Therapeutic Classification: antihypertensives
Pharmacologic Classification: ace inhibitors
Absorption: 25% absorbed following oral administration (much inter-individual variability).
Distribution: Crosses the placenta; may enter breast milk.
Metabolism/Excretion: 100% eliminated by the kidneys.
Half-life: 12 hr (↑ in renal impairment).
(effect on BP-single dose†)
†Full effects may not be noted for several weeks.
Contraindicated in:
- Hypersensitivity
- History of angioedema with previous use of ACE inhibitors
- 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, hypovolemia, hyponatremia, or concurrent diuretic therapy (initial dosage ↓ recommended)
- Black patients (less effective as monotherapy in hypertension; may require additional therapy; higher risk of angioedema)
- Surgery/anesthesia (hypotension may be exaggerated)
- Rep: Women of reproductive potential
- Pedi: Children <6 yr (safety and effectiveness not established)
- Geri: Initial dosage ↓ recommended in older adults.
Exercise Extreme Caution in:
- Family history of angioedema.
CV: hypotension, chest pain.
Derm: rash.
F and E: hyperkalemia.
GI: abdominal pain, diarrhea, nausea, vomiting.
GU: erectile dysfunction, renal impairment.
Neuro: dizziness, fatigue, headache, weakness.
Resp: cough.
Misc: ANGIOEDEMA.
Hypertension
- PO (Adults): 10 mg once daily, can be ↑ up to 20–40 mg/day (initiate therapy at 5 mg/day in patients receiving diuretics).
- PO (Children ≥ 6 yr): 0.07 mg/kg once daily (up to 5 mg/day), may be titrated every 1–2 wk up to 0.6 mg/kg/day (or 40 mg/day).
Renal Impairment
- PO (Adults): CCr 10–30 mL/min: Initiate therapy at 5 mg daily; may be slowly titrated up to 40 mg/day.CCr <10 mL/min: Initiate therapy at 2.5 mg once daily; may be slowly titrated up to 40 mg/day.
Renal Impairment
- (Children ≥ 6 yr): CCr <30 mL/min: Contraindicated.
Heart Failure
- PO (Adults): 5 mg once daily, may be titrated every 2 wk up to 40 mg/day; initiate therapy at 2.5 mg once daily in patients with hyponatremia (serum sodium <130 mEq/L).
Renal Impairment
- (Adults): CCr ≤30 mL/min: Initiate therapy at 2.5 mg once daily.
Acute Myocardial Infarction
- PO (Adults): 5 mg once daily for 2 days, then 10 mg daily.
Renal Impairment
- PO (Adults): Initiate with caution in patients with serum creatinine >2 mg/dL.
Prinivil, Qbrelis, Zestril
