benazepril hydrochloride

(ben a' za pril)

Lotensin

Pregnancy Category C (first trimester)

Pregnancy Category D (second, third trimesters)

Drug classes
Antihypertensive
Angiotensin-converting enzyme (ACE) inhibitor

Therapeutic actions
Blocks ACE from converting angiotensin I to angiotensin II, a potent vasoconstrictor,
leading to decreased BP, decreased aldosterone secretion, a small increase in serum
potassium levels, and sodium and fluid loss; increased prostaglandin synthesis also may
be involved in the antihypertensive action.

Indications
• Treatment of hypertension alone or in combination with thiazide-type diuretics

Contraindications and cautions

• Contraindicated with allergy to benazepril or other ACE inhibitors.
• Use cautiously with impaired renal function, immunosuppresion, CHF,
hypotension, salt or volume depletion, lactation, pregnancy.

Available forms
Tablets—5, 10, 20, 40 mg

Dosages
ADULTS
Initial dose, 10 mg PO daily. Maintenance dose, 20–40 mg/day PO, single or two divided
doses. Patients using diuretics should discontinue them 2–3 d prior to benazepril therapy.
If BP is not controlled, add diuretic slowly. If diuretic cannot be discontinued, begin
benazepril therapy with 5 mg. Maximum dose, 80 mg.
PEDIATRIC PATIENTS
Safety and efficacy not established.
PATIENTS WITH RENAL IMPAIRMENT
For creatinine clearance < 30 mL/min/1.73 m2 (serum creatinine > 3 mg/dL), 5 mg PO
daily. Dosage may be gradually increased until blood pressure is controlled, up to a
maximum of 40 mg/day.

Pharmacokinetics
Route Onset Peak Duration
Oral 0.5–1 hr 3–4 hr 24 hr

Metabolism: Hepatic; T1/2: 10–11 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• CV: Angina pectoris, hypotension in salt- or volume-depleted patients,
palpitations
• Dermatologic: Rash, pruritus, diaphoresis, flushing
• GI: Nausea, abdominal pain, vomiting, constipation
• Respiratory: Cough, asthma, bronchitis, dyspnea, sinusitis
• Other: Angioedema, impotence, decreased libido, asthenia, myalgia, arthralgia

Interactions
Drug-drug
• Increased risk of hypersensitivity reactions with allopurinal
• Increased coughing with capsaicin
• Decreased antihypertensive effects with indomethacin and other NSAIDs
• Increased lithium levels and neurotoxicity may occur if combined
• Increased risk of hyperkalemia with potassium-sparing diuretics or potassium
supplements

Nursing considerations
Assessment
• History: Allergy to benazepril or other ACE inhibitors, impaired renal function,
CHF, salt or volume depletion, lactation, pregnancy
• Physical: Skin color, lesions, turgor; T; P, BP, peripheral perfusion; mucous
membranes, bowel sounds, liver evaluation; urinalysis, renal and liver function
tests, CBC and differential

Interventions
• Alert surgeon: Note use of benazepril on patient's chart; the angiotensin II
formation subsequent to compensatory renin release during surgery will be
blocked; hypotension may be reversed with volume expansion.
• Monitor patient for possible fall in BP secondary to reduction in fluid volume
(excessive perspiration and dehydration, vomiting, diarrhea) because excessive
hypotension may occur.
• Reduce dosage in patients with impaired renal function.

Teaching points
• Do not stop taking the medication without consulting your health care provider.
• Be careful in any situation that may lead to a drop in blood pressure (diarrhea,
sweating, vomiting, dehydration); if light-headedness or dizziness occurs, consult
your health care provider.
• These side effects may occur: GI upset, loss of appetite (transient effects; if
persistent consult health care provider); light-headedness (transient; change
position slowly, and limit activities to those that do not require alertness and
precision); dry cough (irritating but not harmful; consult health care provider).
 • Report mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular
heartbeat, chest pains; swelling of the face, eyes, lips, tongue, difficulty breathing,
persistent cough.

Adverse effects in Italic are most common; those in Bold are life-threatening.