Captopril (Capoten)

Category:

  • Antihypertensive

Description:

  • Angiotensin-converting enzyme (ACE) inhibitor

Indications:

  • Hypertension, heart failure, left ventricular dysfunction after MI

  • Diabetic nephropathy in Type 1 patients (proteinuria > 500mg/daily)

Contraindications:

  • Heart block

  • Bilateral renal artery stenosis

Precautions:

  • Pregnancy category C (1st trimester) and D (3rd trimester)

  • Dialysis patients, hypovolemia, leukemia, scleroderma, lupus erythematosus

  • Blood dyscrasias, thyroid disease, COPD, asthma, CHF, hyperkalemia

  • Potassium sparing diruretics, cough, aortic stenosis, pediatric use

Adverse Reactions (Side Effects):

  • CNS: chills, fever

  • CV: chest pain, hypotension, palpitations, postural hypotension, tachycardia

  • GI: loss of taste

  • GU: acute reversible renal failure, dysuria, frequency, impotence, nephrotic syndrome, oliguria, polyuria, proteinuria

  • HEME: agranulocytosis, neutropenia

  • METAB: hyperkalemia, hyponatremia

  • RESP: angioedema, bronchospasm, cough, dyspnea

  • SKIN: rash

 

Dosage:

Administered orally

  • Adult:            

    • Hypertensive crisis: PO 25mg, increasing every 2 hours until desired response; do not exceed 450mg daily

    • Hypertension: PO initial dose 12.5mg 2-3 times daily; may increase to 50mg 2-3 times daily at 1-2 week intervals; usual range 25-150mg 2-3 times daily; max 450mg daily

    • Diabetic nephropathy: PO 25mg 3 times daily

    • Congestive heart failure: PO 12.5mg 2-3 times daily; may increase to 50mg 2-3 times daily; after 14 days, may increase to 150mg 3 times daily if needed

  • Child:            

    • Hypertension: PO initiate 0.15 mg/kg/dose; double at intervals of approximately 2 hours until blood pressure controlled; max 6 mg/kg/day

Drug Interactions:

  • Allopurinol: increased risk of hypersensitivity reactions including Stevens-Johnson syndrome, skin eruptions, fever, and arthralgias

  • NSAIDS: inhibits the antihypertensive response to ACE inhibition

  • Lithium: increased risk of lithium toxicity

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