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Lotensin (Benazepril) - Indications, Dose, Side effects

Benazepril is an angiotensin-converting enzyme (ACE) inhibitor, which is a type of medication primarily used to treat high blood pressure (hypertension) and heart failure.

Lotensin (Benazepril) has a strong hypotensive effect by inhibiting the conversion of angiotensin I to angiotensin II.

It is used in the treatment of the following conditions:

Hypertension:
- It is used in the management of hypertension

Off Label Usage of Benazepril in Adults:

It is used as off label agent in the following conditions:

Heart failure
Non–ST-elevation acute coronary syndrome
Stable coronary artery disease
ST-elevation acute coronary syndrome

Benazepril Dose in Adults

Lotensin (benazepril) Dose in the treatment of Hypertension:

Starting Dose:
- 5 to 10 mg taken orally once daily.
Titration:
- Dose adjustments are based on the patient's response to the medication.
Maximum Dose:
- Up to 40 mg daily.
Dosing Frequency:
- Can be taken as a single daily dose or split into 1 or 2 divided doses per day.

Dose in Childrens

Lotensin (Benazepril) Dose in the treatment of Hypertension:

Using Benazepril for High Blood Pressure in Kids and Teens (6 years and older):

Starting: Give 0.2 mg for each kg the child weighs, once a day. But don't give more than 10 mg the first day.
Regular Use: Give 0.1 to 0.6 mg for each kg the child weighs, once a day. But don't give more than 40 mg in one day.

Remember: Adjust the dose based on how the child reacts to the medicine. Always aim to use the smallest amount that works.

Lotensin Pregnancy Risk Category: X

[US Boxed Warning]

Some medicines, like those affecting the renin-angiotensin system, can harm or even kill unborn babies.
If someone gets pregnant, they should stop taking these drugs immediately.
Benazepril, which is one of these drugs, can pass to the baby and lead to problems like weak lungs, bone issues, and even death.
These drugs shouldn't be taken during pregnancy, especially if the only concern is high blood pressure.
If pregnant women do need a medicine for high blood pressure or heart issues, they should pick a different one.
Also, women who might become pregnant should avoid these drugs.
If a baby was exposed while in the womb, doctors should watch for issues like too much potassium, low blood pressure, and little urine.
Some severe cases might need special treatments, but we're not fully sure how well these work for babies.
High blood pressure alone during pregnancy can also cause problems, but these specific drugs are not the answer.

Benazepril use during breastfeeding:

Benazepril and a related substance are found in breast milk.
Some experts say it's okay for breastfeeding moms to take benazepril.
But, it's a good idea to keep an eye on the baby's weight for the first month just to be safe.

Benazepril Dose in Renal Disease:

If the kidney's filtration rate (CrCl) is 30 or more: The regular dose is fine.
If it's less than 30: Start with 5 mg daily, but don't go over 40 mg/day.
If on hemodialysis: Take only 25% to 50% of the normal dose. No need for extra doses.
If on peritoneal dialysis: Take 25% to 50% of the usual dose. No added doses needed.

Benazepril Dose in Liver Disease:

The maker of the drug hasn't given any special dosing instructions for people with liver problems

Common Side Effects of Benazepril (Lotensin) Include:

Cardiovascular:
- Hypotension
Central nervous system:
- Headache
- Dizziness
- Drowsiness
- Orthostatic
- Dizziness

Contraindication to Benazepril include:

People shouldn't take benazepril if they:

Are allergic to benazepril, similar drugs, or any ingredient in the pill.
Have had swelling reactions (like angioedema) before, whether from this kind of drug or not.
Are taking aliskiren and have diabetes.
Are switching to or from a neprilysin inhibitor, like sacubitril, within a day and a half (36 hours).

In Canada, there are extra warnings. Don't use benazepril if:

Taking aliskiren and kidney function is weak.
Pregnant or breastfeeding.
Have certain rare sugar processing problems.

Warnings and precautions

Angioedema

It can happen anytime while using the drug, even after the first dose.
This reaction might cause swelling in the head and neck areas, which can block breathing, or in the belly causing pain.
African Americans or those with certain types of angioedema in their family might be at higher risk.
The risk is even higher if you're also on certain other drugs, like everolimus or sacubitril.
Special attention is needed if the swelling involves areas that can block breathing, like the tongue or throat. Those who had throat surgeries might be at extra risk.
It's vital to treat this condition quickly and properly.
People who've had this swelling before, whether from this drug type or not, shouldn't take it.

