Name /bks_53161_deglins_md_disk/captopril 02/11/2014 09:28AM
1 TIME/ACTION PROFILE (effect on BP single dose)
captopril (kap-toe-pril)
Capoten
Classification
Therapeutic: antihypertensives
Pharmacologic: ACE inhibitors
Pregnancy Category D
Indications
Alone or with other agents in the management of hypertension. Management of heart
failure. Reduction of risk of death, heart failure-related hospitalizations, and devel-
opment of overt heart failure following myocardial infarction. Treatment of diabetic
nephropathy in patients with Type 1 diabetes mellitus and retinopathy.
Action
Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin
I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of
bradykinin and other vasodilatory prostaglandins. ACE inhibitors alsoqplasma renin
levels andpaldosterone levels. Net result is systemic vasodilation. Therapeutic
Effects: Lowering of BP in patients with hypertension. Improved survival and re-
duced symptoms in patients with heart failure. Improved survival and reduced devel-
opment of overt heart failure after myocardial infarction. Decreased progression of
diabetic nephropathy with decreased need for transplantation or dialysis.
Pharmacokinetics
Absorption: 60 75% absorbed following oral administration (decreased by
food).
Distribution: Crosses the placenta; enters breast milk in small amounts.
Metabolism and Excretion: 50% metabolized by the liver to inactive com-
pounds, 50% excreted unchanged in urine.
Half-life: Infants with HF: 3.3 hr (range 1.2 12.4 hr); Children: 1.5 hr (range
0.98 2.3 hr); Adults: 1.9 hr (qto 20 40 hr in renal impairment); Adults with HF:
2.1 hr.
Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent.
Plate # 0-Composite pg 1 # 1
ROUTE ONSET PEAK DURATION PDF Page #1
PO 1560 min 6090 min 612 hr
Full effects may not be noted for several weeks
Contraindications/Precautions
Contraindicated in: Hypersensitivity; History of angioedema with previous use of
ACE inhibitors; Concurrent use with aliskiren in patients with diabetes or moderate-
to-severe renal impairment (CCr 60 mL/min); OB: Can cause injury or death of fe-
tus if pregnancy occurs, discontinue immediately; Lactation: Discontinue drug
or use formula.
Use Cautiously in: Patients with collagen vascular disease, renal impairment, hy-
povolemia, hyponatremia, and concurrent diuretic therapy; Surgery/anesthesia (hy-
potension may be exaggerated); Black patients (monotherapy for hypertension
less effective, may require additional therapy; higher risk of angioedema); Women of
childbearing potential; Geri: Initial doseprecommended.
Exercise Extreme Caution in: History of angioedema.
Adverse Reactions/Side Effects
CNS: dizziness, fatigue, headache, insomnia. Resp: cough. CV: hypotension, chest
pain, palpitations, tachycardia. GI: taste disturbances, abdominal pain, anorexia,
constipation, diarrhea, nausea, vomiting. GU: proteinuria, impaired renal function.
Derm: ANGIOEDEMA, rash, pruritis. F and E: hyperkalemia. Hemat: AGRANULOCY-
TOSIS, neutropenia. Misc: fever.
Interactions
Drug-Drug: Excessive hypotension may occur with concurrent use of diuretics.
Additive hypotension with other antihypertensives.qrisk of hyperkalemia with
concurrent use ofpotassium supplements, potassium-sparing diuretics, or
potassium-containing salt substitutes.qrisk of hyperkalemia, renal dysfunc-
tion, hypotension, and syncope with concurrent use of angiotensin II receptor an-
tagonists or aliskiren; avoid concurrent use with aliskiren in patients with diabetes
or CCr 60 mL/min. NSAIDs and selective COX-2 inhibitors may blunt the anti-
hypertensive effect andqthe risk of renal dysfunction.qlevels and mayqthe risk of
lithium toxicity.
Drug-Natural Products: Avoid natural licorice (causes sodium and water reten-
tion and increases potassium loss).
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2 Monitor frequency of prescription refills to determine compliance.

