Benazepril Hydrochloride

Pronunciation

Class: Angiotensin-Converting Enzyme Inhibitors
VA Class: CV400
Chemical Name: [S* - (R*,R*)] - 3 - [[1[(ethoxycarbonyl) - 3 - phenylpropyl]amino] - 2,3,4,5 - tetrahydro - 2 - oxo - 1 - H - 1benzazepine - 1 - acetic acid monohydrochloride
CAS Number: 86541-74-4
Brands: Lotensin, Lotensin HCT, Lotrel

Warning(s)

  • Benazepril may cause fetal and neonatal morbidity and mortality if used during pregnancy.1 11 12 48 49 51 (See Fetal/Neonatal Morbidity and Mortality under Cautions.)

  • If pregnancy is detected, discontinue benazepril as soon as possible.1 11 12 51

Introduction

Benazepril is a nonsulfhydryl ACE inhibitor.1 2 3 4

Uses for Benazepril Hydrochloride

Hypertension

Benazepril is used for management of hypertension (alone or in combination with other classes of antihypertensive agents);1 4 500 may be used in fixed combination with amlodipine or hydrochlorothiazide when such combined therapy is indicated.11 12

ACE inhibitors are recommended as one of several preferred agents for the initial management of hypertension; other options include angiotensin II receptor antagonists, calcium-channel blockers, and thiazide diuretics.501 502 503 504 While there may be individual differences with respect to specific outcomes, these antihypertensive drug classes all produce comparable effects on overall mortality and cardiovascular, cerebrovascular, and renal outcomes.500 501 502 504 Individualize choice of therapy; consider patient characteristics (e.g., age, ethnicity/race, comorbidities, cardiovascular risk) as well as drug-related factors (e.g., ease of administration, availability, adverse effects, cost).500 501 502 503 504 515

ACE inhibitors may be preferred in hypertensive patients with heart failure, ischemic heart disease, diabetes mellitus, chronic kidney disease, or cerebrovascular disease or post-MI.500 501 502 504 520 523 524 525 526 527 534 535 536 543

Slideshow: 14 Essential Health Screenings That All Men Should Consider

Black hypertensive patients generally tend to respond better to monotherapy with calcium-channel blockers or thiazide diuretics than to ACE inhibitors.25 26 46 47 500 501 504 However, diminished response to an ACE inhibitor is largely eliminated when administered concomitantly with a calcium-channel blocker or thiazide diuretic.500 504

The optimum BP threshold for initiating antihypertensive drug therapy is controversial.501 504 505 506 507 508 515 523 530 Further study needed to determine optimum BP thresholds/goals; individualize treatment decisions.501 503 507 515 526 530

JNC 7 recommends initiation of drug therapy in all patients with uncomplicated hypertension and BP ≥140/90 mm Hg;500 JNC 8 panel recommends SBP threshold of 150 mm Hg for patients ≥60 years of age.501 Although many experts agree that SBP goal of <150 mm Hg may be appropriate for patients ≥80 years of age,502 504 505 530 application of this goal to those ≥60 years of age is controversial, especially for those at higher cardiovascular risk.501 502 505 506 508 511 515

In the past, initial antihypertensive drug therapy was recommended for patients with diabetes mellitus or chronic kidney disease who had BP ≥130/80 mm Hg;500 503 current hypertension management guidelines generally recommend a BP threshold of 140/90 mm Hg for these individuals (same as for the general population of patients without these conditions), although a goal of <130/80 mm Hg may still be considered.501 502 503 504 520 530 535 536 541

Addition of benazepril to amlodipine usually does not provide additional antihypertensive effects in blacks but appears to reduce development of amlodipine-associated edema regardless of race.12

Heart Failure

ACE inhibitors are used for management of heart failure, usually in conjunction with cardiac glycosides, diuretics, and β-adrenergic blocking agents.27 31 32 33 34 35

Diabetic Nephropathy

A recommended agent in the management of patients with diabetes mellitus and persistent albuminuria who have modestly elevated (30–300 mg/24 hours) or higher (>300 mg/24 hours) levels of urinary albumin excretion; slows rate of progression of renal disease in such patients.40 41 42 43 44 50 520 535 536

Benazepril Hydrochloride Dosage and Administration

General

BP Monitoring and Treatment Goals

  • Carefully monitor BP during initial titration or subsequent upward adjustment in dosage.500 501

