In the case of marked hypotension, infuse physiological saline solution; as needed, consider vasopressors e. Its chemical name is benazepril 3-[[1- ethoxy-carbonyl phenyl- 1S -propyl]amino]-2,3,4,5-tetrahydrooxo-1 H 3S -benzazepineacetic acid monohydrochloride; its structural formula is.
Benazeprilat, the active metabolite of benazepril, is a non-sulfhydryl angiotensin-converting enzyme inhibitor. The inactive ingredients are crospovidone, lactose anhydrous, magnesium stearate, microcrystalline cellulose, pregelatinized corn starch and talc.
Benazepril and benazeprilat inhibit angiotensin-converting enzyme ACE in human subjects and animals. Benazeprilat has much greater ACE inhibitory activity than does benazepril. ACE is a peptidyl dipeptidase that catalyzes the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II. Angiotensin II also stimulates aldosterone secretion by the adrenal cortex. Inhibition of ACE results in decreased plasma angiotensin II, which leads to decreased vasopressor activity and to decreased aldosterone secretion.
The latter decrease may result in a small increase of serum potassium. Removal of angiotensin II negative feedback on renin secretion leads to increased plasma renin activity.
In animal studies, benazepril had no inhibitory effect on the vasopressor response to angiotensin II and did not interfere with the hemodynamic effects of the autonomic neurotransmitters acetylcholine, epinephrine, and norepinephrine. ACE is identical to kininase, an enzyme that degrades bradykinin. Whether increased levels of bradykinin, a potent vasodepressor peptide, play a role in the therapeutic effects of benazepril HCl remains to be elucidated.
While the mechanism through which benazepril lowers blood pressure is believed to be primarily suppression of the renin-angiotensin-aldosterone system, benazepril has an antihypertensive effect even in patients with low-renin hypertension.
Benazepril HCl has been used concomitantly with beta-adrenergic-blocking agents, calcium-channel-blocking agents, diuretics, digoxin, and hydralazine, without evidence of clinically important adverse interactions. Benazepril, like other ACE inhibitors, has had less than additive effects with beta-adrenergic blockers, presumably because both drugs lower blood pressure by inhibiting parts of the renin-angiotensin system.
The pharmacokinetics of benazepril are approximately dose-proportional within the dosage range of 10 to 80 mg. Following oral administration of benazepril HCl, peak plasma concentrations of benazepril, and its active metabolite benazeprilat are reached within 0.
While the bioavailability of benazepril is not affected by food, time to peak plasma concentrations of benazeprilat is delayed to 2 to 4 hours. The serum protein binding of benazepril is about Benazepril is almost completely metabolized to benazeprilat by cleavage of the ester group primarily in liver.
Both benazepril and benazeprilat undergo glucuronidation. Benazepril and benazeprilat are cleared predominantly by renal excretion. Nonrenal i. The effective half-life of benazeprilat following once daily repeat oral administration of benazepril hydrochloride is 10 to 11 hours.
Thus, steady-state concentrations of benazeprilat should be reached after 2 or 3 doses of benazepril hydrochloride given once daily. The parent compound, benazepril, was not detected in the dialysate. Hepatic impairment In patients with hepatic insufficiency due to cirrhosis , the pharmacokinetics of benazeprilat are essentially unaltered. Drug Interactions The pharmacokinetics of benazepril are not affected by the following drugs: hydrochlorothiazide, furosemide, chlorthalidone, digoxin, propranolol, atenolol, nifedipine, amlodipine, naproxen, acetylsalicylic acid, or cimetidine.
Likewise the administration of benazepril does not substantially affect the pharmacokinetics of these medications cimetidine kinetics were not studied. Pediatrics The pharmacokinetics of benazeprilat, evaluated in pediatric patients with hypertension following oral administration of a single-dose is presented in table below.
When compared on the basis of body weights, this dose is times the maximum recommended human dose. When compared on the basis of body surface areas, this dose is 18 and 9 times rats and mice, respectively the maximum recommended human dose calculations assume a patient weight of 60 kg.
No mutagenic activity was detected in the Ames test in bacteria with or without metabolic activation , in an in vitro test for forward mutations in cultured mammalian cells, or in a nucleus anomaly test. Adult Patients In single-dose studies, benazepril HCl lowered blood pressure within 1 hour, with peak reductions achieved between 2 and 4 hours after dosing.
