Captopril
CAPOTEN
What it isThe first ACE inhibitor; hypertension and heart failure.
Why this oneIts very short action makes it useful as a test dose and in renovascular scintigraphy.
What limits itThree-times-daily dosing, and the sulfhydryl group causes more rash and taste disturbance than later agents. Take on an empty stomach.
FDA-approved for
- hypertension (1981)
- heart failure (~1984)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hypertension | Adults | 25 mg BID–TID | 25–150 mg BID–TID | 450 mg/day |
| Heart failure | Adults | 25 mg TID (6.25–12.5 mg TID if volume/salt-depleted) | 50–100 mg TID | 450 mg/day |
| LV dysfunction after MI | Adults | 6.25 mg once, then 12.5 mg TID | 50 mg TID | |
| Diabetic nephropathy | Adults | 25 mg TID | 25 mg TID |
Titration Increase at 1–2 week intervals; in heart failure delay increases ≥2 weeks once at 50 mg TID
Renal Reduce initial dose and titrate slowly (smaller/less frequent doses) in significant renal impairment
Hepatic Undefined
Instructions
- Take 1 hour before meals
Contraindications
- Prior angioedema with any ACE inhibitor
- Concomitant aliskiren in patients with diabetes
- Concomitant neprilysin inhibitor (e.g., sacubitril); do not use within 36 h of sacubitril/valsartan
Cautions
- Angioedema (head/neck and intestinal)
- Neutropenia/agranulocytosis
- Hypotension (esp. volume/salt-depleted)
- Hyperkalemia
- Proteinuria/renal insufficiency
- Persistent dry cough
Adverse reactions
- Rash/pruritus
- Dysgeusia (taste loss)
- Cough
- Hypotension
- Proteinuria
- Angioedema
- Neutropenia
Pregnancy Can cause fetal injury/death; discontinue as soon as pregnancy is detected (boxed)
Lactation Undefined
⚠ BOXED WARNING
- Fetal toxicity
Cost, est. cash$10–$300/month
Generic entry1995
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilityHyperkalemia, kidney injury, angioedema, fetal toxicity and increased lithium exposure.
Mechanism of action: Captopril ballicule
Open Captopril in the interactive console ↗
Memory aids: mascots and interaction avatars
Easter/April theme → ACE inhibitor = -pril (aPril)
Bananas in bunches → ↑ serum potassium
