Contraindicated in:
- Hypersensitivity
- History of angioedema with previous use of ACE inhibitors
- 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: Can cause injury or death of fetus – if pregnancy occurs, discontinue immediately
- Lactation: Discontinue drug or use formula.
Use Cautiously in:
- Patients with collagen vascular disease, renal impairment, hypovolemia, hyponatremia, and concurrent diuretic therapy
- Surgery/anesthesia (hypotension may be exaggerated)
- Black patients (monotherapy for hypertension less effective, may require additional therapy; higher risk of angioedema)
- Women of childbearing potential
- Geri: Initial dose ↓ recommended.
Exercise Extreme Caution in:
CNS: dizziness, fatigue, headache, insomnia.
Resp: cough .
CV: hypotension, chest pain, palpitations, tachycardia.
GI: taste disturbances, abdominal pain, anorexia, constipation, diarrhea, nausea, vomiting.
GU: proteinuria, impaired renal function.
Derm: ANGIOEDEMA, rash, pruritis.
F and E: hyperkalemia.
Hemat: AGRANULOCYTOSIS, neutropenia.
Misc: fever.
Note: Use lower doses (1/2 of those listed) in patients who are sodium and water depleted due to diuretics.
Hypertension
- PO (Adults and Adolescents): 12.5–25 mg 2–3 times daily, may be ↑ at 1–2 wk intervals up to 150 mg 3 times daily (initiate therapy with 6.25–12.5 mg 2–3 times daily in patients receiving diuretics).
Heart Failure
- PO (Adults): 25 mg 3 times daily (6.25–12.5 mg 3 times daily in patients who have been vigorously diuresed); titrated up to target dose of 50 mg 3 times daily (max dose = 450 mg/day).
- PO (Children): 0.3–0.5 mg/kg 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 every 12–24 hr, titrate up to a maximum of 6 mg/kg/day in 2–4 divided doses.
- PO (Infants): 0.15–0.3 mg/kg, titrate up to a maximum of 6 mg/kg/day in 1–4 divided doses.
- PO (Neonates): 0.05–0.1 mg/kg 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.
Left Ventricular Dysfunction Post-MI
- PO (Adults): 6.25-mg test dose, followed by 12.5 mg 3 times daily, may be ↑ up to 50 mg 3 times daily.
Diabetic Nephropathy
- PO (Adults): 25 mg 3 times daily.
Renal Impairment
- PO (Adults): CCr 10–50 mL/min: Administer 75% of dose; CCr <10 mL/min: Administer 50% of dose.
Therapeutic Classification: antihypertensives
Pharmacologic Classification: ace inhibitors
Absorption: 60–75% absorbed following oral administration (decreased by food).
Distribution: Crosses the placenta; enters breast milk in small amounts.
Metabolism/Excretion: 50% metabolized by the liver to inactive compounds, 50% excreted unchanged in urine.
Half-life: Infants with HF: 3.3 hr (range 1.2–12.4 hr); Children: 1.5 hr (range 0.98–2.3 hr); Adults: 1.9 hr (↑ to 20–40 hr in renal impairment); Adults with HF: 2.1 hr.
(effect on BP — single dose†)
†Full effects may not be noted for several weeks.
