Captopril

(КАР toh pril)

Introduced: 1979

Class: Antihypertensive, ACE in-hibitor

Prescription: USA: Yes

Controlled Drug: USA: No Canada: Yes Canada: No

Available as Generic: No

Brand Names: Capoten, Capozide [CD]

Principal Uses

As a Single Drug Product: Used primarily to treat all degrees of high blood pressure. Mild to moderate high blood pressure usually responds to low doses; severe high blood pressure requires higher doses, with greater risk of serious adverse effects. Also used to treat selected cases of advanced heart failure that have not responded to conventional treatment with digitalis and diuretics.

How This Drug Works: Not completely known. It is thought that by blocking certain enzyme systems that influence arterial function, this drug contributes to the relaxation of arterial walls throughout the body and thus lowers the resistance to blood flow that causes high blood pressure. This, in turn, reduces the workload of the heart and improves its performance.

Available Dosage Forms and Strengths

Tablets — 12.5 mg, 25 mg, 50 mg, 100 mg

Usual Adult Dosage Range: Initially 12.5 to 25 mg 2 or 3 times daily for 2

weeks. If necessary, dose may be increased to 50 mg 3 times daily. Usual maintenance dose is 50 to 100 mg 3 times daily. Total daily dose should not exceed 450 mg. Note: Actual dosage and administration schedule must be determined by the physician for each patient individually.

Dosing Instructions: Take on empty stomach, 1 hour before meals, at same

time each day. Tablet may be crushed for administration.

Usual Duration of Use: Continual use on a regular schedule for several weeks is usually necessary to determine this drug's effectiveness in controlling high blood pressure. The proper treatment of high blood pressure usually requires the long-term use of effective medications. Consult your physician on a regular basis.

This Drug Should Not Be Taken If

• you have had an allergic reaction to it previously.

• you currently have a blood cell or bone marrow disorder.

• you have active liver disease.

• you have an abnormally high level of blood potassium.

Inform Your Physician Before Taking This Drug If

• you have a history of kidney disease or impaired kidney function.

• you have scleroderma or systemic lupus erythematosus.

• you have any form of heart disease.

• you have diabetes.

• you are taking any of the following drugs: other antihypertensives, diuretics, nitrates, allopurinol (Zyloprim), Indocin or potassium sup­- plements.

• you plan to have surgery under general anesthesia in the near future.

Possible Side-Effects (natural, expected and unavoidable drug actions) Dizziness, light-headedness, fainting (excessive drop in blood pressure).

Possible Adverse Effects (unusual, unexpected and infrequent reactions) If any of the following develop, consult your physician promptly for guidance.

Mild Adverse Effects

Allergic Reactions: Skin rash; swelling of face, hands or feet; fever.

Lost or altered taste, mouth or tongue sores.Rapid heart rate, palpitation. Serious Adverse Effects

Bone marrow depression—fatigue, weakness, fever, sore throat, abnormal bleeding or bruising.

Kidney damage—water retention (edema).

Liver damage—with or without jaundice.

Possible Effects on Sexual Function: Decreased male libido (20% to 30%)

with recommended dosage.

Possible Effects on Laboratory Tests

Complete blood cell counts: decreased red cells, hemoglobin, white cells

and platelets; increased eosinophils. Blood antinuclear antibodies (ANA): increased. Blood cholesterol and triglycerides: no effects. Blood sodium level: decreased. Blood urea nitrogen level (BUN): increased. Liver function tests: increased liver enzymes (alkaline phosphatase, AST/GOT, LDH), increased bilirubin. Urine ketone tests: false positive results with Keto-diastix and Chemstrip-6.

CAUTION:

1. If possible, it is advisable to discontinue all other antihypertensive drugs (especially diuretics) for 1 week before starting captopril.

2. Report promptly any indications of infection (fever, sore throat), and any indications of water retention (weight gain, puffiness, swollen feet or ankles).

3. Do not use a salt substitute without your physician's knowledge and approval. (Many salt substitutes contain potassium.)

4. It is advisable to obtain blood cell counts and urine analyses before starting this drug.

Precautions for Use

By Infants and Children: Safety and effectiveness for use by those in this age group have not been established.

By Those over 60 Years of Age: Small doses are advisable until tolerance has been determined. Sudden and excessive lowering of blood pressure can predispose to stroke or heart attack in those with impaired brain circu­lation or coronary artery heart disease.

Advisability of Use During Pregnancy

Pregnancy Category: С (tentative). See Pregnancy Code inside back cover. Animal studies: No birth defects found in rat, rabbit or hamster studies.

However, this drug was shown to be toxic to the embryo and newborn. Human studies: Information from adequate studies of pregnant women

is not available. Avoid during first 3 months if possible. Use only if clearly needed during

last 6 months.

Advisability of Use if Breast-Feeding

Presence of this drug in breast milk: Yes, in small amounts. Monitor nursing infant closely and discontinue drug or nursing if adverse effects develop.

Habit-Forming Potential: None.

Effects of Overdosage: Excessive drop in blood pressure lightheadedness, dizziness, fainting.

Possible Effects of Long-Term Use: Gradual increase in blood potassium level.

Suggested Periodic Examinations While Taking This Drug (at physician's

discretion)

Before starting drug: Complete blood cell counts; urine analysis with measurement of protein content, blood potassium level. During use of drug: Blood cell counts every 2 weeks during the first 3 months of treatment, then periodically for duration of use. Urine protein measurements every month during the first 9 months of treatment, then periodically for duration of use. Periodic measurements of blood potassium.

While Taking This Drug, Observe the Following

Foods: Consult physician regarding salt intake.

Nutritional Support: Do not take potassium supplements unless directed by

your physician.

Beverages: No restrictions. May be taken with milk.

Alcohol: Use caution until combined effect has been determined. Alcohol

may enhance the blood-pressure-lowering effect of this drug.

Tobacco Smoking: No interactions expected.

Other Drugs

Captopril taken concurrently with

• potassium preparations (K-Lyte, Slow-K, etc.) may cause increased blood levels of potassium with risk of serious heart rhythm disturbances.

• potassium-sparing diuretics: amiloride (Moduretic), spironolactone (Aldactazide), triamterene (Dyazide) may cause increased blood levels of potassium with risk of serious heart rhythm disturbances.

The following drugs may decrease the effects of captopril

• indomethacin (Indocin).

• salicylates (aspirin, etc.).

Driving, Hazardous Activities: Usually no restrictions. Be aware of possible drops in blood

Aviation Note: The use of this drug may be a disqualification for piloting. Consult a designated Aviation Medical Examiner.

Exposure to Sun: Caution advised. This drug can cause photosensitivity.

Exposure to Heat: Caution advised. Avoid excessive perspiring with resultant loss of body water and drop in blood pressure.

Occurrence of Unrelated Illness: Report promptly any disorder that causes nausea, vomiting or diarrhea. Fluid and chemical imbalances must be corrected as soon as possible.

TEXT 4. Read the following text and choose the abstract about using metronidazole by a pregnant woman.