1. Introduction
Benazepril is an angiotensin-converting enzyme (ACE) inhibitor used primarily for the treatment of hypertension (high blood pressure). It works by relaxing blood vessels, reducing blood pressure, and improving heart function.
2. Indications
- Hypertension (Primary and Secondary Hypertension)
- Heart Failure (Off-Label Use, in combination with other medications)
- Chronic Kidney Disease (CKD) (Off-Label Use, for proteinuria reduction)
3. Dosage
Adults (Hypertension):
- Starting dose: 10 mg once daily
- Maintenance dose: 20–40 mg/day (single or divided doses)
- Max dose: 80 mg/day (rarely used)
Heart Failure (Off-Label):
- Starting dose: 5 mg once daily
- Target dose: 20–40 mg/day
Paediatric Hypertension (≥6 years, weight-based dosing):
- Starting dose: 0.2 mg/kg once daily (max 10 mg/day)
- Maintenance dose: Up to 0.6 mg/kg/day (max 40 mg/day)
Elderly:
- Start at a lower dose (5 mg/day) due to increased sensitivity.
Renal Impairment:
- Mild-moderate (CrCl 30–60 mL/min): Start with 5 mg/day, max 40 mg/day.
- Severe (CrCl <30 mL/min): Start with 2.5 mg/day, max 20 mg/day.
Hepatic Impairment:
- No dose adjustment required, but use cautiously.
4. Administration
- Take with or without food.
- Take at the same time each day for consistency.
- If using twice daily dosing, space doses evenly (e.g., morning and evening).
5. Forms Available
- Tablets: 5 mg, 10 mg, 20 mg, 40 mg
- Combination Formulations:
- Benazepril + Hydrochlorothiazide (Lotensin HCT)
6. Side Effects
6.1 Common Side Effects:
- Dizziness
- Dry cough (due to bradykinin accumulation)
- Fatigue
- Headache
- Low blood pressure (hypotension)
6.2 Less Common Side Effects:
- Increased potassium levels (hyperkalaemia)
- Skin rash
- Mild swelling in legs (peripheral oedema)
6.3 Rare but Serious Side Effects:
- Angioedema (swelling of face, lips, or throat—life-threatening)
- Severe hypotension (especially in volume-depleted patients)
- Kidney dysfunction (increased creatinine and urea levels)
- Liver toxicity (rare cases of hepatotoxicity)
7. Warnings
- Angioedema Risk:
- Can be fatal—if swelling occurs, discontinue immediately and seek emergency help.
- Higher risk in African American patients.
- Hyperkalaemia Risk:
- Avoid in patients with high potassium levels or on potassium-sparing diuretics.
- Monitor potassium levels regularly.
- Cough Risk:
- Dry, persistent cough is common—consider switching to an angiotensin receptor blocker (ARB) (e.g., losartan) if intolerable.
- Severe Hypotension:
- Risk increases in dehydrated patients or those taking diuretics.
- Renal Function Decline:
- May cause worsening kidney function in bilateral renal artery stenosis.
8. Precautions
- Avoid in pregnancy—causes fetal harm (Category D).
- Monitor kidney function closely in chronic kidney disease (CKD) patients.
- Avoid NSAIDs (e.g., ibuprofen, naproxen)—increased risk of kidney damage.
- Not recommended in patients with a history of angioedema from ACE inhibitors.
9. Interactions
- NSAIDs (e.g., ibuprofen, naproxen): Increases risk of kidney failure and reduced antihypertensive effect.
- Potassium-Sparing Diuretics (e.g., spironolactone): Increased hyperkalaemia risk.
- Loop & Thiazide Diuretics (e.g., furosemide, hydrochlorothiazide): Increased risk of hypotension when combined.
- Lithium: Increased lithium toxicity risk—monitor lithium levels closely.
- Other Antihypertensives (e.g., beta-blockers, calcium channel blockers): May increase blood pressure-lowering effects.
10. Monitoring Parameters
- Blood pressure (BP): Every 2–4 weeks after dose changes.
- Renal function (Creatinine, eGFR): Baseline, then every 3–6 months.
- Serum potassium levels: Monitor especially in kidney disease.
- Signs of angioedema: Discontinue immediately if swelling occurs.
11. Use in Children
- Approved for paediatric hypertension (≥6 years)—weight-based dosing required.
- Monitor kidney function and BP regularly.
12. Use in Pregnancy
- Category D:
- Contraindicated—causes fetal toxicity (renal failure, skull defects, death).
- Must be stopped immediately if pregnancy is detected.
13. Use in Elderly
- Start at a lower dose (5 mg/day) due to increased hypotension risk.
14. Use in Kidney Disease
- Adjust dose in moderate to severe renal impairment (CrCl <30 mL/min).
- Monitor creatinine, eGFR, and potassium levels regularly.
15. Use in Liver Disease
- No major dose adjustment required—use with caution.
16. Patient Counselling Points
- Take at the same time daily for best results.
- Monitor blood pressure regularly.
- Report any swelling of lips, face, or throat (signs of angioedema).
- Expect a dry cough—if severe, discuss switching to another medication.
- Avoid high-potassium foods (e.g., bananas, oranges) unless directed.
- Do not stop abruptly—sudden discontinuation can cause rebound hypertension.
17. Table of Brand Names, Manufacturer, and Prices in USD
Brand Name | Manufacturer | Strength/Dosage Form | Price (USD) |
---|---|---|---|
Lotensin | Novartis | 5 mg, 10 mg, 20 mg, 40 mg Tablets | $50 (30 tabs) |
Generic Benazepril | Various | 5 mg, 10 mg, 20 mg, 40 mg Tablets | $20 (30 tabs) |
Lotensin HCT (Benazepril + HCTZ) | Novartis | 5/6.25 mg, 10/12.5 mg, 20/25 mg | $60 (30 tabs) |
18. 15 FAQs (Frequently Asked Questions)
1. What is Benazepril used for?
It treats high blood pressure and reduces proteinuria in kidney disease.
2. How does Benazepril work?
It relaxes blood vessels, lowering blood pressure and improving heart function.
3. Can I stop taking Benazepril suddenly?
No, stopping suddenly can cause rebound hypertension—taper under medical supervision.
4. Does Benazepril cause weight gain?
No, weight changes are uncommon.
5. Can I take Benazepril with food?
Yes, it can be taken with or without food.
6. Does Benazepril cause drowsiness?
No, but it may cause dizziness or fatigue.
7. Can I drink alcohol while taking Benazepril?
Limit alcohol—may increase dizziness or hypotension.
8. Does Benazepril affect kidney function?
It may reduce kidney function initially—monitor creatinine levels.