Angiotensin Converting Enzyme Inhibitors (ACEIs)
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Type of Drug:

Angiotensin converting enzyme inhibitors (ACEls); drugs used to lower blood pressure.

How the Drug Works:

Angiotensin converting enzyme (ACE) is involved in certain chemical reactions that constrict (narrow) blood vessels and cause sodium and fluid retention by the kidney. This can cause an increase in blood pressure. ACEls lower blood pressure by interfering with ACE, which causes blood vessels to relax (widen). Blow flows more freely and at a lower pressure. ACEls also increase the heart’s ability to pump blood in some types of heart failure.


To treat high blood pressure alone or in combination with other blood pressure-lowering medications.

Captopril, Enalapril, Fosinopril, Lisinopril, Quinapril, Ramipril, Trandolapril: To treat certain types congestive of heart failure, usually in combination with other medications (eg, diuretics, digitalis).

CaptopriL: To treat diabetic nephropathy (kidney damage) in patients with Type I (insulin-dependent) diabetes mellitus and retinopathy.

Lisinopril: To improve survival in patients who have had a heart attack within 24 hours.

Unlabeled Uses: Occasionally, doctors may prescribe captopril for the management of specific types of hypertension crises or neonatal and childhood hypertension, treatment of rheumatoid arthritis, certain types of edema, Batter and Raynaud syndromes, and diagnosis of primary aldosteronism and certain kidney disorders. Enalapril has been used to treat diabetic nephropathy.


Low blood pressure: Dizziness and fainting due to lowered blood pressure may OCcur early in therapy. This effect is more likely to OCcur with concurrent diuretic treatment and when arising from a seated or lying position, but can OCcur at any time early in therapy. This effect can also OCcur if several doses are missed and then the medicine is restarted, if the dosage is increased rapidly, or if other blood pressure medications re added.

Potassium: Elevated serum potassium levels have occurred. Use with caulion in the presence of kidney disease, diabetes, and with potassium­ontaining products (eg, salt substitutes, potassium supplements

Cough: A persistent, dry, nonproductive cough can be caused by ACELs. The cough is more likely to OCCur in women and at low doses. Recovery is rapid and complete in 1 to 4 days when the drug has been discontinued.

Race: ACEls may not be as effective in black patients.

Pregnancy: Report pregnancy or suspected pregnancy to your doctor immediately.

First trimester: Fetal exposure to ACEls only during the first trimester usually causes no problems, but the drug should be stopped as soon as possible. Continue use only if clearly needed and potential benefits outweigh the possible hazards to the fetus.

Second and third trimesters: Studies have shown a potential adverse effect on the fetus. When used during the second and third trimesters, ACEls can cause fetal harm or even death. Discontinue the drug as soon as possible.

Breastfeeding: Several ACEls appear in breast milk. It is not known if lisinopril, moexipril, perindopril, or ramipril appear in breast milk. Do not take fosinopril, ramipril, or trandolapril while breastfeeding. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness have not been established. There is limited experience with the use of captopril in children. Unpredictable decreases in blood pressure and associated complications have occurred. Use catopril in children only when other measures for control­ling blood pressure have not been effective.

Lab Tests: Lab tests will be required periodically during treatment. Tests include urine protein, liver function, kidney function, blood cell counts, and sodium and potassium levels.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over­the-counter or prescription medications or dietary supplements while taking these drugs. Drug doses may need to be modified or a different drug prescribed. The following drugs and drug classes interact with these drugs:

  • Allopurinol (eg, Zyloprim) (captopril only)
  • Antacids (eg, Maalox)
  • Capsaicin (eg, Capsin)
  • Diuretics (eg, furosemide)
  • Lithium (eg, Eskalith)
  • NSAIDs (eg, indomethacin)
  • Phenothiazines (eg, promethazine)
  • Potassium-containing salt substitutes (eg, Nu Salt)
  • Potassium-sparing diuretics (eg, triamterene)
  • Potassium supplements (eg, potassium chloride)
  • Probenecid (captopril only)
  • Rifampin (eg, Rifadin) (enalapril only)
  • Tetracyclines (eg, oxytetracyline) (quinapril only)

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