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Captopril


Pronunciation

 (KAP toe pril)


U.S. Brand Names

 Capoten®


Synonyms

 ACE


Generic Available

 Yes


Canadian Brand Names

 Alti-Captopril; Apo-Capto®; Capoten™; Gen-Captopril; Novo-Captopril; Nu-Capto; PMS-Captopril


Use

 Management of hypertension; treatment of congestive heart failure, left ventricular dysfunction after myocardial infarction, diabetic nephropathy


Use - Unlabeled/Investigational

 Treatment of hypertensive crisis, rheumatoid arthritis; diagnosis of anatomic renal artery stenosis, hypertension secondary to scleroderma renal crisis; diagnosis of aldosteronism, idiopathic edema, Bartter's syndrome, postmyocardial infarction for prevention of ventricular failure; increase circulation in Raynaud's phenomenon, hypertension secondary to Takayasu's disease


Pregnancy Risk Factor

 C/D (2nd and 3rd trimesters)


Pregnancy Implications

 Cranial defects, hypocalvaria/acalvaria, oligohydramnios, persistent anuria following delivery, hypotension, renal defects, renal dysgenesis/dysplasia, renal failure, pulmonary hypoplasia, limb contractures secondary to oligohydramnios, and stillbirth reported. ACE inhibitors should be avoided during pregnancy, particularly in the 2nd and 3rd trimesters.


Lactation

 Enters breast milk/compatible


Contraindications

 Hypersensitivity to captopril or any component of the formulation; angioedema related to previous treatment with an ACE inhibitor; idiopathic or hereditary angioedema; bilateral renal artery stenosis; pregnancy (2nd or 3rd trimester)


Warnings/Precautions

 Anaphylactic reactions can occur. Angioedema can occur at any time during treatment (especially following first dose). Angioedema may involve head and neck (potentially affecting the airway) or the intestine (presenting with abdominal pain). Careful blood pressure monitoring with first dose (hypotension can occur especially in volume depleted patients). Dosage adjustment needed in renal impairment. Use with caution in hypovolemia; collagen vascular diseases; valvular stenosis (particularly aortic stenosis); hyperkalemia; or before, during, or immediately after anesthesia. Avoid rapid dosage escalation which may lead to renal insufficiency. Rare toxicities associated with ACE inhibitors include cholestatic jaundice (which may progress to hepatic necrosis) and neutropenia/agranulocytosis with myeloid hyperplasia. If patient has renal impairment then a baseline WBC with differential and serum creatinine should be evaluated and monitored closely during the first 3 months of therapy. Hypersensitivity reactions may be seen during hemodialysis with high-flux dialysis membranes (eg, AN69). Deterioration in renal function can occur with initiation. Use with caution in unilateral renal artery stenosis and pre-existing renal insufficiency.


Adverse Reactions

1% to 10%:

Cardiovascular: Hypotension (1% to 3%), tachycardia (1%), chest pain (1%), palpitation (1%)

Dermatologic: Rash (maculopapular or urticarial) (4% to 7%), pruritus (2%); in patients with rash, a positive ANA and/or eosinophilia has been noted in 7% to 10%.

Endocrine & metabolic: Hyperkalemia (1% to 11%)

Hematologic: Neutropenia may occur in up to 4% of patients with renal insufficiency or collagen-vascular disease.

Renal: Proteinuria (1%), increased serum creatinine, worsening of renal function (may occur in patients with bilateral renal artery stenosis or hypovolemia)

Respiratory: Cough (<1% to 2%)

Miscellaneous: Hypersensitivity reactions (rash, pruritus, fever, arthralgia, and eosinophilia) have occurred in 4% to 7% of patients (depending on dose and renal function); dysgeusia - loss of taste or diminished perception (2% to 4%)

Frequency not defined:

Cardiovascular: Angioedema, cardiac arrest, cerebrovascular insufficiency, rhythm disturbances, orthostatic hypotension, syncope, flushing, pallor, angina, MI, Raynaud's syndrome, CHF

