Description
Uses and Administration
Captopril is Angiotensin-Converting Enzyme inhibitor. It is used in the management of hypertension, in heart failure, following myocardial infarction, and in diabetic nephropathy.
In the treatment of hypertension in Kenya, the initial dose is Captopril 12.5 mg twice daily by mouth, increased gradually at intervals of 2 to 4 weeks according to the response. Since there may be a precipitous fall in blood pressure in some patients when starting therapy with Captopril, the first dose should preferably be given at bedtime. An initial dose of Captopril 6.25 mg twice daily is recommended if captopril is given in addition to a diuretic or to elderly patients; if possible the diuretic should be stopped 2 or 3 days before introducing captopril. The usual maintenance dose is 25 to 50 mg twice daily and should not normally exceed 50 mg three times daily. If hypertension is not satisfactorily controlled at this dosage, addition of a second drug or substitution of an alternative drug should be considered. In the Kenya higher doses of up to 150 mg three times daily have been suggested for patients with hypertension uncontrolled by lower doses of captopril in conjunction with diuretic therapy.
In the treatment of heart failure severe first-dose hypotension on introduction of an ACE inhibitor is common in patients on loop diuretics, but their temporary withdrawal may cause rebound pulmonary oedema. Thus an initial dose of 6.25 to 12.5 mg of captopril is given by mouth under close medical supervision; the usual maintenance dose is 25 mg two or three times daily, and doses should not normally exceed 50 mg three times daily. Again, in the Kenya higher doses of up to 150 mg three times daily have been suggested.
Following myocardial infarction, captopril is used prophylactically in clinically stable patients with symptomatic or asymptomatic left ventricular dysfunction to improve survival, delay the onset of symptomatic heart failure, and reduce recurrent infarction. It may be started 3 days after myocardial infarction in an initial dose of 6.25 mg by mouth, increased over several weeks to 150 mg daily in divided doses if tolerated.
In diabetic nephropathy (microalbuminuria greater than 30 mg/day) in type 1 diabetics, 75 to 100 mg of captopril may be given daily, in divided doses, by mouth. Other antihypertensives may be used with captopril if a further reduction in blood pressure is required.
Adverse Effects of Captopril
Treatment with Captopril in Kenya has been associated with the development of coughs in up to 20% of hypertensive Kenyan patients; cough may be less troublesome in those with heart failure, although the incidence may be higher. The cough is reported to be persistent, paroxysmal, and non-productive; it causes irritation of the throat, may be accompanied by voice changes (hoarseness or huskiness), and is often worse when lying down. It is more common in women and non-smokers, and may be delayed in onset by weeks or even months.
Other adverse effects of Captopril include hypotension, dizziness, fatigue, headache, and nausea and other gastrointestinal disturbances.
Single-ingredient Preparations of Captopril available in Kenya The symbol ? denotes a preparation which is discontinued or no longer actively marketed.
Arg.: Antasten; Austral.: Acenorm; Capace?; Capoten; Captohexal; Enzace; Topace; Austria: Capace; Capostad; Captomed; Captor; Captotyrol; Debax; Lopirin; Belg.: Capoten; Braz.: Aorten?; Capoten; Capotril; Capril; Captil; Captomed; Capton; Captopiril; Captotec; Captrizin; Catoprol; Ductopril; Hipocatril?; Hipoten; Normapril; Pressomax; Venopril; Canad.: Apo-Capto; Capoten; Captril?; Novo-Captoril; Nu-Capto; Chile: Capoten; Properil; Denm.: Capoten; Captodan; Captol; Catonet; Fin.: Capoten; Captomin; Captostad; Lopril; Fr.: Captirex?; Captolane; Lopril; Oltens?; Ger.: ACE-Hemmer; Acenorm; Adocor; Capto-dura Cor?; Capto-dura M; Capto; Captobeta; Captodoc; Captoflux; Captogamma; Captohexal; Captomerck; Captopress?; Captoreal?; Cardiagen; cor tensobon; Coronorm; Epicordin; Esparil?; Lopirin; Mundil; Phamopril; Sansanal?; Sigacap Cor; Tensiomin-Cor; Tensiomin; Tensobon; Tensostad; Gr.: Capoten; Ftonavil; Hypotensor; Neo-Ipertas; Normolose; Odupril; Pertacilon; Sancap; Hong Kong: Apo-Capto; Capocard; Capoten; Capril; Dexacap; Epsitron; Kimafan; Novo-Captoril; Rilcapton; Ropril; Tensiomin; Hung.: Aceomel; Capin; Captogamma; Huma-Captoril; Tensiomin; India: Aceten; Irl.: Aceomel; Actopril; Capoten; Captor; Geroten; Tensopril; Israel: Aceril; Apocapen?; Capti; Inhibace; Ital.: Acepress; Aceprilex; Capoten; Merapril; Tenpril; Malaysia: Apo-Capto; Apuzin; Capoten; Mex.: Atrisol; Biodezil; Bugazon; Capotena; Captoser; Captral; Cardipril; Catona; Cryopril; Ecapresan; Ecapril?; Ecaten; Hipertex; Kenapril?; Kenolan; Keyerpril; Lenpryl; Lowpre?; Midrat; Novapres; Reductel; Romir; Toprilem; Tropisol?; Neth.: Capoten; Norw.: Capoten; NZ: Capoten; Captohexal; Port.: Calpix; Capoten; Carencil; Convertal; Hipertil; Hipotensil; Mereprine; Prilovase; Tensopril; Vidapril; S.Afr.: Aceten; Capace; Capoten; Captohexal; Captomax; Cardiace; Zapto; Singapore: Apo-Capto; Capoten; Catoplin; Katopril?; Ketanine; Pertacilon; Rilcapton?; Tensoprel; Spain: Alopresin; Capoten; Captosina; Cesplon; Dardex; Dilabar; Garanil; Garranil?; Tensoprel; Swed.: Capoten; Switz.: capto-basan; Captosol; Lopirin; Tensobon?; Thai.: Capoten; Epsitron; Gemzil; Tensiomin; UK: Acepril; Capoten; Ecopace; Hyteneze?; Kaplon; Tensopril; USA: Capoten;
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