benazepril

Absorption: 37% absorbed after oral administration.

Distribution: Crosses the placenta; enters breast milk in small amounts.

Protein Binding: 95%.

Metabolism/Excretion: Converted by the liver to benazeprilat, the active metabolite; 20% excreted in urine; 11–12% nonrenal (biliary) elimination.

Half-Life: Benazeprilat: 10–11 hr.

Time/Action Profile ⬆ ⬇

(antihypertensive effect)

ROUTE	ONSET	PEAK	DURATION
PO	within 1 hr*	1–2 wks‡	24 hr‡

*After single dose.

‡Chronic dosing.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
History of angioedema with or without previous use of ACE inhibitors;
Concurrent use with aliskiren in patients with diabetes or moderate-to-severe renal impairment (CCr <60 mL/min);
OB: Pregnancy (may cause fetal harm).

Use Cautiously in:

Patients with renal impairment, hypovolemia, hyponatremia, and concurrent diuretic therapy;
Black patients (monotherapy for hypertension less effective, may require additional therapy; higher risk of angioedema);
Surgery/anesthesia (hypotension may be exaggerated);
Lactation: Use while breastfeeding only if potential maternal benefit outweighs potential risk to infant;
Pedi: Children 6 yr (safety not established);
Geri: Initial dose recommended.

Family history of angioedema.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension

Derm: rash

F and E: hyperkalemia

GI: nausea

GU: impaired renal function

Neuro: fatigue, dizziness, drowsiness, headache

Resp: cough

Misc: ANGIOEDEMA

Interactions ⬆ ⬇

Drug-drug:

Excessive hypotension may occur with concurrent use of diuretics.
Additive hypotension with other antihypertensives.
↑risk of hyperkalemia with concurrent use of potassium supplements, potassium-sharing diuretics, or potassium-containing salt substitutes.
↑risk of hyperkalemia, renal dysfunction, hypotension, and syncope with concurrent use of angiotensin II receptor blockers or aliskiren; avoid concurrent use with aliskiren in patients with diabetes or CCr <60 mL/min; avoid concurrent use with angiotensin II receptor blockers.
NSAIDs and selective COX-2 inhibitors may blunt the antihypertensive effect and ↑ the risk of renal dysfunction.
↑levels and may ↑ risk of lithium toxicity.
↑risk of angioedema with temsirolimus, sirolimus, or everolimus.

Route/Dosage ⬆ ⬇

PO (Adults ): 10 mg once daily, ↑ gradually to maintenance dose of 20–40 mg/day in 1–2 divided doses (initiate therapy at 5 mg once daily in patients receiving diuretics).
PO (Children ≥6 yr): 0.2 mg/kg once daily; may be titrated up to 0.6 mg/kg/day (or 40 mg/day).

Renal Impairment

PO (Adults ): CCr <30 mL/min: Initiate therapy with 5 mg once daily.

Renal Impairment

PO (Children ≥6 yr): CCr <30 mL/min—: Contraindicated.

Availability ⬆ ⬇

(Generic available)

Tablets: 5 mg; 10 mg; 20 mg; 40 mg
In combination with: amlodipine (Lotrel); hydrochlorothiazide (Lotensin HCT). See Appendix [not included in this PDA edition].

Assessment ⬆ ⬇

Monitor BP and pulse frequently during initial dose adjustment and periodically during therapy. Notify health care professional of significant changes.
Monitor frequency of prescription refills to determine adherence.
Assess patient for signs of angioedema (swelling of face, extremities, eyes, lips, tongue, difficulty in swallowing or breathing); may occur at any time during therapy. Discontinue medication and provide supportive care.

Lab Test Considerations:

Monitor renal function. May cause ↑ BUN and serum creatinine.
- May cause hyperkalemia.
- Monitor CBC periodically during therapy in patients with collagen vascular disease and/or renal disease. May rarely cause slight ↓ in hemoglobin as well as leukopenia and eosinophilia.
- May cause ↑ AST, ALT, alkaline phosphatase, serum bilirubin, uric acid, and glucose.

Implementation ⬆ ⬇

Do not confuse benazepril with Benadryl.
Correct volume depletion, if possible, before initiation of therapy. Precipitous drop in BP during first 1–3 hr after first dose may require volume expansion with normal saline but is not usually an indication for stopping therapy. Discontinuing diuretic therapy or cautiously increasing salt intake 2–3 days before initiation may decrease risk of hypotension. Monitor closely for at least 1 hr after BP has stabilized. Resume diuretics if BP is not controlled.
PO: For patients with difficulty swallowing tablets, pharmacist can compound an oral suspension; stable for 30 days if refrigerated. Shake suspension before each use.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication as directed at the same time each day, even if feeling well. Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses. Warn patient not to discontinue benazepril unless directed by health care professional.
Encourage patient to comply with additional interventions for hypertension (weight reduction, low sodium diet, discontinuation of smoking, moderation of alcohol consumption, regular exercise, and stress management). Medication controls but does not cure hypertension.
Instruct patient and family on correct technique for monitoring BP. Advise them to check BP at least weekly and to report significant changes to health care professional.
Caution patient to avoid salt substitutes containing potassium, or foods containing high levels of potassium or sodium unless directed by health care professional. See Food Sources for Specific Nutrients.
Caution patient to change positions slowly to minimize hypotension. Use of alcohol, standing for long periods, exercising, and hot weather may increase orthostatic hypotension.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially NSAIDs and cough, cold, or allergy remedies.
May cause dizziness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
Advise patient to inform health care professional of medication regimen before treatment or surgery.
Instruct patient to notify health care professional if rash; mouth sores; sore throat; fever; swelling of hands or feet; irregular heartbeat; chest pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue; or if difficulty swallowing or breathing occurs. Persistent dry cough may occur and may not subside until medication is discontinued. Consult health care professional if cough becomes bothersome. Also notify health care professional if nausea, vomiting, or diarrhea occurs and continues.
Advise diabetic patients to monitor blood glucose closely, especially during first mo of therapy; may cause hypoglycemia.
Rep: Advise women of reproductive potential to use contraception and notify health care professional of pregnancy is planned or suspected or if breastfeeding.
Emphasize the importance of follow-up examinations to evaluate effectiveness of medication.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