Posts Tagged ‘captopril’

Generic Name
Captopril (KAP-toe-pril)
Brand Name  Capoten
Combination Products
Generic Ingredients: Captopril + Hydrochlorothiazide [M Capozide
Type of Drug
Angiotensin-converting enzyme (ACE) inhibitor.
Prescribed For
High blood pressure and heart failure; diabetic kidney damage and post-heart attack management; also used for kidney hyperten-Sion, the management of people with a high risk of heart disease, chronic kidney disease, the prevention of a second stroke, and high blood pressure associated with other medical conditions, such as scleroderma and Takayasu’s disease.
General Information
Captopril and other ACE inhibitors work by preventing the conversion of a hormone called angiotensin I to another hormone called angiotensin 11, a potent blood-vessel constrictor. Preventing this conversion relaxes blood vessels, helps to reduce blood pressure, and relieves the symptoms of heart failure. Captopril also affects the production of other hormones and enzymes that participate in the regulation of blood-vessel dilation. Captopril usually begins working about 1 hour after it is taken.
In addition to its labeled uses, captopril has been studied in the diagnosis of certain kidney diseases and of primary aldosteronism; in the treatment of rheumatoid arthritis; in swelling and fluid accumulation; in Bartter’s syndrome; in Raynaud’s disease; and in post–heart attack treatment when the function of the left ventricle is affected.
Cautions and Warnings
Do not take captopril if you are allergic or sensitive to any of its ingredients. Severe sensitivity reactions can occur in hemodialysis patients or in those undergoing venom immunization.
People with impaired kidney function should not take captopril unless other anti hypertensives have not worked or have had unacceptable side effects.
Swelling of the face, extremities, or throat has been known to occur with captopril, which can be dangerous (see “Special Information”).
Although not common, captopril may cause very low blood pressure. It may also affect your kidneys, especially if you have congestive heart failure. Your doctor should check your urine for protein content during the first few months of captopril treatment. Captopril may cause a decline in kidney function.
Captopril may affect white-blood-cell counts, possibly increaSlN I)Ur susceptibility to infection. Your doctor should monitor your blood counts periodically.
Captopril can cause serious injury or death to the fetus if taken during pregnancy. Pregnant women should not take captopril.
ACE inhibitors may be less effective in some black patients with high blood pressure, especially when dietary salt intake is high. Nevertheless, they should still be considered useful blood pressure treatments. Swelling beneath the skin to form welts is more common among black patients.
Possible Side Effects
♦    Most common: rash, itching, and cough that usually goes away a few days after you stop taking the drug.
✓    Less common: dizziness, tiredness, sleep disturbances, headache, tingling in hands or feet, chest pain, heart palpitations, feeling unwell, abdominal pain, nausea, vomiting, diarrhea, constipation, appetite loss, dry mouth, breathing difficulties, and hair loss.
♦    Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    The blood-pressure-lowering effect of captopril is additive with diuretic drugs and beta blockers. Any other drug that causes a rapid blood-pressure drop should be used with caution if you are taking captopril.
•    Combining 325 mg of aspirin a day with captopril carries a higher risk of death than taking lower doses (less than 160 mg a day). People taking aspirin to prevent a heart attack should use the lower dose.
•    Captopril may increase the effects of lithium; this combination should be used with caution.
•    Mixing any ACE inhibitor with an NSAID pain reliever can increase the chances of kidney failure.
•    Severe sensitivity reactions can occur in those taking allopurinol.
•    Captopril may increase blood-potassium levels, especially when taken with dyazide or other potassium-sparing diuretics.
•    Antacids and captbe taken at least 2 hours apart. 1 tapsaicin may trigger or aggravate the cough associated with captopril.
•    Inclomethacin may reduce the blood-pressure-lowering effect of captopril.
•    Phenothiazine sedatives and antivomiting agents may increase the effects of captopril.
•Probenecid increases captopril’s effect as well as the chance of side effects.
•    The combination of allopurinol and captopril increases the chance of an adverse drug reaction.
•    Captopril may affect blood levels of digoxin. More digoxin in
the blood increases the chance of digoxin-related side ef-
fects, while less digoxin in the blood can compromise its
effectiveness.
Food Interactions
Captopril should be taken 1 hour before a meal.
