ACE Inhibitors are primarily used as antihypertensives for a variety of conditions.

Examples

  • Captopril (Capoten)
  • Perindopril
    • Arginine salt (Coversyl)
    • Erbumine salt (Aceon)
  • Ramipril (Prilace/Ramipro)
  • Enalapril (Vasotec/Enaladex)
  • Trandolapril (Mavik)

Uses

Mechanism of action

Block the breakdown of bradykinin and the conversion of angiotensin I to angiotensin II thus reducing the hypertensive effects of angiotensin II (vasoconstriction, sodium retention, aldosterone release and angiotensin II mediated SNS activity)

Clearance

Renal

Drug information

Captopril

Strength
Tablet: 12.5, 25, 50mg; Liquid: 5mg/mL
Dosage/Frequency
6.25-50mg 3/day
Administration
Tablet, oral liquid
Cost
$16.20- $39; $112 - liquid
Half-life
~2hrs
Notes: The short half-life means that captopril use is restricted to situations where the patient may be at high risk of hypotension or renal impairment eg. elderly, low BP

Perindopril

Strength
2,4,8 mg (for erbumine salt);
2.5, 5 & 10mg (for arginine salt)
Dosage/Frequency
2-8mg (erb salt); 2.5-10 (arg salt)
Administration
Tablet
Cost
$12.30-$24.30
Half-life
Up to 17hrs
Notes: Main disadvantage due to availability in two different salts with different doses that are bioequivalent. It is available as the arginine formulation with the brand name Coversyl but Coversyl Plus (which combines it with a diuretic (usually indapamide)) is only available as the erbumine salt

Ramipril

Strength
1.25, 2.5, 5, 10mg
Dosage/Frequency
1.25-10mg daily
Administration
Tablet - oral
Cost
$11.35-$22.40
Half-life
2-4hrs

Enalapril

Strength
2.5, 5, 10, 20mg
Dosage/Frequency
5-20mg BD
Administration
Tablet - oral
Cost
$12.80-$24.40
Half-life
11hrs
Note: Enalapril doesn't have much evidence for use in hypertension, but particularly has evidence for use in heart failure

Trandolapril

Strength
0.5, 1, 2, 4mg
Dosage/Frequency
0.5-4mg daily
Administration
Tablet - oral
Cost
$9.15-$24.50
Half-life
6-10hrs

Contraindications

  • Pregnancy - teratonogenic
  • Bilateral Renal Artery Stenosis
  • Hereditory Familial Angioedema

Side effects

CAPTOPRIL mnemonic:

Cautions

Use with caution in:

Drug Interactions

Pregnancy

Contraindicated - teratogenic

Breastfeeding

Safe for Captopril and Enalapril. No data for others

Monitoring

Check renal function and electrolytes before starting and review after 1-2 weeks. Consider ceasing potassium supplements/potassium sparing diuretics and monitor BP.

Notes

See also

Australian Medicines Handbook - ACE Inhibitors
NPC module: http://learn.nps.org.au/pluginfile.php/111401/mod_scorm/content/10/mobile_pages/m12_npc_06.html