Cholestatic jaundice

It's a type of liver problem where bile doesn't flow properly.
This issue can get worse, leading to severe liver damage.
If liver tests show big changes, or if there's yellowing of the skin or eyes (jaundice), stop taking the drug.

Cough:

It's a dry, nagging cough.
Usually starts within the first months of using the drug.
Should go away 1 to 4 weeks after stopping the drug.
Before stopping the drug, check if something else might be causing the cough, like a lung problem in heart failure patients.

Hematologic effects

Captopril, a similar drug, can lower certain blood cells which can lead to:
- Neutropenia: Fewer white blood cells, which fight infections.
- Agranulocytosis: Even fewer white blood cells.
- Anemia: Fewer red blood cells, causing tiredness.
- Thrombocytopenia: Fewer platelets, affecting blood clotting.
People with kidney problems are at a higher risk of getting neutropenia.
This risk is even higher for those with kidney problems and conditions like lupus.
If someone's at risk, regularly check their complete blood count.

Hyperkalemia:

ACE inhibitors can raise potassium in the blood.
Those more at risk include people with:
- Kidney issues.
- Diabetes.
- Taking water pills that save potassium.
- Taking potassium supplements or salts.
If using these, be careful and check potassium levels regularly.

Hypersensitivity reactions

ACE inhibitors can cause severe allergic reactions.
These reactions can be extra strong during:
- Certain types of dialysis, especially with specific equipment like AN69.
- Treatments to remove bad cholesterol using dextran sulfate cellulose.
- Bee or wasp sting treatments for those on ACE inhibitors.

Hypotension/ Syncope

ACE inhibitors can cause a drop in blood pressure, sometimes making people faint (especially in the first few doses).
This is more common in people who are dehydrated. Make sure they have enough fluids before starting the medicine.
Patients need close watching, especially when starting or increasing the dose.
Even if the dose needs to be lowered, don't stop the ACE inhibitor just because of low blood pressure. In heart failure patients, a drop in blood pressure can actually be a good sign.

Renal function deterioration:

ACE inhibitors can sometimes make kidney function worse, leading to higher BUN and creatinine levels in the blood.
This is especially a concern for people with certain conditions like narrow kidney arteries or heart failure, where the kidney's function heavily relies on the tightening of specific blood vessels.
This can lead to problems like:
- Making less urine.
- Sudden kidney failure.
- Build-up of waste in the blood.
A small rise in creatinine levels can happen after starting the medicine. Only think about stopping the ACE inhibitor if the kidney function gets significantly worse over time.

Aortic stenosis

Be careful using ACE inhibitors in people with a severely narrowed aorta.
It might reduce blood flow to the heart, which can lead to a lack of oxygen in the heart muscles.

Ascites:

Don't use ACE inhibitors in people with fluid build-up in their belly from liver problems.
If you really have to use it in someone with this fluid build-up due to liver issues, keep a close eye on their blood pressure and kidney function. This is to prevent the kidneys from failing quickly.

Cardiovascular disease

Starting this medicine in people with heart or brain blood flow problems needs extra attention because a drop in blood pressure could lead to heart attacks or strokes.
If they're dehydrated, giving them fluids might help their blood pressure. Then, they can continue the medicine.
If their blood pressure drops again, it's best to stop the medicine.

Collagen vascular disease:

Be careful using ACE inhibitors in people with diseases that affect their connective tissues, especially if they also have kidney issues.
They might have a higher risk of blood-related side effects.

Diabetes:

Be careful using ACE inhibitors in people with diabetes who are taking insulin or diabetes pills.
They might have a higher chance of having low blood sugar episodes.

Hypertrophic cardiomyopathy with outflow tract obstruction (HCM)

Use ACE inhibitors carefully in people with HCM where there's a blockage in heart blood flow.
The medicine might make the symptoms of this heart condition worse.

Renal artery stenosis

Be cautious using ACE inhibitors in people with narrow kidney arteries that haven't been treated with a stent.
If both kidney arteries are narrowed and without stents, it's typically best to avoid this medicine because of the high risk of kidney problems, unless the benefits really outweigh the risks.

Renal impairment

Use ACE inhibitors carefully if someone already has kidney issues. They might need a different dose.
Don't quickly increase the dose, as it might make kidney problems worse.