Usual Dose
Adult: 25 mg 2 or 3 times a day to start. Dosage may be increased to 450 mg a day in divided doses, if needed. Dosage must be tailored to your needs. People with poor kidney function must take lower doses.
Child: 0.14-0.28 mg per lb. of body weight, 3 times a day. Infant: 0.07-0.14 mg per 1b. of body weight.
Overdosage
The principal effect of captopril overdose is a rapid drop in blood pressure, which may lead to dizziness or fainting. Take the overdose victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Captopril may cause swelling of the face, lips, hands, and feet. This swelling may also affect the larynx (throat) and tongue and interfere with breathing. If this happens, go to a hospital emergency room at once. Call your doctor if you develop a sore throat, mouth sores, abnormal heartbeat, chest pain, a persistent rash, or losses in the sense of taste.
People who are already taking a diuretic (an agent that increases urination) may experience a rapid blood-pressure drop after their first dose of captopril or when their captopril dose k!Z,iTlr_Teased. To prevent this, your doctor may tell ‘you to stop taking your diuretic or to OYtM8 _’ your salt intake 2 or 3 days before starting captopril. The diuretic may then be restarted gradually.
You may get dizzy if you rise to your feet too quickly from a sitting or lying position when taking captopril.
Avoid strenuous exercise or very hot weather because heavy sweating or dehydration may lead to a rapid drop in blood pressure.
Avoid over-the-counter stimulants that can raise blood pressure while taking captopril, including diet pills and decongestants. Also, do not use potassium supplements or salt substitutes containing potassium without consulting your doctor.
If you forget to take a dose of captopril, take it as soon as you remember. If it is within 4 hours of your next dose, take 1 dose immediately and another in 5 or 6 hours, then go back to your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: ACE inhibitors can cause fetal injury or death. Women who are or might be pregnant should not take ACE inhibitors. If you become pregnant, stop taking captopril and call your doctor immediately.
Small amounts of captopril pass into breast milk. Nursing mothers who must take this drug should consider using infant formula.
Seniors: Seniors may be more sensitive to the effects of captopril due to age-related declines in kidney or liver function.

vasodilators Traditional vasodilators used in the prophylaxis and treatment of angina include glyceryl trinitrate and other nitrates. They have a general effect on the venous system but newer and more selectively acting antihypertensive drugs are the betaadrenoceptor blocking agents represented by propranolol, and the calcium channel blocking agents such as nifedipine. Other vasodilator drugs are the alpha-adrenoceptor blocking agents (indorarnin, prazosin) and the ACE inhibitors (captopril). Cerebral vasodilators are represented by isoxsuprine. Peripheral vasodilators include cinnarizine and thymoxamine. See pages 114 & 148.
vasopressin A preparation of the blood pressure- raising and antidiuretic factors of the pituitary gland. It has been used in doses of 5-20 units twice daily by s.c. or i.m. injection in diabetes insipidus, but has been largely superseded by demopressin. (Pilressin).
vecuronitim A non-depolarizing muscle relaxant of the rocuronium type. It has a medium duration of action, with the advantage of not causing histamine release. Dose: 80-100fLgjkg1min initially, with supplementary doses as required. (Norcuron).
venlafaxine An antidepressant that inhibits the re-uptake of both serotonin and nor-adrenaline.
Dose: in depressive illness, 75 mg daily, rising if necessary after some weeks to 150 ing daily, or exceptionally to 375 mg daily. Prolonged treatment is necessary for an adequate response and reduce potential relapse. Reduced doses are given in hepatic disease and lite elderly. Care is necessary in epilepsy, and before and after morloaniine oxidase inhibator (MAGI) therapy. Many side-effects have been noted, but any skin reaction should be reported to the prescriber. (Ffcxor). See page 128 and Table 11.
