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Captopril is an FDA-approved medication that plays a pivotal role in managing hypertension, left ventricular dysfunction post-myocardial infarction, and diabetic nephropathy. Its therapeutic efficacy primarily stems from inhibiting the renin-angiotensin-aldosterone system (RAAS), making it a cornerstone in treating these cardiovascular conditions. Captopril effectively mitigates the pathophysiological cascades contributing to hypertension and heart failure by impeding the conversion of angiotensin I to angiotensin II. This activity sheds light on captopril's mechanism of action, dosage considerations, pharmacodynamics, and monitoring strategies. Additionally, captopril's off-label uses in acute hypertensive crises and the Raynaud phenomenon will be discussed, equipping clinicians and interprofessional team members with essential knowledge to administer captopril. Awareness of its adverse event profile and potential toxicities is crucial in ensuring captopril's safe and effective integration into clinical practice. Objectives: Identify patients with hypertension, heart failure, post-MI left ventricular dysfunction, or diabetic nephropathy who may benefit from captopril therapy. Screen patients for contraindications, such as a history of angioedema or bilateral renal artery stenosis, before initiating captopril treatment. Implement appropriate dosing strategies for captopril based on the patient's condition, renal function, and concurrent medications. Apply knowledge of the potential adverse effects of captopril, including cough, hypotension, hyperkalemia, and renal dysfunction, to manage and minimize their impact on patient outcomes. Access free multiple choice questions on this topic.

Correction of hypotension is the primary concern through volume expansion with an intravenous infusion of normal saline. Excessive hypotension has been rarely seen in hypertensive patients but is a possible consequence of captopril use in salt/volume-depleted persons. ACE inhibitors have rarely shown an association with a syndrome that begins with cholestatic jaundice and progresses to fulminant hepatic necrosis and sometimes death.[1] Captopril should be discontinued if a marked elevation of hepatic transaminases or jaundice occurs. A persistent, dry, hacking, nonproductive cough within the first few months of treatment can also occur with captopril therapy. ACE inhibitor-induced cough results from inhibiting the degradation of bradykinin and generally resolves within 1 to 4 weeks after discontinuation. Acute captopril overdose presents with profound hypotension, acute kidney injury, central hypoperfusion, and altered mental status. Management is primarily supportive. Maintenance of hemodynamics with IV fluids and vasopressors is required. The literature review suggests the role of dialysis in acute overdose.[38] Case reports also describe the role of naloxone in the reversal of ACE inhibitor toxicity, including captopril.[39] The proposed mechanism is the impact of ACE inhibitors on the endogenous opioid systems, leading to the accumulation of enkephalin and its reversal by naloxone.[40]

Captopril is a widely prescribed drug in clinical medicine. Physicians and advanced practice practitioners who prescribe this medication for hypertension should be aware of its side effects and the need to monitor electrolytes and renal function. Cardiologist consultation is required for managing HFrEF, post-MI LV dysfunction, and optimization of GDMT. Nephrology consultation can provide evidence-based strategies for the management of diabetic neuropathy. Emergency medicine and critical care physicians play an essential role in overdose. Medical toxicologists offer valuable information regarding the latest treatment for overdose. Nurses can provide patient counseling, assess compliance, and coordinate with the prescriber if they note any changes in patient status, including therapeutic failure or adverse events. The pharmacist should keep track of the patient's medications to help reduce polypharmacy and drug interactions and educate the patient about adverse reactions that they should monitor, instructing them to contact their care team promptly should any arise. Nurses and pharmacists should immediately consult with the prescriber to alert them to any concerns regarding the patient's regimen and progress or lack thereof. An interprofessional approach and open communication between all healthcare team members, including clinicians, specialists, pharmacists, and medical toxicologists, can minimize adverse drug reactions and improve the outcomes related to captopril therapy.