Uses of Tenopril: - Hypertension (high blood pressure) - Prevention of heart attack and stroke - Heart failure Hypertension, Congestive heart failure, Post Myocardial infarction, Diabetic nephropathy Known hypersensitivity to the drug. Bilateral renal artery stenosis, hereditary angioedema; renal impairment; pregnancy.

Angiotensin-converting enzyme (ACE) inhibitors

Captopril competitively inhibits the conversion of angiotensin I (ATI) to angiotensin II (ATII), thus resulting in reduced ATII levels and aldosterone secretion. It also increases plasma renin activity and bradykinin levels. Reduction of ATII leads to decreased Na and water retention. This promotes vasodilation and BP reduction.

How to use Captopril: Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Captopril may be taken with or without food, but it is better to take it at a fixed time. Administration: Should be taken on an empty stomach. Take on an empty stomach 1 hr before or 2 hr after meals. Adult Dose: Adult: PO HTN Initial: 12.5 mg twice daily. Maintenance: 25-50 mg twice daily. Max: 50 mg 3 times/day. Elderly: Initially, 6.25 mg bid. Heart failure Initial: 6.25-12.5 mg 2-3 times/day. Max: 50 mg 3 times/day. Post MI Start 3 days after MI. Initial: 6.25 mg/day, may increase after several wk to 150 mg/day in divided doses if needed and tolerated. Diabetic nephropathy 25 mg 3 times/day. Child Dose: Oral Hypertension Child: Neonates and infants: 0.15 mg/kg. Max: 6 mg/kg in 2 or 3 divided doses according to response. Childn and adolescents: 0.3 mg/kg. Max: 6 mg/kg in 2 or 3 divided doses according to response. Heart failure Child: Initially, 0.25 mg/kg/day, increased up to 2.5 or 3.5 mg/kg/day in 3 divided doses. Renal Dose: Renal impairment: CrCl (ml/min) <10 Initially, 6.25 mg/day. Max: 37.5 mg/day. 10-20 Initially, 12.5 mg/day. Max: 75 mg/day. 21-40 Initially, 25 mg/day. Max: 100 mg/day.

Concurrent treatment w/ NSAIDs reduces hypotensive action and increases the risk of nephrotoxicity. Additive hyperkalaemic effect w/ K supplements, K-sparing diuretics, and other drugs (e.g. heparin). May increase risk of leucopenia w/ procainamide, allopurinol, cytostatic or immunosuppressants. May increase risk of lithium toxicity. Increased risk of nitritoid reactions w/ gold (Na aurothiomalate). Potentially Fatal: Increased risk of hypotension, hyperkalaemia, and changes in renal function (including acute renal failure) w/ aliskiren in diabetic patients.

Known hypersensitivity to the drug. Bilateral renal artery stenosis, hereditary angioedema; renal impairment; pregnancy.

Common - Decreased blood pressure - Cough - Increased potassium level in blood - Fatigue - Weakness - Dizziness >10% Hyperkalemia (1-11%) 1-10% Hypersensitivity rxns (4-7%),Skin rash (4-7%),Dysgeusia (2-4%),Hypotension (1-2.5%),Pruritus (2%),Cough (0.5-2%),Chest pain (1%),Palpitations (1%),Proteinuria (1%),Tachycardia (1%) Frequency Not Defined Cardiac arrest,Orthostatic hypotension,Ataxia,Confusion,Depression,Somnolence,Angioedema,Photosensitivity,Neutropenia,ARF if renal artery stenosis,Renal impairment,Impotence Potentially Fatal: Neutropenia, usually occurs within 3 mth of starting therapy especially in patients with renal dysfunction or collagen diseases. Hyperkalaemia. Anaphylactic reactions.

Pregnancy Category D. There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk

Precaution: Patients on diuretics or with sodium depletion should discontinue diuretics or increase sodium intake prior to initiation of therapy. Renal impairment, SLE and other autoimmune collagen disorders and during concurrent use of immunosuppressant or leucopenic drugs, monitor WBC count and urinary protein before and during therapy. Lactation. Porphyria. Severe CHF. Discontinue as soon as pregnancy detected; during the second and third trimesters of pregnancy, drugs that act directly on the renin-angiotensin have been associated with fetal injury that includes hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death Lactation: enters breast milk/not recommended (AAP states compatible with nursing)

Symptoms: Severe hypotension, shock, stupor, bradycardia, electrolyte disturbances and renal failure. Management: Perform gastric lavage, administer adsorbent and sodium sulfate with in 30 min of ingestion; NaCl 0.9% IV infusion. Treatment with angiotensin-II may also be considered. Administer atropine in case of extensive vagal reactions or bradycardia. Pacemaker is also an option. Elimination may be enhanced by haemodialysis.

Store below 30° C

Angiotensin-converting enzyme (ACE) inhibitors

Captopril competitively inhibits the conversion of angiotensin I (ATI) to angiotensin II (ATII), thus resulting in reduced ATII levels and aldosterone secretion. It also increases plasma renin activity and bradykinin levels. Reduction of ATII leads to decreased Na and water retention. This promotes vasodilation and BP reduction.

Pregnancy Category: C; D in 2nd & 3rd trimesters Discontinue as soon as pregnancy detected; during the second and third trimesters of pregnancy, drugs that act directly on the renin-angiotensin have been associated with fetal injury that includes hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death Lactation: enters breast milk/not recommended (AAP states compatible with nursing)