The antihypertensive effect of a single-dose persisted for 24 hours. In multiple-dose studies, once-daily doses of between 20 mg and 80 mg decreased seated pressure 24 hours after dosing by about 6 to 12 mmHg systolic and 4 to 7 mmHg diastolic.
Four dose-response studies using once-daily dosing were conducted in mild-to-moderate hypertensive patients not using diuretics. The minimal effective once-daily dose of benazepril HCl was 10 mg; but further falls in blood pressure, especially at morning trough, were seen with higher doses in the studied dosing range 10 to 80 mg.
In studies comparing the same daily dose of benazepril HCl given as a single morning dose or as a twice-daily dose, blood pressure reductions at the time of morning trough blood levels were greater with the divided regimen. The antihypertensive effects of benazepril HCl were not appreciably different in patients receiving high- or low-sodium diets. In normal human volunteers, single-doses of benazepril caused an increase in renal blood flow but had no effect on glomerular filtration rate.
Use of benazepril HCl in combination with thiazide diuretics gives a blood-pressure-lowering effect greater than that seen with either agent alone. By blocking the renin-angiotensin-aldosterone axis, administration of benazepril HCl tends to reduce the potassium loss associated with the diuretic.
Pediatric Patients In a clinical study of pediatric patients, 7 to 16 years of age, with either systolic or diastolic pressure above the 95th percentile, patients were given 0. After four weeks of treatment, the 85 patients whose blood pressure was reduced on therapy were then randomized to either placebo or benazepril and were followed up for an additional two weeks. At the end of two weeks, blood pressure both systolic and diastolic in children withdrawn to placebo rose by 4 to 6 mm Hg more than in children on benazepril.
No dose-response was observed. Protect from moisture. Pregnancy: Tell female patients of childbearing age about the consequences of exposure to benazepril HCl during pregnancy. Lowering blood pressure can reduce the risk of strokes and heart attacks. Benazepril is an angiotensin-converting enzyme ACE inhibitor. It works by blocking a substance in the body that causes blood vessels to tighten.
As a result, benazepril relaxes the blood vessels. This lowers blood pressure and increases the supply of blood and oxygen to the heart.
Hydrochlorothiazide is a thiazide diuretic water pill. It reduces the amount of water in the body by increasing the flow of urine which helps lower the blood pressure. There is a problem with information submitted for this request. Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual.
You can easily become dehydrated while taking hydrochlorothiazide and benazepril. This can lead to very low blood pressure, electrolyte disorders, or kidney failure. Your blood pressure will need to be checked often. Your kidney function may also need to be checked. Your blood and urine may also be tested if you have been vomiting or are dehydrated.
If you need surgery, tell the surgeon ahead of time that you are using hydrochlorothiazide and benazepril. Keep using this medicine as directed, even if you feel well.
High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life. Store at room temperature away from moisture, heat, and light. Keep the tablets in their original container, along with the packet or canister of moisture-absorbing preservative. Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose.
Do not take two doses at one time. Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids. Follow your doctor's instructions about the type and amount of liquids you should drink. Get emergency medical help if you have signs of an allergic reaction hives, severe stomach pain, difficult breathing, swelling in your face or throat or a severe skin reaction fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. Tell your doctor about all your current medicines. Many drugs can affect hydrochlorothiazide and benazepril, especially:. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription over-the-counter medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements.
You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. Benazepril and Hydrochlorothiazide pronounced as ben ay' ze pril hye droe klor oh thye' a zide. Why is this medication prescribed? How should this medicine be used? Other uses for this medicine What special precautions should I follow?
What special dietary instructions should I follow? What should I do if I forget a dose? What side effects can this medication cause? What should I know about storage and disposal of this medication? Brand names. Other uses for this medicine. What special precautions should I follow? Before taking benazepril and hydrochlorothiazide, tell your doctor and pharmacist if you are allergic to benazepril Lotensin ; hydrochlorothiazide HCTZ, Microzide, Oretic ; angiotensin-converting enzyme ACE inhibitors such as captopril Capoten , enalapril Vasotec, in Vaseretic , fosinopril Monopril , lisinopril in Prinzide, in Zestoretic , moexipril Univasc, in Uniretic , perindopril Aceon , quinapril Accupril, in Accuretic, in Quinaretic , ramipril Altace , and trandolapril Mavik, in Tarka ; sulfa drugs; any other medications; any other medications; or any ingredients in benazepril and hydrochlorothiazide tablets.
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