Benazepril: Drug Interaction

Note: Drug Interaction Categories:

Risk Factor C: Monitor When Using Combination
Risk Factor D: Consider Treatment Modification
Risk Factor X: Avoid Concomitant Use

Risk Factor C (Monitor therapy).
Alfuzosin	May intensify blood pressure lowering medications' hypotensive effects.
Amphetamines	May lessen the effects of antihypertensive medications in treating hypertension.
Angiotensin II	The therapeutic efficacy of angiotensin II may be enhanced by angiotensin-converting enzyme inhibitors.
Antipsychotic Agents, Second Generation (Atypical)	Antipsychotic drugs can have a greater hypotensive effect when blood pressure-lowering medications are used (Second Gen [Atypical]).
Aprotinin	May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.
AzaTHIOprine	AzaTHIOprine's myelosuppressive effects may be enhanced by angiotensin-converting enzyme inhibitors.
Barbiturates	May intensify blood pressure lowering medications' hypotensive effects.
Benperidol	May intensify blood pressure lowering medications' hypotensive effects.
Brigatinib	May lessen the effects of antihypertensive medications in treating hypertension. The bradycardic effects of antihypertensive medications may be exacerbated by brutinib.
Brimonidine (Topical)	May intensify blood pressure lowering medications' hypotensive effects.
Dapoxetine	May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.
Dexmethylphenidate	Antihypertensive agents may have a less therapeutic effect.
Diazoxide	May intensify blood pressure lowering medications' hypotensive effects.
Dipeptidyl Peptidase-IV Inhibitors	May worsen angiotensin-converting enzyme inhibitors' toxic or severe effects. The risk of angioedema in particular could rise.
Drospirenone	Drospirenone's hyperkalemic impact may be enhanced by angiotensin-converting enzyme inhibitors.
DULoxetine	By reducing blood pressure, DULoxetine may intensify the hypotensive effects.
Eplerenone	May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.
Everolimus	May intensify angiotensin-converting enzyme inhibitors' harmful or hazardous effects. The risk of angioedema in particular could rise.
Ferric Gluconate	Angiotensin-Converting Enzyme Inhibitors might make ferric gluconate more harmful or poisonous.
Complex of Ferric Hydroxide Polymaltose	Ferric Hydroxide Polymaltose Complex may have a more negative or toxic effect when taken with angiotensin-converting enzyme inhibitors. Angioedema and allergic responses in particular may become more likely.
Gelatin (Succinylated).	Gelatin's harmful or toxic effects may be increased by angiotensin-converting enzyme inhibitors (Succinylated). Particularly, a higher risk of paradoxical hypotensive reactions to gelatin may exist (Succinylated).
Gold Sodium Thiomalate	Gold Sodium Thiomalate may have a more negative or toxic effect when used with angiotensin-converting enzyme inhibitors. Nitritoid responses have been linked to a higher risk, it has been highlighted.
Heparin	May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.
Heparins (Low Molecular Weight)	May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.
Herbs (Hypertensive Properties)	May lessen the effects of antihypertensive medications in treating hypertension.
Herbs (Hypotensive properties)	May intensify blood pressure lowering medications' hypotensive effects.
HydroCHLOROthiazide	May intensify Benazepril's hypotensive effects. HydroCHLOROthiazide might make Benazepril's nephrotoxic effects worse. HydroCHLOROthiazide in the serum may reduce the effects of HydroCHLOROthiazide.
Hypotension-Associated Agents	The hypotensive action of hypotension-associated agents may be strengthened by blood pressure lowering medications.
Icatibant	May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.
Levodopa-Containing Products	Levodopa-Containing Products' hypotensive effects may be amplified by blood pressure-lowering medications.
Loop Diuretics	May strengthen angiotensin-converting enzyme inhibitors' hypotensive effects. Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be increased by loop diuretics.
Lormetazepam	May intensify blood pressure lowering medications' hypotensive effects.
Methylphenidate	May lessen the effects of antihypertensive medications in treating hypertension.
Molsidomine	May intensify blood pressure lowering medications' hypotensive effects.
Naftopidil	May intensify blood pressure lowering medications' hypotensive effects.
Nicergoline	May intensify blood pressure lowering medications' hypotensive effects.
Nicorandil	May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.
Nicorandil	May intensify blood pressure lowering medications' hypotensive effects.
Nitrogen	Blood pressure lowering medications may intensify Nitroprusside's hypotensive effects.
Nonsteroidal Anti-Inflammatory Drugs	Nonsteroidal Anti-Inflammatory Agents' negative/toxic effects may be increased by angiotensin-converting enzyme inhibitors. The combination can cause renal function to significantly decline. Angiotensin-Converting Enzyme Inhibitors' antihypertensive effects may be lessened by nonsteroidal anti-inflammatory drugs.
Pentoxifylline	May intensify blood pressure lowering medications' hypotensive effects.
Pholcodine	Pholcodine's ability to reduce blood pressure may help to increase hypotensive effects.
Phosphodiesterase 5 Inhibitors	Might increase the hypotensive effects of Blood Pressure Lowering Agents.
Potassium Salts	May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.
Potassium-Sparing Diuretics	May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.
