angiotensin-converting enzyme (ace) inhibitors

Absorption: Benazepril: 37% absorbed after oral administration. Captopril: 60–75% absorbed after oral administration (↓ by food). Enalapril: 55–75% absorbed after oral administration. Enalaprilat: IV administration results in complete bioavailability. Fosinopril: 36% absorbed after oral administration. Lisinopril: 25% absorbed after oral administration (much variability). Moexipril: 13% bioavailability as moexiprilat after oral administration (↓ by food). Perindopril: 25% bioavailability as perindoprilat after oral administration. Quinapril: 60% absorbed after oral administration (high-fat meal may ↓ absorption). Ramipril: 50–60% absorbed after oral administration. Trandolapril: 70% bioavailability as trandolapril at after oral administration.

Distribution: All well distributed to tissues

Protein Binding: Benazepril: 95%, Fosinopril: 99.4%, Moexipril: 90%, Quinapril: 97%.

Metabolism/Excretion: Benazepril: Converted by the liver to benazeprilat, the active metabolite. 20% excreted by kidneys; 11–12% nonrenal (biliary elimination). Captopril: 50% metabolized by the liver to inactive compounds, 50% excreted unchanged by the kidneys. Enalapril, enalaprilat: Enalapril is converted by the liver to enalaprilat, the active metabolite; primarily eliminated by the kidneys. Fosinopril: Converted by the liver and GI mucosa to fosinoprilat, the active metabolite; 50% excreted in urine; 50% in feces. Lisinopril: 100% eliminated by the kidneys. Moexipril: Converted by liver and GI mucosa to moexiprilat, the active metabolite; 13% excreted in urine, 53% in feces. Perindopril: Converted by the liver to perindoprilat, the active metabolite; primarily excreted in urine. Quinapril: Converted by the liver, GI mucosa, and tissue to quinaprilat, the active metabolite: 96% eliminated by the kidneys. Ramipril: Converted by the liver to ramiprilat, the active metabolite; 60% excreted in urine, 40% in feces. Trandolapril: Converted by the liver to trandolaprilat, the active metabolite; 33% excreted in urine, 66% in feces.

Half-Life: Benazeprilat: 10–11 hr. Captopril: 2 hr (↑ in renal impairment). Enalapril: 2 hr (↑ in renal impairment). Enalaprilat: 35–38 hr (↑ in renal impairment). Fosinoprilat: 12 hr. Lisinopril: 12 hr (↑ in renal impairment). Moexiprilat: 2–9 hr (↑ in renal impairment). Perindoprilat: 3–10 hr (↑ in renal impairment). Quinaprilat: 3 hr (↑ in renal impairment). Ramiprilat: 13–17 hr (↑ in renal impairment). Trandolaprilat: 22.5 hr (↑ in renal impairment).

Time/Action Profile ⬆ ⬇

( effect on BP: single dose‡)

ROUTE	ONSET	PEAK	DURATION
Benazepril	within 1 hr	2–4 hr	24 hr
Captopril	15–60 min	60–90 min	6–12 hr
Enalapril PO	1 hr	4–8 hr	12–24 hr
Enalapril IV	15 min	1–4 hr	4–6 hr
Fosinopril	within 1 hr	2–6 hr	24 hr
Lisinopril	1 hr	6 hr	24 hr
Moexipril	within 1 hr	3–6 hr	up to 24 hr
Perindoprilat	within 1–2 hr	3–7 hr	up to 24 hr
Quinapril	within 1 hr	2–4 hr	up to 24 hr
Ramipril	within 1–2 hr	3–6 hr	24 hr
Trandolapril	within 1–2 hr	4–10 hr	up to 24 hr

‡Full effects may not be noted for several weeks.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
History of angioedema with previous use of ACE inhibitors (also in absence of previous use of ACE inhibitors for benazepril);
Concurrent use with aliskiren in patients with diabetes or moderate to severe renal impairment (CCr <60 mL/min);
Concurrent use with sacubitril/valsartan; must be a 36-hr washout period after switching to/from sacubitril/valsartan;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Renal impairment, hepatic impairment, hypovolemia, hyponatremia, or concurrent diuretic therapy;
Black patients with hypertension (monotherapy less effective; may require additional therapy; ↑ risk of angioedema);
Surgery/anesthesia (hypotension may be exaggerated);
Rep: Women of reproductive potential;
Pedi: Safety and effectiveness not established in children <18 yr (moexipril, perindopril, quinapril ramipril, trandolapril) or <6 yr (benazepril, fosinopril, lisinopril);
Geri: Initial dose ↓ recommended for most agents in older adults due to age-related ↓ in renal function.

