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What is an ACE Inhibitors?

ACE Inhibitors (Angiotensin Converting Enzyme Inhibitors) are a class of medications with many different uses. A primary use is Hypertension where they help relax your veins and arteries to lower your blood pressure.

The mechanism of action (MOA) – includes a pathway to lock the rennin-angiotensin-aldosterone system. This is done by preventing an enzyme in your body from producing angiotensin II.

Overall, this medication allows for the relaxation of the blood vessels and decreases blood volume. It can reduce deaths by 20% for those who have symptoms of Heart Failure.

This medication should be avoided in women intending to become pregnant.

ACE Inhibitors Usage can be used in the following conditions:

1.)  Hypertension
2.)  Heart Failure
3.)  Past history of Myocardial infarction  [Heart Attack]
4.)  Coronary Heart Disease
5.)  Diabetes Mellitus
6.)  Chronic Kidney Disease
7.)  Stroke risk
8.)  And more

Three main categories of ACE inhibitors:

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

1.)  Previous Angioedema associated with ACE inhibitor therapy

2.)  Hypersensitivity to ACE inhibitors

ACE inhibitors should be used with caution in patients with:

1.)  Impaired renal function

2.)  Aortic Valve Stenosis or cardiac outflow obstruction

3.)  Severe Dehydration

4.)  History of Hemodialysis with high-flux polyacrylonitrile membranes

Overdose

1.)  Occurs very infrequently

2.)  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   25–50 mg bid   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