Presentation
We present this case report with the informed consent of the patient's guardian. [ncbi.nlm.nih.gov]
We present a case in which a patient took an overdose of captopril (Capoten) and alprazolam (Xanax) in a suicide attempt. The patient presented with hypotension (systolic blood pressure of 80 mm Hg) and drowsiness. [jamanetwork.com]
Entire Body System
- Congestive Heart Failure
Since ACE-1 is the primary producer of Angiotensin II and primary degrader of Bradykinins, inhibition of ACE-1 has proven an effective treatment for Hypertension and Congestive Heart Failure. [proteopedia.org]
The pharmacokinetics of this agent have been studied extensively in healthy subjects and in patients with hypertension, congestive heart failure, and chronic renal failure. [ncbi.nlm.nih.gov]
Effect of captopril on renal function in patients with congestive heart failure. [heart.bmj.com]
heart failure (NOUN) Definition of Captopril a drug (trade name Capoten) that blocks the formation of angiotensin in the kidneys resulting in vasodilation; used in the treatment of hypertension and congestive heart failure Information provided about [dict.hinkhoj.com]
- Swelling
In case 1, an upper chest and facial erythema and dryness of the mouth accompanied the swelling of the salivary glands. In case 2, a conjunctival erythema accompanied the sialadenitis. [ncbi.nlm.nih.gov]
Report any sign of edema (increase in swelling of the arms or legs), which may be a sign of declining kidney function. Heart failure patients. [rxwiki.com]
Coadministration with mTOR inhibitors (temsirolimus, everolimus, sirolimus) may increase risk for skin swelling Intestinal skin swelling, that presented with abdominal pain, reported in patients treated with ACE inhibitors Neutropenia (under 1000/mm³ [rxlist.com]
Other warnings Swelling warning: Captopril can cause severe, sudden swelling of your face, arms, legs, lips, tongue, throat, and intestines. This swelling can even be fatal. Tell your doctor right away if you have swelling or have stomach pain. [healthline.com]
- Weakness
The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence. [peacehealth.org]
Abstract A 37-year-old patient with severe hypokalemia (approximately 1.7 mEq/L) and muscular weakness had a very high serum renin level. [ncbi.nlm.nih.gov]
Check with your doctor right away if you have upper stomach pain, pale stools, dark urine, loss of appetite, nausea, unusual tiredness or weakness, or yellow eyes or skin. These could be symptoms of a serious liver problem. [mayoclinic.org]
Feeling very tired or weak. Liver problems have happened with drugs like this one. Sometimes, this has been deadly. [drugs.com]
Respiratoric
- Cough
Capsaicin, yohimbine : cough Drug-behaviors. [medical-dictionary.thefreedictionary.com]
The rash generally occurs during the first four weeks of treatment, and will resolve even with continued use of Captopril Cough: The cough produced by Captopril and other ACE-inhibitors is typically persistent, non-productive, dry and worse at night. [myvmc.com]
In a double-blind study of patients who had developed a cough attributed to an ACE inhibitor, supplementation with iron (in the form of 256 mg of ferrous sulfate per day) for four weeks reduced the severity of the cough by a statistically significant [peacehealth.org]
Persistent dry cough may occur and may not subside until medication is discontinued. Consult health care professional if cough becomes bothersome. Also notify health care professional if nausea, vomiting, or diarrhea occurs and continues. [nursing.unboundmedicine.com]
Gastrointestinal
- Nausea
Call your doctor right away if you have severe stomach pain (with or without nausea or vomiting). This could be a symptom of intestinal angioedema. [mayoclinic.org]
