Angiotensin-converting enzyme inhibitors dosing

Gattis WA, Larsen RL, Hasselblad V, Bart BA, O Connor CM. Is optimal angiotensin-converting enzyme inhibitor dosing neglected in elderly patients with heart failure . Am Heart J 1998 136(l) 43-8. 

Renal function should be closely monitored when patients on lithium treatment are given angiotensin converting enzyme inhibitors. Doses of both drugs should be chosen with caution to avoid serious drug interaction [27]. 

The most potentially serious drug interactions include the concomitant use of NSAIDs with lithium, warfarin, oral hypoglycemics, high-dose methotrexate, antihypertensives, angiotensin-converting enzyme inhibitors, fi-blockers, and diuretics. 

Tenenbaum, A., et al. (2000). Intermediate, but not low, doses of aspirin can suppress angiotensin-converting enzyme inhibitor-induced cough, Am. J. Hypertens., 13, 776-782. 

Antihypertensive Dose Ranges as Monotherapy for the Angiotensin-Converting Enzyme Inhibitors Shown in Figure 2... 

NSAIDs should be avoided in patients with chronic renal insufficiency due to the risk of inducing further kidney damage. In patients at risk, acute renal feilure can occur after a single dose of drug. Risk fectors include dehydration, hypertension, congestive heart failure, concomitant use of angiotensin-converting enzyme inhibitors, and advanced age. 

Packer M, Poole-Whson PA, Armstrong PW, Cleland JG, Horowitz JD, Massie BM, Ryden L, Thygesen K, Uretsky BF. Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure. ATLAS Study Group. Circulation 1999 100(23) 2312-18. 

Metolazone occupies an intermediate position between the thiazide diuretics and the more potent loop diuretics (1). It is more effective than the thiazides in moderate to advanced renal insufficiency (SED-8, 488) (SED-9, 355). In patients with normal renal function its antihypertensive effect compares favorably with that of bendroflumethia-zide. When severe heart failure is refractory to conventional triple therapy (high-dose loop diuretic, digoxin, and angiotensin-converting enzyme inhibitor) metolazone can restore diuresis, with weight loss and clinical improvement. 

Roc, C.M. Motheral, B.R. Tcitclbaum, F. Rich, M.W. Angiotensin converting enzyme inhibitor compliance and dosing among patients with heart failure. Am. Heart I. 1999, /.IS. 818 825. 

Guazzi M, Brambilla R, Reina G, et al. Aspirin-angiotensin-converting enzyme inhibitor coadministration and mortality in patients with heart failure A dose-related adverse effect of aspirin. Arch Intern Med 2003 163 1574-1579. 

Rostoker G, Maadi AB, Remy P, et al. Low-dose angiotensin-converting-enzyme inhibitor captopril to reduce proteinuria in adult idiopathic membranous nephropathy A prospective study of long-term treatment. Nephrol Dial Transplant 1995 10 25-29. 

Second-line therapy is often required to control the blood pressure of patients with BAH. Agents useful as second-line choices include the calcium channel blockers, angiotensin-converting enzyme inhibitors, and low-dose diuretics such as hydrochlorothiazide. ... 

---