Benazepril/Hydrochlorothiazide

DEA Class; Rx

Common Brand Names; Lotensin HCT

• ACEI/Diuretic Combos; 
• ACEI/HCTZ Combos

Combination product for HTN; contains ACE inhibitor and thiazide diuretic; additive efficacy in HTN; can be dosed qd; counters the potassium loss from HCTZ.

Indicated for the treatment of hypertension.

Not for initial therapy

Hypersensitivity to either component or sulfonamides

History of hereditary or angioedema associated with or without previous ACE inhibitor treatment

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

Benazepril

• Cough (1-10%)
• Dizziness (4%)
• Fatigue (2%)
• Headache (6%)
• Nausea (1%)
• Postural dizziness (2%)
• Serum creatinine increased (2%)
• Somnolence (2%)
• Angioedema, ARF if renal artery stenosis, neutropenia, photosensitivity, agranulocytosis,alopecia, anaphylactoid reaction, angina, angioedema, arthralgia, arthritis, asthma, dermatitis, dyspnea, ECG changes,eosinophilia, flushing, gastritis, hemolytic anemia, hyperglycemia, hyperkalemia, hyponatremia, hypotension, impotence, insomnia, leukopenia, neutropenia, palpitations,pancreatitis, postural hypotension, proteinuria, rash, Stevens-Johnson syndrome, syncope, thrombocytopenia, transaminases increased, uric acid increased, vomiting

Hydrochlorothiazide

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

Excessive hypotension if concomitant diuretics, hypovolemia, hyponatremia

Risk of hyperkalemia, especially 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

Angioedema of the face, extremities, lips, tongue, glottis, and larynx has been reported in patients treated with angiotensin-converting enzyme inhibitors

If laryngeal stridor or angioedema of the face, tongue, or glottis occurs, treatment with Lotensin HCT should be discontinued and appropriate therapy instituted immediately

Patients receiving coadministration of ACE inhibitor and mTOR (mammalian target of rapamycin) inhibitor (e.g. temsirolimus, sirolimus, everolimus) therapy may be at increased risk for angioedema

Instruct patients to protect skin from sun and undergo regular skin cancer screening

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

Biliary cirrhosis or biliary obstruction

Myelosuppression

Renal impairment may occur

Neutropenia/agranulocytosis reported

Cough may occur within the first few months

Cholestatic jaundice may occur

Risk of male sexual dysfunction

Avoid concomitant use with lithium

Pregnancy Category: D

Lactation: excreted in breast milk, use caution