Side Effects > Captopril and Hydrochlorothiazide

Captopril and Hydrochlorothiazide Side Effects

Please note - some side effects for Captopril and Hydrochlorothiazide may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA at http://www.fda.gov/medwatch/ or 1-800-FDA-1088 (1-800-332-1088).

For the professional Captopril and Hydrochlorothiazide

For the professional

Captopril and Hydrochlorothiazide

Captopril

Reported incidences are based on clinical trials involving approximately 7000 patients.

Renal

About one of 100 patients developed proteinuria .

Each of the following has been reported in approximately 1 to 2 of 1000 patients and are of uncertain relationship to drug use: renal insufficiency, renal failure, nephrotic syndrome, polyuria, oliguria, and urinary frequency.

Hematologic

Neutropenia/agranulocytosis has occurred. Cases of anemia, thrombocytopenia, and pancytopenia have been reported.

Dermatologic

Rash, often with pruritus, and sometimes with fever, arthralgia, and eosinophilia, occurred in about 4 to 7 (depending on renal status and dose) of 100 patients, usually during the first four weeks of therapy. It is usually maculopapular, and rarely urticarial. The rash is usually mild and disappears within a few days of dosage reduction, short-term treatment with an antihistaminic agent, and/or discontinuing therapy; remission may occur even if captopril is continued. Pruritus, without rash, occurs in about 2 of 100 patients. Between 7 and 10 percent of patients with skin rash have shown eosinophilia and/or positive ANA titers. A reversible associated pemphigoid-like lesion, and photosensitivity, have also been reported.

Flushing or pallor has been reported in 2 to 5 of 1000 patients.

Cardiovascular

Hypotension may occur; see WARNINGS and  PRECAUTIONS (Drug Interactions) for discussion of hypotension with captopril therapy.

Tachycardia, chest pain, and palpitations have each been observed in approximately 1 of 100 patients.

Angina pectoris, myocardial infarction, Raynaud’s syndrome, and congestive heart failure have each occurred in 2 to 3 of 1000 patients.

Dysgeusia

Approximately 2 to 4 (depending on renal status and dose) of 100 patients developed a diminution or loss of taste perception. Taste impairment is reversible and usually self-limited (2 to 3 months) even with continued drug administration. Weight loss may be associated with the loss of taste.

Angioedema

Angioedema involving the extremities, face, lips, mucous membranes, tongue, glottis or larynx has been reported in approximately one in 1000 patients. Angioedema involving the upper airways has caused fatal airway obstruction..

Cough

Cough has been reported in 0.5 to 2 percent of patients treated with captopril in clinical trials.

The following have been reported in about 0.5 to 2 percent of patients but did not appear at increased frequency compared to placebo or other treatments used in controlled trials: gastric irritation, abdominal pain, nausea, vomiting, diarrhea, anorexia, constipation, aphthous ulcers, peptic ulcer, dizziness, headache, malaise, fatigue, insomnia, dry mouth, dyspnea, alopecia, paresthesias.

Other clinical adverse effects reported since the drug was marketed are listed below by body system. In this setting, an incidence or causal relationship cannot be accurately determined.

Body as a whole

anaphylactoid reactions.

General
asthenia, gynecomastia.

Cardiovascular
cardiac arrest, cerebrovascular accident/insufficiency, rhythm disturbances, orthostatic hypotension, syncope.

Dermatologic
bullous pemphigus, erythema multiforme (including Stevens-Johnson syndrome), exfoliative dermatitis.

Gastrointestinal

pancreatitis, glossitis, dyspepsia.

Hematologic

anemia, including aplastic and hemolytic.

Hepatobilliary

jaundice, hepatitis, including rare cases of necrosis, cholestasis.

Metabolic

symptomatic hyponatremia.

Musculoskeletal

myalgia, myasthenia.

Nervous/Psychiatric

ataxia, confusion, depression, nervousness, somnolence.

Respiratory

bronchospasm, eosinophilic pneumonitis, rhinitis.

Special Senses

blurred vision.

Urogenital

impotence.

As with other ACE inhibitors, a syndrome has been reported which may include: fever, myalgia, arthralgia, interstitial nephritis, vasculitis, rash or other dermatologic manifestations, eosinophilia and an elevated ESR.

Fetal/Neonatal Morbidity and Mortality

See WARNINGS: Captopril, Fetal/Neonatal Morbidity and Mortality.

Hydrochlorothiazide

Gastrointestinal System

anorexia, gastric irritation, nausea, vomiting, cramping, diarrhea, constipation, jaundice (intrahepatic cholestatic jaundice), pancreatitis, and sialadenitis.

Central Nervous System

dizziness, vertigo, paresthesias, headache, and xanthopsia.

Hematologic

leukopenia, agranulocytosis, thrombocytopenia, aplastic anemia, and hemolytic anemia.

Cardiovascular

orthostatic hypotension.

Hypersensitivity

purpura, photosensitivity, rash, urticaria, necrotizing angiitis (vasculitis; cutaneous vasculitis), fever, respiratory distress including pneumonitis, and anaphylactic reactions.

Other

hyperglycemia, glycosuria, hyperuricemia, muscle spasm, weakness, restlessness, and transient blurred vision.

Whenever adverse reactions are moderate or severe, thiazide dosage should be reduced or therapy withdrawn.

Altered Laboratory Findings

Serum Electrolytes

Hyperkalemia: small increases in serum potassium, especially in patients with renal impairment.

Hyponatremia

particularly in patients receiving a low sodium diet or concomitant diuretics.

BUN/Serum Creatinine

Transient elevations of BUN or serum creatinine especially in volume or salt depleted patients or those with renovascular hypertension may occur. Rapid reduction of longstanding or markedly elevated blood pressure can result in decreases in the glomerular filtration rate and, in turn, lead to increases in BUN or serum creatinine.

Hematologic

A positive ANA has been reported.

Liver Function Tests

Elevations of liver transaminases, alkaline phosphatase, and serum bilirubin have occurred.

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