captopril and hydrochlorothiazide, Capozide
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
GENERIC NAME: captopril and hydrochlorothiazide
BRAND NAME: Capozide
DRUG CLASS AND MECHANISM: Capozide is a combination of captopril (Capoten) and hydrochlorothiazide (HCTZ), an angiotensin converting enzyme (ACE) inhibitor and a diuretic (water pill), respectively, and is used in the treatment of high blood pressure. ACE is an enzyme in the body that causes the formation of angiotensin II. Angiotensin II causes the arteries in the body to narrow, thereby elevating blood pressure. ACE inhibitors, such as captopril, lower blood pressure by preventing the formation of angiotensin II thereby relaxing the arteries. HCTZ is a diuretic (water pill) used for treating high blood pressure (hypertension) and accumulation of fluid. It works by blocking salt and fluid reabsorption in the kidneys, causing increased urine output (diuresis). The mechanism of its action in lowering high blood pressure is not well understood. The combination of captopril and HCTZ reduces blood pressure better than either drug alone. Captopril increases potassium levels while HCTZ reduces potassium levels; the combination of both drugs has less effect on potassium levels. The FDA approved captopril/HCTZ in October 1984.
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets (captopril/HCTZ): 25/15, 25/25, 50/15, and 50/25 mg.
STORAGE: Tablets should be stored at room temperature, 15-30 C (59-86 F).
PRESCRIBED FOR: Capozide is used to treat high blood pressure. It may be used as initial treatment or substituted for the individual component drugs.
DOSING: The starting dose is 25/15 mg once daily. The dose may be increased every 6 weeks.
DRUG INTERACTIONS: Captopril may increase potassium levels (hyperkalemia) in blood. Therefore, there is an increased risk of hyperkalemia when captopril is given with potassium supplements or drugs that increase potassium levels (for example, spironolactone [Aldactone]).
There have been reports of increased lithium (Eskalith, Lithobid) levels when lithium is used in combination with ACE inhibitors. The reason for this interaction is not known, but the increased levels may lead to toxicity from lithium.
There have been reports that aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, etc.), indomethacin (Indocin, Indocin-SR), and naproxen (Anaprox, Naprelan, Naprosyn, Aleve) may reduce the effects of ACE inhibitors.
Combining captopril or other ACE inhibitors with nonsteroidal anti-inflammatory drugs (NSAIDs) in patients who are elderly, volume-depleted (including those on diuretic therapy), or with poor kidney function may result in reduced kidney function, including kidney failure. These effects usually are reversible.
Nitritoid reactions (symptoms include facial flushing, nausea, vomiting and hypotension or low blood pressure) may occur when injectable gold (sodium aurothiomalate), used in the treatment of rheumatoid arthritis, is combined with ACE inhibitors, including captopril.
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