ACE Inhibitor

Aka: ACE Inhibitor, Angiotensin Converting Enzyme Inhibitor, Captopril, Capoten, Lisinopril, Prinivil, Zestril, Enalapril, Vasotec, Fosinopril, Monopril, Benzapril, Lotensin, Moexipril, Univasc, Perindopril, Aceon, Quinapril, Accupril, Ramipril, Altace, Trandopril, Mavik

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II. Contraindications

  1. Absolute Contraindications
    1. Angioedema history
      1. Regardless of cause (even if not due to ACE Inhibitor)
    2. Pregnancy (serious Teratogenicity - black box warning)
    3. Renal Artery Stenosis
    4. ACE Inhibitor related Allergic Reaction
  2. Relative Contraindications
    1. Aortic Stenosis
    2. Hypertrophic Cardiomyopathy

III. Indications

  1. Hypertension
    1. Useless in low renin patients (esp. Black ethnicity)
    2. Low renin patients respond better to Diuretics
  2. Myocardial Infarction
    1. Early ACE Inhibitor in acute Myocardial Infarction
      1. Started within 24 hours of Anterior MI
      2. Significant reduction in CHF and death
      3. Significantly lower mortality at 1 year
    2. Reference
      1. Ambrosioni (1995) N Engl J Med 332:80-5 [PubMed]
      2. Stenestrand (2001) JAMA 285:430-6 [PubMed]
  3. Congestive Heart Failure
    1. Left ventricle Systolic Dysfunction
  4. Diabetic Nephropathy
  5. Renal Insufficiency

IV. Mechanism

  1. Renin-Angiotensin System

V. Preparations (Choose once daily dosing if possible)

  1. Captopril (Capoten)
    1. Hypertension: 25 mg orally twice to three times daily (maximum 450 mg/day)
    2. CHF: 6.25 - 12.5 mg orally three times daily (maximum 450 mg/day)
  2. Enalapril (Vasotec)
    1. Hypertension: 5 mg orally daily (maximum 40 mg/day)
    2. CHF: 2.5 mg orally daily to twice daily (maximum 40 mg/day)
    3. IV: 1.25 mg IV every 6 hours
  3. Lisinopril (Prinivil, Zestril)
    1. Hypertension: 10 mg orally daily (target 20-40 mg/day)
    2. CHF: 5 mg orally daily (target 20 mg/day)
    3. Acute MI: 5 mg orally daily for 2 days then 10 mg orally daily
    4. Maximum 40 mg/day
  4. Fosinopril (Monopril)
    1. Hypertension: 10 mg orally daily (target 40 mg/day)
    2. CHF: 10 mg orally daily (target 20-40 mg/day)
    3. Maximum: 80 mg/day
  5. Benzapril (Lotensin)
    1. Hypertension: 10 mg orally daily (target 20-40 mg/day)
    2. Maximum: 80 mg/day
  6. Moexipril (Univasc): Take one hour before meals
    1. Hypertension: 7.5 mg orally daily (maximum 30 mg/day)
  7. Perindopril (Aceon)
    1. Hypertension: 4 mg orally daily (target 4-8 mg/day)
    2. Maximum 16 mg/day
  8. Quinapril (Accupril)
    1. Hypertension: 10 mg orally daily (target 20-40 mg/day)
    2. CHF: 5 mg orally twice daily, titrating weekly to 20-40 mg/day
    3. Maximum: 80 mg/day
  9. Ramipril (Altace)
    1. Hypertension: 2.5 mg orally daily (target 2.5-20 mg orally daily)
    2. CHF: 2.5 mg orally twice daily (target 5 mg orally twice daily)
    3. Maximum 20 mg/day
  10. Trandopril (Mavik)
    1. Hypertension: 1 mg orally daily (target 2 to 4 mg orally daily)
    2. CHF: 1 mg orally daily (target 4 mg orally daily)
    3. Maximum: 8 mg/day

VI. Adverse Effects

  1. Cough (dry and irritating)
    1. Characteristics
      1. Occurs in 5 to 20% of patients
        1. More common in women
        2. More common in black patients
      2. Not dose related
      3. Stops within 4 days of medication cessation
    2. Alternative medications
      1. Angiotensin Receptor Blocker (e.g. Losartan)
    3. Inhalers may relieve cough
      1. Tilade 2 puffs inhaled four times daily
      2. Cromolyn 20 mg inhaled four times daily
  2. Hyperkalemia (5% of patients)
    1. See Drug Interactions below
    2. Asociated with Renal Insufficiency, Diabetes Mellitus
  3. Teratogenicity in second or third trimester
    1. Fetal injury or death
    2. Pregnancy Class C if discontinued in first trimester
  4. Renal Insufficiency
    1. Renal Artery Stenosis (see monitoring below)
    2. No Creatinine level is absolute contraindication
    3. Baseline Serum Creatinine <3.0 mg/dl is safe
  5. Hypotension
    1. Restart ACE Inhibitor at half prior dose
    2. Decrease or hold dose of any concurrent Diuretic
  6. Angioedema
    1. ACE-Inhibitor induced Angioedema is not an Allergic Reaction (unlike typical Angioedema)
      1. Related to bradykinin accumulation
      2. Does not respond to typical Angioedema management (e.g. Corticosteroids, Antihistamines)
    2. Occurs in 1 of 300 patients
      1. More common in african american patients by factor of 2-4 fold
    3. Reaction can occur months to years after starting an ACE Inhibitor
    4. Treatment is withdrawal of medication and supportive care
      1. See Angioedema for management
      2. Reactions may be severe and life threatening with complete airway closure
      3. May respond to agents used for Hereditary Angioedema (e.g. Icatibant, Berinert)
    5. Do not re-challenge with ACE Inhibitor
      1. ACE-Inhibitor Angioedema will recur with ARB agents in 8% of patients
      2. Avoid Angiotensin Receptor Blocker (ARB) unless a very compelling reason exists
        1. If ARB is used, wait at least 4 weeks after ACE Inhibitor has been discontinued
        2. Avoid using ARB in moderate to severe ACE Inhibitor Angioedema episode
  7. Rare Adverse Reactions
    1. Rash
    2. Agranulocytosis
    3. Neutropenia
      1. Associated with comorbid Renal Insufficiency
      2. Associated with comorbid collagen vascular disease

