Captopri
Related Subjects:
|Hypertension
|Acute Heart Failure
|Chronic Heart Failure
⚠️ First-dose hypotension is common.
💡 Start at the lowest dose, ideally at night with the patient in bed.
More frequent when used for heart failure than for hypertension.
If it occurs → lie patient flat, raise legs, and give IV fluids if BP remains low.
- 🔹 Competitively inhibits angiotensin-converting enzyme (ACE).
- 🛑 Prevents formation of angiotensin II, a potent vasoconstrictor.
- ⬆️ Increases bradykinin → cough and angioedema.
- 📉 Reduces BP without reflex tachycardia.
- 📊 Always check U&Es, document starting BP, and identify a target BP before initiation.
🎯 Indications / Dose
- 💔 Heart failure: Start 6.25 mg PO TDS → titrate to max 50 mg TDS.
- ❤️ Hypertension: Start 12.5 mg PO TDS → titrate to max 50 mg TDS.
- 🧪 Diabetes with nephropathy: Start 6.25 mg PO TDS → titrate to max 50 mg TDS.
⚠️ Cautions
- Less effective as monotherapy in African-Caribbean patients (consider CCBs or thiazides first per NICE guidance).
⛔ Contraindications
- 🚫 Pregnancy and breastfeeding – teratogenic.
- ⚠️ Severe aortic stenosis or hypertrophic cardiomyopathy.
- 🚫 Bilateral renal artery stenosis.
- ⚠️ Pre-existing hyperkalaemia.
🔄 Interactions
- ⚠️ With alteplase (tPA) → angioneurotic oedema risk in acute stroke thrombolysis.
- ❌ Avoid NSAIDs (reduce efficacy, worsen renal function).
- ⬆️ Hyperkalaemia risk when combined with potassium-sparing diuretics, ARBs, or supplements.
⚠️ Side Effects
- 📉 Postural hypotension (especially first dose, see above).
- 🤢 Nausea, vomiting.
- 💨 Cough (bradykinin-related).
- 😮 Angioedema (rare but serious).
- 👅 Altered taste (metallic taste).
- 💧 Worsening renal function in bilateral renal artery stenosis.
- 🧪 Hyperkalaemia.
📋 Monitoring
- 🔍 Check renal function & electrolytes at 4 days and 2 weeks after initiation.
- 📈 Repeat 1 week after any dose increase.
- ⚠️ Stop or reduce if creatinine ↑ >30% or K⁺ >6.0 mmol/L.
