Sacubitril Valsartan
Contraindicated
Textbook
Increased risk of angioedema.
Do not use in conjunction with ACEIs.
Source: G&G 14e · p602
Drug reference
Benazepril
Angiotensin-converting enzyme (ACE) inhibitor (prodrug) · Antihypertensive
START
10 mg PO once daily (5 mg if elderly/on diuretic/renal)
TYPICAL MAX
80 mg/day
STOP IF
Angioedema, severe hyperkalaemia, or rising creatinine >30%
WATCH
K, creatinine baseline + 1–2 weeks after start/dose change, BP
CDSCO approvedATC C09AA07
KDIGO 2024 + manufacturer label
- ONSET
- 1h · BP effect
- PEAK
- 1.5h · Tmax
- t½
- 10h · t½
- DURATION
- 1d · once-daily
EXCRETION
Mainly renal — active metabolite
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Contraindicated (fetotoxicity in 2nd/3rd trimesters).
FDA category + note
Top interactionssee all 12 →
- Sacubitril ValsartanContraindicatedTextbookG&G 14e · p602
- AliskirenContraindicatedDatabaseKimi deep-research + Cla
- AlteplaseSevereTextbookG&G 14e · p600
- AminoglycosidesSevereTextbookG&G 14e
Mechanism
Prodrug rapidly hydrolysed to benazeprilat, which competitively inhibits ACE, blocking conversion of angiotensin I to angiotensin II — reducing vasoconstriction and aldosterone secretion.
Indications
HypertensionHeart failure (adjunct)Diabetic nephropathy / proteinuric CKD
Dosing
- Adult
- Start 10 mg PO once daily (5 mg with diuretic or in elderly); usual 20–40 mg/day in 1–2 divided doses; max 80 mg/day.
- Pediatric
- ≥6 y: 0.2 mg/kg once daily (max 0.6 mg/kg/day or 40 mg).
- Renal adjustment
- CrCl <30: start 5 mg/day; titrate cautiously.
- Hepatic adjustment
- Mild–moderate impairment: no adjustment; severe: caution.
- Geriatric
- Start 5 mg; titrate slowly.
- Max dose
- 80 mg/day
Pharmacokinetics
Onset
BP effect 1 h; full antihypertensive effect 1–2 weeks
Peak effect
~1–2 h (Tmax of benazeprilat)
Duration
~24 h
Half-life
Benazeprilat ~10–11 h
Bioavailability
~37% (oral; food does not significantly affect)
Protein binding
~97%
Metabolism
Hepatic hydrolysis to active benazeprilat
Excretion
Mainly renal (active metabolite)
Contraindications
- History of ACE-inhibitor angioedema
- Bilateral renal artery stenosis
- Concomitant aliskiren in diabetes
- Pregnancy (second/third trimester fetotoxicity)
- Hereditary/idiopathic angioedema
- Hypersensitivity
Side effects
Common
Dry coughDizzinessHyperkalaemiaHeadacheFatigueFirst-dose hypotension
Serious
- Angioedema (laryngeal — fatal)
- Acute kidney injury (volume depletion, RAS)
- Hyperkalaemia
- Cholestatic jaundice (rare)
- Neutropenia (rare)
Pregnancy & lactation
Pregnancy
Contraindicated (fetotoxicity in 2nd/3rd trimesters).
Lactation
Excreted in milk; usually compatible (low transfer) but alternative preferred.
Drug interactions
Aliskiren
Contraindicated
Database
Dual RAAS blockade
Avoid combination
Source: Kimi deep-research + Cla
Alteplase
Severe
Textbook
Increased risk of angioedema.
Avoid combination.
Source: G&G 14e · p600
Aminoglycosides
Severe
Textbook
Increased risk and severity of renal impairment and nephrotoxicity.
Not explicitly stated, but implies careful monitoring of renal function and cautious co-administration.
Source: G&G 14e
Angiotensin Receptor Blockers
Severe
Textbook
Greater incidence of acute kidney injury (AKI) and adverse cardiac events.
The combination of these two classes should be avoided.
Source: Harrison 22e · p2396
Azilsartan
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Candesartan
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Dipeptidyl Peptidase Iv Inhibitor
Severe
Textbook
Increased risk of angioedema.
Avoid combination.
Source: G&G 14e · p600
Losartan + Hydrochlorothiazide
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Olmesartan + Amlodipine
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Olmesartan + Hydrochlorothiazide
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Olmesartan Medoxomil
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Related guidelines
Other Angiotensin-converting enzyme (ACE) inhibitor (prodrug) drugs
Ask House about Benazepril
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Verified: 2026-05-20 · House clinical team·Cockpit curated: 2026-05-20