Assess patient for signs of angioedema (dyspnea, facial swelling).
Drug-Food: Food significantly pabsorption. Administer captopril 1 hr before Heart Failure: Monitor weight and assess patient routinely for resolution of fluid PDF Page #2
meals. overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous
distention).
Route/Dosage Lab Test Considerations: Monitor renal function. May causeqBUN and se-
Note: Use lower doses (1/2 of those listed) in patients who are sodium and water de- rum creatinine. IfqBUN or serum creatinine concentrations occur, may require
pleted due to diuretics.
dose reduction or withdrawal.
Hypertension May cause hyperkalemia.
PO (Adults and Adolescents): 12.5 25 mg 2 3 times daily, may beqat 1 2 wk May causeqAST, ALT, alkaline phosphatase, and serum bilirubin.
intervals up to 150 mg 3 times daily (initiate therapy with 6.25 12.5 mg 2 3 times Assess urine protein prior to and periodically during therapy for up to 1 yr in pa-
daily in patients receiving diuretics). tients with renal impairment or those receiving 150 mg/day of captopril. If ex-
Heart Failure cessive or increasing proteinuria occurs, re-evaluate ACE inhibitor therapy.
PO (Adults): 25 mg 3 times daily (6.25 12.5 mg 3 times daily in patients who have May cause positive antinuclear antibody (ANA) titer.
been vigorously diuresed); titrated up to target dose of 50 mg 3 times daily (max dose Monitor CBC with differential prior to initiation of therapy, every 2 wk
450 mg/day). for the first 3 mo, and periodically for up to 1 yr in patients at risk for
PO (Children): 0.3 mg/kg 0.5 mg/kg/dose 3 times daily, titrate up to a maximum neutropenia (patients with renal impairment, or collagen-vascular dis-
of 6 mg/kg/day in 2 4 divided doses; Older Children: 6.25 12.5 mg/dose q 12 24 ease) or at first sign of infection. Discontinue therapy if neutrophil count
hr, titrate up to a maximum of 6 mg/kg/day in 2 4 divided doses. is 1000/mm3.
PO (Infants): 0.15 0.3 mg/kg/dose, titrate up to a maximum of 6 mg/kg/day in 1 May cause false-positive test results for urine acetone.
4 divided doses.
PO (Neonates): 0.05 0.1 mg/kg/dose q 8 24 hr, mayqas needed up to 0.5 mg/ Potential Nursing Diagnoses
kg q 6 24 hr; Premature neonates: 0.01 mg/kg/dose q 8 12 hr. Decreased cardiac output (Indications) (Side Effects)
Noncompliance (Patient/Family Teaching)
Left Ventricular Dysfunction Post-MI
PO (Adults): 6.25-mg test dose, followed by 12.5 mg 3 times daily, may bequp to Implementation
50 mg 3 times daily. Do not confuse captopril with carvedilol.
Correct volume depletion, if possible, before initiation of therapy due to possible
Diabetic Nephropathy precipitous drop in BP during first 1 3 hr following first dose. Risk of hypoten-
PO (Adults): 25 mg 3 times daily. sion may be decreased by discontinuing diuretics or cautiously increasing salt in-
Renal Impairment take 2 3 days prior to beginning captopril. Monitor BP closely. Resume diuretics
PO (Adults): ClCr 10 50 mL/min: Administer 75% of dose; ClCr 10 mL/min: Ad- if BP is not controlled.
minister 50% of dose. PO: Administer 1 hr before meals or 2 hr after meals. May be crushed if patient
has difficulty swallowing. Tablets may have a sulfurous odor.
NURSING IMPLICATIONS An oral solution may be prepared by crushing the tablets.
Assessment
Hypertension: Monitor BP and pulse frequently during initial dose adjustment Patient/Family Teaching
and periodically during therapy. Notify health care professional of significant Instruct patient to take captopril as directed at the same time each day, even if feel-
changes. ing well. Take missed doses as soon as remembered but not if almost time for next
2015 F.A. Davis Company CONTINUED
Name /bks_53161_deglins_md_disk/captopril 02/11/2014 09:28AM Plate # 0-Composite pg 3 # 3

3 Instruct patient and family on correct technique for monitoring BP. Advise them to
check BP at least weekly and to report significant changes to health care profes-
PDF Page #3
CONTINUED sional.

captopril Evaluation/Desired Outcomes

Decrease in BP without appearance of excessive side effects.
dose. Do not double doses. Warn patient not to discontinue ACE inhibitor therapy Improvement in survival and reduction of symptoms in heart failure.
unless directed by health care professional. Reduction of risk of death or development of heart failure following myocardial
Caution patient to avoid salt substitutes containing potassium or foods containing infarction.
high levels of potassium or sodium unless directed by health care professional. Decrease in progression of diabetic nephropathy.
Caution patient to change positions slowly to minimize orthostatic hypotension.
Use of alcohol, standing for long periods, exercising, and hot weather may in- Why was this drug prescribed for your patient?
crease orthostatic hypotension.
Instruct patient to notify health care professional of all Rx or OTC medications, vi-
tamins, or herbal products being taken and consult health care professional be-
fore taking any new medications, especially cough, cold, or allergy remedies.
May cause dizziness. Caution patient to avoid driving and other activities requiring
alertness until response to medication is known.
Advise patient to inform health care professional of medication regimen prior to
treatment or surgery.
Advise patient that medication may cause impairment of taste that generally re-
solves within 8 12 wk, even with continued therapy.
Instruct patient to notify health care professional if rash; mouth sores;
sore throat; fever; swelling of hands or feet; irregular heart beat; chest
pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue; diffi-
culty swallowing or breathing occurs; or if taste impairment or skin rash
persists. Persistent dry cough may occur and may not subside until medication is
discontinued. Consult health care professional if cough becomes bothersome.
Also notify health care professional if nausea, vomiting, or diarrhea occurs and
continues.
Advise women of childbearing age to use contraception and notify health care pro-
fessional immediately if pregnancy is planned or suspected.
Emphasize the importance of follow-up examinations to evaluate effectiveness of
medication.
Hypertension: Encourage patient to comply with additional interventions for hy-
pertension (weight reduction, low sodium diet, discontinuation of smoking, mod-
eration of alcohol consumption, regular exercise, and stress management). Medi-
cation controls but does not cure hypertension.
Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough Discontinued.