Captopril heart failure

Chymostatin-sensitive Il-generating enzyme Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction Trial Collaborative Study Captopril Trial ( The Effect of Angiotensin-Converting Enzyme Inhibition on Diabetic Nephropathy ) calcium channel blocking agents Candesartan in Heart Failure Assessment of Reduction in Morbidity and Mortality Trial congestive heart failure, but the latest recommendations use HF for heart failure chronic kidney disease cardiac output... 

Heart failure - Usual initial dosage is 25 mg 3 times daily. After 50 mg 3 times daily is reached, delay further dosage increases, where possible, for at least 2 weeks to determine if a satisfactory response occurs. Most patients have had a satisfactory clinical improvement at 50 or 100 mg 3 times daily. Do not exceed a daily dose of 450 mg. Captopril should generally be used in conjunction with a diuretic and digitalis. 

Pitt B, Segal R, Martinez FA, Meurers G, Cowley AJ, Thomas I et al. Randomised trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in the Elderly Study, ELITE). Lancet 1997 349(9054) 747-52. 

Captopril enhances cardiac output in patients with congestive heart failure by inducing a reduction in ventricular afterload and preload. Converting enzyme inhibitors have been shown to decrease the mass and wall... 

Captopril, as well as other ACE inhibitors, is indicated in the treatment of hypertension, congestive heart failure, left ventricular dysfunction after a myocardial infarction, and diabetic nephropathy. In the treatment of essential hypertension, captopril is considered first-choice therapy, either alone or in combination with a thiazide diuretic. Decreases in blood pressure are primarily attributed to decreased total peripheral resistance or afterload. An advantage of combining captopril therapy with a conventional thiazide diuretic is that the thiazide-induced hypokalemia is minimized in the presence of ACE inhibition, since there is a marked decrease in angiotensin Il-induced aldosterone release. 

Captopril, many others Inhibit angiotensin converting enzyme Reduce angiotensin II levels reduce vasoconstriction and aldosterone secretion increase bradykinin Hypertension heart failure, diabetes Oral Toxicity Cough, angioedema teratogenic... 

An important class of orally active ACE inhibitors, directed against the active site of ACE, is now extensively used. Captopril and enalapril are examples of the many potent ACE inhibitors that are available. These drugs differ in their structure and pharmacokinetics, but in clinical use, they are interchangeable. ACE inhibitors decrease systemic vascular resistance without increasing heart rate, and they promote natriuresis. As described in Chapters 11 and 13, they are effective in the treatment of hypertension, decrease morbidity and mortality in heart failure and left ventricular dysfunction after myocardial infarction, and delay the progression of diabetic nephropathy. 

Drug Class Angiotensin-converting enzyme [ACE] inhibitors Suffix -pril Common Examples Captopril, enalapril Primary Indication or Desired Effect (Chapter in Parentheses) Antihypertensive [21], congestive heart failure [24]... 

It appears that all ACE inhibitors tested to date have beneficial effects in patients with chronic heart failure. Recent studies have documented these beneficial effects with enalapril, captopril, lisinopril, quinapril, and ramipril. Thus, this benefit appears to be a class effect. 

Parenteral 40, 80, 160 mg/mL for IV injection 80, 160, 320 mg/dL in 5% dextrose for IV infusion Angiotensin-Converting Enzyme Inhibitors Labeled for Use in Congestive Heart Failure Captopril (generic, Capoten)... 

Lejemtel TH, Keung E, Frishman WH, Ribner HS, Sonnenblick EH. Hemodynamic effects of captopril in patients with severe chronic heart failure, Am J Cardiol I 982 49 1484-1488. 

The-Captopril-Multicenter-Research-Group, A placebo-controlled trial of captopril in refractory chronic congestive heart failure, J Am Coll Cardiol I 983 2 755-763,... 

Pitt B, Poole-Wilson PA, Segal R, et al. Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure randomised trial—the Losartan Heart Failure Survival Study ELITE II. Lancet 2000 355 1582-1587. 