He had sudden swelling of the lips, face, and tongue, followed by nausea, emesis, abdominal pain, and diarrhea. Other medications included aspirin, indomethacin, allopurinol, colchicine, and nifedipine. [ncbi.nlm.nih.gov]
Captopril may lead to increased levels of potassium, which could lead to side effects such as heart arrhythmias (irregular heartbeat) and nausea. Cough. [rxwiki.com]
- Abdominal Pain
To increase awareness concerning abdominal pain associated with the use of captopril, which is a molecule frequently used in diabetic patients. [ncbi.nlm.nih.gov]
Low white blood cell count Abdominal pain, constipation, or diarrhea. Palpitations or rapid heartbeat. Persistent dry cough. [smarterhealth.sg]
Uncommon side effects Tachycardia, chest pain and palpitations Gastric irritation Abdominal pain, nausea, vomiting, diarrhoea, anorexia and constipation Stomatitis and tongue ulceration Proteinuria Polyuria, oliguria and increased urinary frequency Reversible [myvmc.com]
pain, reported in patients treated with ACE inhibitors Neutropenia ( Causes false positive urine acetone [reference.medscape.com]
Jaw & Teeth
- Dysgeusia
Adverse Reactions: Hypotension, dysgeusia, rash, pruritus, cough, proteinuria, tachycardia, neutropenia/agranulocytosis, hyperkalemia, hyponatremia, jaundice, angioedema. Note: Formerly known under the brand name Capoten. [empr.com]
[…] captopril is associated with ↑ survival, and ↓ cardiovascular M&M, possibly attenuating ventricular dilatation and remodeling Warning Angioedema of upper airways Adverse effects Neutropenia, agranulocytosis, proteinuria, rash, pruritus, hypotension, dysgeusia [medical-dictionary.thefreedictionary.com]
GI: anorexia, dysgeusia, nausea, vomiting, abdominal pain, constipation, dry mouth. Hematologic: leukopenia, agranulocytosis, pancytopenia, anemia, thrombocytopenia. Metabolic: hyperkalemia. [glowm.com]
- Metallic Taste
It resolves after discontinuation of therapy Taste disturbances such as decreased taste sensitivity, or metallic tastes can occur during the first few weeks of treatment but usually disappear within 1-3 months. [myvmc.com]
Tell your doctor if any of these symptoms are severe or do not go away: dizziness or lightheadedness salty or metallic taste, or decreased ability to taste cough fast heartbeat excessive tiredness Some side effects can be serious. [nlm.nih.gov]
Cardiovascular
- Hypertension
Bravo EL, Tarazi RC (1979) Converting enzyme inhibition with an orally active compound in hypertensive man. Hypertension 1: 39–46 Google Scholar 6. [link.springer.com]
CONCLUSIONS: There was any difference between oral and sublingual captopril efficiency to control of hypertension in patient with hypertensive urgency. [ncbi.nlm.nih.gov]
- Heart Failure
Since ACE-1 is the primary producer of Angiotensin II and primary degrader of Bradykinins, inhibition of ACE-1 has proven an effective treatment for Hypertension and Congestive Heart Failure. [proteopedia.org]
Abstract A patient with a phaeochromocytoma and severe left ventricular heart failure caused by a catecholamine-induced cardiomyopathy is described. [ncbi.nlm.nih.gov]
- Hypotension
A characteristic pattern seen on captopril renography is described that is due to systemic hypotensive response. [ncbi.nlm.nih.gov]
[…] may produce prolonged hypotensive effects that may compromise cerebral and renal function, and thus they may have disadvantages in such cases, as compared with short-acting agents. [nejm.org]
Risperidone: (Moderate) Risperidone may induce orthostatic hypotension and thus enhance the hypotensive effects of antihypertensive agents. [pdr.net]
Adverse Reactions: Hypotension, dysgeusia, rash, pruritus, cough, proteinuria, tachycardia, neutropenia/agranulocytosis, hyperkalemia, hyponatremia, jaundice, angioedema. Note: Formerly known under the brand name Capoten. [empr.com]
The role of captopril in inducing hypotension is discussed herein. (JAMA 1988;259:3302-3305) [jamanetwork.com]
- Chest Pain
