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ACE Inhibitors

For what conditions are ACE inhibitors used?

ACE inhibitors are effective for control of blood pressure, congestive heart failure, and prevention of stroke and hypertension, or diabetes-related kidney damage. ACE inhibitors are especially important because they have been shown to prevent early death resulting from hypertension, heart failure or heart attacks; in studies of patients with hypertension, heart failure, or prior heart attacks, patients who received an ACE inhibitor survived longer than patients who did not receive an ACE inhibitor. ACE inhibitors may be combined with other drugs to achieve optimal blood pressure control.

Are there any differences among the different types of ACE inhibitors?

ACE inhibitors are very similar, and all are effective for treating hypertension. Some are eliminated primarily by the kidneys while others are also eliminated in bile and feces. This difference in elimination may be important in choosing among ACE inhibitors in patients with reduced kidney or liver function, who may accumulate drugs that are excreted via the kidneys or liver. Except for captopril (Capoten) and lisinopril (Prinivil, Zestril), ACE inhibitors are inactive until they are converted to an active form in the body.

What are the side effects of ACE inhibitors?

Common side effects are:

An abnormal taste (metallic or salty), elevated blood potassium levels, and sexual dysfunction may also occur.

A nonproductive and persistent cough may occur in 5%-25% of individuals. It may take up to 2 weeks or longer for coughing to subside after the ACE inhibitor is discontinued. If one ACE inhibitor causes cough, it is likely that the others will also.

ACE inhibitors may cause birth defects and, therefore, should not be used during pregnancy.

Individuals with stenosis (narrowing) of both arteries supplying the kidneys may experience worsening of kidney function.

Other side effects of ACE inhibitors include kidney failure, allergic reactions, a decrease in white blood cells, and swelling of tissues (angioedema).

QUESTION

Salt and sodium are the same. See Answer

With which drugs do ACE inhibitors interact?

ACE inhibitors have few important interactions with other drugs.

  • Quinapril (Accupril) may reduce the absorption of tetracycline because quinapril (Accupril) contains magnesium which binds to tetracycline in the intestine and prevents its absorption.

  • Combining potassium supplements, salt substitutes (which often contain potassium), or other drugs that increase potassium levels with ACE inhibitors may result in excessive blood potassium levels because ACE inhibitors can further increase potassium to toxic levels.

  • ACE inhibitors may increase blood concentrations of lithium (Eskalith) and possibly increase side effects of lithium.

  • Nonsteroidal antiinflammatory drugs [NSAIDs, for example, aspirin, ibuprofen, indomethacin (Indocin, Indocin IV), and naproxen (Naprosyn, Naprelan)] may reduce the blood pressure-lowering effects of ACE inhibitors.

What are some examples of ACE inhibitors available?

The following is a list of the ACE inhibitors that are available in the United States:

With which drugs do ACE inhibitors interact?

ACE inhibitors have few important interactions with other drugs.

  • Quinapril (Accupril) may reduce the absorption of tetracycline because quinapril (Accupril) contains magnesium which binds to tetracycline in the intestine and prevents its absorption.

  • Combining potassium supplements, salt substitutes (which often contain potassium), or other drugs that increase potassium levels with ACE inhibitors may result in excessive blood potassium levels because ACE inhibitors can further increase potassium to toxic levels.

  • ACE inhibitors may increase blood concentrations of lithium (Eskalith) and possibly increase side effects of lithium.

  • Nonsteroidal antiinflammatory drugs [NSAIDs, for example, aspirin, ibuprofen, indomethacin (Indocin, Indocin IV), and naproxen (Naprosyn, Naprelan)] may reduce the blood pressure-lowering effects of ACE inhibitors.

What are some examples of ACE inhibitors available?

The following is a list of the ACE inhibitors that are available in the United States:

  • benazepril (Lotensin, Lotensin Hct),
  • captopril (Capoten),
  • enalapril (Vasotec),
  • fosinopril (Monopril),
  • lisinopril (Prinivil, Zestril),
  • moexipril (Univasc)
  • perindopril (Aceon),
  • quinapril (Accupril),
  • ramipril (Altace), and
  • trandolapril (Mavik).

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References
Robert J. Bryg, MD
Board Certified Internal Medicine with subspecialty in Cardiovascular Disease
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