  • When available, use evidence-based dosing information (i.e., dosages shown in randomized controlled trials to reduce complications of hypertension) to determine target dosages; target dosages usually can be achieved within 2–4 weeks but may take up to several months.501

  • If adequate BP response not achieved with a single antihypertensive agent, add a second drug with demonstrated benefit; if goal BP still not achieved with optimal dosages of 2 antihypertensive agents, add a third drug.501 May maximize dosage of the first drug before adding a second drug, or add a second drug before maximizing dosage of the initial drug.501

  • Consider initiating antihypertensive therapy with a combination of drugs if patient's BP exceeds goal BP by >20/10 mm Hg.500 501 503 504

  • Goal is to achieve and maintain optimal control of BP; individualize specific target BP based on consideration of multiple factors, including patient age and comorbidities, and currently available evidence from clinical studies.500 501 (See Hypertension under Uses.)

Administration

Oral Administration

Administer benazepril orally once or twice daily without regard to meals.1

Administer benazepril as extemporaneously prepared oral suspension in pediatric patients unable to swallow tablets or in those for whom the calculated daily dosage does not correspond to the available tablet strengths.1

Reconstitution

Preparation of extemporaneous suspension containing benazepril hydrochloride 2 mg/mL: Add 75 mL of suspending vehicle (Ora-Plus) to a polyethylene terephthalate (PET) bottle containing fifteen 20-mg tablets of benazepril hydrochloride; shake the contents for ≥2 minutes.1 Allow concentrated suspension to stand for a minimum of 60 minutes following reconstitution, then shake for a minimum of 1 additional minute.1 Dilute the concentrated suspension with 75 mL of syrup (Ora-Sweet); shake the container to disperse the ingredients.1 Shake suspension before dispensing each dose.1

Dosage

Benazepril is available as benazepril hydrochloride; dosage expressed in terms of the salt.1 11 12

Pediatric Patients

Hypertension
Oral

Children ≥6 years of age: Initially, 0.2 mg/kg (up to 10 mg) once daily.1 45 Adjust dosage until the desired BP goal is achieved (up to maximum dosage of 0.6 mg/kg or 40 mg daily).1 45

Adults

Hypertension
Benazepril Therapy
Oral

Initially, 10 mg once daily in patients not receiving a diuretic.1 4 13

In patients currently receiving diuretic therapy, discontinue diuretic, if possible, 2–3 days before initiating benazepril.1 May cautiously resume diuretic therapy if BP not controlled adequately with benazepril alone.1 If diuretic cannot be discontinued, increase sodium intake and give lower initial benazepril hydrochloride dose (5 mg) under close medical supervision.1 13

Adjust dosage at approximately monthly intervals (more aggressively in high-risk patients) to achieve BP control.13

Usual dosage: 20–40 mg daily, given in 1 dose or 2 divided doses.1 13

If effectiveness diminishes toward end of dosing interval in patients treated once daily, consider increasing dosage or administering benazepril in 2 divided doses.1 13

If intolerable adverse effects occur, consider dosage reduction; if adverse effects worsen or fail to resolve, may need to discontinue and switch to another antihypertensive drug class.501

Benazepril/Hydrochlorothiazide Fixed-combination Therapy
Oral

Manufacturer states fixed-combination preparation should not be used for initial antihypertensive therapy.11

In studies using benazepril/hydrochlorothiazide fixed combination in dosages of benazepril hydrochloride 5–20 mg daily and hydrochlorothiazide 6.25–25 mg daily, BP response increased with increasing dosages of the drugs.11

If BP is not adequately controlled by monotherapy with benazepril, can switch to the fixed-combination preparation containing benazepril hydrochloride 10 mg and hydrochlorothiazide 12.5 mg or, alternatively, benazepril hydrochloride 20 mg and hydrochlorothiazide 12.5 mg.11 Adjust dosage of either or both drugs according to patient’s response.11

If BP is controlled by monotherapy with hydrochlorothiazide 25 mg daily but potassium loss is problematic, can switch to fixed-combination preparation containing benazepril hydrochloride 5 mg and hydrochlorothiazide 6.25 mg.11

If BP is controlled with benazepril and hydrochlorothiazide (administered separately), can switch to the fixed-combination preparation containing the corresponding individual doses for convenience.11

Benazepril/Amlodipine Fixed-combination Therapy
Oral

Manufacturer states fixed-combination preparation should not be used for initial antihypertensive therapy.12

