20 to 50     : Start low – adjust according to response
10 to 20     : Start low – adjust according to response
<10           : Start low – adjust according to response
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Not dialysed. Dose as in GFR <10 mL/min
HD                     :Dialysed. Dose as in GFR
<10           : mL/min
HDF/high flux   :Dialysed. Dose as in GFR
<10           : mL/min
CAV/VVHD      :Dialysed. Dose as in GFR=10–20 mL/min
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
Anaesthetics: enhanced hypotensive effect cinAnalgesics: antagonism of hypotensive effect and increased risk of renal impairment with NSAIDs; hyperkalaemia with ketorolac and other NSAIDs
Ciclosporin: increased risk of hyperkalaemia and nephrotoxicity
Diuretics: enhanced hypotensive effect; hyperkalaemia with potassium-sparing diuretics
Epoetin: increased risk of hyperkalaemia; antagonism of hypotensive effect
Lithium: reduced excretion, possibility of enhanced lithium toxicity
Potassium salts: increased risk of hyperkalaemia.
Tacrolimus: increased risk of hyperkalaemia and nephrotoxicity
ADMINISTRATION
Reconstition
–
Route
Oral
Rate of Administration
–
Comments
Tablets may be dispersed in water
OTHER INFORMATION
A
dverse reactions, especially hyperkalaemia, are more common in patients with renal impairment
Effective sub-lingually in emergencies As renal function declines a hepatic elimination route for captopril becomes increasingly more significant
Renal failure has been reported in association with ACE inhibitors in patients with renal artery stenosis, post renal transplant, or in those with congestive heart failure
A high incidence of anaphylactoid reactions has been reported in patients dialysed with high-flux polyacrylonitrile membranes and treated concomitantly with an ACE inhibitor – this combination should therefore be avoided
Close monitoring of renal function during therapy is necessary in those with renal insufficiency.