page137
dose; diabetic nephropathy (microalbuminuria greater
than 30 mg/day) in type 1 diabetes
Cautions
see notes above
Contra-indications
see notes above
Renal impairment
see notes above;
reduce dose;
max.
initial dose 25 mg daily (do not exceed 100 mg
daily) if eGFR 20–40 mL/minute/1.73 m
2
; max. initial
dose 12.5 mg daily (do not exceed 75 mg daily) if
eGFR 10–20 mL/minute/1.73 m
2
;
max.
initial dose
6.25 mg daily (do not exceed 37.5 mg daily) if eGFR
less than 10 mL/minute/1.73 m
2
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see notes above;
tachycardia, serum
sickness, weight loss, stomatitis,
maculopapular rash,
photosensitivity,
flushing and acidosis
Dose
. Hypertension,
used alone,
initially 12.5 mg twice
daily; if used in addition to diuretic (see notes above),
or in elderly, initially 6.25 mg twice daily (first dose at
bedtime);
usual maintenance dose 25 mg twice daily;
max. 50 mg twice daily (rarely 3 times daily in severe
hypertension)
. Heart failure (adjunct), initially 6.25–12.5 mg 2–3
times daily under close medical supervision (see notes
above), increased gradually at intervals of at least 2
weeks up to max.
150 mg daily in divided doses if
tolerated
. Prophylaxis after infarction in clinically stable patients
with asymptomatic or symptomatic left ventricular
dysfunction (radionuclide ventriculography or echo-
cardiography undertaken before initiation),
initially
6.25 mg,
starting as early as 3 days after infarction,
then increased over several weeks to 150 mg daily (if
tolerated) in divided doses
. Diabetic nephropathy,
75–100 mg daily in divided
doses;
if further blood pressure reduction required,
other antihypertensives may be used in conjunction
with captopril;
in severe renal impairment, initially
12.5 mg twice daily (if concomitant diuretic therapy
required,
loop diuretic rather than thiazide should be
chosen)
Captopril
(Non-proprietary) A
Tablets
,
captopril 12.5 mg,
net price 56-tab pack =
£1.51; 25 mg, 56-tab pack = £1.56; 50 mg, 56-tab pack
= £1.96
Brands include
Ecopace
c
,
Kaplon
c
Capoten
c
(Squibb) A
Tablets
,
captopril 25 mg,
net price 28-tab pack =
£5.26;
50 mg (scored),
56-tab pack = £17.96
With diuretic
Note
For mild to moderate hypertension in patients stabi-
lised on the individual components in the same proportions.
For prescribing information on thiazides,
see section 2.2.1
Co-zidocapt
(Non-proprietary) A
Tablets
,
co-zidocapt 12.5/25 (hydrochlorothiazide
12.5 mg,
captopril 25 mg),
net price 28-tab pack =
£14.10
Brands include
Capto-co
c
Tablets
,
co-zidocapt 25/50 (hydrochlorothiazide
25 mg,
captopril 50 mg),
net price 28-tab pack =
£14.00
Brands include
Capto-co
c
Capozide
c
(Squibb) A
LS tablets
,
scored,
co-zidocapt 12.5/25 (hydro-
chlorothiazide 12.5 mg, captopril 25 mg), net price 28-
tab pack = £10.05
Tablets
,
scored,
co-zidocapt 25/50 (hydrochloro-
thiazide 25 mg, captopril 50 mg), net price 28-tab pack
= £7.02
CILAZAPRIL
Indications
essential hypertension;
congestive heart
failure (adjunct—see section 2.5.5)
Cautions
see notes above
Contra-indications
see notes above
Hepatic impairment
see notes above;
max.
dose
500 micrograms daily in liver cirrhosis;
manufacturer
advises avoid in ascites
Renal impairment
see notes above;
max.
initial dose
500 micrograms once daily (do not exceed 2.5 mg
once daily) if eGFR 10–40 mL/minute/1.73 m
2
; avoid
if eGFR less than 10 mL/minute/1.73 m
2
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see notes above; also
less commonly
dry
mouth,
decreased appetite,
angina,
tachycardia, pal-
pitation,
flushing,
dyspnoea,
impotence,
excessive
sweating;
rarely
glossitis,
bronchitis,
interstitial lung
disease,
gynaecomastia,
peripheral neuropathy,
Ste-
vens-Johnson syndrome,
toxic epidermal necrolysis
Dose
. Hypertension,
initially 1 mg once daily (reduced to
500 micrograms daily if used in addition to diuretic
(see notes above), or in cardiac decompensation,
in
severe hypertension,
in volume depletion,
in the
elderly,
or in renal impairment), then adjusted
according to response;
usual maintenance dose 2.5–
5 mg once daily;
max.
5 mg daily
. Heart failure (adjunct), initially 500 micrograms once
daily under close medical supervision (see notes
above), increased at weekly intervals to 1–2.5 mg
once daily if tolerated;
max.
5 mg once daily
Vascace
c
(Roche) A
Tablets
,
f/c,
cilazapril 500 micrograms (white),
net
price 30-tab pack = £3.68; 1 mg (yellow), 30-tab pack
= £6.07;
2.5 mg (pink),
28-tab pack = £7.20;
5 mg
(brown),
28-tab pack = £12.51
ENALAPRIL MALEATE
Indications
hypertension;
symptomatic heart failure
(adjunct—see section 2.5.5);
prevention of sympto-
matic heart failure in patients with asymptomatic left
ventricular dysfunction
Cautions
see notes above
Contra-indications
see notes above
Hepatic impairment
see notes above
Renal impairment
see notes above;
max.
initial dose
2.5 mg daily if eGFR less than 30 mL/minute/1.73 m
2
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see notes above;
also dyspnoea;
depres-
sion,
asthenia;
blurred vision;
less commonly
dry
mouth,
peptic ulcer,
anorexia,
ileus;
arrhythmias,
palpitation,
flushing;
confusion, nervousness,
drowsi-
ness,
insomnia, vertigo;
impotence;
muscle cramps;
tinnitus;
alopecia,
sweating;
hyponatraemia;
rarely
BNF 61
2.5.5 Drugs affecting the renin-angiotensin system
117
2
Cardiovascular system