Exercise Extreme Caution in:

Family history of angioedema.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension, chest pain, edema, tachycardia

Derm: flushing, pruritus, rashes

F and E: hyperkalemia

GI: abdominal pain, anorexia, constipation, diarrhea, nausea, vomiting

GU: erectile dysfunction, proteinuria, renal impairment

Hemat: AGRANULOCYTOSIS, neutropenia(captopril only)

Metab: hyperuricemia

MS: back pain, muscle cramps, myalgia

Neuro: dysgeusia, dizziness, drowsiness, fatigue, headache, insomnia, vertigo, weakness

Resp: cough, dyspnea

Misc: ANGIOEDEMA, fever

Interactions ⬆ ⬇

Drug-drug:

Sacubitril↑ risk of angioedema; concurrent use contraindicated; do not administer within 36 hr of switching to/from sacubitril/valsartan.
Excessive hypotension may occur with diuretics and other antihypertensives.
↑risk of hyperkalemia with potassium supplements, potassium-sparing diuretics, or potassium-containing salt substitutes.
↑risk of hyperkalemia, renal dysfunction, hypotension, and syncope with 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 ↑ risk of renal impairment.
Absorption of fosinopril may be ↓ by antacids (separate administration by 1–2 hr).
May ↑ levels and risk of toxicity of lithium.
Quinapril may ↓ absorption of tetracycline, doxycycline, and fluoroquinolones (because of magnesium in tablets).
↑risk of angioedema with temsirolimus, sirolimus, or everolimus.

Drug-Food:

Food significantly ↓ absorption of captopril and moexipril; administer drugs 1 hr before meals.

Route/Dosage ⬆ ⬇

Benazepril

PO (Adults ): 10 mg once daily; ↑ gradually to maintenance dose of 20–40 mg/day in 1–2 divided doses (begin with 5 mg/day in patients receiving diuretics).
PO (Children ≥6 yr): 0.2 mg/kg once daily; may titrate 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.

Captopril

PO (Adults ): Hypertension: 12.5–25 mg 2–3 times daily; may ↑ at 1–2 wk intervals up to 150 mg 3 times daily (begin with 6.25–12.5 mg 2–3 times daily in patients receiving diuretics) (maximum dose = 450 mg/day); HF: 25 mg 3 times daily (6.25–12.5 mg 3 times daily in patients who have been vigorously diuresed); titrate up to target dose of 50 mg 3 times daily; Post-MI: 6.25-mg test dose, followed by 12.5 mg 3 times daily; may ↑ up to 50 mg 3 times daily; Diabetic nephropathy: 25 mg 3 times daily.
PO (Children ): HF: 0.3–0.5 mg/kg/dose 3 times daily; titrate up to a maximum of 6 mg/kg/day in 2–4 divided doses; Older Children: 6.25–12.5 mg/dose every 12–24 hr; titrate up to a maximum of 6 mg/kg/day in 2–4 divided doses.
PO (Infants ): HF: 0.15–0.3 mg/kg/dose; titrate up to a maximum of 6 mg/kg/day in 1–4 divided doses.
PO (Neonates ): HF: 0.05–0.1 mg/kg/dose every 8–24 hr; may ↑ as needed up to 0.5 mg/kg every 6–24 hr; Premature neonates: 0.01 mg/kg/dose every 8–12 hr.

Renal Impairment

PO (Adults ): CCr 10–50 mL/min: Administer 75% of dose; CCr <10 mL/min: Administer 50% of dose.

