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CARDIOVASCULAR SYSTEM › AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM › ACE INHIBITORS, COMBINATIONS › ACE inhibitors and diuretics
captopril and diuretics
C09BA01
Forms & Strengths
- Captopril 25 mg / Hydrochlorothiazide 15 mg tablet
- Captopril 25 mg / Hydrochlorothiazide 25 mg tablet
- Captopril 50 mg / Hydrochlorothiazide 15 mg tablet
- Captopril 50 mg / Hydrochlorothiazide 25 mg tablet
Adult Dosing
- Initial: 1 tablet daily, titrated based on clinical response
- Maintenance: Usually 1 to 2 tablets daily administered as a single dose or divided
- Maximum daily dose: Captopril 150 mg / Hydrochlorothiazide 50 mg
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
Indications
- Treatment of hypertension, particularly when monotherapy with either agent is insufficient
- Reduction of blood pressure to reduce the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions
Mechanism of Action
- Captopril inhibits angiotensin-converting enzyme (ACE), preventing the conversion of angiotensin I to angiotensin II, leading to decreased vasoconstriction and reduced aldosterone secretion
- Hydrochlorothiazide inhibits sodium reabsorption in the distal renal tubules, increasing excretion of sodium, water, potassium, and hydrogen ions
Contraindications
- Hypersensitivity to captopril, other ACE inhibitors, sulfonamide-derived drugs, or any component
- History of angioedema related to previous ACE inhibitor therapy
- Hereditary or idiopathic angioedema
- Anuria
- Co-administration with aliskiren in patients with diabetes mellitus
- Concomitant use with neprilysin inhibitors (e.g., sacubitril)
Adverse Reactions
- Persistent dry cough related to the ACE inhibitor component
- Hypotension and orthostatic hypotension
- Dizziness, headache, fatigue, and asthenia
- Electrolyte disturbances including hypokalemia, hyponatremia, and hyperuricemia (due to diuretic)
- Hyperkalemia (due to ACE inhibitor)
- Renal impairment and elevated serum creatinine
- Rash, pruritus, and rare angioedema
Drug Interactions
- Potassium-sparing diuretics, potassium supplements, or salt substitutes containing potassium increase the risk of severe hyperkalemia
- Lithium: Decreased renal clearance of lithium, increasing the risk of lithium toxicity
- NSAIDs may reduce the antihypertensive and diuretic efficacy and increase the risk of renal deterioration
- Antidiabetic agents (insulin and oral hypoglycemics): Increased risk of hypoglycemia
- Other antihypertensive agents: Additive hypotensive effects
Curated Content: Needs Vetting Before Put to Clinical Use