In studies using benazepril/amlodipine fixed combination in dosages of benazepril hydrochloride 10–40 mg daily and amlodipine 2.5–10 mg daily, BP response increased with increasing amlodipine dosage in all patient groups and increased with increasing benazepril dosage in nonblack patient groups.12

If BP is not adequately controlled by monotherapy with benazepril (or another ACE inhibitor) or amlodipine (or another dihydropyridine-derivative calcium-channel blocker), can switch to benazepril/amlodipine fixed combination.12

If BP is adequately controlled by monotherapy with amlodipine, but edema has developed, can switch to benazepril/amlodipine fixed combination to achieve similar or better BP control without edema.12 May be prudent to reduce amlodipine dosage, especially in nonblack patients, when benazepril is initiated to avoid excessive antihypertensive response.12

If BP is controlled with benazepril and amlodipine (administered separately), can switch to the fixed-combination preparation containing the corresponding individual doses for convenience.12

Adjust dosage of benazepril/amlodipine fixed combination according to patient’s response; consider that steady-state plasma concentrations of benazepril and amlodipine are reached after 2 and 7 days, respectively.12

In small or frail individuals, preparations containing benazepril in fixed combination with 5 or 10 mg of amlodipine exceed the initial recommended dosage (2.5 mg daily) of amlodipine.12

Prescribing Limits

Pediatric Patients

Hypertension
Oral

Maximum 0.6 mg/kg or 40 mg of benazepril hydrochloride daily.1 45

Adults

Hypertension
Oral

Maximum 80 mg of benazepril hydrochloride daily.1

Special Populations

The following information addresses dosage of benazepril in special populations. Dosages of drugs administered in fixed combination with benazepril also may require adjustment in certain patient populations; the need for such dosage adjustments must be considered in the context of cautions, precautions, and contraindications specific to that population and drug.11 12

Hepatic Impairment

Preparations containing benazepril in fixed combination with 5 or 10 mg of amlodipine exceed the initial recommended dosage of amlodipine (2.5 mg daily) in patients with hepatic impairment.12

Renal Impairment

Initially, benazepril hydrochloride 5 mg once daily in adults with Clcr <30 mL/minute or Scr >3 mg/dL; titrate until BP is controlled or to maximum of 40 mg daily.1 Use of benazepril not recommended in pediatric patients with Clcr <30 mL/minute per 1.73 m2.1 45

Preparations containing benazepril in fixed combination with hydrochlorothiazide are not recommended in patients with Clcr ≤30 mL/minute or Scr >3 mg/dL.11 Loop diuretics are preferred to thiazides in these patients.11

Preparations containing benazepril in fixed combination with amlodipine are not recommended in patients with Clcr ≤30 mL/minute or Scr >3 mg/dL.12

Geriatric Patients

Select dosage of benazepril carefully.1 11 12 (See Geriatric Use under Cautions.)

Preparations containing benazepril in fixed combination with 5 or 10 mg of amlodipine exceed the initial recommended dosage (2.5 mg daily) of amlodipine in geriatric patients.12

Volume- and/or Salt-depleted Patients

Correct volume and/or salt depletion prior to initiation of benazepril therapy or initiate therapy under close medical supervision using lower initial dosage.1

Cautions for Benazepril Hydrochloride

Contraindications

  • Known hypersensitivity (e.g., history of angioedema) to benazepril or another ACE inhibitor.1 11 12

  • When benazepril is used in fixed combination with hydrochlorothiazide or amlodipine, consider contraindications associated with the concomitant agent.11 12

Warnings/Precautions

Warnings

Hypotension

Possible symptomatic hypotension with ACE inhibitors, particularly in volume- and/or salt-depleted patients (e.g., those with restricted salt intake, treated with diuretics, undergoing dialysis, with diarrhea or vomiting).1 11 12 Correct volume and/or salt depletion before initiating benazepril.1 11 12

Risk of marked hypotension, sometimes associated with oliguria and azotemia, and rarely acute renal failure and death in patients with heart failure with or without associated renal insufficiency.1 11 12

Hypotension may occur in patients undergoing surgery or during anesthesia with agents that produce hypotension; recommended treatment is fluid volume expansion.1 11 12

To minimize potential for hypotension, consider recent antihypertensive therapy, extent of BP elevation, sodium intake, fluid status, and other clinical conditions.1 May minimize potential for hypotension by withholding diuretic therapy and/or increasing sodium intake for 2–3 days prior to initiation of benazepril.1 (See Dosage and also Special Populations under Dosage and Administration.)

