Can I restart benazepril (angiotensin-converting enzyme inhibitor) 10mg-hydrochlorothiazide (HCTZ) (thiazide diuretic) 12.5mg after a 3-month hiatus?

Restarting Benazepril-HCTZ After a 3-Month Hiatus

Yes, you can safely restart benazepril 10mg-hydrochlorothiazide 12.5mg after a 3-month hiatus, especially since the patient previously had good results with this medication. 1

Rationale for Restarting Therapy

• Discontinuation of antihypertensive medications, including diuretics like HCTZ, can lead to recurrence of hypertension in a significant percentage of patients (up to 59% in some studies) 1
• Patients who previously responded well to a specific antihypertensive regimen are likely to respond favorably when the same medication is restarted 1
• The combination of an ACE inhibitor (benazepril) with a thiazide diuretic (HCTZ) provides synergistic antihypertensive effects through complementary mechanisms 2

Monitoring After Restarting

• Measure blood pressure within 2-4 weeks after restarting therapy to confirm efficacy 1
• Monitor renal function and electrolytes (particularly potassium) within 4 weeks of restarting therapy, as ACE inhibitors can affect renal function 2, 3
• Assess for any signs of fluid retention, which may occur when restarting beta-blockers but is less common with ACE inhibitors 1

Efficacy of Benazepril-HCTZ Combination

• The combination of benazepril 10mg with HCTZ 12.5mg has been shown to be effective in controlling blood pressure in patients with mild-to-moderate hypertension 4
• In clinical studies, this combination provided additional blood pressure reduction of 4.7 mmHg in patients who did not respond adequately to benazepril monotherapy 4
• The fixed-dose combination improves medication adherence compared to taking separate pills 5

Potential Concerns and Precautions

• Monitor for hypotension, especially during the first few days of restarting therapy 3
• Be aware of potential renal effects, particularly in patients with renal artery stenosis, chronic kidney disease, heart failure, or volume depletion 3
• Watch for hyperkalemia, especially in patients with diabetes or renal insufficiency 3
• The most common side effects include cough (with benazepril) and electrolyte disturbances (with HCTZ) 6

Special Considerations

• If the patient has developed any new medical conditions during the 3-month hiatus (such as renal impairment or electrolyte disturbances), reassess the appropriateness of this medication 3
• If the patient is taking any new medications that might interact with benazepril-HCTZ, evaluate for potential drug interactions 3
• For patients who previously experienced good blood pressure control with this medication, restarting the same regimen is generally preferable to trying a new medication 1

Alternative Approaches (If Needed)

• If blood pressure is not controlled after restarting benazepril-HCTZ, consider increasing the dose or adding another agent from a different class 1
• If the patient experiences side effects, consider switching to an ARB-thiazide combination, which may have a better tolerability profile in some patients 5