captopril

(kap' toe pril)

Apo-Capto (CAN), Capoten, Gen-Captopril (CAN), Novo-Captopril (CAN),
Nu-Capto (CAN)

Pregnancy Category C (first trimester)

Pregnancy Category D (second, third trimesters)

Drug classes
Angiotensin-converting enzyme (ACE) inhibitor
Antihypertensive

Therapeutic actions
Blocks ACE from converting angiotensin I to angiotensin II, a powerful vasoconstrictor,
leading to decreased blood pressure, decreased aldosterone secretion, a small increase in
serum potassium levels, and sodium and fluid loss; increased prostaglandin synthesis also
may be involved in the antihypertensive action.

Indications
• Treatment of hypertension alone or in combination with thiazide-type diuretics
• Treatment of CHF in patients unresponsive to conventional therapy; used with
diuretics and digitalis
• Treatment of diabetic nephropathy
• Treatment of left ventricular dysfunction after MI
• Unlabeled uses: Management of hypertensive crises; treatment of rheumatoid
arthritis; diagnosis of anatomic renal artery stenosis, hypertension related to
scleroderma renal crisis; diagnosis of primary aldosteronism, idiopathic edema;
Bartter's syndrome; Raynaud's syndrome

Contraindications and cautions

• Contraindicated with allergy to captopril, history of angiodema.
• Use cautiously with impaired renal function; CHF; salt or volume depletion,
lactation, pregnancy.

Available forms
Tablets—12.5, 25, 50, 100 mg

Dosages
ADULTS
• Hypertension: 25 mg PO bid or tid; if satisfactory response is not noted within 1–
2 wk, increase dosage to 50 mg bid–tid; usual range is 25–150 mg bid–tid PO
with a mild thiazide diuretic. Do not exceed 450 mg/day.
• CHF: 6.25–12.5 mg PO tid in patients who may be salt or volume depleted. Usual
initial dose, 25 mg PO tid; maintenance dose, 50–100 mg PO tid. Do not exceed
450 mg/day. Use in conjunction with diuretic and digitalis therapy.
 • Left ventricular dysfunction after MI: 50 mg PO tid, starting as early as 3 days
post MI. Initial dose of 6.25 mg, then 12.5 mg tid, increasing slowly to 50 mg tid.
• Diabetic nephropathy: 25 mg PO tid.
PEDIATRIC PATIENTS
Safety and efficacy not established.
GERIATRIC PATIENTS AND PATIENTS WITH RENAL IMPAIRMENT
Excretion is reduced in renal failure; use smaller initial dose; adjust at smaller doses with
1- to 2-wk intervals between increases; slowly adjust to smallest effective dose. Use a
loop diuretic with renal dysfunction.

Pharmacokinetics
Route Onset Peak
Oral 15 min 30–90 min

Metabolism: T1/2: 2 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• CV: Tachycardia, angina pectoris, MI, Raynaud's syndrome, CHF, hypotension in
salt- or volume-depleted patients
• Dermatologic: Rash, pruritus, pemphigoid-like reaction, scalded mouth
sensation, exfoliative dermatitis, photosensitivity, alopecia
• GI: Gastric irritation, aphthous ulcers, peptic ulcers, dysgeusia, cholestatic
jaundice, hepatocellular injury, anorexia, constipation
• GU: Proteinuria, renal insufficiency, renal failure, polyuria, oliguria, urinary
frequency
• Hematologic: Neutropenia, agranulocytosis, thrombocytopenia, hemolytic
anemia, pancytopenia
• Other: Cough, malaise, dry mouth, lymphadenopathy

Interactions
Drug-drug
• Increased risk of hypersensitivity reactions with allopurinol
• Decreased antihypertensive effects with indomethacin
• Increased captopril effects with probenecid
Drug-food
• Decreased absorption of captopril with food
Drug-lab test
• False-positive test for urine acetone

Nursing considerations
Assessment
• History: Allergy to captopril, history of angioedema, impaired renal function,
CHF, salt or volume depletion, pregnancy, lactation
 • Physical: Skin color, lesions, turgor; T; P, BP, peripheral perfusion; mucous
membranes, bowel sounds, liver evaluation; urinalysis, renal and liver function
tests, CBC and differential

Interventions
• Administer 1 hr before or 2 hr after meals.
• Alert surgeon and mark patient's chart with notice that captopril is being taken;
the angiotensin II formation subsequent to compensatory renin release during
surgery will be blocked; hypotension may be reversed with volume expansion.
• Monitor patient closely for fall in BP secondary to reduction in fluid volume
(excessive perspiration and dehydration, vomiting, diarrhea); excessive
hypotension may occur.
• Reduce dosage in patients with impaired renal function.

Teaching points
• Take drug 1 hr before or 2 hr after meals; do not take with food. Do not stop
without consulting your health care provider.
• Be careful of drop in blood pressure (occurs most often with diarrhea, sweating,
vomiting, dehydration); if light-headedness or dizziness occurs, consult your
health care provider.
• Avoid over-the-counter medications, especially cough, cold, allergy medications
that may contain ingredients that will interact with ACE inhibitors. Consult your
health care provider.
• These side effects may occur: GI upset, loss of appetite, change in taste perception
(limited effects, will pass); mouth sores (perform frequent mouth care); rash; fast
heart rate; dizziness, light-headedness (usually passes after the first few days;
change position slowly, and limit your activities to those that do not require
alertness and precision).
• Report mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular
heartbeat, chest pains; swelling of the face, eyes, lips, tongue, difficulty breathing.

Adverse effects in Italic are most common; those in Bold are life-threatening.