Enalapril/Enalaprilat

PO (Adults ): Hypertension: 2.5–5 mg once daily; ↑ as required up to 40 mg/day in 1–2 divided doses (initiate therapy at 2.5 mg once daily in patients receiving diuretics); HF: 2.5 mg 1–2 times daily; titrate up to target dose of 10 mg twice daily; begin with 2.5 mg once daily in patients with hyponatremia (serum sodium <130 mEq/L); Asymptomatic left ventricular dysfunction: 2.5 mg twice daily; titrate up to a target dose of 10 mg twice daily.
PO (Children >1 mo): Hypertension: 0.08 mg/kg once daily; may slowly titrate up to a maximum of 0.58 mg/kg/day.
IV (Adults ): Hypertension: 0.625–1.25 mg (0.625 mg if receiving diuretics) every 6 hr; can titrate up to 5 mg every 6 hr.
IV (Children >1 mo): Hypertension: 5–10 mcg/kg/dose given every 8–24 hr.

Renal Impairment

PO IV (Adults ): HypertensionCCr 10–50 mL/min: Administer 75% of dose; CCr <10 mL/min: Administer 50% of dose.

Renal Impairment

PO IV (Children >1 mo): CCr <30 mL/min: Contraindicated.

Fosinopril

PO (Adults ): Hypertension: 10 mg once daily; may ↑ as required up to 80 mg/day. HF: 10 mg once daily (5 mg once daily in patients who have been vigorously diuresed); may ↑ over several weeks up to 40 mg/day.
PO (Children ≥6 yr and >50 kg): Hypertension: 5–10 mg once daily.

Lisinopril

PO (Adults ): Hypertension: 10 mg once daily; can ↑ up to 20–40 mg/day (initiate therapy at 5 mg/day in patients receiving diuretics); HF: 5 mg once daily; may titrate every 2 wk up to 40 mg/day; begin with 2.5 mg once daily in patients with hyponatremia (serum sodium <130 mEq/L); Post-MI: 5 mg once daily for 2 days, then 10 mg daily.
PO (Children ≥6 yr): Hypertension: 0.07 mg/kg once daily (up to 5 mg/day); may titrate every 1–2 wk up to 0.6 mg/kg/day (or 40 mg/day).

Renal Impairment

PO (Adults ): CCr 10–30 mL/min: Begin with 5 mg once daily; may slowly titrate up to 40 mg/day; CCr <10 ml/min: Begin with 2.5 mg once daily; may slowly titrate up to 40 mg/day.

Renal Impairment

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

Moexipril

PO (Adults ): 7.5 mg once daily; may ↑ up to 30 mg/day in 1–2 divided doses (begin with 3.75 mg/day in patients receiving diuretics).

Renal Impairment

PO (Adults ): CCr ≤40 mL/min: Initiate therapy at 3.75 mg once daily; may titrated upward carefully to 15 mg/day.

Perindopril

PO (Adults ): Hypertension: 4 mg once daily; may slowly titrate up to 16 mg/day in 1–2 divided doses (should not exceed 8 mg/day in older adults) (begin with 2–4 mg/day in 1–2 divided doses in patients receiving diuretics); Stable CAD: 4 mg once daily for 2 wk; may ↑, if tolerated, to 8 mg once daily; for older adults, begin with 2 mg once daily for 1 wk (may ↑, if tolerated, to 4 mg once daily for 1 wk; then ↑ as tolerated to 8 mg once daily).

Renal Impairment

PO (Adults ): CCr 30–60 mL/min: 2 mg/day initially; may slowly titrate up to 8 mg/day in 1–2 divided doses.

Quinapril

PO (Adults ): Hypertension: 10–20 mg once daily initially; may titrated every 2 wk up to 80 mg/day in 1–2 divided doses (initiate therapy at 5 mg/day in patients receiving diuretics); HF: 5 mg twice daily initially; may titrate at weekly intervals up to 20 mg twice daily.

Renal Impairment

PO (Adults ): CCr >60 mL/min: Initiate therapy at 10 mg/day; CCr 30–60 mL/min: Initiate therapy at 5 mg/day; CCr 10–30 mL/min: Initiate therapy at 2.5 mg/day.

