Clinical beta

FMBM is currently in clinical beta. Content is for professional review/testing and must not replace local protocols, senior clinical judgment, or official prescribing references.

Drug Monograph

Captopril

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Captopril

ACE inhibitor (shorter half-life)

AdultACEiHTNHF

Indication

HTN β€’ HFrEF (selected workflows) β€’ RAAS blockade trials/titration contexts

At a glance

INDICATIONS (CORE USE)

HTN and HFrEF contexts where shorter-acting ACEi schedule is acceptable.

ADULT DOSE (STANDARD)

PO START low (e.g. 6.25–12.5 mg BID/TID), titrate with BP + labs.

MAX DOSE

Indication-specific, often up to ~150 mg/day in divided doses.

Route

PO (shorter-acting; divided dosing)

PEDIATRIC DOSE

Specialist only.

Do not miss

Must-not-miss safety points

Major warning

- Angioedema can be delayed and fatal β†’ DO NOT re-challenge any ACE inhibitor - Pregnancy is contraindicated β†’ DO NOT use

Indications

Shorter half-life ACEi; requires disciplined dose timing and lab monitoring.

Primary

  • Hypertension
  • HFrEF

Secondary

  • Post-MI context (protocol-dependent)

Dosing

STANDARD (ADULT PO)

START low and divide doses; titrate with safety labs.

ADULT DOSE

Common START 6.25–12.5 mg BID/TID, then titrate by response and labs.

PEDIATRIC DOSE

N/A

MAX DOSE

Common ceiling near 150 mg/day divided.

Practical Note

Short half-life means missed doses can drop effect quickly.

Warnings

Clinical warnings

  • Angioedema can be delayed and fatal β€” DO NOT re-challenge. First-dose hypotension risk is higher with volume depletion / HF / high-renin states; correct volume before starting.

Adverse effects

  • Cough
  • hyperkalemia
  • hypotension
  • AKI trend
  • angioedema

Contraindications

  • Pregnancy
  • Prior ACE inhibitor-induced angioedema
  • Bilateral renal artery stenosis (known/suspected)
  • Baseline K+ β‰₯5.5 mmol/L

Drug interactions

  • ARB / aliskiren combination: avoid routine dual RAAS blockade (AKI, hyperkalemia, hypotension risk)
  • Potassium-sparing agents / supplements: hyperkalemia risk
  • NSAIDs β†’ ↑ AKI risk + ↓ ACEi effect β€” avoid or monitor closely
  • Frequent-dose schedules increase risk of unnoticed cumulative hypotension with diuretics.

Special populations

Pediatrics

Specialist only.

Pregnancy

Pregnancy: contraindicated.

Lactation

specialist review.

Renal impairment

Conservative dosing with CKD; monitor potassium/creatinine tightly.

Hepatic impairment

No dominant hepatic limitation; still titrate cautiously.

Elderly

Lower starting dose and slower titration preferred.

Administration

PO in divided schedule (BID/TID).

Monitoring

  • Recheck: - Check creatinine + potassium within 1–2 weeks after initiation - Recheck creatinine + potassium within 1–2 weeks after dose increase - Check earlier if CKD, elderly, volume depletion, or interacting drugs
  • Hold if:
    - HOLD if:
    - SBP <90–100
    - K+ β‰₯5.5 mmol/L
    - creatinine rise >30% from baseline
    - symptomatic hypotension
    - STOP permanently if angioedema
  • If targets not met after reassessment of dose, organ function, and interactions β†’ escalate per protocol (DO NOT continue blindly)

Overdose / toxicity

Clinical Picture

A) Mild β†’ dizziness, hypotension, fatigue B) Moderate β†’ persistent hypotension, AKI trend, hyperkalemia C) Severe β†’ refractory shock, severe hyperkalemia, respiratory compromise (e.g. angioedema context)

Immediate Actions

β€’ Airway + continuous monitoring (ABC, BP, telemetry) β€’ Hypotension β†’ IV fluids first-line β€’ Refractory hypotension β†’ early vasopressors (norepinephrine) β€’ Check potassium immediately β†’ treat per hyperkalemia protocol if elevated β€’ Stop ACE inhibitor

Antidote

- No specific antidote - Supportive care + hemodynamic stabilization - Hyperkalemia treatment β†’ calcium + insulin/dextrose + potassium-shifting protocol - Airway intervention β†’ if angioedema compromises respiration

Decontamination

β€’ Recent oral ingestion β†’ activated charcoal if protected airway and early presentation (toxicology-guided)

Escalation

- Refractory hypotension or airway compromise β†’ ICU + early vasopressors / airway team - Severe hyperkalemia / AKI β†’ nephrology + renal replacement planning if indicated

Clinical pearls

Common mistakes, resistance logic, and bedside traps

High-Yield Summary

Captopril identity = shorter half-life and tighter schedule adherence.

Clinical pearls

Do not assume once-daily behavior from captopril kinetics.

ACE inhibitor safety

  • Document dose timing clearly on discharge plans

Pharmacy Tool

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Captopril 1 mg/mL oral suspension

solution Β· oral

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Pharmacokinetics

Shorter half-life than many ACEi; divided dosing commonly required.

Mechanism of action

ACE inhibition (RAAS blockade) with shorter-acting dose profile.

Common brand names

Saudi Arabia

Capoten, Captopril

Global

(placeholder β€” verify local formulation)

Common trade names are curated examples only β€” formulations and availability vary. Verify the exact product name with your local pharmacy and national regulator before prescribing or dispensing.

Country practice notes

Global data (no country-specific data available)

  • Follow local antimicrobial stewardship policy, hospital formulary, and national resistance guidance.
  • Confirm dosing, stock, and restrictions with institutional pharmacy and current product labeling.

References

Saudi Arabia

  • SFDA (Saudi Food & Drug Authority)
  • Saudi National Formulary / MOH (where available)

International

  • WHO Model List of Essential Medicines (verify current edition)
  • US FDA or EU EMA product information (when national SmPC is unavailable)
  • ACC / AHA HF, post-MI, and HTN guidance
  • KDIGO CKD and proteinuria guidance
  • FDA / SFDA product labeling

Do not miss

  • Angioedema can be delayed and fatal β†’ DO NOT re-challenge
  • Pregnancy contraindicated β†’ DO NOT use
  • First-dose hypotension risk (especially HF / volume depletion) β†’ correct volume before starting
  • Hyperkalemia risk β†’ monitor potassium early
  • Document dose timing clearly on discharge plans