ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS

Brand & Generic Names

Accupril	Lotensin
Altace	Monopril
Apo-Capto	Novo-Captoril
BENAZEPRIL	Prinivil
Capoten	QUINAPRIL
CAPTOPRIL	RAMIPRIL
ENALAPRIL	Syn-Captopril
FOSINOPRIL	Vasotec
LISINOPRIL	Zestril

Basic Information

• Habit forming? No
• Prescription needed? Yes
• Available as generic? No
• Drug class: Antihypertensive, ACE inhibitor

Uses

Treatment for high blood pressure and congestive heart failure.

Dosage & Usage Information

How to take:
Tablet--Swallow with liquid. Instructions to take on empty stomach mean 1 hour before or 2 hours after eating.

When to take:
At the same times each day, usually 2-3 times daily. Take first dose at bedtime and lie down immediately.

If you forget a dose:
Take as soon as you remember up to 2 hours late. If more than 2 hours, wait for next scheduled dose (don't double this dose).

What drug does:
Reduces resistance in arteries.
Strengthens heartbeat.

Time lapse before drug works:
60 to 90 minutes.

Don't take with:
Any other medicine without consulting your doctor or pharmacist.

Overdose

SYMPTOMS:
Low blood pressure, fever, chills, sore throat, fainting, convulsions, coma.

WHAT TO DO:

• Dial 911 (emergency) or O (operator) for an ambulance or medical help. Then give first aid immediately.
• See EMERGENCY Information.

Possible Adverse Reactions or Side Effects

Life-threatening:

Hives, rash, intense Seek emergency itching, faintness treatment immediately. soon after a dose (anaphylaxis); difficulty breathing.

Common:

Rash, loss of taste.

Infrequent:

• Swelling of mouth, face, hands or feet.
• Dizziness, fainting, chest pain, fast or irregular heartbeat, coughing, confusion, nervousness, numbness and tingling in hands or feet.
• Diarrhea, headache, tiredness.

Rare:

• Sore throat, cloudy urine, fever, chills.
• Nausea, vomiting, indigestion, abdominal pain.

Warnings & Precautions

Don't take if:

• You are allergic to captopril, enalapril or lisinopril.
• You are receiving blood from a blood bank.
• You will have surgery within 2 months, including dental surgery, requiring general or spinal anesthesia.

Before you start, consult your doctor:

• If you have had a stroke.
• If you have angina or heart or blood vessel disease.
• If you have any autoimmune disease, including AIDS or lupus.
• If you have high level of potassium in blood.
• If you have kidney or liver disease.
• If you are on severe salt-restricted diet.
• If you have a bone marrow disorder.

Over age 60:
Adverse reactions and side effects may be more frequent and severe than in younger persons.

Pregnancy:
Risk to unborn child outweighs drug benefits. Don't use.

Breast-feeding:
Drug passes into milk. Avoid drug or discontinue nursing until you finish medicine. Consult doctor for advice on maintaining milk supply.

Infants & children:
Use under close medical supervision only.

Prolonged use:

• May decrease white cells in blood or cause protein loss in urine.
• Request periodic laboratory blood counts and urine tests.

Skin & sunlight:
No problems expected.

Driving, piloting or hazardous work:
Avoid if you become dizzy or faint. Otherwise, no problems expected.

Discontinuing:
Don't discontinue without consulting doctor. Dose may require gradual reduction if you have taken drug for a long time. Doses of other drugs may also require adjustment.

Others:

• Stop taking diuretics or increase salt intake 1 week before starting any ACE inhibitor.
• Avoid exercising in hot weather.
• May affect results in some medical tests.
• Advise any doctor or dentist whom you consult that you take this medicine.

Possible Interaction with Other Drugs

GENERIC NAME	COMBINED EFFECT
------------------------	-----------------------
Amiloride	Possible excessive potassium in
	blood.
Antihypertensives,	Increased antihypertensive
other*	effect. Dosage of each may require
	adjustment.
Beta-adrenergic	Increased antihypertensive
blockers*	effect. Dosage of each may require
	adjustment.
Carteolol	Increased antihypertensive effects
	of both drugs. Dosages may require
	adjustment.
Chloramphenicol	Possible blood disorders.
Diuretics*	Possible severe blood pressure drop
	with first dose.
Diclofenac	May decrease ACE inhibitor effect.
Guanfacine	Increased effect of both drugs.
Nicardipine	Possible excessive potassium in
	blood. Dosages may require
	adjustment.
Nimodipine	Possible excessive potassium in
	blood. Dangerous blood pressure
	drop.
Nitrates*	Possible excessive blood pressure
	drop.
Non-steroidal	Decreased ACE
anti-inflammatory	inhibitor effect.
Pentamidine	May increase bone marrow depression
	or make kidney damage more likely.
Pentoxifylline	Increased antihypertensive effect.
Potassium	Possible increased
supplements*	potassium in blood.
Potassium iodide	May raise potassium levels in blood
	to toxic levels.
Sotalol	Increased antihypertensive effects
	of both drugs. Dosages may require
	adjustment.
Spironolactone	Possible excessive potassium in
	blood.
Terazosin	Decreases effectiveness of
	terazosin.
Tiopronin	Increased risk of toxicity to
	kidneys.
Triamterene	Possible excessive potassium in
	blood.

Possible Interaction with Other Substances

INTERACTS WITH	COMBINED EFFECT
---------------	---------------
Alcohol:	Possible excessive blood pressure
	drop.
Low-salt milk.	Possible excessive potassium in
	blood.
Cocaine	Increased risk of heart block and
	high blood pressure.
Salt substitutes.	Possible excessive potassium.
Marijuana:	Increased dizziness.
Tobacco:	May decrease ACE inhibitor effect.