- Captopril/hydrochlorothiazide cause fetal/neonatal morbidity/mortality when administered to a pregnant woman [US Black Box Warning]
- Anaphylactoid reactions including head, neck or intestinal angioedema has been reported in patients receiving ACE inhibitors. Angioedema involving tongue, glottis or larynx can lead to airway obstruction and can be fatal. Discontinue therapy and immediately provide emergency treatment including administration of subcutaneous epinephrine injection 1:1000 (0.3-0.5 mL)
- Life-threatening anaphylactoid reactions have occurred in patients undergoing desensitizing therapy with hymenoptera venom while receiving ACE inhibitors. Patients dialyzed with high-flux membranes and concomitantly treated with an ACE inhibitor and patients undergoing low-density lipoprotein apheresis with dextran sulfate absorption are prone to anaphylactoid reactions
- Agranulocytosis and bone marrow depression has been reported with ACE inhibitor therapy, particularly in patients with renal impairment, especially those who also have collagen-vascular diseases such as systemic lupus erythematosus or scleroderma. Monitor WBC counts in patients with impaired renal function prior to starting treatment and at approximately two-week intervals for about three months, then periodically
- Captopril should be used cautiously after an assessment of benefit and risk in patients with collagen vascular disease or who are exposed to other drugs known to affect the white cells or immune response, particularly when there is impaired renal function
- Symptomatic hypotension can occur with captopril/hydrochlorothiazide therapy especially who are volume-and/or salt-depleted or receiving high doses of diuretics, correct the volume depletion prior to administration of captopril/hydrochlorothiazide, if excessive hypotension occurs place the patient in a supine position and, if necessary, given an intravenous infusion of normal saline
- Closely monitor the infants with histories of in utero exposure to ACE inhibitors for hypotension, oliguria, and hyperkalemia, if oliguria occurs, attention should be directed toward support of blood pressure and renal perfusion
- Cholestatic jaundice progressing to fulminant hepatic necrosis and sometimes death has occurred with ACE inhibitors; discontinue therapy and provide appropriate medical treatment
- Thiazide diuretics exacerbates or activates systemic lupus erythematosus
- Thiazides should be used cautiously in patients renal disease, as it can precipitate azotemia
- ACE inhibitors causes nonproductive cough, due to the inhibition of the degradation of endogenous bradykinin, which resolves on discontinuation of therapy
- Hypertensive patients with renal artery stenosis may experience increase in blood urea nitrogen and serum creatinine with captopril therapy, these increases were reversible upon discontinuation or dose reduction. Monitor renal function in these patients during the first few weeks of therapy
- Use captopril/hydrochlorothiazide cautiously in patients with impaired hepatic function or progressive liver disease as minor alterations of fluid and electrolyte balance may precipitate hepatic coma
- Captopril monotherapy causes hyperkalemia and conversely treatment with thiazide diuretics has been associated with hypokalemia. The opposite effects of captopril and hydrochlorothiazide on serum potassium balance each other in some patients and one or the other effect may be dominant in some, monitor serum electrolytes to detect possible electrolyte imbalance periodically
- Prolong use of thiazide can cause hypercalcemia, hypophosphatemia, and hypomagnesemia
- Thiazide diuretics exacerbates or activates systemic lupus erythematosus
- As thiazide diuretics tend to reduce glucose tolerance and raise serum levels of cholesterol, triglycerides, and uric acid, it can precipitate gout or diabetes in susceptible patients
- Elevated BUN and serum creatinine indicating progressive renal impairment was observed with diuretic therapy. Consider temporary withholding or discontinuation of the therapy
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Renal artery stenosis
- Volume depletion
- Congestive heart failure
- Severe CAD
- Diabetes mellitus
- Hypotension
- Postsympathectomy
- Collagen vascular disease
- Hyponatremia
- Black patients
- Antigen desensitization treatment
- Surgery/Anesthesia
- SLE
- History of gout
- Low-density lipoprotein apheresis with dextran sulfate
- Dialysis with high-flux membranes
- Geriatrics
Pregnancy Category:C (first trimester) and D (second and third trimesters)
Breastfeeding: As low level of captopril is excreted in breastmilk, amount ingested by the infant is small and would not be expected to cause any adverse effects in breastfed infants. During lactation hydrochlorothiazide at a dose of 50 mg daily or less is acceptable. Intense diuresis with large doses may decrease breastmilk production. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 22 February 2011). As per manufacturer's data both captopril and hydrochlorothiazide are excreted in human milk. Because of the potential for serious adverse reactions from hydrochlorothiazide and captopril in nursing infants, a decision should be made whether to discontinue nursing or to discontinue captopril/hydrochlorothiazide taking into account the importance of the drug to the mother.
US Trade Name(s)
US Availability
captopril/hydrochlorothiazide (generic)
- TABS:
- 25 mg/15 mg
- 25 mg/25 mg
- 50 mg/15 mg
- 50 mg/25 mg
Capozide (captopril/hydrochlorothiazide)
- TABS:
- 25 mg/15 mg
- 25 mg/25 mg
- 50 mg/15 mg
- 50 mg/25 mg
Canadian Trade Name(s)
Canadian Availability
UK Trade Name(s)
UK Availability
Capozide LS (captopril/hydrochlorothiazide)
Capozide (captopril/hydrochlorothiazide)
Australian Trade Name(s)
Australian Availability