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.
Adverse 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
Mechanism 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