BENAZEPRIL HYDROCHLORIDE

BENAZEPRIL HYDROCHLORIDE
(ben-a'ze-pril)
Lotensin
Classifications: antihypertensive agent; angiotensin-converting enzyme (ace) inhibitor;
Therapeutic: antihypertensive agent
; ace inhibitor
Prototype: Enalapril
Pregnancy Category: D second and third trimester; C first trimester

Availability

5 mg, 10 mg, 20 mg, 40 mg tablets

Action

Lowers blood pressure by specific inhibition of the angiotensin-converting enzyme (ACE) and thus by decreasing angiotensin II (a potent vasoconstrictor) and aldosterone secretion.

Therapeutic Effect

Achieves an antihypertensive effect by suppression of the renin-angiotensin-aldosterone system.

Uses

Treatment of mild to moderate hypertension.

Unlabeled Uses

CHF, reno-protective agent.

Contraindications

Hypersensitivity to benazepril or another ACE inhibitor; pregnancy (category C first trimester and category D second and third trimester), lactation, or in children <6 y or with a GFR <30 mL/h.

Cautious Use

Renal impairment, renal-artery stenosis; patients with hypovolemia, receiving diuretics, undergoing dialysis; patients in whom excessive hypotension would present a hazard (e.g., cerebrovascular insufficiency); CHF; hepatic impairment; diabetes mellitus.

Route & Dosage

Hypertension
Adult: PO 10–40 mg/d in 1–2 divided doses

Administration

Oral
  • Consult physician about initial dose if patient is also receiving diuretics. Typically an initial dose of 5 mg is used to minimize the risk of hypotension.
  • Store at room temperature, but not above 30° C (86° F).

Adverse Effects (≥1%)

CV: Hypotension. CNS: Headache, dizziness, fatigue, weakness. Endocrine: Hyperkalemia (at higher doses). GI: Nausea, diarrhea or constipation, gastritis. Urogenital: Azotemia, oliguria, renal failure in patients with CHF. Respiratory: Cough, rhinitis, bronchitis. Other: Back pain.

Diagnostic Test Interference

Elevations in serum bilirubin have been observed after benazepril administration. Benazepril inhibits aldosterone secretion, which causes an increase in serum potassium.

Interactions

Drug: potassium-sparing diuretics may increase the risk of hyperkalemia. Benazepril may increase lithium levels, resulting in lithium toxicity.

Pharmacokinetics

Absorption: Readily from GI tract; 37% reaches the systemic circulation. Peak: 2–6 h. Duration: 20–24 h. Distribution: Small amounts cross the blood-brain barrier; crosses placenta; small amount excreted in breast milk. Metabolism: In liver to active metabolite, benazeprilat. Elimination: Benazeprilat is primarily excreted in urine. Half-Life: Benazepril 0.6 h; benazeprilat 22 h.

Nursing Implications

Assessment & Drug Effects

  • Assess for hypotension, especially in patients who may be volume depleted (e.g., prolonged diuretic therapy, recent vomiting or diarrhea, salt restriction) or who have CHF.
  • Lab tests: Monitor serum potassium levels for hyperkalemia (see Appendix F).

Patient & Family Education

  • Do not use salt substitutes unless recommended by physician.
  • Report swelling of face, eyes, lips, or tongue or difficulty breathing immediately to physician.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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