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ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS AND HYDROCHLOROTHIAZIDE (Systemic)†
Some commonly used brand names are:
In the U.S.—
† Not commercially available in Canada.
This combination belongs to the class of medicines called high blood pressure medicines (antihypertensives). It is used to treat high blood pressure (hypertension).
High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.
The exact way in which benazepril, captopril, enalapril, lisinopril, moexipril, and quinapril work is not known. They block an enzyme in the body that is necessary to produce a substance that causes blood vessels to tighten. As a result, they relax blood vessels. This lowers blood pressure and increases the supply of blood and oxygen to the heart. Hydrochlorothiazide helps reduce the amount of salt and water in the body by acting on the kidneys to increase the flow of urine; this also helps to lower blood pressure.
This combination may also be used for other conditions as determined by your doctor.
This medicine is available only with doctor"s prescription, in the following dosage forms:
Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For the angiotensin-converting enzyme (ACE) inhibitors and hydrochlorothiazide, the following should be considered:
Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to benazepril, enalapril, captopril, lisinopril, moexipril, quinapril, sulfonamides (sulfa drugs), bumetanide, furosemide, acetazolamide, dichlorphenamide, or methazolamide or to hydrochlorothiazide or any of the other thiazide diuretics (water pills). Also tell your health care professional if you are allergic to any other substances, such as foods, sulfites or other preservatives, or dyes.
Pregnancy—Studies with this combination medicine have not been done in pregnant women. However, use of any of the ACE inhibitors during pregnancy, especially in the second and third trimesters (after the first three months), can cause low blood pressure, kidney failure, too much potassium, or even death in newborns. Therefore, it is important that you check with your doctor immediately if you think that you may be pregnant . Be sure that you have discussed this with your doctor before taking this medicine. In addition, if your medicine contains:
Children—Children may be especially sensitive to the blood pressure-lowering effect of ACE inhibitors. This may increase the chance of side effects or other problems during treatment. Extra caution may be necessary when using hydrochlorothiazide in infants with jaundice because it can make this condition worse. Therefore, it is especially important that you discuss with the child"s doctor the good that this medicine may do as well as the risks of using it.
Older adults—Dizziness or lightheadedness and symptoms of too much potassium loss may be more likely to occur in the elderly, who may be more sensitive to the effects of this medicine.
Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When taking ACE inhibitors and hydrochlorothiazide it is especially important that your health care professional know if you are taking any of the following:
Other medical problems—The presence of other medical problems may affect the use of the ACE inhibitors. Make sure you tell your doctor if you have any other medical problems, especially:
Proper Use of This Medicine
To help you remember to take your medicine, try to get into the habit of taking it at the same time each day.
For patients taking captopril and hydrochlorothiazide or moexipril and hydrochlorothiazide :
For patients taking this medicine for high blood pressure :
This medicine may cause you to have an unusual feeling of tiredness when you begin to take it. You may also notice an increase in the amount of urine or in your frequency of urination. After you have taken the medicine for a while, these effects should lessen. In general, to keep the increase in urine from affecting your sleep:
However, it is best to plan your dose or doses according to a schedule that will least affect your personal activities and sleep. Ask your health care professional to help you plan the best time to take this medicine.
Dosing—The dose of these medicines will be different for different patients. Follow your doctor"s orders or the directions on the label . The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.
The number of tablets that you take depends on the strength of the medicine.
Missed dose—If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Storage—To store this medicine:
Precautions While Using This Medicine
It is important that your doctor check your progress at regular visits to make sure that this medicine is working properly and to check for unwanted effects.
Dizziness or lightheadedness may occur, especially after the first dose of this medicine. Make sure you know how you react to the medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy.
Check with your doctor right away if you become sick while taking this medicine, especially with severe or continuing nausea and vomiting or diarrhea. These conditions may cause you to lose too much water and lead to low blood pressure.
Check with your doctor if you have signs of infection, such as sore throat, fever, and/or chills. Infections may be a sign of low white blood cell count (neutropenia).
Check with your doctor if you have strong stomach pain. This could be a symptom of a condition called intestinal angioedema. Your doctor may have to use a CT scan or an ultrasound to diagnose this condition.
Dizziness, lightheadedness, or fainting may also occur if you exercise or if the weather is hot. Heavy sweating can cause loss of too much water and low blood pressure. Use extra care during exercise or hot weather.
Avoid alcoholic beverages until you have discussed their use with your doctor . Alcohol may make the low blood pressure effect worse and/or increase the possibility of dizziness or fainting.
Before having any kind of surgery (including dental surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are taking this medicine.
For patients taking captopril and hydrochlorothiazide :
For patients taking this medicine for high blood pressure :
For diabetic patients :
Hydrochlorothiazide (contained in this combination medicine) may cause your skin to be more sensitive to sunlight than it is normally. Exposure to sunlight, even for brief periods of time, may cause a skin rash, itching, redness or other discoloration of the skin, or a severe sunburn. When you first begin taking this medicine:
If you have a severe reaction from the sun, check with your doctor.
Before you have any medical tests, tell the doctor in charge that you are taking this medicine. The results of some tests may be affected by this medicine.
Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Seek medical attention immediately or call your doctor if any of the following side effects occur:
Swelling of face, mouth, hands, or feet; trouble in swallowing or breathing (sudden); hoarseness; fever and chills
Check with your doctor as soon as possible if any of the following side effects occur:
Dizziness, lightheadedness, or fainting; skin rash, with or without itching, fever, or joint pain
Chest pain; joint pain; lower back or side pain; stomach pain (severe) with nausea and vomiting; unusual bleeding or bruising; yellow eyes or skin
Signs and symptoms of too much or too little potassium in the body
Dryness of mouth; increased thirst; irregular heartbeat; mood or mental changes; muscle cramps or pain; numbness or tingling in hands, feet, or lips; weakness or heaviness of legs; weak pulse
Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:
Cough (dry, persistent)
Diarrhea; headache; increased sensitivity of skin to sunlight (skin rash, itching, redness or other discoloration of skin or severe sunburn after exposure to sunlight); loss of appetite; loss of taste; stomach upset; unusual tiredness
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.
Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although this use is not included in product labeling, ACE inhibitors and hydrochlorothiazide are used in certain patients with the following medical condition:
Other than the above information, there is no additional information relating to proper use, precautions, or side effects for this use.
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