This Post is adapted from the Canadian Pharmacists Association (CPhA) Drug Monograph: ACE Inhibitors
ACE Inhibitors
Product Summary Information
| Drug | Administration | Dosage Form | Strength |
| Benazepril | Oral | Tablet | 5 mg, 10 mg, 20 mg |
| Captopril | Oral | Tablet | 6.25 mg, 12.5 mg, 25 mg, 50 mg, 100 mg |
| Cilazapril | Oral | Tablet | 1 mg, 2.5 mg, 5 mg |
| Enalapril Maleate | Oral | Tablet | 2.5 mg, 5 mg, 10 mg, 20 mg |
| Enalaprilat | IV | Solution | 1.25 mg/mL |
| Fosinopril | Oral | Tablet | 10 mg, 20 mg |
| Lisinopril | Oral | Tablet | 5 mg, 10 mg, 20 mg |
| Perindopril | Oral | Tablet | 2 mg, 4 mg, 8 mg |
| Quinapril | Oral | Tablet | 5 mg, 10 mg, 20 mg, 40 mg |
| Ramipril | Oral | Capsule | 1.25 mg, 2.5 mg, 5 mg, 10 mg, 15 mg |
| Trandolapril | Oral | Capsule | 0.5 mg, 1 mg, 2 mg, 4 mg |
Indications
- Inhibitors of ACE suppress the production of angiotensin II, which is the most vasoactive product of the renin-angiotensin system.
- They are used as first-line agents in the management of hypertension and in the treatment of heart failure
- They slow the progression of nephropathy in diabetic patients with or without proteinuria and in nondiabetic nephropathy.
- They are considered standard therapy in post- MI patients, to reduce afterload and preload and to prevent complications, such as left ventricular remodeling and HF.
- They have been shown to reduce cardiovascular morbidity (e.g., hospitalization for cardiac causes) and mortality post-MI.
Warnings
Angioedema
- Angioedema has been reported with the use of ACE inhibitors. Involvement of the larynx may be fatal.
- If swelling is limited to the face and lips, discontinuation of the ACE inhibitor is usually the only corrective measure required. However, if there is involvement of the tongue, glottis or larynx, appropriate therapy (e.g., epinephrine) should be instituted as life-threatening airway obstruction may occur.
- Patients should be advised that swelling in the mouth or facial area or difficulty breathing or swallowing may be signs of angioedema and that they should discontinue the ACE inhibitor and contact their physician immediately, if any of these symptoms occur.
Hypotension
- Severe hypotension may occur with the use of ACE inhibitors, particularly in patients who are volume depleted, hyponatremic, receiving concomitant diuretics or on dialysis.
Precautions and Drug Interaction
Cough
- A persistent, dry cough occurs in some patients after initiating treatment with an ACE inhibitor. The overall incidence has been reported to range from 5–35%, is more common in women, patients with HF, nonsmokers and those of Chinese heritage. The onset of cough has been reported to occur within hours of the first dose of medication to weeks or months after initiating treatment.
NSAIDs (including COX-2 inhibitors)
- Some evidence suggests that the antihypertensive effect of ACE inhibitors may be antagonized by NSAIDs.
- Patients taking these agents concurrently should be monitored for signs of worsening heart failure or renal function or loss of blood pressure control.
Source:
Canadian Pharmacists Association: Compendium of Pharmaceuticals and Specialties, online version (e-CPS), accessed on April 25, 2013
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