📋 Indications & Clinical Dosage
*Hypertension:*
Adult: Initially 10 mg once daily; usual maintenance 20 mg once daily; max. 80 mg per day.
*Hypertension (in addition to diuretic) in cardiac decompensation or in volume depletion:*
Adult: Initially 2.5-5 mg once daily; usual maintenance 20 mg once daily; max. 80 mg per day.
*Short-term treatment following myocardial infarction in haemodynamically stable patients (systolic blood pressure over 120mmHg):*
Adult: Initially 5 mg, taken within 24 hours of myocardial infarction, followed by 5 mg and then 10 mg, to be taken at 24 hours intervals, then 10 mg once daily for 6 weeks (or continued if heart failure), temporarily reduce maintenance dose to 5mg and if necessary 2.5mg daily if systolic blood pressure 100mmHg or less during treatment; withdraw if prolonged hypotension occurs during treatment (systolic blood pressure less than 90mmHg for more than 1 hour).
*Short-term treatment following myocardial infarction in haemodynamically stable patients (systolic blood pressure 100-120mmHg):*
Adult: Initially 2.5 mg once daily, maintenance 5 mg once daily, increase to maintenance dose only after at least 3 days of the initial dose, should not be started after myocardial infarction if systolic blood pressure less than 100 mmHg.
*Renal complications of diabetes mellitus:*
Adult: Initially 2.5-5 mg once daily, adjusted according to response; usual dose 10-20 mg once daily.
*Heart failure (adjunct):*
Adult: Initially 2.5 mg once daily; increased in steps of up to 10 mg at least every 2 weeks; max. 35 mg per day.
⛔ Contraindications
Aortic stenosis, outflow obstruction, cor pulmonale. Angioneurotic oedema related to previous ACE-inhibitor therapy, renal dysfunction, Systolic BP <100 mmHg in acute MI
⚠️ Precautions & Warnings
Renovascular hypertension, severe congestive heart failure, low systolic BP in acute MI, haemodialysis, renal impairment; monitor renal function before and during treatment, anaesthesia.
🔄 Drug Interactions
K+-sparing diuretics, K+ supplement, lithium, NSAIDs, antidiabetic agents, neuroleptics, tricyclic, antihypertensives.
⚠️ Adverse Reactions / Side Effects
Hypotension, renal failure, angioedema, rash, dizziness, headache GI upset, cough, fatigue, palpi-tations, asthenia, Raynauds syndrome, vertigo, asthenia, cerebrovascular accident, confusion, impotence, mood changes, myocardial infarction,palpitation, sleep disturbances, tachycardia. Rare: Alopecia, dry mouth, gynaecomastia, psoriasis
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Contraindicated in pregnancy.
Lactation / Breastfeeding:
Caution advised
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.