Central nervous system: Ataxia, confusion, depression, nervousness, somnolence

Dermatologic: Bullous pemphigus, erythema multiforme, Stevens-Johnson syndrome, exfoliative dermatitis

Endocrine & metabolic: Alkaline phosphatase increased, bilirubin increased, gynecomastia

Gastrointestinal: Pancreatitis, glossitis, dyspepsia

Genitourinary: Urinary frequency, impotence

Hematologic: Anemia, thrombocytopenia, pancytopenia, agranulocytosis, anemia

Hepatic: Jaundice, hepatitis, hepatic necrosis (rare), cholestasis, hyponatremia (symptomatic), transaminases increased

Neuromuscular & skeletal: Asthenia, myalgia, myasthenia

Ocular: Blurred vision

Renal: Renal insufficiency, renal failure, nephrotic syndrome, polyuria, oliguria

Respiratory: Bronchospasm, eosinophilic pneumonitis, rhinitis

Miscellaneous: Anaphylactoid reactions

<1% (Limited to important or life-threatening symptoms; frequency to placebo): Gastric irritation, abdominal pain, nausea, vomiting, diarrhea, anorexia, constipation, aphthous ulcers, peptic ulcer, dizziness, headache, malaise, fatigue, insomnia, xerostomia, dyspnea, alopecia, paresthesia, angina, glomerulonephritis, cholestatic jaundice, psoriasis, hyperthermia, myalgia, arthralgia

Postmarketing and/or case reports: Aplastic anemia, hemolytic anemia, bronchospasm, alopecia, systemic lupus erythematosus, Kaposi's sarcoma, pericarditis, exacerbations of Huntington's disease, Guillain-Barré syndrome, seizure (in premature infants). A syndrome which may include fever, myalgia, arthralgia, interstitial nephritis, vasculitis, rash, eosinophilia, and elevated ESR has been reported for captopril and other ACE inhibitors.


Overdosage/Toxicology

 Mild hypotension has been the primary toxic effect seen with acute overdose. Bradycardia may also occur. Hyperkalemia occurs even with therapeutic doses, especially in patients with renal insufficiency and those taking NSAIDs. Treatment is symptom-directed and supportive.


Drug Interactions

 Substrate of CYP2D6 (major)

Allopurinol: Case reports (rare) indicate a possible increased risk of Stevens-Johnson syndrome when combined with captopril.

Alpha1 blockers: Hypotensive effect increased.

Aspirin: The effects of ACE inhibitors may be blunted by aspirin administration, particularly at higher dosages (see Cardiovascular Considerations) and/or increase adverse renal effects.

CYP2D6 inhibitors: May increase the levels/effects of captopril. Example inhibitors include chlorpromazine, delavirdine, fluoxetine, miconazole, paroxetine, pergolide, quinidine, quinine, ritonavir, and ropinirole.

Diuretics: Hypovolemia due to diuretics may precipitate acute hypotensive events or acute renal failure.

Insulin: Risk of hypoglycemia may be increased.

Lithium: Risk of lithium toxicity may be increased; monitor lithium levels, especially the first 4 weeks of therapy.

Mercaptopurine: Risk of neutropenia may be increased.

NSAIDs: May attenuate hypertensive efficacy; effect has been seen with captopril and may occur with other ACE inhibitors; monitor blood pressure. May increase adverse renal effects.

Potassium-sparing diuretics (amiloride, potassium, spironolactone, triamterene): Increased risk of hyperkalemia.

Potassium supplements may increase the risk of hyperkalemia.

Trimethoprim (high dose) may increase the risk of hyperkalemia.


Ethanol/Nutrition/Herb Interactions

Food: Captopril serum concentrations may be decreased if taken with food. Long-term use of captopril may result in a zinc deficiency which can result in a decrease in taste perception.

Herb/Nutraceutical: Avoid dong quai if using for hypertension (has estrogenic activity). Avoid ephedra, yohimbe, ginseng (may worsen hypertension). Avoid garlic (may have increased antihypertensive effect).


