CLINICAL USE


Angiotensin converting enzyme inhibitor:Hypertension Heart failure

DOSE IN NORMAL RENAL FUNCTION

2.5–80 mg daily in 1–2 divided doses In heart failure 40 mg is normal maximum dose

PHARMACOKINETICS

  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :475 (as hydrochloride)
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :97
  • %Excreted unchanged in urine &nbsp &nbsp : 30

  • Volume of distribution (L/kg) &nbsp &nbsp &nbsp :1.5

  • half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :1/12–14

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50 &nbsp &nbsp : Start with low dose, adjust according to response
  • 10 to 20 &nbsp &nbsp : Start with low dose, adjust according to response
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : Start with low dose, adjust according to response

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Not dialysed. Dose as in GFR <10 mL/min
  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :25% dialysed. Dose as in GFR <10 mL/min
  • HDF/high flux &nbsp :Dialysed. Dose as in GFR
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : mL/min
  • CAV/VVHD &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in GFR 10 to 20 mL/min

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs

  • Anaesthetics: enhanced hypotensive effect
  • Analgesics: 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

    –

    OTHER INFORMATION

    Renal failure has been reported with ACE inhibitors: mainly in patients with renal artery stenosis, post renal transplant and those with severe congestive heart failureA 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 be avoidedHyperkalaemia and other side effects more common in patients with renal impairmentClose monitoring of renal function during therapy is necessary in those patients with known renal insufficiency.
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