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Lotensin: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on May 12, 2021.

1. How it works

  • Lotensin is a brand (trade) name for benazepril.
  • Lotensin (benazepril) inhibits an enzyme called angiotensin-converting enzyme. This enzyme is involved in the production of angiotensin II, a powerful vasoconstrictor (narrows arteries), which also stimulates the release of the hormone aldosterone from the adrenal glands (aldosterone increases blood pressure). By inhibiting this enzyme, benazepril opens up the arteries (vasodilates) and lowers blood pressure.
  • Lotensin (benazepril) belongs to a group of medicines known as angiotensin-converting enzyme (ACE) inhibitors.

2. Upsides

  • May be used to lower blood pressure in people with high blood pressure (hypertension). Research has shown that reducing high blood pressure reduces the risk of fatal and nonfatal cardiac events, such as strokes and heart attacks.
  • Lotensin is effective alone or in combination with other treatments for high blood pressure. It is usually given with a diuretic in adults.
  • The initial starting dose is 10mg once a day in people not receiving a diuretic (5mg in those receiving a diuretic). The usual dosage range is 20mg to 40mg a day. A dose of 80mg gives an increased response but experience with this dose is limited.
  • Available as 10mg, 20mg, and 40mg tablets.
  • May be administered as a single daily dose or in two equally divided doses. A divided dose gives better control over trough (pre-dosing) blood pressure.
  • May be given to children aged at least 6 years as long as their kidney function is at least 30 mL/min/1.73m2.
  • Lotensin is available as a generic under the name benazepril.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • A headache and a cough are the most common side effects. The cough usually resolves on discontinuation of therapy and is a side effect common to all ACE inhibitors.
  • Dizziness, tiredness, and postural hypotension (rapid lowering of blood pressure when going from a sitting or lying down position to standing) are also common.
  • Occasionally lowering of blood pressure may be excessive. The risk is higher in those on diuretic therapy or who are sodium depleted or dehydrated. When initiating treatment with Lotensin, monitor the patient's blood pressure regularly during the first two weeks of treatment or whenever the dose of Lotensin or the diuretic is increased.
  • Rarely may cause angioedema of the face, lips, tongue, throat, and extremities. May occur at any time during treatment. Immediate discontinuation is warranted if angioedema is affecting breathing.
  • Should not be used by people with a history of hypersensitivity to benazepril or any other ACE inhibitor or in those with a history of angioedema with or without previous ACE inhibitor treatment.
  • Also rare is the development of blood disorders and kidney and liver failure. Acute renal failure has been associated with medications that inhibit the renin-angiotensin system, such as Lotensin.
  • May increase blood potassium levels, the risk is higher in people with diabetes, poor kidney function, and in people using potassium-sparing diuretics or taking potassium supplements. Monitor potassium levels regularly.
  • A ready-made suspension is not available; however, one can be prepared using 75mL of Ora-Plus oral suspending vehicle and fifteen Lotensin 20mg tablets in an amber PET bottle and shaking for at least 2 minutes. The suspension should be allowed to stand for at least one hour, and then shaken for an additional minute. 75mL of Ora-Sweet oral syrup should then be added and the whole contents shaken. This suspension provides a dosage of Lotensin 2mg/mL which should be refrigerated at 2º to 8°C (36º to 46°F) for up to 30 days.
  • May have less of a blood pressure-lowering effect in patients of African-American descent compared to those without this ethnicity. Also, the incidence of angioedema (skin reaction associated with head and neck swelling) is higher in African-American patients.
  • Should not be used by women who are pregnant or at risk of pregnancy because it may cause injury or death to the developing fetus. Minimal amounts are secreted into breast milk.
  • May not be suitable for some people and can interact with several medications (including NSAIDs, lithium) - consult your prescribing doctor before taking any other medications including those brought over the counter. Do not use within 36 hours of sacubitril, a neprilysin inhibitor.
  • A dosage reduction may be needed in people with kidney disease.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Lotensin is used for the treatment of high blood pressure. Lotensin, as with other ACE inhibitors, may not be as effective in people of African-American descent. If pregnancy is detected while a woman is taking Lotensin, the medication should be discontinued immediately.

