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ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS (Systemic)
Some commonly used brand names are:
In the U.S.—
ACE inhibitors belong to the class of medicines called high blood pressure medicines (antihypertensives). They are used to treat high blood pressure (hypertension).
High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.
Lisinopril, captopril, ramipril, and trandolapril are used in some patients after a heart attack. After a heart attack, some of the heart muscle is damaged and weakened. The heart muscle may continue to weaken as time goes by. This makes it more difficult for the heart to pump blood. Lisinopril use may be started within 24 hours after a heart attack to increase survival rate. Captopril, ramipril, and trandolapril help slow down the further weakening of the heart.
Captopril is also used to treat kidney problems in some diabetic patients who use insulin to control their diabetes. Over time, these kidney problems may get worse. Captopril may help slow down the further worsening of kidney problems.
In addition, some ACE inhibitors are used to treat congestive heart failure or may be used for other conditions as determined by your doctor.
The exact way that these medicines work is not known. They block an enzyme in the body that is necessary to produce a substance that causes blood vessels to tighten. As a result, they relax blood vessels. This lowers blood pressure and increases the supply of blood and oxygen to the heart.
These medicines are available only with your doctor"s prescription, in the following dosage forms:
Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For the angiotensin-converting enzyme (ACE) inhibitors, the following should be considered:
Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to benazepril, captopril, cilazapril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, or trandolapril. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.
Pregnancy—Use of ACE inhibitors during pregnancy, especially in the second and third trimesters (after the first three months) can cause low blood pressure, severe kidney failure, too much potassium, or even death in the newborn. Therefore, it is important that you check with your doctor immediately if you think that you may be pregnant . Be sure that you have discussed this with your doctor before taking this medicine. In addition, if you are taking:
Children—Children may be especially sensitive to the blood pressure-lowering effect of ACE inhibitors. This may increase the chance of side effects or other problems during treatment. Therefore, it is especially important that you discuss with the child"s doctor the good that this medicine may do as well as the risks of using it.
Older adults—This medicine has been tested in a limited number of patients 65 years of age or older and has not been shown to cause different side effects or problems in older people than it does in younger adults.
Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking or receiving ACE inhibitors it is especially important that your health care professional know if you are taking any of the following:
Other medical problems— The presence of other medical problems may affect the use of the ACE inhibitors. Make sure you tell your doctor if you have any other medical problems, especially:
Proper Use of This Medicine
To help you remember to take your medicine, try to get into the habit of taking it at the same time each day.
For patients taking captopril or moexipril :
For patients taking ramipril capsules: If you have trouble swallowing capsules, you may open the ramipril capsule and mix the medicine with applesauce, water or apple juice. Mix only one dose at a time just before taking it. You may mix a dose ahead of time and save it for no more than 24 hours at room temperature or 18 hours in the refrigerator. If you are unsure about these instructions, ask your doctor or pharmacist.
For patients taking this medicine for high blood pressure :
Dosing—The dose of the ACE inhibitor will be different for different patients. Follow your doctor"s orders or the directions on the label . The following information includes only the average doses. If your dose is different, do not change it unless your doctor tells you to do so.
The number of capsules or tablets that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking the ACE inhibitor .
Missed dose—If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Storage—To store this medicine:
Precautions While Using This Medicine
It is important that your doctor check your progress at regular visits to make sure that this medicine is working properly and to check for unwanted effects.
For patients taking this medicine for high blood pressure :
Dizziness or light-headedness may occur after the first dose of this medicine, especially if you have been taking a diuretic (water pill). Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy.
Check with your doctor right away if you become sick while taking this medicine, especially with severe or continuing nausea and vomiting or diarrhea. These conditions may cause you to lose too much water and lead to low blood pressure.
Notify your doctor immediately if you are or become pregnant while taking this medicine.
Check with your doctor if you have any signs of infection such as chills, fever, or sore throat, because these may be signs of neutropenia.
Check with your doctor right away if you have symptoms of jaundice (yellow skin or eyes) because these may be signs of a serious liver condition.
Dizziness, light-headedness, or fainting also may occur if you exercise or if the weather is hot. Heavy sweating can cause loss of too much water and low blood pressure. Use extra care during exercise or hot weather.
Avoid alcoholic beverages until you have discussed their use with your doctor . Alcohol may make the low blood pressure effect worse and/or increase the possibility of dizziness or fainting.
Check with your doctor if you experience any welts or swelling around your face, throat or tongue. Swelling in the mouth or throat area may cause breathing to become very difficult and could result in death.
Check with your doctor if you have strong stomach pain. This could be a symptom of a condition called intestinal angioedema. Your doctor may have to use a CT scan or an ultrasound to diagnose this condition.
Before having any kind of surgery (including dental surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are taking this medicine.
For patients taking captopril or fosinopril :
Side Effects of This Medicine
Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Fever and chills; hoarseness; swelling of face, mouth, hands, or feet; trouble in swallowing or breathing (sudden); stomach pain, itching of skin, or yellow eyes or skin
Check with your doctor as soon as possible if any of the following side effects occur:
Dizziness, light-headedness, or fainting; skin rash, with or without itching, fever, or joint pain
Abdominal pain, abdominal distention, fever, nausea, or vomiting; chest pain
Signs and symptoms of too much potassium in the body
Confusion; irregular heartbeat; nervousness; numbness or tingling in hands, feet, or lips; shortness of breath or difficulty breathing; weakness or heaviness of legs
Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:
Cough (dry, persistent); headache
Diarrhea; loss of taste; nausea; unusual tiredness
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.
Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, ACE inhibitors are used in certain patients with the following medical conditions:
Other than the above information, there is no additional information relating to proper use, precautions, or side effects for these uses.
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