Sacubitril Valsartan
Contraindicated
Textbook
Increased risk of angioedema.
Do not use in conjunction with ACEIs.
Source: G&G 14e · p602
Drug reference
Captopril
ACE Inhibitor · Antihypertensive
ACE InhibitorAntihypertensive
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Avoid in pregnancy unless essential. May adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported. Can cause transient anuric renal failure and oligohydramnios.
FDA category + note
Top interactionssee all 12 →
- Sacubitril ValsartanContraindicatedTextbookG&G 14e · p602
- AminoglycosidesSevereTextbookG&G 14e
- Angiotensin Receptor BlockersSevereTextbookHarrison 22e · p2396
- AzilsartanSevereTextbookG&G 14e
Mechanism
Captopril acts as an Angiotensin-Converting Enzyme (ACE) inhibitor. Inhibition of ACE impacts physiological pathways regulating blood pressure control and renal function. This action is utilized for treating hypertension and cardiac decompensation, although it can also lead to clinical consequences such as hyperkalaemia.
Indications
HypertensionEssential hypertension if used in volume depletion, cardiac decompensation, or renovascular hypertensionHeart failureShort-term treatment within 24 hours of onset of myocardial infarction in clinically stable patientscardiovascular diseasediabetic nephropathyacute myocardial infarctionhigh risk of cardiovascular eventscoronary artery disease (without heart failure)Hypertension (all grades, renovascular, resistant)Congestive heart failure (CHF)Myocardial infarction (MI)Prophylaxis in high cardiovascular risk subjectsNondiabetic nephropathyScleroderma crisisHypertensive urgencies (historically)
Dosing
- Adult
- Hypertension: Initially 12.5–25 mg twice daily, then increased if necessary up to 150 mg daily in 2 divided doses, doses to be increased at intervals of at least 2 weeks, once-daily dosing may be appropriate if other concomitant antihypertensive drugs taken.…
- Renal adjustment
- Use with caution, starting with low dose, and adjust according to response. Hyperkalaemia and other side-effects of ACE inhibitors are more common in those with impaired renal function and the dose may need to be reduced.
- Geriatric
- Hypertension: Initially 6.25 mg twice daily, then increased if necessary up to 150 mg daily in 2 divided doses, doses to be increased at intervals of at least 2 weeks, once-daily dosing may be appropriate if other concomitant antihypertensive drugs taken.
- Max dose
- 150 mg daily
Pharmacokinetics
Peak effect
within an hour
Duration
6–12 hr
Half-life
2.2 h
Bioavailability
65%
Protein binding
30%
Metabolism
Methylation
Excretion
38% urinary
Contraindications
- Hypersensitivity to ACE inhibitors (including angioedema)
- Pregnancy (unless essential)
Side effects
Common
coughhypotensionhyperkalemiaskin rashcough (5%-10%)increase in serum creatinine (<25% normal)Hypotension (initial sharp fall, especially in diuretic-treated and CHF patients)Hyperkalaemia (more likely in patients with impaired renal function and in those taking K+ sparing diuretics, NSAIDs or beta blockers)Cough (persistent, brassy, 4–16%)Rashes (1–4%)Urticaria (1–4%)Dysgeusia (reversible loss or alteration of taste sensation)Headache (1–4%)Dizziness (1–4%)Nausea (1–4%)Bowel upset (1–4%)
Serious
- Agranulocytosis
- Hepatitis
- Leucopenia
- Neutropenia
- Pancytopenia
- Stevens-Johnson syndrome
- Thrombocytopenia
- Cholestatic jaundice
- Fulminant hepatic necrosis
- Hepatic failure
- Angioedema
- Transient anuric renal failure (in newborn when used during pregnancy)
- Oligohydramnios (in newborn when used during pregnancy)
- Stroke
- acute renal failure
- fetopathic syndrome
- glycosuria
- anemia
- hepatotoxicity
- dysgeusia
- hepatic failure (rare)
- agranulocytosis (rare)
- Angioedema (0.06–0.5%, may cause airway obstruction)
- Granulocytopenia (rare)
- Proteinuria (rare)
- Acute renal failure (in patients with bilateral renal artery stenosis)
- excessive hypotension (risk of)
Pregnancy & lactation
Pregnancy
Avoid in pregnancy unless essential. May adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported. Can cause transient anuric renal failure and oligohydramnios.
Lactation
Information on the use of ACE inhibitors in breast-feeding is limited.
Drug interactions
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
Sacubitril With Valsartan
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
Telmisartan + 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
Related guidelines
Other ACE Inhibitor drugs
Ask House about Captopril
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Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-13 · House clinical team