Stability

 Unstable in aqueous solutions; to prepare solution for oral administration, mix prior to administration and use within 10 minutes


Mechanism of Action

 Competitive inhibitor of angiotensin-converting enzyme (ACE); prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor; results in lower levels of angiotensin II which causes an increase in plasma renin activity and a reduction in aldosterone secretion


Pharmacodynamics/Kinetics

Onset of action: Peak effect: Blood pressure reduction: 1-1.5 hours after dose

Duration: Dose related, may require several weeks of therapy before full hypotensive effect

Absorption: 60% to 75%; reduced 30% to 40% by food

Protein binding: 25% to 30%

Metabolism: 50%

Half-life elimination (renal and cardiac function dependent):

Adults, healthy volunteers: 1.9 hours; Congestive heart failure: 2.06 hours; Anuria: 20-40 hours

Excretion: Urine (95%) within 24 hours


Dosage

 Note: Dosage must be titrated according to patient's response; use lowest effective dose. Oral:

Infants: Initial: 0.15-0.3 mg/kg/dose; titrate dose upward to maximum of 6 mg/kg/day in 1-4 divided doses; usual required dose: 2.5-6 mg/kg/day

Children: Initial: 0.5 mg/kg/dose; titrate upward to maximum of 6 mg/kg/day in 2-4 divided doses

Older Children: Initial: 6.25-12.5 mg/dose every 12-24 hours; titrate upward to maximum of 6 mg/kg/day

Adolescents: Initial: 12.5-25 mg/dose given every 8-12 hours; increase by 25 mg/dose to maximum of 450 mg/day

Adults:

Acute hypertension (urgency/emergency): 12.5-25 mg, may repeat as needed (may be given sublingually, but no therapeutic advantage demonstrated)

Hypertension:

Initial dose: 12.5-25 mg 2-3 times/day; may increase by 12.5-25 mg/dose at 1- to 2-week intervals up to 50 mg 3 times/day; maximum dose: 150 mg 3 times/day; add diuretic before further dosage increases

Usual dose range (JNC 7): 25-100 mg/day in 2 divided doses

Congestive heart failure:

Initial dose: 6.25-12.5 mg 3 times/day in conjunction with cardiac glycoside and diuretic therapy; initial dose depends upon patient's fluid/electrolyte status

Target dose: 50 mg 3 times/day

Maximum dose: 150 mg 3 times/day

LVD after MI: Initial dose: 6.25 mg followed by 12.5 mg 3 times/day; then increase to 25 mg 3 times/day during next several days and then over next several weeks to target dose of 50 mg 3 times/day

Diabetic nephropathy: 25 mg 3 times/day; other antihypertensives often given concurrently

Dosing adjustment in renal impairment:

Clcr 10-50 mL/minute: Administer at 75% of normal dose.

Clcr<10 mL/minute: Administer at 50% of normal dose.

Note: Smaller dosages given every 8-12 hours are indicated in patients with renal dysfunction; renal function and leukocyte count should be carefully monitored during therapy.

Hemodialysis: Moderately dialyzable (20% to 50%); administer dose postdialysis or administer 25% to 35% supplemental dose.

Peritoneal dialysis: Supplemental dose is not necessary.


Monitoring Parameters

 BUN, serum creatinine, urine dipstick for protein, complete leukocyte count, and blood pressure


Test Interactions

 Increased BUN, creatinine, potassium, positive Coombs' [direct]; decreased cholesterol (S); may cause false-positive results in urine acetone determinations using sodium nitroprusside reagent


Dietary Considerations

 Should be taken at least 1 hour before or 2 hours after eating.


