What are the recommendations for long-term use of captopril (Angiotensin-Converting Enzyme inhibitor) zinc?

From the Guidelines

Long-term use of captopril, an Angiotensin-Converting Enzyme (ACE) inhibitor, is recommended for patients with heart failure with reduced ejection fraction (HFrEF) to reduce morbidity and mortality, as evidenced by the 2017 ACC/AHA/HFSA focused update 1.

Key Considerations for Long-Term Captopril Use

• The clinical strategy of inhibition of the renin-angiotensin system with ACE inhibitors, such as captopril, is beneficial for patients with prior or current symptoms of chronic HFrEF to reduce morbidity and mortality 1.
• ACE inhibitors have been shown in large randomized controlled trials (RCTs) to reduce morbidity and mortality in patients with HFrEF with mild, moderate, or severe symptoms of heart failure, with or without coronary artery disease 1.
• Patients on long-term captopril therapy should be monitored for potential side effects, including angioedema, cough, and increased levels of bradykinin, which can induce cough but also may contribute to beneficial vasodilation 1.
• The use of ACE inhibitors, including captopril, should be started at low doses and titrated upward to doses shown to reduce the risk of cardiovascular events in clinical trials, with careful consideration of patients with low systemic blood pressures, renal insufficiency, or elevated serum potassium 1.

Dosage and Administration

• The initial daily dose of captopril is 6.25 mg three times, with a maximum dose of 50 mg three times, as outlined in the 2005 ACC/AHA guideline update for the diagnosis and management of chronic heart failure in the adult 1.
• It is essential to monitor patients' response to captopril and adjust the dosage accordingly to minimize adverse effects while maximizing therapeutic benefits.

Special Considerations

• Although the interaction between captopril and zinc is a consideration, the primary focus for long-term captopril use should be on its established benefits in reducing morbidity and mortality in patients with HFrEF, as supported by the highest quality evidence 1.
• Patients on long-term captopril therapy should be managed under the guidance of a healthcare provider, with regular monitoring of their condition and adjustment of treatment as necessary to ensure optimal outcomes.

From the FDA Drug Label

The recommended dose for long-term use in patients following a myocardial infarction is a target maintenance dose of 50 mg t.i.d. The recommended dose of captopril tablets for long term use to treat diabetic nephropathy is 25 mg t.i.d.

The recommended dose for long-term use of captopril is:

• 50 mg t.i.d. for patients following a myocardial infarction 2
• 25 mg t.i.d. for patients with diabetic nephropathy 2 Key points:
• The dose may need to be adjusted based on the patient's clinical condition and response to therapy.
• Captopril should be used in conjunction with a diuretic and digitalis, and therapy must be initiated under close medical supervision.
• The maximum daily dose of captopril should not exceed 450 mg. 2

From the Research

Long-term Use of Captopril Zinc

• The long-term use of captopril, an Angiotensin-Converting Enzyme (ACE) inhibitor, has been studied in various contexts, including its effectiveness and safety in patients with hypertension 3, pulmonary hypertension 4, non-insulin-dependent diabetes mellitus (NIDDM) 5, and diabetic nephropathy 6.
• In terms of safety, one study found that serum zinc levels are unaffected by effective captopril treatment of hypertension, suggesting that zinc depletion is unlikely to be a consequence of long-term exposure to captopril 7.
• The effectiveness of long-term captopril therapy has been demonstrated in several studies, including one that showed a significant decrease in urinary protein excretion and a slower rate of decline in glomerular filtration rate (GFR) in patients with NIDDM and non-diabetic renal diseases 5.
• Another study found that long-term captopril therapy had a beneficial effect on diabetic nephropathy in normotensive type 1 diabetic patients, with a significant reduction in albuminuria and a minimal loss of GFR 6.
• However, it is worth noting that the effectiveness of captopril can vary depending on the specific context and patient population, and that combination therapy with other medications may be necessary to achieve optimal blood pressure control 3.

Recommendations for Long-term Use

• Based on the available evidence, it appears that captopril can be safely and effectively used for long-term treatment of hypertension and related conditions, including diabetic nephropathy and non-diabetic renal diseases.
• However, patients should be closely monitored for potential side effects, such as ageusia, and for changes in renal function and serum electrolyte levels.
• The dosage of captopril should be adjusted based on individual patient needs and response to treatment, and combination therapy with other medications may be necessary to achieve optimal blood pressure control 3, 5, 6.