Description:
Properties :
Captopril is a specific competitive inhibitor of ( ACE ) ( angiotensin I converting
enzyme),enzyme that converts angiotensin I to angiotensin II .
Captopril produces a reduction in peripheral resistance in hypertensive patients with either no change
or an increase in cardiac output . Clinical significant reductions in blood pressure are often observed
60 to 90 minutes after oral administration of Captopril .
Indications and usage :
Hypertension : Captomed 25 – 50 is indicated for the treatment of hypertension alone and in
combination with other antihypertensive agents, especially thiazide-type diuretics.
Heart failure: Captomed 25 – 50 is indicated in the treatment of congestive heart failure usually in
combination with diuretics and digitalis .
Left ventricular dysfunction after myocardial infarction :
Captomed 25 – 50 is indicated to improve survival following myocardial infarction in clinically
stable patients with left ventricular dysfunction, and reduce the incidence of overt heart failure and
subsequent hospitalizations for congestive heart failure in these patients.
Contraindications :
A history of previous Hypersensitivity to Captopril .
Pregnancy categories C ( first trimester ) and D (second and third trimesters )
Female patients of childbearing age should be told about the consequences of second-and third-trimester exposure to (ACE ) inhibitors, these patients should be asked to report pregnancies to their
physicians as soon as possible.
Side effects :
Following side effects may occur rarely :
Rash, often with pruritus and sometimes with fever, photosensitivity, a reversible penphigiod like
lesion , the elevation of liver enzyme , gastric irritation, abdominal pain neutropenia / agranulocytosis,
cases of anaemia, cough.
Cardiovascular : hypotension may occur in patients with heart failure , rennin-dependent hypotension
or who are significantly volume depleted.
Afew patients have developed swelling of the face, mucous membranes of the mouth, and the
extremities which is reversible upon discontinuation of the drug
Precautions :
Impaired Renal Function :
some patients with renal disease, particularly those with severe renal artery stenosis have developed
increases in ( BUN) and serum creatinine after reduction of blood pressure with Captopril , Captopril
dosage reduction and/or discontinuation of diuretic may be required. Heart failure: about 20% of
patients develop stable develop stable elevations of BUN serum Creatinine , less than 5% of patients
those with severe preexisting renal disease , required discontinuation of treatment. Hyperkalemia :
elevations in serum potassium have been observed in patients at Risk for the development of hyperkalemia
include those with renal insufficiency, Diabetes mellitus; and those using concomitant
potassium-sparing diuretics,
Cough:ACE inhibitor-induced cough should be considered in the differential diagnosis of cough .
Valvular stenosis: the patients with aortic stenosis might be at particular risk of decreased coronary
perfusion when treated with vasodilators.
Surgery / Anesthesia :
in patients undergoing major surgery or during anaesthesia with agents that produce hypotension,
Captopril will block angiotensin II Hemodialysis: recent clinical observation has shown an
association of hypersensitivity like reactions during Hemodialysis in patients receiving ACE
inhibitors .
Drug interactions :
Captomed should not ne taken with potassium-sparing diuretics , potassium supplements and lithium . Indomethacine and other NSAIDS may reduce the antihyperrensive effect of Captopril .
Diuretics and other antihypertensive agents enhance the hypotensive effect of Captopril
Caution should be exercised in prescribing Captopril for patients receiving concomitant therapy with
immunosuppressants , and other drugs are known to cause neutropenia.
Dosage & administration :
Hypertension: the initial dose of Captopril is 25 mg ( 2 – 3 ) times daily
if satisfactory reduction of blood pressure has not been achieved after one or two weeks , the dose
may be increased to 50 mg ( 2- 3 ) times daily ( not exceed 50 mg three times daily ) . if the blood
pressure has not been satisfactory controlled after one to two weeks at this dose , a modest dose of
thiazide-type diuretic should be added.
Heart failure: the usual starting dose is 25 mg three times daily , a starting dose of 6.25 mg or 12.5
mg three times may minimize the duration of any transient hypertensive effect . usually it has been
added to conventional treatment with diuretic and / or digitalis After a dose of 50 mg three times
daily is reached, further increases in dosage should be delayed to determine if a satisfactory
Response occurs .
Left ventricular dysfunction after myocardial infraction :
The recommended dose for long term use in patients following a myocardial infraction is a target
maintenance dose is 50 mg tid . therapy may be initiated as early as three days following a
myocardial infarction .
After a single dose of 6.25 mg Captopril therapy should be initialled at 12.5 mg tid. Captopril should
then be increased to 25 mg tid during the next several days and to a target dose of 50 mg. tid over the
next several weeks as tolerated.
Captopril may be used in patients treated with other post-myocardial infarction Therapies , e.g
thrombolytics , aspirin , beta-blockers .
Storage conditions : store up to 25oC