Ramipril

PO (Adults ): Hypertension: 2.5 mg once daily; may ↑ slowly up to 20 mg/day in 1–2 divided doses (initiate therapy at 1.25 mg/day in patients receiving diuretics). HF post-MI: 1.25–2.5 mg twice daily initially; may ↑ slowly up to 5 mg twice daily. Reduction in risk of MI, stroke, and death from cardiovascular causes: 2.5 mg once daily for 1 wk, then 5 mg once daily for 3 wk; then ↑ as tolerated to 10 mg once daily (can also be given in 2 divided doses).

Renal Impairment

PO (Adults ): CCr <40 mL/min: Initiate therapy at 1.25 mg once daily; may slowly titrate up to 5 mg/day in 1–2 divided doses.

Trandolapril

PO (Adults ): Hypertension: 1 mg once daily (2 mg once daily in Black patients); HF post-MI: Initiate therapy at 1 mg once daily; titrate up to 4 mg once daily if possible.

Renal Impairment

PO (Adults ): CCr <30 mL/min: Initiate therapy at 0.5 mg once daily; may slowly titrate upward (maximum dose = 4 mg/day).

Hepatic Impairment

PO (Adults ): Initiate therapy at 0.5 mg once daily; may slowly titrated upward (maximum dose = 4 mg/day).

Availability ⬆ ⬇

Benazepril

(Generic available)

Tablets: 5 mg; 10 mg; 20 mg; 40 mg
In combination with:
amlodipine (generic only) and hydrochlorothiazide (Lotensin HCT). See Combination Drugs.

Captopril

(Generic available)

Tablets: 12.5 mg; 25 mg; 50 mg; 100 mg
In combination with:
hydrochlorothiazide.

Enalapril

(Generic available)

Tablets: 2.5 mg; 5 mg; 10 mg; 20 mg
Oral solution mixed berry flavor: 1 mg/mL
In combination with:
hydrochlorothiazide (Vaseretic). See Combination Drugs.

Enalaprilat

(Generic available)

Solution for injection: 1.25 mg/mL

Fosinopril

(Generic available)

Tablets: 10 mg; 20 mg; 40 mg
In combination with:
hydrochlorothiazide.

Lisinopril

(Generic available)

Tablets: 2.5 mg; 5 mg; 10 mg; 20 mg; 30 mg; 40 mg
Oral solution: 1 mg/mL
In combination with:
hydrochlorothiazide (Zestoretic). See Combination Drugs.

Moexipril

(Generic available)

Tablets: 7.5 mg; 15 mg

Perindopril

(Generic available)

Tablets: 2 mg; 4 mg; 8 mg

Quinapril

(Generic available)

Tablets: 5 mg; 10 mg; 20 mg; 40 mg
In combination with:
hydrochlorothiazide.

Ramipril

(Generic available)

Capsules: 1.25 mg; 2.5 mg; 5 mg; 10 mg ; 15 mg

Trandolapril

(Generic available)

Tablets: 0.5 mg; 1 mg; 2 mg; 4 mg
In combination with:
verapamil.

Assessment ⬆ ⬇

Hypertension: Monitor BP and HR frequently during initial dose adjustment and periodically during therapy. Notify health care provider of significant changes.
- Monitor frequency of prescription refills to determine adherence.
- Assess for signs of angioedema (swelling of face, extremities, eyes, lips, or tongue; difficulty in swallowing or breathing); may occur at any time during therapy. Discontinue medication and provide supportive care.
HF: Monitor weight and assess patient routinely for resolution of fluid overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention).

Lab Test Considerations:

Monitor BUN, serum creatinine, and electrolytes periodically. May ↑ serum potassium, BUN and creatinine. May ↓ sodium. If ↑ BUN or serum creatinine concentrations occur, dose ↓ or withdrawal may be required.
- Monitor CBC periodically during therapy. Certain drugs may rarely cause slight ↓ in hemoglobin and hematocrit, leukopenia, and eosinophilia.
- May ↑ AST, ALT, alkaline phosphatase, serum bilirubin, uric acid, and glucose.
- Assess urine protein before and periodically during therapy for up to 1 yr in patients with renal impairment or those receiving >150 mg/day of captopril. If excessive or ↑ proteinuria occurs, re-evaluate ACE inhibitor therapy.
- Captopril: May cause positive ANA titer.
- Captopril: May cause false-positive test results for urine acetone.
- Captopril: Monitor CBC with differential before initiation of therapy, every 2 wk for 1st 3 mo, and periodically for up to 1 yr in patients at risk for neutropenia (patients with renal impairment or collagen-vascular disease) or at 1st sign of infection. Discontinue therapy if neutrophil count <1000/mm³.

