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Captopril / Hydrochlorothiazide

Pronunciation: KAP-toe-prill/high-droe-klor-oh-THIGH-uh-zide
Class: Antihypertensive combination

Trade Names

Captopril/Hydrochlorothiazide
- Tablets captopril 25 mg/hydrochlorothiazide 15 mg
- Tablets captopril 25 mg/hydrochlorothiazide 25 mg
- Tablets captopril 50 mg/hydrochlorothiazide 15 mg
- Tablets captopril 50 mg/hydrochlorothiazide 25 mg

Pharmacology

Captopril

Competitively inhibits angiotensin I-converting enzyme, resulting in the prevention of angiotensin I conversion to angiotensin II, a potent vasoconstrictor that also stimulates aldosterone secretion. This action results in a decrease in sodium and fluid retention, increase in diuresis, and a decrease in BP.

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Hydrochlorothiazide

Increases chloride, sodium, and water excretion by interfering with transport of sodium ions across renal tubular epithelium.

Indications and Usage

Treatment of hypertension.

Contraindications

Anuric patients; history of angioedema; patients hypersensitive to captopril or any other ACE inhibitor, hydrochlorothiazide, or other sulfonamide derivative.

Dosage and Administration

Adults

PO captopril/hydrochlorothiazide may be substituted for previously titrated individual components. Alternatively, therapy may be started with a single captopril/hydrochlorothiazide tablet (25 mg captopril combined with 15 mg hydrochlorothiazide) every day. For patients not responding sufficiently, the dose may be titrated upward, usually at 6-wk intervals. Maximum daily dose should not exceed 150 mg of captopril or 50 mg of hydrochlorothiazide.

General Advice

Give dose 1 h before or 2 h after meals.

Storage/Stability

Store tablets at controlled room temperature (59° to 86°F). Keep container tightly closed and protect from moisture.

Drug Interactions

Alcohol, barbiturates (eg, phenobarbital), narcotics

Orthostatic hypotension may be potentiated.

Anticoagulants (eg, warfarin)

Anticoagulant effect may be decreased.

Antidiabetic agents (eg, insulin, sulfonylureas)

Dosage adjustment may be necessary because of possible hydrochlorothiazide-induced elevation in blood glucose levels.

Antigout agents (eg, probenecid)

Dosage adjustment may be necessary because of possible hydrochlorothiazide-induced elevation in blood uric acid levels.

Cardiac glycosides (eg, digoxin)

Possible digitalis toxicity associated with hypokalemia.

Cholestyramine, colestipol

May impair the absorption of hydrochlorothiazide.

Food

Reduces bioavailability of captopril.

Lithium

Plasma levels of lithium may be elevated, increasing the risk of toxicity.

NSAIDs

May reduce the natriuretic and antihypertensive effect of hydrochlorothiazide.

Potassium supplements, potassium-sparing diuretics (eg, spironolactone)

Increased risk of hyperkalemia.

Nondepolarizing muscle relaxants (eg, tubocurarine)

Effects may be increased.

Laboratory Test Interactions

Captopril

May cause false-positive urine acetone test.

Hydrochlorothiazide

May cause diagnostic interference of bentiromide test; may decrease serum protein-bound iodine levels without signs of thyroid disturbances; may cause diagnostic interference of serum electrolyte levels, blood and urine glucose levels, serum bilirubin levels, and serum uric acid levels.

Adverse Reactions

Cardiovascular

Captopril

Hypotension; tachycardia; chest pain; palpitations; angina pectoris; MI; Raynaud syndrome; CHF; cardiac arrest; cerebrovascular accident; rhythm disturbances; orthostatic hypotension; syncope.

Hydrochlorothiazide

Orthostatic hypotension; necrotizing angiitis.

CNS

Captopril

Ataxia; confusion; depression; nervousness; somnolence.

Hydrochlorothiazide

Dizziness; vertigo; paresthesia; headache; xanthopsia; restlessness.

Dermatologic

Captopril

Rash; pruritus; pemphigoid-like lesion; photosensitivity; bullous pemphigus; erythema multiforme (including Stevens-Johnson syndrome); exfoliative dermatitis.

Hydrochlorothiazide

Purpura; photosensitivity; rash; urticaria.

EENT

Captopril

Glossitis; blurred vision.

Hydrochlorothiazide

Transient blurred vision.

GI

Captopril

Dysgeusia; pancreatitis; dyspepsia.

Hydrochlorothiazide

Anorexia; gastric irritation; nausea; vomiting; cramping; diarrhea; constipation; jaundice (intrahepatic cholestatic jaundice); pancreatitis; sialadenitis.

Genitourinary

Captopril

Proteinuria; gynecomastia; impotence.

Hydrochlorothiazide

Glycosuria.