Patient Education

 Inform prescriber of all prescriptions, OTC medications, or herbal products you are taking, and any allergies you have. Do not take any new medication during therapy unless approved by prescriber. Do not use potassium supplement or salt substitutes without consulting prescriber. Take exactly as directed; do not discontinue without consulting prescriber. Take first dose at bedtime. Take all doses on an empty stomach, 1 hour before or 2 hours after meals. This drug does not eliminate need for diet or exercise regimen as recommended by prescriber. May cause dizziness, fainting, or lightheadedness (use caution when driving or engaging in tasks that require alertness until response to drug is known); postural hypotension (use caution when rising from lying or sitting position or climbing stairs); or nausea, vomiting, abdominal pain, dry mouth, or transient loss of appetite (small, frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help). Report chest pain or palpitations; mouth sores; fever or chills; swelling of extremities, face, mouth, or tongue; skin rash; numbness, tingling, or pain in muscles; respiratory difficulty or unusual cough; and other persistent adverse reactions. Pregnancy precautions Inform prescriber if you are or intend to become pregnant. This drug should not be used in the 2nd or 3rd trimester of pregnancy. Consult prescriber for appropriate contraceptive measures if necessary.


Nursing Implications

 Watch for hypotensive effect within 1-3 hours of first dose or new higher dose


Anesthesia and Critical Care Concerns/Other Considerations

 Severe hypotension may occur in patients who are sodium and/or volume depleted.

ACE inhibitors are indicated in patients postmyocardial infarction in whom left ventricular ejection fraction is <40%. When used in patients with heart failure, the target dose of 50 mg 3 times/day should be achieved, if possible. Lower daily doses of ACE inhibitors have not demonstrated the same cardioprotective effects.

ACE inhibitor therapy may elicit rapid increases in potassium and creatinine, especially when used in patients with bilateral renal artery stenosis. When ACE inhibition is introduced in patients with pre-existing diuretic therapy who are hypovolemic, the ACE inhibitor may induce acute hypotension. Because of the potent teratogenic effects of ACE inhibitors, these drugs should be avoided, if possible, when treating women of childbearing potential not on effective birth control measures.


Cardiovascular Considerations

 The duration of action of captopril is limited compared to other ACE inhibitors and it is important that every 8-hour dosing be employed for effective treatment. However, when captopril is combined with hydrochlorothiazide, the duration of action of captopril may be prolonged.

ACE inhibitors decrease morbidity and mortality in patients with asymptomatic and symptomatic left ventricular dysfunction. In this situation, they decrease hospitalizations for, and retard progression to, congestive heart failure. According to 2004 ACC/AHA STEMI guidelines, an ACE inhibitor should be administered orally within the first 24 hours of STEMI to patients with anterior infarction, pulmonary congestion or LVEF <0.4, in the absence of hypotension or known contraindications to that class of medicines. In the emergency management of complicated STEMI, a short-acting ACEI (eg, captopril 1-6.25 mg) may be added once the patient's systolic blood pressure is >100 mm Hg and not <30 mm Hg below baseline. When used in patients with heart failure, the target dose of 50 mg 3 times/day should be achieved, if possible. Lower daily doses of ACE inhibitors have not demonstrated the same cardioprotective effects. ACE inhibitors have renal protective effects in patients with proteinuria and possibly cardioprotective effects in high-risk patients.

ACE inhibitor therapy may elicit rapid increases in potassium and creatinine, especially when used in patients with bilateral renal artery stenosis. When ACE inhibition is introduced in patients with pre-existing diuretic therapy who are hypovolemic, the ACE inhibitor may induce acute hypotension. In those patients experiencing cough on an ACE inhibitor, the ACE inhibitor may be discontinued and, if necessary, angiotensin receptor blocker therapy instituted. Concomitant indomethacin therapy may blunt the reduction in sitting and 24-hour ambulatory diastolic blood pressure; use of NSAIDs should be avoided or limited, with monitoring of blood pressure control in this setting. In patients with heart failure, NSAID use may be associated with an increased risk for fluid accumulation and edema. Because of the potent teratogenic effects of ACE inhibitors, these drugs should be avoided, if possible, when treating women of childbearing potential not on effective birth control measures.