Pregabalin	Angiotensin-Converting Enzyme Inhibitors may intensify Pregabalin's negative/toxic effects. Risk of gioedema could rise.
Prostacyclin Analogues	May intensify blood pressure lowering medications' hypotensive effects.
Quinagolide	May intensify blood pressure lowering medications' hypotensive effects.
Racecadotril	May intensify angiotensin-converting enzyme inhibitors' harmful or hazardous effects. Angioedema may be more likely as a result of this combination.
Ranolazine	May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.
Salicylates	May intensify angiotensin-converting enzyme inhibitors' nephrotoxic effects. The therapeutic benefit of angiotensin-converting enzyme inhibitors may be reduced by salicylates.
Sirolimus	May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.
Tacrolimus (Systemic)	Tacrolimus's effect of making you more hyperkalemic may be enhanced by angiotensin-converting enzyme inhibitors (Systemic).
Temsirolimus	May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.
Thiazide and Thiazide - Like Diuretics	May increase the angiotensin-converting enzyme inhibitors' hypotensive effects. Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be increased by thiazide and thiazide-like diuretics.
TiZANidine	May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.
Tolvaptan	May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.
Trimethoprim	May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.
Yohimbine	May lessen the effects of antihypertensive medications in treating hypertension.
Risk Factor D (Consider therapy modifications)
Aliskiren	Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects. Angiotensin-Converting Enzyme Inhibitors' hypotensive effects may be strengthened by aliskiren. Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be made worse by aliskiren. Aliskiren shouldn't be taken along with ACEIs or ARBs if the patient has diabetes. In diabetic patients, it is best to avoid combining Aliskiren with ACEIs or ARBs, especially if CrCl is less than 60 mL/min. If present together, carefully watch blood pressure, potassium, and creatinine levels.
Allopurinol	Angiotensin-Converting Enzyme Inhibitors might make Allopurinol more likely to cause allergic or hypersensitive reactions.
Amifostine	The hypotensive effects of amifostine may be strengthened by blood pressure reducing medications. Treatment: Stop taking blood pressure medications at least 24 hours before taking amifostine. If taking blood pressure medicine cannot be stopped, amifostine should be avoided.
Angiotensin II Receptor Blockers	May worsen angiotensin-converting enzyme inhibitors' toxic or severe effects. Angiotensin-Converting Enzyme Inhibitors' serum levels may rise in response to angiotensin II receptor blockers. Management: It is not advised to label telmisartan and ramipril in the US. It is unknown whether another ACE inhibitor and ARB combo would be less dangerous. If at all possible, think about combining different elements.
Grass Pollen Allergen Extract (5 Grass Extract)	Grass pollen allergen extract may have a more negative or toxic effect if angiotensin-converting enzyme inhibitors are used (5 Grass Extract). In particular, ACE inhibitors may raise the possibility of life-threatening allergic reactions to grass pollen allergen extract (5 Grass).
Iron Dextran Complex	Angiotensin-Converting Enzyme Inhibitors might make Iron Dextran Complex more harmful or poisonous. Patients who take ACE inhibitors may be more prone to responses of this nature. Management: Carefully follow the iron dextran instructions for setting up resuscitation equipment, educating staff before administering iron dextran, and using a test dosage before beginning the initial therapeutic dose.
Lanthanum	May lower angiotensin-converting enzyme inhibitors' serum concentration. Angiotensin-converting enzyme inhibitors should be given at least two hours before or after lanthanum.
Lithium	The serum concentration of lithium may rise in response to angiotensin-converting enzyme inhibitors. It is likely that you will need to lower your lithium dosage after adding an ACE inhibitor. After stopping or starting concomitant ACE inhibitor medication, monitor how patients respond to lithium.
Obinutuzumab	The effects of blood pressure lowering medications may become more hypotensive as a result. Treatment: Starting 12 hours before the obinutuzumab injection and continuing for 1 hour after the infusion, you may temporarily stop taking blood pressure-lowering medications.
Sodium Phosphates	The nephrotoxic impact of sodium phosphates may be enhanced by angiotensin-converting enzyme inhibitors. Particularly, there may be an elevated risk of acute phosphate nephropathy. Treatment: You can temporarily stop taking ACEIs or explore for alternatives to the oral sodium phosphate bowel preparation to prevent this combo. In the event that the combination is not possible, be sure to drink enough water and keep a close eye on your renal function.
Urapidil	Angiotensin-Converting Enzyme Inhibitors may interact with them through an unidentified method. Avoid taking urapidil and ACE inhibitors simultaneously as a management strategy.
Risk Factor X (Avoid Combination)
Bromperidol	The hypotensive effects of bromperidol may be strengthened by blood pressure-lowering medications. The hypotensive effects of blood pressure-lowering medications may be lessened by bromperidol.
Sacubitril	The negative or hazardous effects of sacubitril may be increased by angiotensin-converting enzyme inhibitors. Angioedema may be more likely as a result of this combination.