Transient hypotension is not a contraindication to additional doses; may reinstate benazepril therapy cautiously after BP is stabilized (e.g., with volume expansion).1 11 12

Initiate benazepril therapy in patients with heart failure (with or without associated renal insufficiency) under close medical supervision; monitor closely for first 2 weeks following initiation of benazepril or diuretic therapy or any increase in benazepril or diuretic dosage.1 11 12

Fetal/Neonatal Morbidity and Mortality

Possible fetal and neonatal morbidity and mortality when benazepril is used during pregnancy.1 11 12 14 15 16 17 18 19 20 49 51 (See Boxed Warning.) Such potential risks occur throughout pregnancy, especially during the second and third trimesters.49 Benazepril also may increase the risk of major congenital malformations when administered during the first trimester of pregnancy.1 11 12 48 49

Discontinue benazepril as soon as possible when pregnancy is detected, unless continued use is considered lifesaving.1 11 12 49 Nearly all women can be transferred successfully to alternative therapy for the remainder of their pregnancy.8 19

Hepatic Effects

Clinical syndrome that usually is manifested initially by cholestatic jaundice and may progress to fulminant hepatic necrosis (occasionally fatal) reported rarely with ACE inhibitors.1 11 12

If jaundice or marked elevation of liver enzymes occurs, discontinue drug and monitor patient.1 11 12

Hematologic Effects

Neutropenia and agranulocytosis reported with captopril; risk of neutropenia appears to depend principally on degree of renal impairment and presence of collagen vascular disease (e.g., systemic lupus erythematosus, scleroderma); risk with benazepril is unknown.1 11 12

Consider monitoring leukocytes in patients with collagen vascular disease, especially if renal impairment exists.1 11 12

Sensitivity Reactions

Anaphylactoid reactions and/or angioedema possible with ACE inhibitors; if associated with laryngeal edema, may be fatal.1 11 12 Institute immediate medical intervention (e.g., epinephrine) for involvement of tongue, glottis, or larynx.1 11 12

Intestinal angioedema possible with ACE inhibitors; consider in differential diagnosis of patients who develop abdominal pain.1 11 12

Anaphylactoid reactions reported in patients receiving ACE inhibitors while undergoing LDL apheresis with dextran sulfate absorption or following initiation of hemodialysis that utilized high-flux membrane.1 11 12

Life-threatening anaphylactoid reactions reported in at least 2 patients receiving ACE inhibitors while undergoing desensitization treatment with hymenoptera venom.1 11 12

Benazepril is contraindicated in patients with a history of angioedema associated with ACE inhibitors.1 11 12

General Precautions

Use of Fixed Combinations

When benazepril is used in fixed combination with hydrochlorothiazide or amlodipine, consider cautions, precautions, contraindications, and interactions associated with the concomitant agent.11 12 Consider cautionary information applicable to specific populations (e.g., pregnant or nursing women, individuals with hepatic or renal impairment, geriatric patients) for each drug in the fixed combination.11 12

Renal Effects

Transient increases in BUN and Scr possible with benazepril, especially in patients with preexisting renal impairment or those receiving concomitant diuretic therapy.1 11 12 Possible increases in BUN and Scr in patients with unilateral or bilateral renal artery stenosis; generally reversible following discontinuance of ACE inhibitor and/or diuretic.1 11 12

Oliguria, progressive azotemia, and, rarely, acute renal failure and/or death reported in patients with severe heart failure receiving benazepril.1 11 12

Closely monitor renal function following initiation of benazepril therapy in such patients.1 Some patients may require dosage reduction or discontinuance of ACE inhibitor or diuretic and/or adequate sodium repletion.1

Hyperkalemia

Hyperkalemia reported with benazepril, especially in patients with renal impairment or diabetes mellitus and those receiving drugs that can increase serum potassium concentration (e.g., potassium-sparing diuretics, potassium supplements, potassium-containing salt substitutes).1 11 12 (See Specific Drugs under Interactions.)

Monitor serum potassium concentration carefully in these patients.1

Cough

ACE inhibitors associated with persistent and nonproductive cough; resolves after drug discontinuance.1 11 12

Specific Populations

Pregnancy

Benazepril: Category D.1 11 12 (See Fetal/Neonatal Morbidity and Mortality under Cautions and see Boxed Warning.)