Like all medicines captopril can cause side effects, including: Common: dizziness, headache cough nausea, vomiting, diarrhea skin rash chest pain itching sleep problems constipation hair loss Uncommon: fast, irregular, heartbeat tiredness chest pain feeling [onlinedoctorcheckup.com]
Uncommon side effects Tachycardia, chest pain and palpitations Gastric irritation Abdominal pain, nausea, vomiting, diarrhoea, anorexia and constipation Stomatitis and tongue ulceration Proteinuria Polyuria, oliguria and increased urinary frequency Reversible [myvmc.com]
Cough Unlikely but report : Dizziness, lightheadedness, fainting Headache Fever Swelling, rash Sore mouth/throat Irregular heartbeat Chest pain This information does not cover all the uses, precautions, side effects or interactions of this medicine. [med.umich.edu]
Do not take this medication with any of the following medications: sacubitril; valsartan This medicine may also interact with the following: antacids diuretics lithium medicines for chest pain like nitroglycerin medicines for high blood pressure NSAIDs [my.clevelandclinic.org]
Check with your doctor immediately if any of the following side effects occur while taking captopril: Less common Chest pain cloudy urine fast, pounding, or irregular heartbeat or pulse Rare Arm, back, or jaw pain bloody urine chest discomfort chest tightness [drugs.com]
- Tachycardia
tachycardia. Captopril also has well documented efficiency for heart failure: it reduces the ventricular preload and afterload. [infomed.ch]
Adverse Reactions: Hypotension, dysgeusia, rash, pruritus, cough, proteinuria, tachycardia, neutropenia/agranulocytosis, hyperkalemia, hyponatremia, jaundice, angioedema. Note: Formerly known under the brand name Capoten. [empr.com]
Uncommon side effects Tachycardia, chest pain and palpitations Gastric irritation Abdominal pain, nausea, vomiting, diarrhoea, anorexia and constipation Stomatitis and tongue ulceration Proteinuria Polyuria, oliguria and increased urinary frequency Reversible [myvmc.com]
There were no side effects, including a dangerous fall in blood pressure or reflex tachycardia. Sublingual nifedipine lowered diastolic blood pressure and systolic blood pressure in eight of 10 patients. [jamanetwork.com]
Skin
- Angioedema
Although angiotensin-converting enzyme inhibitors (ACEIs) are well-known causes of orofacial angioedema, angioedema from these agents involving the bowel is not often considered. [ncbi.nlm.nih.gov]
Discontinue if neutropenia, agranulocytosis, angioedema, laryngeal edema, elevated liver enzymes, or jaundice occurs. Black patients may have higher risk of angioedema than non-black patients. Neonates. Pregnancy (Cat.D); avoid. [empr.com]
Hereditary or idiopathic angioedema Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan Bilateral renal [reference.medscape.com]
- Skin Rash
Less frequent are skin rashes, taste disturbances, proteinuria and symptoms of a hypotension. Neutropenias and angioneurotic edemas are rare but hazardous. [infomed.ch]
Like all medicines captopril can cause side effects, including: Common: dizziness, headache cough nausea, vomiting, diarrhea skin rash chest pain itching sleep problems constipation hair loss Uncommon: fast, irregular, heartbeat tiredness chest pain feeling [onlinedoctorcheckup.com]
The symptoms of a drug allergy include one or more of the following: Swollen face/eyes/lips/tongue Difficulty in breathing Itchy skin rashes over your whole body If you experience any of these symptoms, you should stop your medicine immediately and see [singhealth.com.sg]
rash, angioedema Other: altered taste, fever Interactions Drug-drug. [medical-dictionary.thefreedictionary.com]
- Pruritus
Adverse Reactions: Hypotension, dysgeusia, rash, pruritus, cough, proteinuria, tachycardia, neutropenia/agranulocytosis, hyperkalemia, hyponatremia, jaundice, angioedema. Note: Formerly known under the brand name Capoten. [empr.com]
