflex)

Comment:

Patients on ACEI have developed severe hypotension after starting tizanidine therapy. Tizanidine, like the antihypertensive drug clonidine, is an alpha-2 adrenergic agonist, and may have additive hypotensive effects with ACE inhibitors.

Class 3: Assess Risk & Take Action if Necessary

• Consider Alternative: In patients taking ACEI, consider using muscle relaxants other than tizanidine (that are not alpha-2 adrenergic agonists). Some other muscle relaxants can also cause hypotension, but the risk is probably less than for tizanidine.
• Monitor: If tizanidine is used in a patient taking an ACEI, monitor cardiovascular status carefully for evidence of an acute hypotensive reaction.