Source:http://www4.wiwiss.fu-berlin.de/dailymed/resource/drugs/181
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Captopril and Hydrochlorothiazide (Tablet)
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DOSAGE MUST BE INDIVIDUALIZED ACCORDING TO PATIENT'S
RESPONSE. Captopril and Hydrochlorothiazide tablets may be substituted for
the previously titrated individual components. Alternatively, therapy may be instituted with a single tablet of
Captopril and Hydrochlorothiazide 25 mg/15 mg taken once daily. For
patients insufficiently responsive to the initial dose, additional
captopril or hydrochlorothiazide may be added as individual components
or by using Captopril and Hydrochlorothiazide tablets 50 mg/15 mg, 25
mg/25 mg or 50 mg/25 mg, or divided doses may be used. Because the full effect of a given dose may not be attained for 6
to 8 weeks, dosage adjustments should generally be made at 6 week
intervals, unless the clinical situation demands more rapid adjustment. In general, daily doses of captopril should not exceed 150 mg and of hydrochlorothiazide should not exceed 50 mg. Captopril and Hydrochlorothiazide tablets should be taken one
hour before meals.<br/>Dosage Adjustment in Renal Impairment: Because captopril and hydrochlorothiazide are excreted
primarily by the kidneys, excretion rates are reduced in
patients with impaired renal function. These patients will take
longer to reach steady-state captopril levels and will reach
higher steady-state levels for a given daily dose than patients
with normal renal function. Therefore, these patients may
respond to smaller or less frequent doses of Captopril and
Hydrochlorothiazide tablets. After the desired therapeutic effect has been achieved,
the dose intervals should be increased or the total daily dose
reduced until the minimal effective dose is achieved. When
concomitant diuretic therapy is required in patients with severe
renal impairment, a loop diuretic (e.g., furosemide), rather
than a thiazide diuretic is preferred for use with captopril;
therefore, for patients with severe renal dysfunction the
captopril-hydrochlorothiazide combination tablet is not usually
recommended (See WARNINGS:
Captopril: Anaphylactoid reactions during membrane
exposure and PRECAUTIONS:
Hemodialysis).
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USE IN PREGNANCYWhen used in pregnancy during the second
and third trimesters, ACE inhibitors can cause injury and even death
to the developing fetus. When pregnancy is detected, Captopril and Hydrochlorothiazide should be discontinued as soon as
possible. See WARNINGS:
Captopril, Fetal/Neonatal Morbidity and
Mortality.
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Captopril and Hydrochlorothiazide
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Captopril and Hydrochlorothiazide (Tablet)
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Captopril and Hydrochlorothiazide tablets are indicated for the
treatment of hypertension. The blood pressure lowering effects of
captopril and thiazides are approximately additive. This fixed combination drug may be used as initial therapy or
substituted for previously titrated doses of the individual components. When captopril and hydrochlorothiazide are given together it may
not be necessary to administer captopril in divided doses to attain
blood pressure control at trough (before the next dose). Also, with such
a combination, a daily dose of 15 mg of hydrochlorothiazide may be
adequate. Treatment may, therefore, be initiated with Captopril and
Hydrochlorothiazide tablets 25 mg/15 mg once daily. Subsequent titration
should be with additional doses of the components (captopril,
hydrochlorothiazide) as single agents or as Captopril and
Hydrochlorothiazide tablets 50 mg/15 mg, 25 mg/25 mg, or 50 mg/25 mg
(see DOSAGE AND
ADMINISTRATION). In using Captopril and Hydrochlorothiazide tablets, consideration
should be given to the risk of neutropenia/agranulocytosis . Captopril and Hydrochlorothiazide tablets may be used for
patients with normal renal function, in whom the risk is relatively low.
In patients with impaired renal function, particularly those with
collagen vascular disease, Captopril and Hydrochlorothiazide tablets should be reserved for hypertensives who have either developed
unacceptable side effects on other drugs, or have failed to respond
satisfactorily to other drug combinations. ACE inhibitors (for which adequate data are available) cause a
higher rate of angioedema in black than in non-black patients (seeWARNINGS:
Angioedema).
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Captopril and Hydrochlorothiazide
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