ANGIOTENSIN-CONVERTING ENZYME (ACE)

Brand & Generic Names

Capozide	Prinzide
CAPTOPRIL &	Vaseretic
HYDROCHLOROTHIAZIDE	Zestoretic
ENALAPRIL &
HYDROCHLOROTHIAZIDE
LISINOPRIL &
HYDROCHLOROTHIAZIDE

Basic Information

• Habit forming? No
• Prescription needed? Yes
• Available as generic? No
• Drug class: Antihypertensive, diuretic (thiazide), ACE inhibitor

Uses

• Treatment for high blood pressure and congestive heart failure.
• Reduces fluid retention.

Dosage & Usage Information

How to take:
Tablet--Swallow with liquid. Instructions to take on empty stomach mean 1 hour before or 2 hours after eating.

When to take:
At the same times each day, usually 2 to 3 times daily. Take first dose at bedtime and lie down immediately.

If you forget a dose:
Take as soon as you remember up to 2 hours late. If more than 2 hours, wait for next scheduled dose (don't double this dose).

What drug does:
Forces sodium and water excretion, reducing body fluid.
Relaxes muscle cells of small arteries.
Reduced body fluid and relaxed arteries lower blood pressure.
Reduces resistance in arteries.
Strengthens heartbeat.

Time lapse before drug works:
4 to 6 hours. May require several weeks to lower blood pressure.

Don't take with:
Non-prescription drugs without consulting doctor.
Any other medicine without consulting your doctor or pharmacist.

Overdose

SYMPTOMS:
Cramps, weakness, drowsiness, weak pulse, low blood pressure.

WHAT TO DO:

• Dial 911 (emergency) or O (operator) for an ambulance or medical help. Then give first aid immediately.
• See EMERGENCY Information.

Possible Adverse Reactions or Side Effects

Life-threatening:

Irregular heartbeat (fast Discontinue. Seek or uneven); hives, rash, emergency treatment. intense itching, faintness soon after a dose (anaphylaxis).

Common:

• Dry mouth, thirst, tiredness, weakness, muscle cramps, vomiting, chest pain, skin rash, coughing, weak pulse.
• Taste loss, dizziness.

Infrequent:

• Face, mouth, hands swell.
• Nausea, diarrhea.

Rare:

Jaundice (yellow eyes and skin), bruising, back pain.

Warnings & Precautions

Don't take if:

• You are allergic to any ACE inhibitor or any thiazide diuretic drug.
• You are receiving blood from a blood bank.
• If you will have surgery within 2 months, including dental surgery, requiring general or spinal anesthesia.

Before you start, consult your doctor:

• If you have had a stroke.
• If you have angina, heart or blood vessel disease, a high level of potassium in blood, lupus, gout, liver, pancreas or kidney disorder.
• If you have any autoimmune disease, including AIDS or lupus.
• If you are on severe salt-restricted diet.
• If you are allergic to any sulfa drug.
• If you have a bone marrow disorder.

Over age 60:
Adverse reactions and side effects may be more frequent and severe than in younger persons, especially dizziness and excessive potassium loss.

Pregnancy:
Risk to unborn child outweighs drug benefits. Don't use.

Breast-feeding:
Drug passes into milk. Avoid drug or discontinue nursing until you finish medicine. Consult doctor for advice on maintaining milk supply.

Infants & children:
Not recommended.

Prolonged use:
Talk to your doctor about the need for follow-up medical examinations or laboratory studies to check blood pressure, ECG*, liver function, kidney function.

Skin & sunlight:
May cause rash or intensify sunburn in areas exposed to sun or sunlamp.

Driving, piloting or hazardous work:
Don't drive or pilot aircraft until you learn how medicine affects you. Don't work around dangerous machinery. Don't climb ladders or work in high places. Danger increases if you drink alcohol or take medicine affecting alertness and reflexes, such as antihistamines, tranquilizers, sedatives, pain medicine, narcotics and mind-altering drugs.

Discontinuing:
Don't discontinue without consulting doctor. Dose may require gradual reduction if you have taken drug for a long time. Doses of other drugs may also require adjustment.

Others:

• Hot weather and fever may cause dehydration and drop in blood pressure. Dose may require temporary adjustment. Weigh daily and report any unexpected weight decreases to your doctor.
• May cause rise in uric acid, leading to gout.
• May cause blood-sugar rise in diabetics.

Possible Interaction with Other Drugs

GENERIC NAME	COMBINED EFFECT
------------------------	-----------------------
Allopurinol	Decreased allopurinol effect.
Amiloride	Possible excessive potassium in
	blood.
Antidepressants,	Dangerous drop in
tricyclic (TCA)*	blood pressure. Avoid combination
	unless under medical supervision.
Antihypertensives,	Increased antihypertensive
other*	effect. Dosage of each may require
	adjustment.
Barbiturates*	Increased hydrochlorothiazide
	effect.
Beta-adrenergic	Increased antihypertensive
blockers*	effect. Dosage of each may require
	adjustments.
Carteolol	Increased antihypertensive effects
	of both drugs. Dosages may require
	adjustment.
Chloramphenicol	Possible blood disorders.
Cholestyramine	Decreased hydrochlorothiazide
	effect.
Cortisone drugs*	Excessive potassium loss that
	causes dangerous heart rhythms.
Digitalis	Excessive potassium
preparations*	loss that causes dangerous heart
	rhythms.
Diuretics*	Decreased blood pressure.
Lisinopril	Increased antihypertensive effect.
	Dosage of each may require
	adjustment.
Lithium	Increased effect of lithium.
MAO inhibitors*	Increased hydrochlorothiazide
	effect.
Nicardipine	Blood pressure drop. Dosages may
	require adjustment.
Nimodipine	Possible irregular heartbeat. May
	worsen congestive heart failure.
Nitrates*	Excessive blood pressure drop.
Non-steroidal	Decreased captopril
anti-inflammatory	effect.
Potassium	Excessive potassium
supplements*	in blood.
Probenecid	Decreased probenecid effect.
Sotalol	Increased antihypertensive effects
	of both drugs. Dosages may require
	adjustment.
Spironolactone	Possible excessive potassium in
	blood.
Triamterene	Possible excessive potassium in
	blood.

Possible Interaction with Other Substances

INTERACTS WITH	COMBINED EFFECT
---------------	---------------
Alcohol:	Dangerous blood pressure drop.
	Avoid.
Low-salt milk.	Possible excessive potassium in
	blood.
Cocaine	Increased risk of heart block and
	high blood pressure.
Salt substitutes.	Possible excessive potassium.
Marijuana:	Increased dizziness, may increase
	blood pressure.
Tobacco:	May decrease blood pressure
	lowering effect.