Captopril/Hydrochlorothiazide

DEA Class; Rx

Common Brand Names; Capozide

• ACEI/Diuretic Combos; 
• ACEI/HCTZ Combos

Combination ACE inhibitor and thiazide diuretic; usually given 2—3 times daily; additive efficacy in HTN; counters the potassium loss from HCTZ; more effective than ACE monotherapy in black patients; captopril contains a sulfhydryl group and is shortest-acting.

Indicated for the treatment of hypertension.

Hypersensitivity to either component or sulfonamides

History of hereditary or idiopathic angioedema

Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan

Bilateral renal artery stenosis or anuria

Do not coadminister with aliskiren in patients with diabetes

Captopril

• Chest pain (1%)
• Cough (1-2%)
• Dysgeusia (2-4%)
• Hypersensitivity reactions
• Hyperkalemia (1-11%)
• Hypotension (1-3%)
• Palpitations (1%)
• Pruritis rash (2%)
• Tachycardia (1%)
• Angioedema
• ARF if renal artery stenosis
• Impotence
• Neutropenia
• Photosensitivity
• Orthostatic hypotension, ataxia, angioedema, cardiac arrest, CHF, rhythm disturbances, somnolence, confusion, nervousness, depression, Stevens-Johnson syndrome, exfoliative dermatitis, bullous pemphigus, increased billirubin, gynecomastia, increased alkaline phosphatase, dyspepsia, pancreatitis, glossitis, impotence, urinary frequency, agranulocytosis anemia, thrombocytopenia, anemia, pancytopenia, blurred vision, bronchospasm, eosinophilic pneumonitis, rhinitis, cholestasis, hyponatremia

Hydrochlorothiazide

• Anaphylaxis, anemia, confusion, erythema multiforme skin reactions including Stevens-Johnson syndrome, exfoliative dermatitis including toxic epidermal necrolysis, hypomagnesemia, hyponatremia, hypochloremia, dizziness, fatigue, headache, hypercalcemia, hyperuricemia, hyperglycemia, hyperlipidemia, hypercholesterolemia, muscle weakness or cramps, nausea, purpura, rash, vertigo, vomiting
• Anorexia
• Epigastric distress
• Hypotension
• Orthostatic hypotension
• Photosensitivity

Excessive hypotension if concomitant diuretics, hypovolemia, hyponatremia

Risk of hyperkalemia, especially in patients with renal impairment, DM or those taking concomitant K+-elevating drugs

Dual blockade of the renin angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for hypotension, hyperkalemia, and renal function changes (including acute renal failure) compared to monotherapy

DM, fluid or electrolyte imbalance, hyperuricemia or gout, SLE, liver disease, renal disease

May aggravate digitalis toxicity

Sensitivity reactions may occur with or without history of allergy or asthma

Aortic stenosis/ hypertrophic cardiomyopathy

Biliary cirrhosis or biliary obstruction

Myelosuppression

Blood levels do not correlate with BP response

Causes false positive urine acetone

Risk of male sexual dysfunction

Avoid concomitant use with lithium

Acute transient myopia and acute angle-closure glaucoma has been reported, particularly with history of sulfonamide or penicillin allergy (hydrochlorothiazide is a sulfonamide)

Pregnancy Category: C (1st trimester); D (2nd and 3rd trimester)

Lactation: excreted in breast milk, use caution