Dose: 120-480 mg daily according to the condition and degree of response. In severe arrhythinias, 5-10 mg i.v. under ECG control. Contraindicated in bradycardia, heart failure and heart block. Side-effects include nausea, hypotension and heart block. It should be used with caution in a patient already receiving a betaadrenoceptor blocking agent. (Cordilox; Securon). See page 148 and Table 21.
vigabatrin A new anti-epileptic drug. GABA (a gamma aminobutyric acid) is an inhibitor of neurotransmission, and epileptic seizures may be linked with a GABA deficiency. Vigabatrin has an inhibitory action on the GABAmetabolizing enzyme, and so indirectly permits a rise in the brain level of GABA. It is used in the treatment of epilepsy not responding to other anticonvulsants. Dose: 2 g daily initially, with adjustments up to 4 g daily together with current antiepileptic therapy. Side effects are numerous, and include drowsiness, fatigue, dizziness and weight gain. Sudden withdrawal is inadvisable. (Sabril). See page 136 and Table 15.
viloxazine An antidepressant with the general action, uses and side-effects of amitriptyline, but with a reduced sedative activity. It is given in depression associated with apathy, and in the depression of epilepsy.
Dose: 150-400 mg daily. It may increase the action of phenytoin and antihypertensive agents. (Vivalan). See page 128 an(] Table 11.
vinblastine An alkaloid of periwinkle that has cytotoxic properties. It is used in the control of acute leukaemias, lymphomas and other malignant conditions, and in mycosis fungoides.
Dose: 100 ltrjkg weekly i.v., increased by 50 pg/ki; weekly, up to 500 µg/kg weekly according to response. Side-effects include myclosuppress.ion, neurotoxicity and abdominal disturbances. The drug should be handled with care as it is a tissue irritant. (Velbe). See page 122 and Table 8.
105
verapamil A calcium channel blocking agent that reduces the movement ofcalciurn ions in cardiac tissues. It reduces the oxygen demand as well as the contractility of the myocardium, and it is used in angina, arrhythmias and hypertension.
vincristine A vinca alkaloid with the action and uses of vinblastine, but much less likely to cause myclodepression. It is used mainly in the treatment of acute
leukaemias in children, Hodgkin’s disease and other malignant lymphomas.

Neuromuscular side-effects may limit the dose. Other side-effects are abdominal disturbance and alopecia. The injection of the drug requires care as it is a tissue irritant. (Oncovin). See page 122 and Table 8.
vindesine A vinca alkaloid with an action similar to that of vincristine. It is used mainly in acute lyniphoblastic leukaemia in children, and in other malignant conditions not responding to treatment.
Dose: 3 nig/m` weekly by i.m. injection, subsequently increased up to 5 mg/in’ according to response. The side-effects are similar to those of other vinca alkaloids, but granulocytopenia may be a close-limiting factor. Extravasation should he avoided, as it may cause considerable local irritation. (Eldesine). See page 122 and fable R.
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vitamin D. Calciferol.
vitamin E The vitamin in the germ of wheat, rice and other grains. Deficiency States are uncommon, but may occur in cystic fibrosis and other conditions where fat absorption is impaired. It has been used empirically in many other
conditions, but its therapeutic value is questionable.
Dose: 5-15 ing daily. Now largely replaced by the synthetic form tocopherol.
vitamin K The vitamin concerned with the formation of prothrombin, and so with blood coagulation. Given as menadiol in haemorrhagic disorders, vitamin K, or phytomenadione has a similar but more rapid and sustained action. Of no value when the prothrombin level of the blood is adequate.
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vinorelbine A cytostatic drug of the vinca alkaloid type. It is used in non-small cell lung cancer and in advanced breast cancer resistant to other drugs.
Dose: 25-36 ing/inweekly by i.v.
infusion. Main side-effect is neutropenia. (Navelbine). See page 122.
vitamin A One of the vitamins obtained from fish-liver oils. A deficiency in the diet causes night-blindness, skin changes and a decreased resistance to infection. Dose: 2500-25 000 units daily.
vitamin B A group of water soluble vitamins obtained from yeast or rice polishings. The constituents include thiamine, riboflavine, nicotinic acid, pyridoxine, and small amounts of other factors.
vitamin B. Pyridoxine.
vitamin B,, Cynacobalamin. vitamin C Ascorbic acid.
warfarin A synthetic anticoagulant similar to phenindione, but with reduced side-effects and it is now the preferred drug. It is used mainly in deep-vein thrombosis and transient brain ischaernia, in doses based on the prothrombin time as
reported by the laboratory in terms of the International Normalized Ratio (INR). Dose: Pending INR report, 10 ing daily initially for up to 3 days. Haemorrhage is the main side-effect, and may require the use of phytornenadione to control the excessive response.