In the treatment of unstable angina/non-ST-segment elevation MI, ACE inhibitors are recommended when hypertension persists despite treatment with nitroglycerin and a beta-blocker in patients with LV systolic dysfunction or CHF and in ischemic patients with diabetes (Class I). ACE inhibitors are also recommended for all post-ACS individuals (Class IIa).


Dental Health: Effects on Dental Treatment

 Key adverse event(s) related to dental treatment: Loss or diminished perception of taste and orthostatic hypotension.


Dental Health: Vasoconstrictor/Local Anesthetic Precautions

 No information available to require special precautions


Mental Health: Effects on Mental Status

 May cause drowsiness or insomnia


Mental Health: Effects on Psychiatric Treatment

 May rarely cause agranulocytosis; use caution with clozapine and carbamazepine; may decrease lithium clearance resulting in an increase in serum lithium levels and potential lithium toxicity; monitor serum lithium levels


Dosage Forms

 Tablet: 12.5 mg, 25 mg, 50 mg, 100 mg


Extemporaneously Prepared

 Captopril has limited stability in aqueous preparations. The addition of an antioxidant (sodium ascorbate) has been shown to increase the stability of captopril in solution; captopril (1 mg/mL) in syrup with methylcellulose is stable for 7 days stored either at 4°C or 22°C; captopril (1 mg/mL) in distilled water (no additives) is stable for 14 days if stored at 4°C and 7 days if stored at 22°C; captopril (1 mg/mL) with sodium ascorbate (5 mg/mL) in distilled water is stable for 56 days at 4°C and 14 days at 22°C. Captopril 0.75 mg/mL was found stable for up to 60 days at 5°C and 25°C in a 1:1 mixture of Ora-Sweet® and Ora-Plus®, in Ora-Sweet® SF and Ora-Plus®, and in cherry syrup.

Powder papers can also be made; powder papers are stable for 12 weeks when stored at room temperature

Allen LV and Erickson III MA, "Stability of Baclofen, Captopril, Diltiazem Hydrochloride, Dipyridamole, and Flecainide Acetate in Extemporaneously Compounded Oral Liquids," Am J Health Syst Pharm , 1996, 53:2179-84.

Nahata MC, Morosco RS, and Hipple TF, "Stability of Captopril in Three Liquid Dosage Forms," Am J Hosp Pharm , 1994, 51(1):95-96.

Taketomo CK, Chu SA, Cheng MH, et al, "Stability of Captopril in Powder Papers Under Three Storage Conditions," Am J Hosp Pharm , 1990;47(8):1799-1801.


References

Antman EM, Anbe SC, Alpert JS, et al, "ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction - Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)," Circulation, 2004, 110:588-636. Available at: http://www.circulationaha.org/cgi/content/full/110/5/588. Last accessed October 26, 2004.

Braunwald E, Antman EM, Beasley JW, et al, "ACC/AHA 2002 Guideline Update for the Management of Patients With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction - Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina)," J Am Coll Cardiol , 2002, 40(7):1366-74. Available at: http://www.acc.org/clinical/guidelines/unstable/incorporated/index.htm. Accessed May 20, 2003.

Chase MP, Fiarman GS, Scholz FJ, et al, "Angioedema of the Small Bowel Due to an Angiotensin-Converting Enzyme Inhibitor," J Clin Gastroenterol , 2000, 31(3):254-7.

Chobanian AV, Bakris GL, Black HR, et al, "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report," JAMA , 2003, 289(19):2560-71.

Conlin P, Moore T, Swartz S, et al, "Effect of Indomethacin on Blood Pressure Lowering by Captopril and Losartan in Hypertensive Patients," Hypertension , 2000, 36(3):461-5.

"Consensus Recommendations for the Management of Chronic Heart Failure. On Behalf of the Membership of the Advisory Council to Improve Outcomes Nationwide in Heart Failure," Am J Cardiol , 1999, 83(2A):1A-38A.

Hunt SA, Baker DW, Chin MH, et al, "ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure)," J Am Coll Cardiol , 2001, 38(7):2101-13.

