Cilazapril

CLINICAL USE

Angiotensin-converting enzyme inhibitor: Hypertension, heart failure

DOSE IN NORMAL RENAL FUNCTION

0.5–5 mg daily

PHARMACOKINETICS

Molecular weight :435.5

%Protein binding :No data

%Excreted unchanged in urine : 80–90

Volume of distribution (L/kg) :0.5–0.8

half-life – normal/ESRD (hrs) :9/Increased

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

40–50 Start at low dose and adjust according to response10–40 Start at low dose and adjust according to response

<10 : Start at low dose and adjust according to response

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unknown dialysability. 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 :Unknown dialysability. Dose as in GFR=10–40 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsAnaesthetics: enhanced hypotensive effect Ciclosporin: decreased renal function and increased risk of hyperkalaemiaNSAIDs: antagonism of hypotensive effect and increased risk of renal failure; hyperkalaemiaDiuretics: enhanced hypotensive effect; hyperkalaemia with potassium-sparing diureticsEpoetin: increased risk of hyperkalaemia Lithium: ACE inhibitors reduce excretion of lithium (increased plasma lithium concentration)Potassium salts: hyperkalaemia Tacrolimus: decreased renal function and increased risk of hyperkalaemia

ADMINISTRATION

Reconstition

–

Route

Oral

Rate of Administration

–

Comments

Take dose about the same time each day

OTHER INFORMATION

Data refer to active drug – cilazaprilat Symptomatic hypotension reported in patients with sodium or volume depletion, i.e. sickness, diarrhoea, on diuretics, low sodium diet or post dialysisRenal failure has been associated with ACE inhibitors in patients with renal artery stenosis, post renal transplant, and 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 avoidedHyperkalaemia and other side effects are more common in patients with impaired renal functionClose monitoring of renal function during therapy is necessary in those with renal insufficiency

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

Home