Pfeffer MA, McMurray JJ, Velazquez EJ, et al, Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both, N Engl J Med 2003 349 1893-1906. 

Congestive heart failure (CHF), other high-risk patients Angiotensin-converting enzyme (ACE) inhibition Enalapril Captopril Ramipril Reduction in cardiovascular, all-cause mortality reduced hospitalizations and recurrent CHF in patients post-MI, with CHF and with decreased left ventricular ejection fraction (LVEF) CONSENSUS SAVE SOLVD AIRE HOPE >23,000 14... 

Clinical testing began in 1976 in a study in normal volunteers, in which the pressor activity of intravenous angiotensin I was inhibited by increasing oral doses of captopril ranging from 1 to 20 mg (106). The extensive clinical studies that led to its approvals have been reviewed (98,107-111). Captopril was first approved in 1981 for use in hypertensive patients poorly responsive to multidrug therapy. It received FDA approval in 1982 for heart failure and in 1985 for general use in hypertension (101). For... 

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. 

The main argument in favor of a beneficial effect of ACE inhibition on coronary heart diseases comes from the pooled results of the SOLVE) treatment trial, the SOLVE) prevention trial, and the SAVE, AIRE, and TRACE studies, which indicate a 21% (95% Cl, 11-29%, p <. 001) relative risk reduction for myocardial infarction associated with ACE inhibitor therapy. Enalapril (SOLVE)) significantly reduced hospitalization for unstable angina, and captopril (SAVE) reduced revascularization procedures (291). In patients treated for 38 to 42 months with enalapril or captopril and selected on the basis of a reduction in ejection fraction with or without heart failure, it is necessary to treat 49 patients to avoid one myocardial infarction (95% Cl 32-117). 

Khattar, R.S., Senior, R., Soman, P., van der Does, R., and Lahiri, A. 2001. Regression of left ventricular remodeling in chronic heart failure Comparative and combined effects of captopril and carvedilol. Am. Heart J. 142 704-713. 

Examples of specific drugs used in the treatment of chronic heart failure include digitalis glycosides (e.g., digoxin, positive inotropic agent), diuretics (hydrochlortiazide and furosemide), and vasodilators (nitrates such as nitroglycerin, ACE inhibitors, such as captopril, and hydralazine). 

Captopril a drug that is used for hypertension and congestive heart failure. It is an angiotensin-converting enzyme (ACE) inhibitor. 

ANTI HYPERTENSIVES AND HEART FAILURE DRUGS ALBUMIN-CONTAINING SOLUTIONS Acute 1 BP following rapid infusion with captopril or enalapril Uncertain at present Use alternative colloids monitor BP closely while on infusion... 

ANTI HYPERTENSIVES AND HEART FAILURE DRUGS NS AIDs 1 hypotensive effect, especially with indometacin. The effect is variable amongst different ACE inhibitors and NSAIDs, but is most notable between captopril and indometacin NSAIDs cause sodium and water retention and raise BP by inhibiting vasodilating renal prostaglandins. ACE inhibitors metabolize tissue kinins (e.g. bradykinin) and this may be the basis for indometacin attenuating hypotensive effect of captopril Monitor BP at least weekly until stable. Avoid co administering indometacin with captopril... 

ACE INHIBITORS DIGOXIN t plasma concentrations of digoxin when captopril is co-administered in the presence of heart failure (class II or more severe) or renal insufficiency. No other ACE inhibitors seem to interact in the same way Uncertain postulated to be due to 1 renal excretion of digoxin Monitor digoxin levels watch for digoxin toxicity... 

ALLOPURINOL ANTI HYPERTENSIVES AND HEART FAILURE DRUGS-ACE INHIBITORS Risk of serious hypersensitivity with captopril and enalapril Uncertain. Both drugs can cause hypersensitivity reactions Warn patient to look for clinical features of hypersensitivity and Stevens-Johnson syndrome... 

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