Implementation ⬆ ⬇

Do not confuse Accupril with Aciphex. Do not confuse benazepril with Benadryl. Do not confuse captopril with carvedilol. Do not confuse Zestril with Zegerid, Zetia, or Zyprexa.
Correct volume depletion, if possible, before initiation of therapy.
PO: Precipitous drop in BP during 1st 1–3 hr after 1st dose may require volume expansion with normal saline but is not usually considered an indication for stopping therapy. Discontinuing diuretic therapy or cautiously ↑ salt intake 2–3 days before initiation may ↓ risk of hypotension. Monitor closely for >1 hr after BP has stabilized. Resume diuretics if BP not controlled.

PO: If difficulty swallowing tablets, pharmacist may compound oral suspension; stable for 30 days if refrigerated. Shake suspension before each use.

PO: Administer 1 hr before or 2 hr after meals. May be crushed if patient has difficulty swallowing. Tablets may have a sulfurous odor.
- An oral solution may be prepared by crushing a 25-mg tablet and dissolving it in 25–100 mL of water. Shake for >5 min and administer within 30 min.

PO: For patients with difficulty swallowing tablets, oral solution is available ready to use. Shake solution before each use. Solution is stable at controlled room temperature for 60 days.

PO: Oral solution is clear to slightly opalescent. Administer without dilution.

PO: Administer moexipril on an empty stomach, 1 hr before a meal.

PO: Capsules may be opened and sprinkled on applesauce or dissolved in 4 ounces water or apple juice for patients with difficulty swallowing. Effectiveness is same as capsule. Prepared mixtures can be stored for up to 24 hr at room temperature or up to 48 hr if refrigerated.

PO: May be taken with or without food.

Benazepril

Captopril

Enalapril

Enalaprilat

IV Administration:

IV Push: Diluent: May be administered undiluted. Concentration: 1.25 mg/mL.
Rate: Administer over ≥5 min.
Intermittent Infusion: Diluent: Dilute in up to 50 mL of D5W, 0.9% NaCl, D5/0.9% NaCl, or D5/LR. Diluted solution is stable for 24 hr.
Rate: Infuse slowly over ≥5 min.
Y-Site Compatibility:
- acyclovir
- alemtuzumab
- allopurinol
- amikacin
- aminocaproic acid
- aminophylline
- amiodarone
- amphotericin B liposomal
- anidulafungin
- argatroban
- arsenic trioxide
- ascorbic acid
- atracurium
- atropine
- azathioprine
- azithromycin
- aztreonam
- benztropine
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- butorphanol
- calcium chloride
- calcium gluconate
- cangrelor
- carboplatin
- carmustine
- cefazolin
- cefotaxime
- cefotetan
- cefoxitin
- ceftaroline
- ceftazidime
- ceftobiprole
- ceftriaxone
- cefuroxime
- chloramphenicol
- chlorpromazine
- cisatracurium
- cisplatin
- cladribine
- clindamycin
- cyanocobalamin
- cyclophosphamide
- cyclosporine
- cytarabine
- dacarbazine
- dactinomycin
- daptomycin
- daunorubicin,
- dexamethasone
- dexmedetomidine
- dexrazoxane
- digoxin
- diltiazem
- diphenhydramine
- dobutamine
- docetaxel
- dopamine
- doxorubicin hydrochloride
- doxorubicin liposomal
- doxycycline
- ephedrine
- epinephrine
- epirubicin
- epoetin alfa
- eptifibatide
- ertapenem
- erythromycin
- esmolol
- etoposide
- etoposide phosphate
- famotidine
- fentanyl
- filgrastim
- fluconazole
- fludarabine
- fluorouracil
- folic acid
- foscarnet
- fosphenytoin
- furosemide
- ganciclovir
- gemcitabine
- gentamicin
- glycopyrrolate
- granisetron
- heparin
- hydrocortisone
- hydromorphone
- idarubicin
- ifosfamide
- imipenem/cilastatin
- imipenem/cilastatin/relebactam
- indomethacin
- insulin, regular
- irinotecan
- isoproterenol
- ketorolac
- labetalol
- leucovorin
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- melphalan
- meperidine
- meropenem
- mesna
- methadone
- methotrexate
- methylprednisolone
- metoclopramide
- metoprolol
- metronidazole
- midazolam
- milrinone
- mitomycin
- mitoxantrone
- morphine
- moxifloxacin
- multivitamins
- mycophenolate
- nafcillin
- nalbuphine
- naloxone
- nicardipine
- nitroglycerin
- nitroprusside
- norepinephrine
- octreotide
- ondansetron
- oxacillin
- oxaliplatin
- oxytocin
- paclitaxel
- palonosetron
- pamidronate
- papaverine
- pemetrexed
- penicillin G
- pentamidine
- pentobarbital
- phenobarbital
- phentolamine
- phenylephrine
- phytonadione
- piperacillin/tazobactam
- potassium acetate
- potassium chloride
- potassium phosphates
- procainamide
- prochlorperazine
- promethazine
- propofol
- propranolol
- protamine
- pyridoxine
- remifentanil
- rituximab
- rocuronium
- sodium acetate
- sodium bicarbonate
- succinylcholine
- sufentanil
- tacrolimus
- theophylline
- thiamine
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- topotecan
- trastuzumab
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vincristine
- vinorelbine
- voriconazole
- zoledronic acid
Y-Site Incompatibility:
- amphotericin B deoxycholate
- caspofungin
- cefepime
- dantrolene
- diazepam
- diazoxide
- gemtuzumab ozogamicin
- phenytoin