Hematologic

Captopril

Neutropenia; agranulocytosis; anemia; thrombocytopenia; pancytopenia; eosinophilia; aplastic anemia; hemolytic anemia.

Hydrochlorothiazide

Leukopenia; agranulocytosis; thrombocytopenia; aplastic anemia; hemolytic anemia.

Hepatic

Captopril

Jaundice; hepatitis, including necrosis and cholestasis.

Metabolic

Captopril

Hyponatremia; hyperkalemia.

Hydrochlorothiazide

Hyperglycemia; hyperuricemia; hypokalemia; hyponatremia.

Respiratory

Captopril

Bronchospasm; eosinophilic pneumonitis; rhinitis; persistent dry cough.

Hydrochlorothiazide

Respiratory distress, including pneumonitis.

Miscellaneous

Captopril

Fever; arthralgia; angioedema; anaphylactoid reactions; asthenia; myalgia; myasthenia; syndrome including fever, myalgia, arthralgia, interstitial nephritis, vasculitis, rash or other dermatologic symptoms, eosinophilia, and elevated erythrocyte sedimentation rate.

Hydrochlorothiazide

Muscle spasm; weakness; fever; anaphylactic reactions.

Precautions

Warnings

When used in pregnancy during the second and third trimesters, ACE inhibitors can cause injury and even death to the developing fetus. When pregnancy is detected, discontinue therapy as soon as possible.


Monitor

Blood sugar

Monitor blood sugar in diabetic patient when drug is started or dose is changed. Report significant changes to health care provider.

BP

Monitor and record BP and pulse. Should hypotension result, hold medication and notify health care provider.

Serum electrolytes

Ensure that serum electrolytes are monitored periodically.

WBC

Ensure that WBC with differential is determined prior to starting treatment, every 2 wk for 3 mo, and periodically thereafter in hypertensive patients with renal function impairment or CHF.


Pregnancy

Category D (second and third trimester); Category C (first trimester). ACE inhibitors (eg, captopril) can cause injury or death to fetus if used during second or third trimester. When pregnancy is detected, discontinue as soon as possible.

Lactation

Excreted in breast milk.

Children

Safety and efficacy not established.

Renal Function

Use with caution.

Hepatic Function

Use with caution.

Angioedema

Use with extreme caution in patients with hereditary angioedema. Angioedema associated with laryngeal edema may be fatal.

Hypotension

Decreases in BP may occur, especially in salt- or volume-depleted patients as a result of dialysis, prolonged diuretic therapy, dietary salt restriction, diarrhea, or vomiting. Volume and salt depletion should be corrected before initiating therapy with benazepril/hydrochlorothiazide.

Neutropenia/agranulocytosis

Has occurred with other ACE inhibitors.

Overdosage

Symptoms

Dehydration, electrolyte disturbances, hypotension, CNS depression, lethargy, coma.

Patient Information

  • Advise patient to take every day as prescribed. Advise patient that if more than 1 daily dose is prescribed to take the second dose late in the afternoon to avoid excessive urination at night.
  • Instruct patient to take each dose at least 1 h before meals.
  • Advise patient to try to take each dose at about the same time each day if possible.
  • Inform patient that drug controls, but does not cure, hypertension and to continue taking drug as prescribed even when BP is not elevated.
  • Caution patient not to change the dose or stop taking unless advised by health care provider.
  • Instruct patient to continue taking other BP medications as prescribed by health care provider.
  • Instruct patient in BP and pulse measurement skills.
  • Advise patient to monitor and record BP and pulse at home and to inform health care provider if abnormal measurements are noted. Also advise patient to take record of BP and pulse to each follow-up visit.
  • Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
  • Instruct patient to lie or sit down if experiencing dizziness or lightheadedness when standing.
  • Caution patient that inadequate fluid intake, excessive perspiration, diarrhea, or vomiting can lead to excessive fall in BP, resulting in lightheadedness or fainting.
  • Instruct diabetic patient to monitor blood glucose more frequently when drug is started or dose is changed and to inform health care provider of significant changes in readings.
  • Caution patient to avoid unnecessary exposure to UV light (eg, sunlight, tanning booths), use sunscreen, and wear protective clothing when exposed to UV light to avoid photosensitivity reaction.
  • Emphasize to hypertensive patient importance of other modalities on BP: weight control, regular exercise, smoking cessation, and moderate intake of alcohol and salt.
  • Instruct patient to stop taking drug and immediately report any of the following symptoms to health care provider: persistent cough; fainting; swelling of the face, lips, eyelids or tongue; sore throat; fever or other signs of infection; yellowing of skin or eyes; persistent nausea or vomiting; swelling of the feet or ankles.
  • Caution patient to not take any prescription or OTC medications, salt substitutes, or dietary supplements unless advised by health care provider.

Copyright © 2009 Wolters Kluwer Health.

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