Benazepril

DEA Class; Rx

Common Brand Names; Lotensin

• ACE Inhibitors

Direct renin inhibitor
Used for hypertension
Black box warning for pregnancy

Indicated ACE inhibitor
Used for hypertension and congestive heart failure
Long duration of action allows for once daily dosing

Hypersensitivity

History of hereditary or idiopathic angioedema

Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan

Concomitant administration with aliskiren in patients with diabetes mellitus or with renal impairment

• Cough (1-10%)
• Headache (6%)
• Dizziness (4%)
• Fatigue (2%)
• Postural dizziness (2%)
• Serum creatinine increased (2%)
• Somnolence (2%)
• Nausea (1%)
• ARF if renal artery stenosis (1%)
• Anaphylactoid reaction
• Angina
• Angioedema
• ECG changes
• Flushing
• Hypotension
• Palpitations
• Postural hypotension
• Syncope
• Insomnia
• Alopecia
• Dermatitis
• Rash
• Hyperglycemia
• Pancreatitis
• Gastritis
• Vomiting
• Agranulocytosis
• Eosinophilia
• Hemolytic anemia
• Hyperkalemia
• Hyponatremia
• Leukopenia
• Neutropenia
• Thrombocytopenia
• Transaminases increased
• Arthritis
• Arthralgia
• Impotence
• Proteinuria
• Asthma
• Dyspnea

Excessive hypotension with or without syncope may occur if hypovolemia/hyponatremia present or if coadministered with diuretics

Dual blockade of the renin-angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for hypotension, hyperkalemia, and renal function changes (including acute renal failure), compared with monotherapy

Most patients receiving the combination of two RAS inhibitors do not obtain any additional benefit compared to monotherapy; avoid combined use of RAS inhibitors; closely monitor blood pressure, renal function and electrolytes in patients on benazepril and other agents that affect the RAS

Not for coadministration with aliskiren in patients with diabetes; avoid use of aliskiren with benazepril in patients with renal impairment (GFR <60 ml/min/1.73 m²)

ACE inhibition causes increased bradykinin levels, which putatively mediates angioedema (higher incidence in black patients)

Cough may occur due to increased bradykinin levels

Cholestatic jaundice reported with use

Avoid use in bilateral renal artery stenosis

Angioedema may occur; coadministration with mTOR inhibitors (eg, temsirolimus) may increase risk for angioedema; discontinue therapy and treat appropriately if angioedema occurs

Discontinue immediately if pregnancy occurs (see Black Box Warnings)

ACE inhibitors are less effective in black patients

Renal impairment may occur

Lotensin can cause fetal harm when administered to a pregnant woman; use of drugs that act on renin-angiotensin system during second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death

Minimal amounts of unchanged benazepril and of benazeprilat are excreted into the breast milk of lactating women receiving therapy; a newborn child ingesting entirely breast milk would receive less than 0.1% of mg/kg maternal dose of benazepril and benazeprilat