Lisinopril

Moexipril

Ramipril

Trandolapril

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy. Advise to take medication as directed at the same time each day, even if feeling well. Take missed doses as soon as possible but not if almost time for next dose. Do not double doses. Advise not to discontinue therapy unless directed by health care provider.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications, especially cough, cold, or allergy remedies.
Advise patient to avoid salt substitutes or foods containing high levels of potassium or sodium unless directed by health care provider (see Food Sources for Specific Nutrients).
- Advise patient to change positions slowly to minimize hypotension. Use of alcohol, standing for long periods, exercising, and hot weather may ↑ risk of orthostatic hypotension.
- May cause dizziness. Advise patient to avoid driving and other activities requiring alertness until response to medication is known.
- Advise patient to inform health care provider of medication regimen before treatment or surgery.
- Advise patient that medication may cause impairment of taste that generally resolves within 8–12 wk, even with continued therapy.
- Advise patient to notify health care provider immediately 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 difficulty swallowing or breathing occur; or if taste impairment or skin rash persists. Persistent dry cough may occur and may not subside until medication is discontinued. Consult health care provider if cough becomes bothersome. Also notify health care provider if nausea, vomiting, or diarrhea occurs and continues.
- Advise patient with diabetes to monitor blood glucose closely, especially during 1st month of therapy; may cause hypoglycemia.
Hypertension: Encourage patient to comply with additional interventions for hypertension (weight reduction, low sodium diet, discontinuation of smoking, moderation of alcohol consumption, regular exercise, stress management). Medication controls but does not cure hypertension.
- Advise patient and family/caregiver on correct technique for monitoring BP. Advise them to check BP at least weekly and to report significant changes to health care provider.
- May cause fetal harm. Advise women of reproductive potential to use effective contraception during therapy and notify health care provider if pregnancy is planned or suspected. If pregnancy is detected, discontinue medication as soon as possible. Closely observe infants with histories of in utero exposure to ACE inhibitors for hypotension, oliguria, and hyperkalemia. If oliguria or hypotension occur, support blood pressure and renal perfusion. Exchange transfusions or dialysis may be required as a means of reversing hypotension and substituting for disordered renal function. Advise patient to avoid breastfeeding during therapy.

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆ ⬇

Canadian Brand Names ⬆