"K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Kidney Disease Outcome Quality Initiative," Am J Kidney Dis , 2002, 39(2 Suppl 2):1-246. Available at: http://www.kidney.org/professionals/doqi/kdoqi/toc.htm. Accessed August 1, 2003.

Packer M, Poole-Wilson PA, Armstrong PW, et al, "Comparative Effects of Low and High Doses of the Angiotensin-Converting Enzyme Inhibitor, Lisinopril, on Morbidity and Mortality in Chronic Heart Failure," Circulation , 1999, 100(23):2312-8.

Pfeffer MA, Greaves SC, Arnold JM, et al, "Early Versus Delayed Angiotensin-Converting Enzyme Inhibition Therapy in Acute Myocardial Infarction. The Healing and Early Afterload Reducing Therapy Trial," Circulation , 1997, 95(12):2643-51.

Smoger SH and Sayed MA, "Simultaneous Mucosal and Small Bowel Angioedema Due to Captopril," South Med J , 1998, 91(11):1060-3.


International Brand Names

 ACE-Hemmer® (DE); ACE-Hemmer-ratiopharm® (DE); Acenorm® (AU, DE); Aceomel® (HU, IE); Acepress® (ID, IT); Aceprilex® (IT); Acepril® (GB); Aceten® (IN, RU, ZA); Actopril® (IE); Adco-Captopril® (ZA); Adocor® (DE); Alkadil® (CZ, RO, SI, YU); Alopresin® (ES); Alti-Captopril (CA); Altran® (CO); Angiopril® (RU); Angiten® (BD); Apo-Capto® (CA, CZ, SG); Apo-Captopril® (ZA); Asisten® (AR); Calpix® (PT); Capace® (AT, ZA); Capin® (HU); Capocard® (LB, RO); Capoten® (AU, BE, BR); Capoten™ (CA); Capoten® (CL, CN, CO, CR, CZ, DK, ES, FI, GB, GT, HN, ID, IE, IT, LU, MX, NL, NO, NZ, PA, PT, RO, RU, SE, SG, SV, TH, ZA); Capotril® (BD); Capril® (BD); Captensin® (ID); Capti® (IL); Capto 1A Pharma® (DE); Capto AbZ® (DE); capto-basan® (CH); Captobeta® (DE); Capto Biochemie® (DE); Capto-corax® (DE); Captodan® (DK); Captodoc® (DE); Capto-dura® (DE); Capto Eu Rho® (DE); Captoflux® (DE); Captogamma® (DE); Captohexal® (AU, DE, LU, NZ, PL, ZA); Capto-Isis® (DE); Captolane® (FR); Captol® (DK); Capto Lich® (DE); Captomax® (ZA); Captomerck® (DE); Captomin® (FI); Captophar® (BE); Captopren® (CO); Captopril 1 A Pharma® (DE); Captopril acis® (DE); Captopril AL® (DE); Captopril Alpharma® (PT, SE); Captopril Alter® (ES); Captoprilan® (DO); Captopril Apogepha® (DE); Captopril Apothecon® (ES); Captopril Atid® (DE); Captopril® (AU, BR, CL, CO, CZ, EC, ES, GB, LU, NO, PL, RO, RU, YU); Captopril-axsan® (DE); Captopril Basics® (DE); Captopril Bayvit® (ES); Captopril-BC (AU); Captopril BC® (BE); Captopril Bexal® (ES, PT); Captopril Biochemie® (CO, FI, SE); Captopril Chinoin® (HU); Captopril Cinfa® (ES); Captopril-Cophar® (CH); Captopril Denk® (DE); Captopril DOC® (IT); Captopril Dorom® (IT); Captopril Dumex-Alpharma® (DK); Captopril Edigen® (ES); Captopril EG® (IT); Captopril Esteve® (ES); Captopril Geminis® (ES); Captopril Genericon® (AT); Captopril