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Captopril and Hydrochlorothiazide


Pronunciation

 (KAP toe pril & hye droe klor oh THYE a zide)


U.S. Brand Names

 Capozide®


Synonyms

 Hydrochlorothiazide and Captopril


Generic Available

 Yes


Canadian Brand Names

 Capozide®


Use

 Management of hypertension and treatment of congestive heart failure


Pregnancy Risk Factor

 C/D (2nd and 3rd trimesters)


Pregnancy Implications

 See individual monographs.


Lactation

 Enters breast milk/compatible


Contraindications

 Hypersensitivity to captopril, hydrochlorothiazide, or any component of the formulation; pregnancy (2nd and 3rd trimesters)


Adverse Reactions

 See individual agents.


Drug Interactions

 Captopril: Substrate of CYP2D6 (major)

Also see individual agents.


Mechanism of Action

 Captopril is a competitive inhibitor of angiotensin-converting enzyme (ACE); prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This results in lower levels of angiotensin II which causes an increase in plasma renin activity and a reduction in aldosterone secretion. Hydrochlorothiazide inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water as well as potassium and hydrogen ions.


Pharmacodynamics/Kinetics

 See individual agents.


Dosage

 Oral: Adults: Hypertension, CHF: May be substituted for previously titrated dosages of the individual components; alternatively, may initiate as follows:

Initial: Single tablet (captopril 25 mg/hydrochlorothiazide 15 mg) taken once daily; daily dose of captopril should not exceed 150 mg; daily dose of hydrochlorothiazide should not exceed 50 mg


Patient Education

 See individual agents. Pregnancy precaution: Inform prescriber if you are or intend to become pregnant.


Cardiovascular Considerations

 Combination therapy for the treatment of hypertension should be individualized for each patient. Potential advantages for captopril and hydrochlorothiazide combination therapy may include improved compliance and synergistic reductions in blood pressure with an accomplished reduction in side effects. See Special Cardiovascular Considerations for individual agents.


Dental Health: Effects on Dental Treatment

 No significant effects or complications reported


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:

25/15: Captopril 25 mg and hydrochlorothiazide 15 mg

25/25: Captopril 25 mg and hydrochlorothiazide 25 mg

50/15: Captopril 50 mg and hydrochlorothiazide 15 mg

50/25: Captopril 50 mg and hydrochlorothiazide 25 mg


References

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.

Kaplan NM and Sever PS, "Combination Therapy: A Key to Comprehensive Patient Care," Am J Hypertens , 1997, 10(7 Pt 2):127S.

Moser M and Black HR, "The Role of Combination Therapy in the Treatment of Hypertension," Am J Hypertens , 1998, 11(6 Pt 2):73S-8S, 95S-100S.


International Brand Names

 Capozide® (CA)


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