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| __NOTOC__
| | #REDIRECT [[Captopril#Adult Indications and Dosage]] |
| {{Captopril}}
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| {{CMG}}; {{AE}} {{AM}}
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| ==Dosage and Administration==
| | [[Category: Cardiovascular Drugs]] |
| | | [[Category: Drug]] |
| Captopril should be taken one hour before meals. Dosage must be individualized.
| | [[Category:ACE inhibitors]] |
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| ====Hypertension====
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| Initiation of therapy requires consideration of recent [[antihypertensive drug]] treatment, the extent of [[blood pressure]] elevation, salt restriction, and other clinical circumstances. If possible, discontinue the patient's previous antihypertensive drug regimen for one week before starting captopril.
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| The initial dose of captopril tablets, USP is 25 mg b.i.d. or t.i.d. If satisfactory reduction of [[blood pressure]] has not been achieved after one or two weeks, the dose may be increased to 50 mg b.i.d. or t.i.d. Concomitant [[sodium]] restriction may be beneficial when captopril is used alone.
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| The dose of captopril in [[hypertension]] usually does not exceed 50 mg t.i.d. Therefore, if the [[blood pressure]] has not been satisfactorily controlled after one to two weeks at this dose, (and the patient is not already receiving a [[diuretic]]), a modest dose of a [[thiazide]]-type [[diuretic]] (e.g., [[hydrochlorothiazide]], 25 mg daily), should be added. The diuretic dose may be increased at one- to two-week intervals until its highest usual [[antihypertensive]] dose is reached.
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| If captopril is being started in a patient already receiving a [[diuretic]], captopril therapy should be initiated under close medical supervision, with dosage and titration of captopril as noted above.
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| If further [[blood pressure]] reduction is required, the dose of captopril may be increased to 100 mg b.i.d. or t.i.d. and then, if necessary, to 150 mg b.i.d. or t.i.d. (while continuing the [[diuretic]]). The usual dose range is 25 to 150 mg b.i.d. or t.i.d. A maximum daily dose of 450 mg captopril should not be exceeded.
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| For patients with severe [[hypertension]] (e.g., accelerated or [[malignant hypertension]]), when temporary discontinuation of current [[antihypertensive therapy]] is not practical or desirable, or when prompt titration to more normotensive [[blood pressure]] levels is indicated, diuretic should be continued but other current [[antihypertensive medication]] stopped and captopril dosage promptly initiated at 25 mg b.i.d. or t.i.d., under close medical supervision.
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| When necessitated by the patient's clinical condition, the daily dose of captopril may be increased every 24 hours or less under continuous medical supervision until a satisfactory [[blood pressure]] response is obtained or the maximum dose of captopril is reached. In this regimen, addition of a more potent [[diuretic]], e.g., [[furosemide]], may also be indicated.
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| [[Beta-blockers]] may also be used in conjunction with captopril therapy, but the effects of the two drugs are less than additive.
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| ====Heart Failure====
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| Initiation of therapy requires consideration of recent [[diuretic]] therapy and the possibility of severe salt/volume depletion. In patients with either normal or low [[blood pressure]], who have been vigorously treated with [[diuretics]] and who may be [[hyponatremic]] and/or [[hypovolemic]], a starting dose of 6.25 or 12.5 mg t.i.d. may minimize the magnitude or duration of the hypotensive effect; for these patients, titration to the usual daily dosage can then occur within the next several days.
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| For most patients the usual initial daily dosage is 25 mg t.i.d. After a dose of 50 mg t.i.d. is reached, further increases in dosage should be delayed, where possible, for at least two weeks to determine if a satisfactory response occurs. Most patients studied have had a satisfactory clinical improvement at 50 or 100 mg t.i.d. A maximum daily dose of 450 mg of captopril should not be exceeded.
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| Captopril should generally be used in conjunction with a [[diuretic]] and [[digitalis]]. Captopril therapy must be initiated under very close medical supervision.
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| ====Left Ventricular Dysfunction After Myocardial Infarction====
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| The recommended dose for long-term use in patients following a [[myocardial infarction]] is a target maintenance dose of 50 mg t.i.d.
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| Therapy may be initiated as early as three days following a [[myocardial infarction]]. After a single dose of 6.25 mg, captopril therapy should be initiated at 12.5 mg t.i.d.
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| Captopril should then be increased to 25 mg t.i.d. during the next several days and to a target dose of 50 mg t.i.d. over the next several weeks as tolerated (see CLINICAL PHARMACOLOGY).
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| Captopril may be used in patients treated with other post-[[myocardial infarction]] therapies, e.g., [[thrombolytics]], [[aspirin]], [[beta blockers]].
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| ====Diabetic Nephropathy====
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| The recommended dose of captopril for long term use to treat [[diabetic nephropathy]] is 25 mg t.i.d.
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| Other antihypertensives such as [[diuretics]], [[beta blockers]], centrally acting agents or [[vasodilators]] may be used in conjunction with captopril if additional therapy is required to further lower [[blood pressure]].
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| ====Dosage Adjustment in Renal Impairment====
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| Because captopril is excreted primarily by the kidneys, excretion rates are reduced in patients with [[impaired renal function]]. These patients will take longer to reach steady-state captopril levels and will reach higher steady-state levels for a given daily dose than patients with normal renal function. Therefore, these patients may respond to smaller or less frequent doses.
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| Accordingly, for patients with significant renal impairment, initial daily dosage of captopril should be reduced, and smaller increments utilized for titration, which should be quite slow (one- to two-week intervals). After the desired therapeutic effect has been achieved, the dose should be slowly back-titrated to determine the minimal effective dose. When concomitant diuretic therapy is required, a [[loop diuretic]] (e.g., [[furosemide]]), rather than a [[thiazide]] diuretic, is preferred in patients with severe [[renal impairment]].<ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = CAPTOPRIL (CAPTOPRIL ) TABLET CAPTOPRIL TABLET [APOTEX CORP.] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=2c0f1ee3-b2b7-a1bc-059a-d65bea6cd0ef | publisher = | date = | accessdate =}}</ref>
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| ==References==
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| {{Reflist}}
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| {{FDA}}
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| [[Category:Cardiovascular Drugs]] | |
| [[Category:Drugs]] | |