ACE Inhibitors is a class of medications with many different types of uses and can also referred to as Angiotension Converting Enzyme Inhibitors.

The mechanism of action of this class of medications includes a pathway to lock the rennin-angiotension-aldosterone system.

It also causes relaxation of the blood vessels and decreases blood volume.

Reduces deaths by 20% with those who have symptoms of Heart failure.

Should be avoided in women intending to become pregnant.

 

ACE Inhibitors Usage can be use in the following conditions:

 

Three main categories of ACE inhibitors:

1.)  Dicarboxylate-containing agents
2.)  Sulfhydryl-containing agents
3.)  Phosphonate-containg agents

 

Types/Names

  • Benazepril  (Lotension) – Dicarboxylate
  • Captopril  (Capoten) – Sulfhydryl
  • Enalapril  (Vasotec) – Dicarboxylate
  • Fosinopril  (Monopril) – Phosphonate
  • Lisinopril  (Prinivil, Zestril) – Dicarboxylate
  • Moexipril  (Univasc)
  • Perindopril  (Aceon)
  • Quinapril  (Accupril) – Dicarboxylate
  • Ramipril  (Altace) – Dicarboxylate
  • Trandolapril  (Mavik)

 

Side Effects/Adverse Effects

  • Hypotension
  • Headaches
  • Dizziness
  • Fatigue
  • Nausea
  • Rash
  • Changes in taste
  • Cough
  • Hyperkalemia  (high concentration of potassium in the blood)
  • Renal impairments
  • Angioedema
  • Neutropenia
  • Agranulocytosis

The ACE inhibitors are contraindicated in patients with:

  • Previous Angioedema associated with ACE inhibitor therapy
  • Hypersensitivity to ACE inhibitors

ACE inhibitors should be used with caution in patients with:

  • Impaired renal function
  • Aortic Valve Stenosis or cardiac outflow obstruction
  • Severe Dehydration
  • History of Hemodialysis with high-flux polyacrylonitrile membranes

 

Overdose

  • Occurs very infrequently
  • Hypotension can be severe

 

ACE inhibitors dosages for hypertension

DosageNote: BID = two times a day, TID = three times a day, d = daily

Drug dosages from Drug Lookup, Epocrates Online.

Name                      Equivalent daily dose         Start                             Usual                          Maximum

Benazepril                    10 mg                           10 mg                           20–40 mg                  80 mg

Captopril                       50 mg (25 mg bid)    12.5–25 mg bid-tid   25–50 mg bid-tid      450 mg/d

Enalapril                       5 mg                             5 mg                             10–40 mg                    40 mg

Fosinopril                     10 mg                           10 mg                           20–40 mg                   80 mg

Lisinopril                      10 mg                           10 mg                           10–40 mg                   80 mg

Moexipril                      7.5 mg                          7.5 mg                          7.5–30 mg                  30 mg

Perindopril                  4 mg                             4 mg                             4–8 mg                       16 mg

Quinapril                      10 mg                           10 mg                           20–80 mg                   80 mg

Ramipril                        2.5 mg                         2.5 mg                          2.5–20 mg                  20 mg

Trandolapril                2 mg                             1 mg                             2–4 mg                        8 mg

 

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