Generics® (FI); Captopril Genfar® (EC); Captopril-GRY® (DE); Captopril Heumann® (DE); Captopril Hexal® (RU); Captopril Higea® (CO); Captopril Lindo® (DE); Captopril Mabo® (ES); Captopril Medartuum® (SE); Captopril-Mepha® (CH); Captopril Merck® (ES, IT, PT); Captopril MK® (CO, CR, DO, GT, HN, PA, SV); Captopril Mundogen® (ES); Captopril NM® (DK); Captopril NM Pharma® (SE); Captopril Normon® (ES); Captopril PB® (DE); Captopril Pfleger® (DE); Captopril Pharmagenus® (ES); Captopril Pharmavit® (HU); Captopril Pliva® (DK, FI, SE); Captopril Qualix® (ES); Captopril Ratiopharm® (AT, ES); Captopril-ratiopharm® (IT); Captopril Ratiopharm® (SE); Captopril Rubio® (ES); Captopril Sandoz® (DE); Captopril Stada® (DE); Captopril Tamarang® (ES); Captopril Tarbis® (ES); Captopril Teva® (IT); Captopril T.S.® (IT); Captopril Ur® (ES); Captopril Verla® (DE); Capto-Puren® (DE); Captor® (IE); Captosina® (ES); Captosol® (CH); Captostad® (FI); capto von ct® (DE); Captral® (MX); Cardiace® (ZA); Cardipril® (MX); Cardopril® (BD); Carencil® (PT); Casipril® (ID); Catonet® (DK); Catoplin® (SG); Catoprol® (BR); Cesplon® (ES); Chem mart Captopril® (AU); Coronorm® (DE); cor tensobon® (DE); Cryopril® (MX); Dardex® (ES); DBL Captopril® (AU); Debax® (AT); Dexacap® (ID); Dilabar® (ES); Doccaptopri® (BE); Ecaten® (MX); Ecopace® (GB); Enzace® (AU); Epicordin® (DE); Epsitron® (CY, TH); Eukaptil® (YU); Europril® (RO); Farcopril® (RO); Farmoten® (ID); Garanil® (ES); Gemzil® (TH); Gen-Captopril (CA); GenRX Captopril® (AU); Geroten® (IE); Healthsense Captopril® (AU); Hipertil® (PT); Hipocatril® (BR); Hipotensil® (PT); Huma-Captopril® (HU); Hypotensor® (RO); Impax® (BE); Inhibace® (IL); Jucapt® (DE); Kaplon® (GB); Kapril® (RO, TR); Kaptopril-Akri® (RU); Kaptopril® (RU, SI, YU); Kaptoril® (TR); Katopil® (YU); Kenolan® (MX); Ketanine® (SG); Lenpryl® (MX); Locap® (ID); Lopirin® (AT, CH, DE); Lopril® (FI, FR); Maxipril® (IT); Merck-Captopril® (BE, ZA); Mereprine® (PT); Metopril® (ID); Miniten® (RO); MTW-Captopril® (DE); Mundil® (DE); Novo-Captopril (CA); Novo-Captoril® (RO); Nu-Capto (CA); Pertacilon® (SG); Phamopril® (DE); PMS-Captopril (CA); Praten® (ID); Prilovase® (PT); Prilpressin® (BR); Properil® (CL); Rilcapton® (RO, RU, SG, SK, VN); Rolab-Captopril® (ZA); Romir® (MX); Ropril® (BG, KW, LB, MA, MY, SY); Scantensin® (ID); Sigacap® (DE); Sintofarma Captopril® (BR); Tenofax® (ID); Tenpril® (IT); Tensicap® (ID); Tensiomin® (CZ, DE, HU, RO, RU, TH); Tensobon® (DE, ID); Tensoprel® (CR, DO, ES, SG); Tensopril® (GB, IE, PT); Tensostad® (DE); Terry White Chemists Captopril® (AU); Topril® (BD); Trensin® (PA, SV); Vapril® (ID); Venopril® (BR); Vidapril® (PT); Zapto® (ZA); Zorkaptil® (YU)


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