Lactation

Benazepril and benazeprilat are distributed into milk in minimal amounts.1 11 12 Discontinue nursing or the drug.1 11 12

Pediatric Use

Safety and efficacy of benazepril not established in children <6 years of age1 or in those with Clcr <30 mL/minute per 1.73 m2.1 45

Safety and efficacy of benazepril in fixed combination with amlodipine or hydrochlorothiazide not established in children.11 12

Geriatric Use

Safety and efficacy profiles of benazepril alone or in fixed combination with hydrochlorothiazide or amlodipine are similar to those in younger adults.1 11 12 However, possible decreased elimination of benazepril due to age-related changes in renal function; cautious dosing recommended.1 11 12

Renal Impairment

Systemic exposure to benazeprilat may be increased.1 (See Absorption: Special Populations, under Pharmacokinetics.) Initial benazepril dosage adjustment recommended in patients with severe renal impairment.1 (See Renal Impairment under Dosage and Administration.)

Deterioration of renal function may occur.1 11 12 Possible increased risk of hyperkalemia.1 Theoretical risk of neutropenia/agranulocytosis.1 11 12 (See Warnings and also General Precautions under Cautions.)

Use of preparations containing benazepril in fixed combination with amlodipine12 or hydrochlorothiazide11 is not recommended in patients with severe renal impairment. (See Renal Impairment under Dosage and Administration.)

Black Patients

BP reduction with ACE inhibitors may be smaller in black patients compared with nonblack patients.500 504 (See Hypertension under Uses.)

Higher incidence of angioedema reported with ACE inhibitors in black patients compared with other races.1 26 500

Common Adverse Effects

Benazepril: Headache, dizziness, fatigue, somnolence, postural dizziness, nausea, cough.1

Interactions for Benazepril Hydrochloride

The following information addresses potential interactions with benazepril. When benazepril is used in fixed combination with hydrochlorothiazide or amlodipine, consider interactions associated with the concomitant agent.11 12

Specific Drugs

Drug

Interaction

Comments

Anticoagulants, oral

Interaction unlikely1

Antidiabetic agents (insulin, oral agents)

Possible hypoglycemia1 11

Advise diabetic patients about the possibility of hypoglycemia; monitor appropriately1 11

Diuretics

Increased hypotensive effect1

If possible, discontinue diuretic before initiating benazepril1 (see Dosage under Dosage and Administration)

Diuretics, potassium-sparing (amiloride, spironolactone, triamterene)

Enhanced hyperkalemic effect1

Use with caution; monitor serum potassium concentrations frequently1

Lithium

Increased serum lithium concentrations; possible toxicity1

Use with caution; monitor serum lithium concentrations frequently1

Potassium supplements or potassium-containing salt substitutes

Enhanced hyperkalemic effect1

Use with caution; monitor serum potassium concentrations frequently1

Benazepril Hydrochloride Pharmacokinetics

Absorption

Bioavailability

About 37% of oral benazepril dose is absorbed.1 Peak plasma concentrations of benazepril and benazeprilat are achieved within 0.5–1 and 1–2 hours, respectively.1

Onset

Following a single oral benazepril dose, antihypertensive effects are observed within 1 hour, with peak BP reduction at 2–4 hours.1

During chronic benazepril therapy, maximum antihypertensive effect with any dose is achieved after 1–2 weeks.1

Duration

Antihypertensive effect of a single benazepril dose persists for about 24 hours.1

Food

Food does not affect absorption of benazepril.1

Peak plasma concentrations of benazeprilat are attained within 2–4 hours following oral administration of benazepril with food.1

Special Populations

In patients with cirrhosis, benazeprilat concentrations essentially unchanged.1

In patients with severe renal impairment, increased peak serum benazeprilat concentrations and increased time to steady-state benazeprilat concentrations.1

Distribution

Extent

In animal studies, benazepril and its metabolites crossed the blood-brain barrier only slightly.1 11

Benazepril crosses the placenta and is distributed into breast milk.1

Plasma Protein Binding

Benazepril: 96.7%.1

Benazeprilat: 95.3%.1

Elimination

Metabolism

Benazepril is metabolized in the liver, principally to an active metabolite, benazeprilat.1

Elimination Route

Benazepril is eliminated principally in urine (as metabolites) and to lesser extent via biliary excretion.1

