Drug Class: ACE inhibitors with thiazides
Usual Adult Dose for Hypertension
Initial dose: Captopril 25 mg-Hydrochlorothiazide 15 mg orally once a day 1 hour before meals
Maximum dose: Captopril 150 mg-Hydrochlorothiazide 50 mg per day
Comments: The full effect of a given dose may not be attained for 6 to 8 weeks; dose adjustments should be made at 6 week intervals, unless the clinical situation demands more rapid adjustment.
Use: Treatment of hypertension as initial therapy or substituted for previously titrated doses of the individual components.
Renal Dose Adjustments
Mild to moderate renal dysfunction (CrCl 30 to less than 90 mL/min): Once the desired therapeutic effect has been achieved, increase the dose interval or decrease the total daily dose until the minimum effective dose is achieved.
Severe renal dysfunction (CrCl less than 30 mL/min): Not recommended
If progressive renal impairment becomes evident as indicated by a rising BUN or nonprotein nitrogen: Consider withholding or discontinuing this drug
Liver Dose Adjustments
Use with caution
Precautions
US BOXED WARNING:
- USE IN PREGNANCY: When used in pregnancy during the second and third trimesters, angiotensin-converting enzyme (ACE) inhibitors can cause injury and even death to the developing fetus. If pregnancy is detected, discontinue this drug as soon as possible.
Safety and efficacy have not been established in patients younger than 18 years.
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
Other Comments
Administration advice: Should be taken 1 hour before meals.
Storage requirements: Protect from light.
Monitoring:
- Metabolic: Serum electrolytes periodically.
- Hematologic: Patients with impaired renal function: White blood cell and differential counts prior to starting treatment and approximately every 2 weeks for the first 3 months, then periodically.
Patient advice:
- Advise patients to immediately report any signs or symptoms of angioedema (breathing difficulty or swelling of face, eyes, lips, or tongue) and to stop taking this drug until consulting a physician.
- Tell patients to promptly report any sign of infection (e.g., sore throat, fever), which may be a sign of neutropenia.
- Caution patients to consult their physician if excessive perspiration, dehydration, vomiting, or diarrhea occurs as it may lead to excessive blood pressure reduction due to reduced fluid volume.
- Advise patients against using potassium-sparing diuretics, potassium supplements or potassium-containing salt substitutes without consulting their physician.
