Hypertension

• PO (Adults 65 yr): As monotherapy — 2.5 mg once daily initially, may be increased every 2 wk by 2.5 mg/day; usual dose 2.5–5 mg once daily, not to exceed 10 mg/day. Twice daily administration may be necessary in some patients; With diuretics — 0.5 mg once daily initially, titrate carefully.
• PO (Adults >65 yr): As monotherapy — 1.25 mg once daily initially, titrate carefully.

Heart Failure

• PO (Adults): After considering concurrent diuretic therapy/salt/volume depletion, Initial dose — 0.5 mg/day with careful monitoring, after 5 days dose may be ↑ to 1 mg/day, dose may then be carefully titrated as needed/tolerated up to 2.5 mg/day, rarely patients may require 5 mg/day.

• ACE inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of bradykinin and other vasodilatory prostaglandins. ACE inhibitors also ↑ plasma renin levels and ↓ aldosterone levels. Net result is systemic vasodilation.

• Lowering of BP in hypertensive patients.
• Improved symptoms in patients with HF.

Therapeutic Classification: antihypertensives

Pharmacologic Classification: ace inhibitors

Absorption: Well absorbed following oral administration, rapidly converted to active metabolite, cilazaprilat (57% bioavailability for cilazaprilat).

Distribution: Enters breast milk.

Metabolism/Excretion: Cilazaprilat is eliminated unchanged by the kidneys (91%).

Half-life: Early elimination phase — 0.9 hr; terminal elimination phase (enzyme–bound cilazaprilat) 36–49 hr.

Inhibace

(effects on hemodynamics)

• Instruct patient to take cilazapril as directed. Take missed dose as soon as remembered. If not until the following day, skip missed dose. Do not double doses.
• Caution patient to change positions slowly to minimize hypotension. Use of alcohol, standing for long periods, exercising, and hot weather may ↑ orthostatic hypotension.
• May cause dizziness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
• Instruct patient on proper technique for monitoring blood pressure. Advise patient to check BP and weight weekly and record and report results to health care professional.
• Provide patient with additional interventions for hypertension control (weight reduction, low sodium diet, cessation of smoking, exercise regimen, stress management, and moderation of alcohol consumption). Medication controls but does not cure hypertension.
• 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 cough, cold, or allergy remedies.
• Advise women of childbearing potential to use contraception and to notify health care professional if planning or suspecting pregnancy. Discontinue medication immediately if pregnancy is confirmed.

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