5. Tips

  • May be taken with or without food.
  • Usually administered once daily; however, it can be administered twice daily if Lotensin's blood pressure-lowering capabilities start to wear off too early.
  • Treatments that lower blood pressure, such as Lotensin, should always be part of a comprehensive cardiovascular risk reduction plan that also targets, if appropriate, cholesterol-lowering, diabetes risk reduction, exercise, weight loss, and smoking cessation.
  • Report a sore throat or any signs or symptoms of angioedema (swelling of the face or throat, difficulty breathing) immediately to your doctor.
  • Your doctor may require you to undergo regular monitoring (such as kidney and liver tests) while taking Lotensin.
  • May cause a fall in blood pressure that may be noticed as light-headedness; this usually goes away after a few days of therapy. However, if it persists, call your doctor and ask for advice; symptoms usually resolve with continued therapy. Ensure you do not become dehydrated.
  • Do not use salt substitutes containing potassium without first consulting your doctor.
  • Report any signs of a fever or a sore throat to your doctor who may carry out further tests to ensure it is not neutropenia (a decrease in white blood cells).
  • Ensure you use adequate contraception or are abstaining from sex to avoid pregnancy while taking Lotensin. If you inadvertently become pregnant while taking Lotensin, discontinue it and contact your healthcare provider immediately.

6. Response and effectiveness

  • Peak concentrations of Lotensin are reached within half an hour to one hour of oral administration. Lotensin (benazepril) is metabolized to an active metabolite, benazeprilat, which also lowers blood pressure.
  • Blood pressure-lowering effects are seen within an hour of oral administration with peak effects achieved between two and four hours after dosing. Blood pressure-lowering effects are maintained for at least 24 hours, although in some patients these effects may diminish towards the end of the 24 hours. It may take several weeks before optimal blood pressure lowering effects are achieved.
  • Abrupt withdrawal of Lotensin has not resulted in an abrupt increase in blood pressure; however, as with most antihypertensive drugs, it is best to discontinue Lotensin slowly.

7. Interactions

Medicines that interact with Lotensin may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Lotensin. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Lotensin include:

  • aliskiren
  • allopurinol (may enhance the potential for allergic reactions)
  • amifostine
  • amphetamines
  • antipsychotic agents (may enhance the blood pressure-lowering effect)
  • aspirin
  • azathioprine
  • diuretics (will enhance blood pressure-lowering response but commonly used together)
  • duloxetine
  • ferric gluconate
  • gold injections for arthritis
  • grass pollen allergen extract
  • heparin
  • levodopa
  • lithium
  • mTOR inhibitors, such as everolimus, sirolimus, or temsirolimus
  • NSAIDs, such as ibuprofen, diclofenac, and naproxen
  • other ACE inhibitors (such as captopril or lisinopril) or ARBs (such as candesartan or irbesartan)
  • phosphodiesterase-5-inhibitors, such as sildenafil
  • potassium supplements or potassium-sparing diuretics (such as spironolactone, amiloride, or triamterene)
  • sacubitril (avoid)
  • sodium aurothiomalate (gold) (may cause nitritoid reactions such as flushing, nausea, or vomiting)
  • trimethoprim.

Lotensin may also cause blood sugar levels to drop more than expected when taken with diabetes medication, including insulin. Increased blood sugar monitoring may be required.

Note that this list is not all-inclusive and includes only common medications that may interact with Lotensin. You should refer to the prescribing information for Lotensin for a complete list of interactions.

References

Lotensin (benazepril) [Package Insert]. Revised 12/2020. Validus Pharmaceuticals LLC. https://www.drugs.com/pro/lotensin.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Lotensin only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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