Monitor:

Monitoring:

Keep an eye on blood pressure.
Check BUN, creatinine, and potassium in the blood.
If someone has connective tissue disease or kidney problems, also check their complete blood count.

High Blood Pressure Guidelines:

For adults with proven high blood pressure and known heart and blood vessel risks:
- Aim for a blood pressure below 130/80 mm Hg.
For adults with high blood pressure but without high heart and blood vessel risks:
- It might be good to aim for blood pressure below 130/80 mm Hg.

For People with Diabetes and High Blood Pressure:

Adults 18-65 years old, no known heart and blood vessel disease, and low 10-year risk:
- Aim for blood pressure below 140/90 mm Hg.
Adults 18-65 years old with known heart and blood vessel disease or higher 10-year risk:
- Try for blood pressure below 130/80 mm Hg, if it's safe.
Adults over 65, in good or average health:
- Aim for blood pressure below 140/90 mm Hg.
Adults over 65, in poor health:
- Aim for blood pressure below 150/90 mm Hg.

How to take Benazepril (Lotensin)?

It can be taken orally and with or without food.

Mechanism of action of Benazepril (Lotensin):

The drug stops the change of a substance called angiotensin I into another one called angiotensin II.
Angiotensin II usually tightens blood vessels.
By blocking its creation, blood vessels relax.
This also makes the body produce more of a signal called renin and release less of a hormone called aldosterone.

How it Works on ACE Activity:

Starts Working: 1 to 2 hours after taking a 2 to 20 mg dose.
Lasts Long: Over 90% activity blockage for a day after taking 5 to 20 mg.

How it Works on Blood Pressure:

Quick Effect: 2 to 4 hours after a single dose.
Full Effect: After 2 weeks of regular use.

How the Body Absorbs It:

Speed: Fast (37% is absorbed).
Food Impact: Eating doesn't change how it's absorbed much.

Where It Goes in the Body:

Volume Spread: Around 8.7 liters.

How It Sticks to Proteins:

Benazepril: Sticks to about 97% of proteins.
Benazeprilat (a related substance): Sticks to about 95% of proteins.

How the Body Changes It:

Where: Mostly in the liver.
Into What: Turns into benazeprilat, its active form.

How Long It Stays:

Benazeprilat:
- Effective: 10 to 11 hours.
- Total: 5 hours in kids, 22 hours in adults.

When It Peaks in the Body:

Benazepril: 0.5 to 1 hour.
Benazeprilat: 1 to 2 hours on an empty stomach; 2 to 4 hours otherwise.

How It Leaves the Body:

Through Urine: A tiny bit as benazepril, 20% as benazeprilat, 12% as other forms.
Other Ways Out: Mostly through the liver. If kidneys aren't working well, it finds other ways out, like bile.
Dialysis: Only about 6% of benazeprilat is removed in 4 hours of dialysis. The original drug doesn't appear in the dialysis liquid.

Benazepril International Brands:

Benace
Boncordin
Cibacen
Lotensin
Sotrel
Unitense
Xbenzi
Zaprace
PMS-Benazepril

Benazepril Brands in Pakistan:

You can check for availability and prices by clicking the WhatsApp link here: https://wa.me/message/HV6M3JGTA6RJB1