Benazepril
LOTENSIN
What it isACE inhibitor prodrug; hypertension and renal protection in proteinuric kidney disease.
Why this oneIts common fixed combination with amlodipine provides single-tablet RAAS and calcium-channel blockade.
What limits itCough, hyperkalemia, and creatinine rise are common; angioedema can occur late, and pregnancy is contraindicated.
FDA-approved for
- hypertension (1991)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hypertension | Adult | 10 mg QD (5 mg QD if on a diuretic) | 20-40 mg/day (QD or two divided doses) | 80 mg/day |
| Hypertension | Peds ≥6 y, GFR >30 mL/min/1.73m² | 0.2 mg/kg QD | titrate to effect | 0.6 mg/kg QD (≤40 mg) |
Renal Initiate 5 mg QD if GFR <30 mL/min/1.73m² (or hemodialysis); no adjustment if CrCl >30
Hepatic Undefined
Instructions
- Take once daily or in two divided doses
- Discontinue as soon as pregnancy is detected
- Do not use within 36 h of switching to/from sacubitril/valsartan
- Oral suspension (2 mg/mL) may be compounded from tablets
Contraindications
- History of angioedema (hereditary, idiopathic, or prior ACE inhibitor-related)
- Concomitant use with a neprilysin inhibitor (e.g., sacubitril); do not use within 36 h of sacubitril/valsartan
- Co-administration with aliskiren in patients with diabetes
Cautions
- Fetal toxicity — discontinue when pregnancy detected (boxed)
- Angioedema (head/neck and intestinal); higher rate in Black patients; anaphylactoid reactions during desensitization, dialysis with high-flux membranes, or LDL apheresis
- Impaired renal function/acute renal failure in RAAS-dependent patients
- Symptomatic hypotension; hyperkalemia; hepatic failure (cholestatic jaundice progressing to necrosis)
Adverse reactions
- Headache (6%)
- Dizziness (4%)
- Somnolence, postural dizziness (2%)
- Cough
- Fatigue
Pregnancy Can cause fetal harm (RAAS effects: oligohydramnios, renal failure, death); discontinue when pregnancy detected
Lactation Minimal amounts in breast milk (<0.1% of maternal dose)
⚠ BOXED WARNING
- Fetal toxicity; discontinue as soon as pregnancy is detected
Principal riskAngioedema and hyperkalemia
Cost, est. cash$5–$150/month
Generic entry2004
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilityHyperkalemia, kidney injury, angioedema, fetal toxicity and increased lithium exposure.
Active metabolites
Mechanism of action: Benazepril ballicule
Open Benazepril in the interactive console ↗
Memory aids: mascots and interaction avatars
Easter/April theme → ACE inhibitor = -pril (aPril)
Bananas in bunches → ↑ serum potassium
