General Toxicity Notes
Blood pressure is the best guide to dose and interval. Hypotensive effects magnified by natriuretic agents or sodium depletion. May cause hyperkalemia, metabolic acidosis. Acute renal dysfunction with bilateral or transplant renal artery stenosis, low renal perfusion pressure. Dry cough in 5-10% of patients.
Excreted Unchanged %
40-50
Half-Life (Normalesrd) Hours
2-3/21-32
Plasma Protein Binding %
25-30
Volume Of Distribution L/Kg
0.7-3
Dose For Normal Renal Function
25-50 mg q8h
Second Dose
Second Dose: 50-150 mg q8h-q12h
Adjustment For Renal Failure Method
D, I
Adjustment For Renal Failure Gfr, Ml/Min >50 [Recommended Level]
100% q8-12h [A]
Adjustment For Renal Failure Gfr, Ml/Min 10-50 [Recommended Level]
75% q12-18h [A]
Adjustment For Renal Failure Gfr, Ml/Min <10 [Recommended Level]
50% q24h [A]
Supplement For Dialysis [Recommendation Level]: Ihd
IHD: Dose after dialysis, [A]
Supplement For Dialysis [Recommendation Level]: Pd
PD: Dose for GFR 10-50,[A]
Supplement For Dialysis [Recommendation Level]: Crrt
CRRT: Dose for GFR 10-50, titrate, [D]
References
Brogden RN, Todd PA, Sorkin EM. Captopril. An update of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in hypertension and congestive heart failure. Drugs. 1988; 36: 540-600. [PMID: 3063499] / Drummer OH, Workman BS, Miach PJ, Jarrott B, Louis WJ. The pharmacokinetics of captopril and captopril disulfide conjugates in uraemic patients on maintenance dialysis: comparison with patients with normal renal function. Eur J Clin Pharmacol. 1987; 32: 267-71. [PMID: 3297733] / Duchin KL, Pierides AM, Heald A, Singhvi SM, Rommel AJ. Elimination kinetics of captopril in patients with renal failure. Kidney Int. 1984; 25: 942-7. [PMID: 6381858] / Fujimura A, Kajiyama H, Ebihara A, Iwashita K, Nomura Y, Kawahara Y. Phar-macokinetics and pharmacodynamics of captopril in patients undergoing continuous ambulatory peritoneal dialysis. Nephron. 1986; 44: 324-8. [PMID: 3025754]
Toxicity Notes
Rare proteinuria, nephrotic syndrome, dysgeusia, granulocytopenia. Increases serum digoxin levels. Anaphylactoid reactions have been reported in patients dialyzed with high-flux membranes and treated concomitantly with an ACE inhibitor.