captopril (kap' toe pril) Apo-Capto (CAN), Capoten, Gen-Captopril (CAN), Novo-Captopril (CAN), Nu-Capto

(CAN) Pregnancy Category C (first trimester) Pregnancy Category D (second, third trimesters) Drug classes Angiotensin-converting enzyme (ACE) inhibitor Antihypertensive Therapeutic actions Blocks ACE from converting angiotensin I to angiotensin II, a powerful vasoconstrictor, leading to decreased blood pressure, decreased aldosterone secretion, a small increase in serum potassium levels, and sodium and fluid loss; increased prostaglandin synthesis also may be involved in the antihypertensive action. Indications • Treatment of hypertension alone or in combination with thiazide-type diuretics • Treatment of CHF in patients unresponsive to conventional therapy; used with diuretics and digitalis • Treatment of diabetic nephropathy • Treatment of left ventricular dysfunction after MI • Unlabeled uses: Management of hypertensive crises; treatment of rheumatoid arthritis; diagnosis of anatomic renal artery stenosis, hypertension related to scleroderma renal crisis; diagnosis of primary aldosteronism, idiopathic edema; Bartter's syndrome; Raynaud's syndrome Contraindications and cautions • Contraindicated with allergy to captopril, history of angiodema. • Use cautiously with impaired renal function; CHF; salt or volume depletion, lactation, pregnancy. Available forms Tablets—12.5, 25, 50, 100 mg Dosages ADULTS

PEDIATRIC PATIENTS Safety and efficacy not established. GERIATRIC PATIENTS AND PATIENTS WITH RENAL IMPAIRMENT Excretion is reduced in renal failure; use smaller initial dose; adjust at smaller doses with 1- to 2-wk intervals between increases; slowly adjust to smallest effective dose. Use a loop diuretic with renal dysfunction. Pharmacokinetics Route Onset Oral 15 min Peak 30–90 min

Metabolism: T1/2: 2 hr Distribution: Crosses placenta; enters breast milk Excretion: Urine Adverse effects

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CV: Tachycardia, angina pectoris, MI, Raynaud's syndrome, CHF, hypotension in saltor volume-depleted patients Dermatologic: Rash, pruritus, pemphigoid-like reaction, scalded mouth sensation, exfoliative dermatitis, photosensitivity, alopecia GI: Gastric irritation, aphthous ulcers, peptic ulcers, dysgeusia, cholestatic jaundice, hepatocellular injury, anorexia, constipation GU: Proteinuria, renal insufficiency, renal failure, polyuria, oliguria, urinary frequency Hematologic: Neutropenia, agranulocytosis, thrombocytopenia, hemolytic anemia, pancytopenia Other: Cough, malaise, dry mouth, lymphadenopathy

Interactions Drug-drug • Increased risk of hypersensitivity reactions with allopurinol • Decreased antihypertensive effects with indomethacin • Increased captopril effects with probenecid Drug-food • Decreased absorption of captopril with food Drug-lab test • False-positive test for urine acetone Nursing considerations Assessment

Hypertension: 25 mg PO bid or tid; if satisfactory response is not noted within 1–2 wk, increase dosage to 50 mg bid–tid; usual range is 25–150 mg bid–tid PO with a mild thiazide diuretic. Do not exceed 450 mg/day. CHF: 6.25–12.5 mg PO tid in patients who may be salt or volume depleted. Usual initial dose, 25 mg PO tid; maintenance dose, 50–100 mg PO tid. Do not exceed 450 mg/day. Use in conjunction with diuretic and digitalis therapy. Left ventricular dysfunction after MI: 50 mg PO tid, starting as early as 3 days post MI. Initial dose of 6.25 mg, then 12.5 mg tid, increasing slowly to 50 mg tid. Diabetic nephropathy: 25 mg PO tid.

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History: Allergy to captopril, history of angioedema, impaired renal function, CHF, salt or volume depletion, pregnancy, lactation Physical: Skin color, lesions, turgor; T; P, BP, peripheral perfusion; mucous membranes, bowel sounds, liver evaluation; urinalysis, renal and liver function tests, CBC and differential

Interventions • Administer 1 hr before or 2 hr after meals. • Alert surgeon and mark patient's chart with notice that captopril is being taken; the angiotensin II formation subsequent to compensatory renin release during surgery will

be blocked; hypotension may be reversed with volume expansion. Monitor patient closely for fall in BP secondary to reduction in fluid volume (excessive perspiration and dehydration, vomiting, diarrhea); excessive hypotension may occur. Reduce dosage in patients with impaired renal function.

Teaching points • Take drug 1 hr before or 2 hr after meals; do not take with food. Do not stop without consulting your health care provider. • Be careful of drop in blood pressure (occurs most often with diarrhea, sweating, vomiting, dehydration); if light-headedness or dizziness occurs, consult your health care provider. • Avoid over-the-counter medications, especially cough, cold, allergy medications that may contain ingredients that will interact with ACE inhibitors. Consult your health care provider. • These side effects may occur: GI upset, loss of appetite, change in taste perception (limited effects, will pass); mouth sores (perform frequent mouth care); rash; fast heart rate; dizziness, light-headedness (usually passes after the first few days; change position slowly, and limit your activities to those that do not require alertness and precision). • Report mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular heartbeat, chest pains; swelling of the face, eyes, lips, tongue, difficulty breathing. Adverse effects in Italic are most common; those in Bold are life-threatening.

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