Results We assessed a 36 years old female with a history of palpebral and lips oedema, flaking and pruritus, for two months, especially during her work. [waojournal.biomedcentral.com]
[…] long-term administration of captopril is associated with ↑ survival, and ↓ cardiovascular M&M, possibly attenuating ventricular dilatation and remodeling Warning Angioedema of upper airways Adverse effects Neutropenia, agranulocytosis, proteinuria, rash, pruritus [medical-dictionary.thefreedictionary.com]
- Eruptions
The clinical and histological features were consistent with a lichenoid eruption. The rash spontaneously resolved without any treatment three months after captopril was discontinued. [ncbi.nlm.nih.gov]
Wilkin JK, Hammond JJ, Kirkendall M (1980) The captopril-induced eruption. A possible mechanism: cutaneous kinin potentiation. Arch Dermatol 116: 902–905 Google Scholar Copyright information Authors and Affiliations J. H. B. de Bruyn 1 A. J. [link.springer.com]
- Alopecia
[Ref] Dermatologic Very common (10% or more): Rash (up to 13.1%) Common (1% to 10%): Pruritus, alopecia Uncommon (0.1% to 1%): Angioedema Very rare (less than 0.01%): Urticaria, Stevens-Johnson syndrome, erythema multiforme, photosensitivity, erythroderma [drugs.com]
Skin: urticarial rash, maculopapular rash, pruritus, alopecia. Other: angioedema. [glowm.com]
2.0 xerostomia / Early / 0.5-2.0 nausea / Early / 0.5-2.0 cough / Delayed / 0.5-2.0 fatigue / Early / 0.5-2.0 headache / Early / 0.5-2.0 insomnia / Early / 0.5-2.0 paresthesias / Delayed / 0.5-2.0 dizziness / Early / 0.5-2.0 malaise / Early / 0.5-2.0 alopecia [pdr.net]
Urogenital
- Kidney Failure
This can damage the blood vessels of the brain, heart, and kidneys resulting in a stroke, heart failure, or kidney failure. Hypertension may also increase the risk of heart attacks. [mayoclinic.org]
Neurologic
- Headache
The most common complaints were headache, nausea/vomiting and weakness. 65 (91.5%) patients were using antihypertensive drugs before admitted to hospital. [ncbi.nlm.nih.gov]
Cough Unlikely but report : Dizziness, lightheadedness, fainting Headache Fever Swelling, rash Sore mouth/throat Irregular heartbeat Chest pain This information does not cover all the uses, precautions, side effects or interactions of this medicine. [med.umich.edu]
Like all medicines captopril can cause side effects, including: Common: dizziness, headache cough nausea, vomiting, diarrhea skin rash chest pain itching sleep problems constipation hair loss Uncommon: fast, irregular, heartbeat tiredness chest pain feeling [onlinedoctorcheckup.com]
[…] diabetes mellitus Consider starting an ACE inhibitor in high-risk patients, even if no hypertension or congestive heart failure May prolong survival in congestive heart failure, may preserve renal function in diabetes mellitus May help to prevent migraine headache [rxlist.com]
Check with your doctor if any of these most common side effects persist or become bothersome: Cough; diarrhea; dizziness or lightheadedness when sitting or standing quickly; fatigue; fever; headache; itching; joint pain; nausea; taste changes; vomiting [viagra-canadian-pharma.com]
- Asthenia
[…] multiforme (including Stevens-Johnson syndrome) and exfoliative dermatitis, photosensitivity Paraesthesia of the hands Myalgia Fatigue Dizziness Dry mouth Dyspnoea Bronchospasm Disturbed vision Itching and/or dry eyes Impotence and loss of libido Insomnia Asthenia [myvmc.com]
0.01% to 0.1%): Loss of libido Very rare (less than 0.01%): Confusion, depression Frequency not reported: Nervousness[Ref] Other Uncommon (0.1% to 1%): Chest pain, fatigue, malaise Very rare (less than 0.01%): Gynecomastia, fever Frequency not reported: Asthenia [drugs.com]
