BLACK BOX WARNING
- fetal toxicity
captopril
Brand: Capoten
⚠ BBW Prototype: lisinopril
Drug Class: ACE inhibitor
Drug Family: antihypertensive
Subclass: short-acting ACE inhibitor
Organ Systems: cardiovascularrenal
Mechanism of Action
First ACE inhibitor; contains sulfhydryl group; active drug (not prodrug) inhibiting ACE directly.
ACE (angiotensin-converting enzyme)
Indications
- hypertension
- heart failure
- post-MI LV dysfunction
- diabetic nephropathy
Contraindications
- pregnancy
- ACE-inhibitor angioedema
- bilateral RAS
Adverse Effects
Common
- cough
- hyperkalemia
- rash (sulfhydryl-related)
- dysgeusia
Serious
- angioedema
- AKI
- neutropenia (rare, sulfhydryl-related)
Pharmacokinetics (ADME)
| Absorption | 60-75% oral; reduced with food (take 1 hour before meals) |
| Distribution | crosses placenta |
| Metabolism | partial hepatic |
| Excretion | renal |
| Half-life | 2 hours |
| Onset | 15-30 minutes |
| Peak | 1-2 hours |
| Duration | 6-12 hours |
| Protein Binding | 25-30% |
| Vd | moderate |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| NSAIDs | reduced efficacy | moderate |
| potassium-sparing diuretics | hyperkalemia | major |
| probenecid | reduced renal clearance of captopril | moderate |
Nursing Considerations
- Administer on empty stomach (1h before meals)
- Short duration requires TID-QID dosing
- Monitor CBC in patients with renal impairment or autoimmune disease (risk of neutropenia)
- Taste changes common; reassure patient
Clinical Pearls
- First ACE inhibitor approved (1981)
- Sulfhydryl group confers rare risk of rash and neutropenia not seen with other ACEIs
- Short half-life useful for rapid-acting hypertensive urgency management
Safety Profile
Pregnancy contraindicated
Lactation avoid
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.