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).
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.
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.
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