[…] the 136 types of adverse events encountered were reported in more than 5 percent of the patients, and there were no differences between the captopril and enalapril groups in the incidence of these adverse events: headache (15 percent vs. 16 percent), asthenia [nejm.org]
[…] photosensitivity / Delayed / Incidence not known myalgia / Early / Incidence not known leukocytosis / Delayed / Incidence not known arthralgia / Delayed / Incidence not known drowsiness / Early / Incidence not known gynecomastia / Delayed / Incidence not known asthenia [pdr.net]
Workup
Serum
- Leukopenia
Case DB, Whittman HH III, Laragh JH, et al: Successful low-dose captopril rechallenge following drug-induced leukopenia. Lancet 1981;1:1362. Crossref 5. Gavras I, Graff LG, Rose BD, et al: Fatal pancytopenia associated with the use of captopril. [jamanetwork.com]
[…] drowsiness, fatigue, weakness, insomnia CV: angina pectoris, tachycardia, hypotension EENT: sinusitis GI: nausea, diarrhea, anorexia GU: proteinuria, erectile dysfunction, decreased libido, gynecomastia, renal failure Hematologic: anemia, agranulocytosis, leukopenia [medical-dictionary.thefreedictionary.com]
Hematologic: leukopenia, agranulocytosis, pancytopenia, anemia, thrombocytopenia. Metabolic: hyperkalemia. Respiratory: dry, persistent, tickling, nonproductive cough; dyspnea. Skin: urticarial rash, maculopapular rash, pruritus, alopecia. [glowm.com]
Adverse effects[edit] Adverse effects of captopril include cough due to increase in the plasma levels of bradykinin, angioedema, agranulocytosis, proteinuria, hyperkalemia, taste alteration, teratogenicity, postural hypotension, acute renal failure, and leukopenia [en.wikipedia.org]
- Leukocytes Decreased
hematocrit decreased, leukocytes decreased, thrombocytes decreased, erythrocyte sedimentation rate elevated[Ref] Hepatic Very rare (less than 0.01%): Liver enzymes elevated, bilirubin elevated, impaired hepatic function, cholestasis, hepatitis Frequency [drugs.com]
Treatment
Surgical excision or captopril treatment led to significant decline in the mean levels of ATII. All three treatment modalities had no significant effect on the mean levels of ACE. [ncbi.nlm.nih.gov]
Prognosis
Given the poor prognosis of glioblastoma, we have been investigating treatments adjunctive to the current standard of resection, irradiation and temozolomide. [ncbi.nlm.nih.gov]
However, the prognosis in the short and long term, as the BP outcome in mothers with severe preeclampsia, the most effective treatment for the control of hypertensive crisis and metabolic and cardiovascular events after two years of termination of pregnancy [clinicaltrials.gov]
The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual. [medicinenet.com]
Br J Rheumatol. 1983; 22: 224-232 Keith NM Wagener HP Barker NW Some different types of essential hypertension: their course and prognosis. [mayoclinicproceedings.org]
Etiology
The etiology is unknown, although a systemic immunologic process seems most likely. About half the reported cases also revealed involvement of the pulmonary and renal arteries. [ncbi.nlm.nih.gov]
The etiology of these complications is multifactorial; however, dysregulation of the innate immunity leading to an increased inflammatory response seems to be a common feature. [dx.doi.org]
Epidemiology
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Pathophysiology
This exposure suggests that captopril and pathophysiology of angioedema stimulated the development of pemphigus vulgaris, which was diagnosed using the novel, indirect immunofluorescence BIOCHIP mosaic, with the modification to detect serum IgG4 autoantibodies [ncbi.nlm.nih.gov]
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Prevention
Preventive and therapeutic effects of RAS blockers - captopril and losartan - were examined on MCF-7 and TAM-R cells. [ncbi.nlm.nih.gov]
Captopril binds to the ACE-1 binding site of, preventing ACE-1 from binding angiotensin. [proteopedia.org]