Half-life

Benazeprilat: 10–11 hours.1

Special Populations

In patients with renal failure, biliary clearance of benazeprilat may compensate to some extent for reduced renal clearance.1

Stability

Storage

Oral

Extemporaneous Suspension

Benazepril hydrochloride 2 mg/mL in Ora-Sweet and Ora-Plus (see Reconstitution under Dosage and Administration): Up to 30 days at 2–8°C.1

Tablets

Benazepril: Tight container at ≤30°C.1

Benazepril/hydrochlorothiazide fixed combination: Tight, light-resistant container at ≤30ºC.11

Capsules

Benazepril/amlodipine fixed combination: Tight container at 25ºC (may be exposed to 15–30ºC).12

Actions

  • Benazepril is a prodrug; not pharmacologically active until hydrolyzed in the liver to benazeprilat.1 2 3 4

  • Benazepril suppresses the renin-angiotensin-aldosterone system.1

Advice to Patients

  • When benazepril is used in fixed combination with hydrochlorothiazide or amlodipine, importance of advising patients of important precautionary information about the concomitant agent.11 12

  • Risk of angioedema, anaphylactoid reactions, or other sensitivity reactions.1 Importance of reporting sensitivity reactions (e.g., edema of face, eyes, lips, tongue, or extremities; hoarseness; swallowing or breathing with difficulty) immediately to clinician and of discontinuing the drug.1

  • Importance of reporting signs of infection (e.g., sore throat, fever).1

  • Risk of hypotension.1 Importance of informing clinicians promptly if lightheadedness or fainting occurs.1

  • Importance of adequate fluid intake; risk of volume depletion with excessive perspiration, dehydration, vomiting, or diarrhea.1

  • Risks of use during pregnancy.1 11 12 48 49 (See Boxed Warning.)

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs (including salt substitutes containing potassium), as well as any concomitant illnesses.1

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1

  • Importance of advising patients of other important precautionary information.1 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Benazepril Hydrochloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets, film-coated

5 mg*

Benazepril Hydrochloride Tablets

Lotensin

Novartis

10 mg*

Benazepril Hydrochloride Tablets

Lotensin

Novartis

20 mg*

Benazepril Hydrochloride Tablets

Lotensin

Novartis

40 mg*

Benazepril Hydrochloride Tablets

Lotensin

Novartis

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Benazepril Hydrochloride Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules

10 mg with Amlodipine Besylate 2.5 mg (of amlodipine)*

Amlodipine Besylate and Benazepril Hydrochloride Capsules (combination)

Lotrel

Novartis

10 mg with Amlodipine Besylate 5 mg (of amlodipine)*

Amlodipine Besylate and Benazepril Hydrochloride Capsules (combination)

Lotrel

Novartis

20 mg with Amlodipine Besylate 5 mg (of amlodipine)*

Amlodipine Besylate and Benazepril Hydrochloride Capsules (combination)

Lotrel

Novartis

20 mg with Amlodipine Besylate 10 mg (of amlodipine)*

Amlodipine Besylate and Benazepril Hydrochloride Capsules (combination)

Lotrel

Novartis

40 mg with Amlodipine Besylate 5 mg (of amlodipine)*

Amlodipine Besylate and Benazepril Hydrochloride Capsules

Lotrel

Novartis

40 mg with Amlodipine Besylate 10 mg (of amlodipine)*

Amlodipine Besylate and Benazepril Hydrochloride Capsules

Lotrel

Novartis

Tablets, film-coated

5 mg with Hydrochlorothiazide 6.25 mg*

Benazepril with Hydrochlorothiazide Tablets

Lotensin HCT (scored)

Novartis

10 mg with Hydrochlorothiazide 12.5 mg*

Benazepril with Hydrochlorothiazide Tablets

Lotensin HCT (scored)

Novartis

20 mg with Hydrochlorothiazide 12.5 mg*

Benazepril with Hydrochlorothiazide Tablets

Lotensin HCT (scored)

Novartis

20 mg with Hydrochlorothiazide 25 mg*

Benazepril with Hydrochlorothiazide Tablets

Lotensin HCT (scored)

Novartis

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 01/2015. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Amlodipine Besy-Benazepril HCl 10-20MG Capsules (SANDOZ): 30/$89.99 or 90/$259.97

Amlodipine Besy-Benazepril HCl 10-40MG Capsules (SANDOZ): 30/$115.99 or 90/$319.98

