Angiten

• Hypertension:
  Treatment of mild to moderate hypertension to reduce blood pressure and decrease risk of cardiovascular events.
• Heart Failure:
  Used in symptomatic heart failure to improve symptoms and reduce mortality and hospitalizations.
• Left Ventricular Dysfunction Post-Myocardial Infarction:
  For management of left ventricular dysfunction and to reduce risk of heart failure or death following MI.
• Diabetic Nephropathy:
  Indicated for treatment of diabetic nephropathy with proteinuria in patients with type 1 diabetes mellitus to delay progression of nephropathy.
• Off-label Uses:
  Management of scleroderma renal crisis and prevention of contrast-induced nephropathy in at-risk patients.

• Hypertension (Adults):
  Initial dose: 25 mg orally twice daily.
  Maintenance dose: 25–150 mg daily divided into 2–3 doses. Adjust dose based on blood pressure response.
• Heart Failure:
  Starting dose: 6.25 mg orally 3 times daily; titrate to 50 mg 3 times daily as tolerated.
• Post-Myocardial Infarction:
  Initial dose: 6.25 mg orally 3 times daily; titrate to 50 mg 3 times daily.
• Diabetic Nephropathy:
  Typical dose: 75–100 mg daily in divided doses.
• Renal/Hepatic Impairment:
  Use caution; start at lower doses and monitor renal function closely.
• Pediatrics:
  Initial dose typically 0.3 mg/kg orally 2–3 times daily; titrate carefully.
• Administration:
  Oral tablets taken on an empty stomach, 1 hour before meals.

Captopril is an angiotensin-converting enzyme (ACE) inhibitor. It competitively inhibits ACE, preventing the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This results in vasodilation, decreased aldosterone secretion, reduced sodium and water retention, and lowered blood pressure. Additionally, it inhibits degradation of bradykinin, which contributes to vasodilation. These combined effects reduce afterload and preload on the heart, improving cardiac output and protecting renal function.

• Absorption:
  Rapidly absorbed orally; peak plasma levels in 1 hour.
• Bioavailability:
  Approximately 70%, reduced if taken with food.
• Distribution:
  Widely distributed; plasma protein binding ~25–30%.
• Metabolism:
  Partially metabolized in the liver to active and inactive metabolites.
• Half-life:
  Approximately 2 hours; duration of action up to 6–12 hours.
• Elimination:
  Primarily renal excretion (unchanged drug and metabolites).

• Pregnancy:
  FDA Category D. Contraindicated during the second and third trimesters due to risk of fetal toxicity (renal dysplasia, oligohydramnios, fetal death).
• Lactation:
  Excreted in breast milk in small amounts. Use with caution; breastfeeding not generally recommended during therapy.

• Primary: Antihypertensive
• Subclass: Angiotensin-Converting Enzyme (ACE) Inhibitor

• Known hypersensitivity to captopril or other ACE inhibitors.
• History of angioedema related to previous ACE inhibitor therapy.
• Hereditary or idiopathic angioedema.
• Pregnancy (second and third trimesters).
• Severe renal impairment or bilateral renal artery stenosis.
• Concurrent use with aliskiren in patients with diabetes or renal impairment.

• Risk of angioedema; monitor for swelling of face, lips, tongue, or airway.
• Hyperkalemia risk; monitor serum potassium.
• Hypotension, especially in volume-depleted or salt-restricted patients.
• Renal function deterioration possible; monitor serum creatinine and renal function.
• Caution in patients with renal artery stenosis.
• May cause neutropenia/agranulocytosis; periodic blood counts recommended in high-risk patients.
• Avoid use during pregnancy.

Common:

• Cough (dry, persistent)
• Rash
• Taste disturbances (metallic or salty)
• Hypotension/dizziness
• Elevated blood potassium
• Fatigue

Serious/Rare:

• Angioedema
• Neutropenia/agranulocytosis
• Hepatic dysfunction
• Proteinuria
• Renal impairment

• Potassium-sparing diuretics or potassium supplements: Increase risk of hyperkalemia.
• NSAIDs: May reduce antihypertensive effect and increase risk of renal impairment.
• Lithium: Increased risk of lithium toxicity.
• Other antihypertensives: Additive blood pressure lowering effect.
• Aliskiren: Contraindicated in patients with diabetes or renal impairment when combined.
• No significant CYP450 involvement.

• Guidelines continue to recommend ACE inhibitors like captopril as first-line agents for hypertension with comorbid diabetes or heart failure.
• Updated warnings emphasize careful use in renal impairment and monitoring for hyperkalemia and angioedema.
• New recommendations limit use in pregnancy due to fetal risk.

• Store at 20°C to 25°C (68°F to 77°F).
• Protect from moisture and light.
• Keep tablets in original container tightly closed.
• Keep out of reach of children.