Hydrochlorothiazide + Captopril

Indications

Hydrochlorothiazide + Captopril is used for: Hypertension, Chronic heart failure

Adult Dose

Oral Hypertension, Chronic heart failure Adult: Per tablet contains captopril 25 mg and hydrochlorothiazide 15 mg: Initially, 1 tablet once daily. Daily dose should not exceed: 150 mg (captopril) and 50 mg (hydrochlorothiazide).

Child Dose

Renal Dose

Renal impairment CrCl >30mL/min: No dosage adjustment required CrCl <30mL/min: Not recommended

Administration

Should be taken on an empty stomach. Take on an empty stomach 1 hr before meals.

Contra Indications

Hypersensitiviry, anuria and severe renal impairment, allergy to sulphonamide-related drugs, collagen - vascular disease, renal artery stenosis. Pregnancy (2nd and 3rd trimesters).

Precautions

Neonates and children, elderly patients, renal disease, liver disease, DM, gout, hyperlipidaemia, ECG evidence of LVH. Lactation.

Pregnancy-Lactation

Pregnancy Category: C (1st trimester); D (2nd and 3rd trimester) Lactation: excreted in breast milk, use caution

Interactions

Hypotensive action of captopril blunted by NSAIDs. Impairment in glycaemic control by thiazides. Decreased renal excretion of captopril by probenecid. Hypotensive effect of captopril may be increased by other hypotensives. Symptomatic hyponatremia and impaired renal function may result with concomitant use of carbamazepine and allopurinol. Thiazide absorption is increased and decreased by anticholinergics and cholestyramine respectively. May reduce clearance of lithium; monitor serum lithium levels when used together. Potentially Fatal: Increase in bone marrow depression on concomitant therapy with immunosuppressants. Analgesic and resp depression effects of morphine potentiated. Potentiation of nephrotoxicity caused by aminoglycosides, precipitation of digitalis toxicity and lithium toxicity by thiazide diuretics.

Side Effects

Side effects of Hydrochlorothiazide + Captopril : Captopril 1-10% Chest pain (1%) Cough (1-2%) Dysgeusia (2-4%) Hypersensitivity reactions Hyperkalemia (1-11%) Hypotension (1-3%) Palpitations (1%) Pruritis rash (2%) Tachycardia (1%) <1% Angioedema ARF if renal artery stenosis Impotence Neutropenia Photosensitivity Frequency Not Defined 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 <1% 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 Frequency Not Defined Anorexia Epigastric distress Hypotension Orthostatic hypotension Photosensitivity

Mode of Action

Captopril/hydrochlorothiazide is a fixed-combination tablet that combines an angiotensin-converting enzyme (ACE) inhibitor, captopril, and a thiazide diuretic, hydrochlorothiazide Captopril prevents the conversion of angiotensin I to angiotensin II (a potent vasoconstrictor) through inhibition of ACE by competing with physiologic substrate (angiotensin I) for active site of ACE; inhibition of ACE initially results in decreased plasma angiotensin II concentrations & consequently, blood pressure may be reduced in part through decreased vasoconstriction, increased renin activity, and decreased aldosterone secretion Hydrochlorothiazide is a thiazide diuretic that inhibits Na reabsorption in distal renal tubules resulting in increased excretion of Na+ and water, also K+ and H+ ions