Precautions and Special Considerations
|Captopril(Capoten)**||12.5-150||Can cause reversible, acute renal failure in patients with bilateral renal arterial stenosis or unilateral stenosis in an artery to a solitary kidney and in patients with preexisting renal insufficiency or congestive heart failure. Excreted by kidney; may require dosage reduction in patients with renal insufficiency. Hypotension has been observed with initiation of AGE inhibitors, especially in patients with high plasma renin activity or hypovolemia (e.g., in those receiving diuretic therapy).||Cough, angioedema (rare, hyperkalemia (especially when given to patients with renal failure and/or with a potassium-sparing diuretic or a nonsteroidal anti-inflammatory drug), dysgeusia, neutropenia (rare), proteinuria (rare at recommended doses), rash.|
|Lisinopril (Prinivil, Zestril)||5-40|
|Special indications: Congestive heart
failure, young patient, white patient, heavy proteinuria, diabetes mellitus
with or without renal disease, impotence from other drugs.
Contraindications: History of hypersensitivity to these agents or history of angioedema; bilateral renal artery stenosis or severe stenosis In an artery to a solitary kidney; hyperkalemia; advanced renal failure; pregnancy.
Advantages: Beneficial for congestive heart failure, no metabolic side effects (except for hyperkalemia as noted), low side effect profile, effective, long-acting (except captopril), no pseudotolerance, easy to titrate, reduce TPR.
Disadvantages: Expensive, risk of acute renal failure and/or hyperkalemia (see above), no long-term trials to demonstrate reduction in cardiovascular morbidity or mortality.
*The dosage range may differ slightly from recommended dosage in Physicians' Desk Reference or package insert. Given once daily unless otherwise indicated.
^Fosinopril is excreted by the liver as well as by the kidney; may require dosage reduction in patients with hepatic insufficiency.
**This drug is usually given in divided doses two or three times daily.
***Pending approval by the Food and Drug Administration.