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ACE Inhibitors: Mechanism, Doses, Indications, Adverse Effects, and Contraindications
Enumerate ACE Inhibitors
- Enalapril
- Lisinopril
- Ramipril
- Captopril
- Benazepril
- Quinapril
- Fosinopril
- Moexipril
- Perindopril
Mechanism of Action
ACE inhibitors (Angiotensin-Converting Enzyme inhibitors) block the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, by inhibiting the enzyme ACE. This results in decreased levels of angiotensin II, leading to vasodilation, reduced blood pressure, decreased aldosterone secretion, and reduced sodium and water retention. Consequently, this helps to lower blood pressure and decrease the workload on the heart.
Therapeutic Dose
- Enalapril: 5-40 mg/day
- Lisinopril: 10-40 mg/day
- Ramipril: 2.5-20 mg/day
- Captopril: 25-150 mg/day
- Benazepril: 10-40 mg/day
- Quinapril: 10-80 mg/day
- Fosinopril: 10-40 mg/day
- Moexipril: 7.5-30 mg/day
- Perindopril: 4-16 mg/day
Doses may vary based on specific indications, patient tolerance, and clinical response.
Indications
- Hypertension
- Heart failure
- Left ventricular dysfunction following myocardial infarction
- Chronic kidney disease (to slow progression)
- Diabetic nephropathy
- Risk reduction for cardiovascular events in high-risk patients
Adverse Effects
- Common: Cough, hyperkalemia (increased potassium levels), hypotension, dizziness, fatigue.
- Serious: Angioedema (swelling of deeper layers of the skin), renal impairment, rash, hepatotoxicity.
- Rare: Anaphylaxis, agranulocytosis.
Contraindications
- History of angioedema related to previous ACE inhibitor therapy.
- Pregnancy (due to teratogenic effects, particularly in the second and third trimesters).
- Bilateral renal artery stenosis (risk of renal failure).
- Significant renal impairment (caution advised).
