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benazepril (Rx)Brand and Other Names:Lotensin

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 5mg
  • 10mg
  • 20mg
  • 40mg
more...

Hypertension

Patients taking a diuretic: 5 mg/day PO initially, to avoid excessive hypotension

Patients not taking a diuretic: 10 mg/day PO

May increase to maintenance dose of 20-40 mg/day PO qDay or divided q12hr

Nephropathy-Nondiabetic (Off-label)

10-20 mg PO qDay

Dosing Modifications

Renal Impairment

  • CrCl< 30 mL/min: 5 mg PO qDay initially; not to exceed 40 mg/day

Hepatic Impairment

  • Not studied

Dosing Considerations

Consider starting an ACE inhibitor in high-risk patients, even if no hypertension or CHF

No sexual dysfunction side effect

Good choice in hyperlipidemia patients

Requires weeks for full effect; to start, use low dose and titrate q1-2wk

Abrupt discontinuance not associated with rapid increase in BP

Beneficial for many patients at risk for heart disease

Reduces risk of MI, stroke, diabetic nephropathy, microalbuminuria, new-onset diabetes mellitus

May preserve renal function in diabetes mellitus

May help to prevent migraine headaches

Dosage Forms & Strengths

tablet

  • 5mg
  • 10mg
  • 20mg
  • 40mg

Hypertension

<6 years: Safety and efficacy not established

≥6 years: 0.1-0.6 mg/kg PO qDay initially, not to exceed 5 mg/day; THEN 

Adjust dose based on BP response; not to exceed 0.6 mg/kg/day or 40 mg/day

Suspension preparation

  • The following prepares 150 mL of 2 mg/mL oral suspension
  • Add 75 mL of Ora-Plus oral suspending vehicle to an amber polyethylene terephthalate (PET) bottle containing fifteen benazepril 20 mg tablets, and shake for at least 2 minutes
  • Allow the suspension to stand for a minimum of 1 hr
  • After the standing time, shake the suspension for a minimum of 1 additional minute, then add 75 mL of Ora-Sweet oral syrup vehicle to the bottle and shake the suspension to disperse the ingredients
  • Store refrigerated at 2-8°C (36-46°F) for up to 30 days in the PET bottle with a child-resistant screw-cap closure
  • Shake the suspension before each use

Dosing Modification

Renal impairment (CrCl <30 mL/min): Insufficient data to recommend dosage adjustment

Hypertension

5-10 mg/day PO initially in single or divided doses

Maintenance: 20-40 mg/day PO adjust for renal function

Dosing Modifications

Adjust dose for renal function; benazepril and benazeprilat are substantially excreted by the kidney

Because elderly patients are more likely to have decreased renal function, take care in dose selection; it may be useful to monitor renal function

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Interactions

Interaction Checker

benazepril and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            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%)

            <1% (selected)

            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

            Stevens-Johnson syndrome

            Uric acid increased

            Postmarketing Reports

            Dermatologic: Stevens-Johnson syndrome, pemphigus, apparent hypersensitivity reactions (manifested by dermatitis, pruritus, or rash), photosensitivity, and flushing

            Gastrointestinal: Nausea, pancreatitis, constipation, gastritis, vomiting, and melena

            Hematologic: Thrombocytopenia and hemolytic anemia

            Neurologic and psychiatric: Anxiety, decreased libido, hypertonia, insomnia, nervousness, and paresthesia

            Fatigue

            Asthma

            Bronchitis

            Dyspnea

            Sinusitis

            Urinary tract infection

            Frequent urination

            Infection

            Arthritis

            Impotence

            Alopecia

            Arthralgia

            Myalgia

            Asthenia

            Sweating

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            Warnings

            Black Box Warnings

            Discontinue as soon as possible when pregnancy is detected; affects renin-angiotensin system, causing oligohydramnios, which may result in fetal injury and/or death

            Contraindications

            Hypersensitivity

            History of hereditary or idiopathic angioedema

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

            Cautions

            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

            Rare cases of agranylocytosis reported ACE inhibitor therapy

            May cause hypotension during surgery; additive hypotensive effects may occur with anesthetic agents that produce hypotension (correct by volume expansion)

            Deterioration of renal function may occur; may consider discontinuation of therapy in patients with progressive and/or significant deterioration in renal function

            Monitor for jaundice or signs of liver failure

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            Pregnancy & Lactation

            Pregnancy category: D

            Discontinue as soon as pregnancy detected; during the second and third trimesters of pregnancy, drugs that act directly on the renin-angiotensin system have been associated with fetal injury that includes hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death

            Lactation: Minimal amount excreted in breast milk; use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Competitively inhibits angiotensin-converting enzymes, resulting in decreased plasma angiotensin II concentrations; consequently, blood pressure may be reduced, in part through decreased vasoconstriction; increases renin activity and decreases aldosterone secretion

            Also increases renal blood flow

            Absorption

            Bioavailability: 37%

            Onset: 1-2 hr (peak effect with 2-20 mg dose)

            Duration: 24 hr (with 5-20 mg dose)

            Peak plasma time: 0.5-1 hr (parent drug)

            Distribution

            Protein bound: 95-97%

            Vd: 8.7 L

            Metabolism

            Metabolite: Benazeprilat (active)

            Elimination

            Half-life: 10-11 hr

            Dialyzable: Minimal

            Excretion: Urine (primarily); bile (11-12%)

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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