Angiotensin converting enzyme inhibitors effects

Kitagawa, S., J. Takeda, and S. Sato. pH-dependent inhibitory effects of angiotensin-converting enzyme inhibitors on cefroxadine uptake by rabbit small intestinal brush-border membrane vesicles and their relationship with hydrophobicity and the ratio of zwitterionic species. Biol. Pharm. Bull. 1999, 22, 721-724. 

All angiotensin-converting enzyme inhibitors including enalapril, may precipitate a hypoglycaemic attack in a diabetic patient because they may potentiate the effect of sulphonylureas. 

Concomitant administration of methotrexate and Voltarol, a proprietary preparation of diclofenac, a non-steroidal anti-inflammatory drug, may result in accumulation of methotrexate as its excretion is reduced. The use of diclofenac and diuretics such as bendroflumethiazide may increase the risk of nephrotoxicity. Concomitant use of alcohol and an angiotensin-converting enzyme inhibitor such as lisinopril (Zestril) may result in an enhanced hypotensive effect. Alcohol and the benzodiazepine diazepam (Valium) may result in enhanced sedation. 

Angiotensin-converting enzyme inhibitors should be used with caution in patients taking diuretics because of an enhanced hypotensive effect. Angiotensin-converting enzyme inhibitors should also be used with caution in patients with renal impairment. Renal function needs to be monitored in patients with renovascular disease. 

Angiotensin-converting enzyme inhibitors have turned out to be very effective antihypertensive drugs that have begun to overtake )3-adrenoblockers, especially in monotherapy of hypertension. 

Moreover, whether or not hypertension is caused by an elevated level of renin or other reasons, angiotensin-converting enzyme inhibitors lower both systolic and diastolic arterial pressure in hypertensive patients, and their effects are enhanced by diuretics. Angiotensin-converting drugs of this series (captopril, enalapril) are effective antihypertensive drugs used both independently and in combination with other drugs to treat all types of hypertension as well as to treat cardiac insufficiency. 

Bakris GL, Griffin KA, Picken MM, Bidani AK. Combined effects of an angiotensin converting enzyme inhibitor and a calcium antagonist on renal injury. Hy-pertens 1997 8 249-59. 

Vantrimpont P, Rouleau JL, Wun CC, for the SAVE Investigators. Additive beneficial effects of beta-blocker to angiotensin-converting enzyme inhibitor in the Survival and Ventricular Enlargement (SAVE) Smdy. J Am Coll Cardil 1997 29 229-36. 

Potentially as effective as or more effective than angiotensin-converting enzyme inhibitors, without cough no evidence yet for reduction in morbidity and mortality as first-line agents in hypertension whether they provide the same cardiac and renal protection also still tentative like ACE inhibitors, less effective in black patients... 

P.K. Shiromani and J.F. Bavitz, Effect of moisture on the physical and chemical stability of granulations and tablets of the angiotensin converting enzyme inhibitor, enalapril maleate. Drug Dev. Ind. Pharm., 12 (1986) 2467. 

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