Whitfield’s ointment Benzoic acid 6%, salicylic acid 3%. Has keratolytic and fungicidal properties, and is used mainly for ringworm.
wool alcohols A water-in-oil emulsifying agent obtained from wool fat. It is used in many water-containing ointments, such as ointment of wool alcohols and hydrous ointment.
vitamin D The vitamin essential for the absorption of calcium and phosphorus and subsequent bone formation. Several forms of the vitamin are known, but it is used chiefly as calciferol. Vitamin D is activated in the liver and kidneys to more powerful derivatives such as calcitriol and alfacalcidol.
wool fat A pale yellow, waxy substance, also known as lanolin, obtained from sheep’s wool. It consists mainly of cholesterol-derivatives, and is a constituent of various water-in-oil emulsifying and emollient ointment bases. It may cause skin sensitization in some susceptible patients.

xamoterol A partial 0, adrenoceptor agonist with a cardiac stimulant action. It is given only in mild chronic heart failure to control exercise-induced symptoms. Dose: 400 ing daily. Side-effects are dizziness, headache and gastrointestinal disturbances. Contraindicated in severe heart failure, and care is necessary in asthmatic conditions. (Corwin). See page 141 and Table 18.
xipamide A long-acting diuretic and anti-hypertensive similar to chlorthalidone. Dose: in hypertension, 20 ing is given as a morning close: in oedematous states, 40-90 mg as a single dose, reduced later as necessary. (Diurexan). See page 148 and Table 21.
xylometazoline A sympathomimetic agent used as a nasal decongestant, and to relieve allergic conjuncfivitis as drops of 0.05-0.1%. Rebound congestion may be a side-effect.
Z
zalcitabineV An antiviral agent used in the suppressive treatment of AIDS patients who have become resistant to or have failed to respond to zidovudine therapy. Dose: 2.25 nig daily under expert supervision, as the drug has many side-effects including
., peripheral neuropathy. 0 livid).
zidovudine An antiviral agent effective against the human immunodeficiency virus (HIV) associated with the acquired immune deficiency syndrome (AIDS). It inhibits the enzyme reverse transcriptase and, by preventing the formation of viral DNIA, it inhibits viral development. Dose: 33 ing/kg4-hourly for some months. Side-effects include anaemia, neutropenia, nausea, fever and malaise. Liver-function tests are necessary during treatment. The chronic use of analgesics such as paracetamol may increase the risk of neutropenia. (Retrovir). See page 144 and “table 19.
zinc oxide A soft white powder widely used in dusting powders, ointments, pastes, etc., for its mild astringent and antiseptic properties. It is a constituent of Lassar’s paste, Unna’s paste, Calamine Lotion and similar preparations.
zinc sulphate Used as an astringent and stimulating lotion (1%) for indolent ulcers; and in conjunctivitis as eye drops (0.25%).
zinc undecenoate A white insoluble powder. Constituent of dusting powders and ointments for mycolic conditions.
zolmitriptan A serotonin receptor agonist used only in the treatment of acute migraine.
Dose: 2.5 ing as soon as possible after onset. .A second dose may be given not less than 2 hours later if symptoms persist. Vornig). See page 154 and Table 23.
zolpidem A mild hypnotic that acts by binding with a sub-group of benzodiazepine receptors. It has a rapid action, and is used in the short-term treatment of insomnia.
Dose: 10 mg. Side-effects are dizziness and gastrointestinal disturbance. (SI ilnoct). See page 152 and Table 22.
zopiclone A mild hypnotic that binds with a sub-group of benzodiazepine receptors, and may modulate the neurotransmitter GABA.
Dose: in insomnia and early awakening, 7.. —]S mg with initial doses of 3.75 mg for the elderly. A side-effect is a bitter or metallic after-taste. (Zimovane). See page 152.
zuclopenthixol A powerful tranquillizing drug with actions, uses and side-effects similar to those of chlorpromazine. It is of value in schizophrenia with agitation and aggression.
Dose: 20-30 mg or more up to 150 mg daily. For depot maintenance treatment, 100-200 mg or more by deep i.m. injection at intervals of 2-3 weeks, according to need and response. (Clopixol). See page 168.