Captopril adverse effects

With the data included in the overview of Garg et al. (316), it is possible to calculate that 18 patients need to be treated for 90 days to avoid one death or one hospitalization for congestive heart failure (95% confidence interval [Cl] 16-23). This meta-analysis includes 32 trials with the ACE inhibitors captopril, enalapril, lisinopril, quinapril, ramipril, and perindopril. It is likely that high doses (for instance, lisinopril 35 mg daily) are more effective than low doses (lisinopril 5 mg daily) (302). Treating 30 patients for 4 years with a high dose of lisinopril (95% Cl 16-509) will avoid one hospitalization for cardiovascular reasons or one death in comparison with a low dose, without increasing the number of adverse effects requiring withdrawal from treatment. 

Captopril (Capoten) has a of 2 h and is partly metabolised and partly excreted unchanged adverse effects are more common if renal fimction is impaired it is given twice or thrice daily. Captopril is the shortest-acting of the ACE inhibitors, one of the few where the oral drug is itself active, not requiring de-esterification after absorption. 

Hepatic injury is a rare adverse effect of the ACE inhibitors (60,61). Both acute and chronic hepatitis and cholestatic jaundice can occur (62,63), as can cross-reactivity, as identified in a report involving enalapril and captopril (64). 

Enalapril has been specifically studied in patients who are resistant to other drugs and intolerant of captopril (99) and in patients with collagen vascular disease and renal disease known to be at high risk of adverse effects (100). In the first study (99), the major reasons for discontinuing captopril were a low white blood cell count, proteinuria, taste disturbance, and rash. In the vast majority of the 281 patients, these adverse effects did not recur during enalapril treatment. The main adverse events that warranted withdrawal of enalapril were impairment of renal function (5%), hypotension (2%), and rashes (2%). The authors noted that patients with angioedema should not be given alternative ACE inhibitors. 

Adverse effects observed at therapeutic doses include cough, dermal reactions, blood dyscrasias, bronch-ospasm, and hypogeusia. Angioedema has been reported, but does not appear to be an IgG related immune response. Reversible renal failure has been reported with chronic therapy. Clinical effects that may occur include hypotension with or without a reflex tachycardia, changes in level of consciousness that are directly related to vascular changes, and hyperkalemia. Hyperkalemia can occur as a response to sodium loss. Delayed hypotension, at 19 and 25 h, has been observed following ingestion of captopril. 

The Valsartan in Acute Myocardial Infarction Trial (VALIANT) compared the effects of valsartan, captopril, and the combination of the two agents in post-MI patients with symptomatic heart failure, left ventricular dysfunction, or both. The primary end point of total mortality occurred in 19.3% of patients receiving valsartan and captopril, 19.5% of captopril-treated patients, and 19.9% of the valsartan-treated group. Thus, in this high-risk post-MI population, valsartan was as effective as captopril in reducing the risk of death, but combination therapy only increased the risk of adverse effects and did not improve survival compared with monotherapy with either agent. 

Marked postural hypotension occurred in a patient given chlo-rpromazine and captopril. The hypotensive adverse effects of antipsychotics such as the phenothiazines may be additive with the effects of ACE inhibitors. 

Chang Y-P, Shih P-Y. A case of Parkinson s disease worsened by captopril an unexpected adverse effect. Mov Disord 2009 24(5) 790. 

Susceptibility factors Sex There are differences in blood pressure between the sexes, the mechanisms of which are unknown furthermore, it is not known whether sex can influence the response to antihypertensive therapy. In a prospective study 3535 untreated hypertensive Chinese patients were randomized to atenolol, sustained-release nifedipine, captopril, or hydrochlorothiazide for 8 weeks [32 ]. Women had significantly better pressure responses, but more adverse effects with sustained-release nifedipine and captopril than men. The authors suggested that sex should be taken into account when selecting antihypertensive drugs. 

When the dmg was introduced into the clinic it was most efficacious, although a number of adverse side effects were observed including skin rash and loss of taste, and thus the search for better ACE inhibitors began. This has resulted in a large number of compounds presently available as ACE inhibitors. Some of these are captopril, cilazapril, enala-pril (maleate), fosinopril, imidapril, lisinapril, moexipril (hychochloride), perindopril (erbumine, [t-butyl amine]), quinapril, ramipril and trandolapril (Figs 12.11, 12.12). 

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