ACE INHIBITORS: Ref: ESC guidelines.
| Drug | Dosage | Renal elimination % |
Dosage in Renal failure CrCl 10 - 30 ml/min |
|
|---|---|---|---|---|
| 1. | Enalapril | 2.5 - 20 mg bid | 88 % | 2.5 - 20mg bid |
| 2. | Ramipril | 2.5 - 10 mg daily | 85% | 1.25 - 5 mg daily |
| 3. | Benazepril | 2.5 - 20 mg bid | 85% | 2.5 - 10 mg bid |
| 4. | Captopril | 25 - 100 mg tid | 95% | 6.25 - 12.5 mg tid |
| 5. | Zofenopril | 7.5 - 30 mg bid | 60 % | 7.5 - 30 mg bid |
| 6. | Cilazapril | 1.25 - 5 mg daily | 80% | 0.5 - 2.5 daily |
| 7. | Lisinopril | 2.5 - 10 daily | 70% | 2.5 - 5 daily |
| 8. | Perindopril | 4 - 8 mg daily | 75% | 2 mg daily |
| 9. | Quinapril | 10 - 40 mg daily | 75% | 2.5 - 5 mg daily |
| 10. | Spirapril | 3 - 6 mg daily | 50% | 3 - 6 mg daily |
| 11. | Trandolapril | 1 - 4 mg daily | 15% | 0.5m- 1 mg daily |
| 12. | Fosinopril | 10 - 40 mg daily | 50% | 10 - 40 mg daily |
Note:
1.All are prodrugs except Captopril, Spirapril, Trandolapril, Cilazapril.
2.Significant Hepatic elimination: Zofenopril, Spirapril, Trandolapril, Fosinopril.
Practical Points:
1.Double dose at 2 weeks intervals
2.Faster titration in hypertensive patients, mild heart failure, asymptomatic LV dysfunction, In hospitalised patients
RENAL FAILURE patients:
1. Up to 30 % rise in creatinine is tolerable during initiation
2. Caution if Creatinine > 2.5 mg/dl
3. Contraindicated(STOP) if creatinine > 3 mg/dl, or creatinine increases by 50%, or K+ > 6 mmol/L.
4. Dialysis patients can be treated with ACEI, provided hyperkalemia can be prevented by low K+ diet & avoiding K+ sparing diuretics.
Switch over between drugs:
1. Stop ACE I and start ARBs on following day at an equivalent dose
2. Stop ACE I and start ARNi after 36 hours.
3. Combinations of ACEI with ARB,ARNI,direct renin inhibitor is Contraindicated.