Amlodipine Besy-Benazepril HCl 2.5-10MG Capsules (LUPIN PHARMACEUTICALS): 30/$69.99 or 90/$199.96

Amlodipine Besy-Benazepril HCl 5-10MG Capsules (SANDOZ): 30/$76.99 or 90/$215.96

Amlodipine Besy-Benazepril HCl 5-20MG Capsules (DR.REDDY'S LABORATORIES): 30/$82.99 or 90/$229.96

Amlodipine Besy-Benazepril HCl 5-40MG Capsules (SANDOZ): 30/$115.99 or 90/$319.96

Benazepril HCl 20MG Tablets (AMNEAL PHARMACEUTICALS): 30/$25.99 or 90/$69.97

Benazepril HCl 40MG Tablets (AMNEAL PHARMACEUTICALS): 30/$25.99 or 90/$69.97

Benazepril HCl 5MG Tablets (SANDOZ): 90/$72.99 or 180/$144.97

Benazepril-Hydrochlorothiazide 10-12.5MG Tablets (SANDOZ): 30/$22.99 or 90/$56.96

Benazepril-Hydrochlorothiazide 20-12.5MG Tablets (SANDOZ): 30/$26.99 or 90/$69.96

Benazepril-Hydrochlorothiazide 20-25MG Tablets (SANDOZ): 30/$27.99 or 90/$71.97

Benazepril-Hydrochlorothiazide 5-6.25MG Tablets (SANDOZ): 30/$25.91 or 90/$67.18

Lotensin 10MG Tablets (NOVARTIS): 30/$67.99 or 90/$177.98

Lotensin 20MG Tablets (NOVARTIS): 30/$64.99 or 90/$185.96

Lotensin 40MG Tablets (NOVARTIS): 30/$67.99 or 90/$177.98

Lotensin 5MG Tablets (NOVARTIS): 30/$62.80 or 90/$163.34

Lotensin HCT 10-12.5MG Tablets (NOVARTIS): 30/$62.99 or 90/$175.98

Lotensin HCT 20-12.5MG Tablets (NOVARTIS): 30/$63.99 or 90/$168.97

Lotensin HCT 20-25MG Tablets (NOVARTIS): 30/$65.99 or 90/$179.97

Lotrel 10-20MG Capsules (NOVARTIS): 30/$158.99 or 90/$461.99

Lotrel 10-40MG Capsules (NOVARTIS): 30/$175.00 or 90/$499.97

Lotrel 2.5-10MG Capsules (NOVARTIS): 30/$123.99 or 90/$345.98

Lotrel 5-10MG Capsules (NOVARTIS): 30/$127.99 or 90/$350.96

Lotrel 5-10MG Capsules (NOVARTIS): 30/$139.99 or 90/$399.96

Lotrel 5-40MG Capsules (NOVARTIS): 30/$145.98 or 90/$426.95

AHFS DI Essentials. © Copyright, 2004-2015, Selected Revisions January 1, 2015. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

1. Novartis. Lotensin (benazepril hydrochloride) tablets prescribing information. East Hanover, NJ; 2007 Nov.

2. Kaiser G, Ackermann R, Sioufi A. Pharmacokinetics of a new angiotensin-converting enzyme inhibitor, benazepril hydrochloride, in special populations. Am Heart J. 1989; 117:746-51. [IDIS 252976] [PubMed 2919553]

3. Kaiser G. Benazepril—pharmacokinetic profile in specific subpopulations. In: Brunner HR, Salvetti A, Sever PS, eds. Benazepril: profile of a new ACE inhibitor. Royal Society of Medicine Services International Congress and Symposium Series No. 166. London: Royal Society of Medicine Services Limited; 1990:29-39.

4. Balfour JA, Goa KL. Benazepril. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in hypertension and congestive heart failure. Drugs. 1991; 42:511-39. [PubMed 1720384]

5. Squibb. Capoten (captopril) tablets prescribing information. In: Physician’s Desk Reference. 47th ed. Montvale, NJ: Medical Economics Company Inc; 1993: 2356-62.

6. Reviewers’s comments in Enalaprilat/Enalapril 24:32.04 (personal observations).

8. US Food and Drug Administration. Dangers of ACE inhibitors during second and third trimesters of pregnancy. FDA Med Bull. 1992; 22:2.

9. Ciba Pharmaceutical Company, Summit, NJ: Personal communication.

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