VII. Drug Interactions

  1. Increases Lithium levels (follow levels)
  2. Decreased ACE Inhibitor levels with concurrent Antacids
  3. Decreased Renal Function with concurrent NSAID use
  4. Agents predisposing to Hyperkalemia
    1. Bactrim
    2. Potassium supplements or salt substitute
    3. Beta Blockers
    4. NSAIDs
    5. Potassium sparing Diuretics
      1. Triamterene
      2. Spironolactone

VIII. Monitoring

  1. Serum Potassium (if patient at risk)
  2. Serum Creatinine
    1. Timing
      1. Baseline
      2. Recheck in 4 days to 2 weeks
    2. Expect an increase in Chronic Kidney Disease
      1. Despite this, renal protective effect outweighs mild to moderate Creatinine increase
    3. Indication to consider stopping ACE Inhibitor
      1. Serum Creatinine increased >20% in 4 days
    4. Additional precautions when increasing dose
      1. Serum Creatinine should not increase >30%

IX. References

  1. (1987) N Engl J Med 316(23):1429-35 [PubMed]
  2. Bicket (2002) Am Fam Physician 66(3):461-73 [PubMed]
  3. Pfeffer (1992) N Engl J Med 327(10):669-77 [PubMed]
  4. Yeun (2001) Postgrad Med 110(5):39-40 [PubMed]

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Cost: Medications

Lisinopril-HCTZ (on 6/18/2017 at Walmart.com)
Lisinopril-HCTZ 10mg-12.5mg #30 tablets for $4.00 $0.13 each
Lisinopril-HCTZ 10mg-12.5mg #90 tablets for $10.00 $0.11 each
Lisinopril-HCTZ 20mg-12.5mg #30 tablets for $4.00 $0.13 each
Lisinopril-HCTZ 20mg-12.5mg #90 tablets for $10.00 $0.11 each
Lisinopril-HCTZ 20mg-25mg #30 tablets for $4.00 $0.13 each
Lisinopril-HCTZ 20mg-25mg #90 tablets for $10.00 $0.11 each
Lisinopril (on 6/18/2017 at Walmart.com)
Lisinopril 10mg #30 tablets for $4.00 $0.13 each
Lisinopril 10mg #90 tablets for $10.00 $0.11 each
Lisinopril 2.5mg #30 tablets for $4.00 $0.13 each
Lisinopril 2.5mg #90 tablets for $10.00 $0.11 each
Lisinopril 20mg #30 tablets for $4.00 $0.13 each
Lisinopril 20mg #90 tablets for $10.00 $0.11 each
Lisinopril 5mg #30 tablets for $4.00 $0.13 each
Lisinopril 5mg #90 tablets for $10.00 $0.11 each
Enalapril-HCTZ (on 6/18/2017 at Walmart.com)
Enalapril-HCTZ 5mg-12.5mg #30 tablets for $4.00 $0.13 each
Enalapril-HCTZ 5mg-12.5mg #90 tablets for $10.00 $0.11 each
captopril (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
CAPTOPRIL 100 MG TABLET Generic $1.85 each
CAPTOPRIL 12.5 MG TABLET Generic $0.73 each
CAPTOPRIL 25 MG TABLET Generic $0.88 each
CAPTOPRIL 50 MG TABLET Generic $1.50 each
CAPTOPRIL-HYDROCHLOROTHIAZIDE 25-15 MG TABLET Generic $0.94 each
CAPTOPRIL-HYDROCHLOROTHIAZIDE 50-25 MG TABLET Generic $1.58 each
lisinopril (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
LISINOPRIL 10 MG TABLET Generic $0.02 each
LISINOPRIL 2.5 MG TABLET Generic $0.01 each
LISINOPRIL 20 MG TABLET Generic $0.02 each
LISINOPRIL 30 MG TABLET Generic $0.06 each
LISINOPRIL 40 MG TABLET Generic $0.05 each
LISINOPRIL 5 MG TABLET Generic $0.02 each
LISINOPRIL-HYDROCHLOROTHIAZIDE 10-12.5 MG TAB Generic $0.03 each
LISINOPRIL-HYDROCHLOROTHIAZIDE 20-12.5 MG TAB Generic $0.04 each
LISINOPRIL-HYDROCHLOROTHIAZIDE 20-25 MG TAB Generic $0.04 each
prinivil (on 6/8/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
PRINIVIL 20 MG TABLET Generic $0.02 each
zestril (on 12/1/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
ZESTRIL 10 MG TABLET Generic $0.02 each
enalapril (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
ENALAPRIL MALEATE 10 MG TAB Generic $0.22 each
ENALAPRIL MALEATE 2.5 MG TAB Generic $0.22 each
ENALAPRIL MALEATE 20 MG TAB Generic $0.32 each
ENALAPRIL MALEATE 5 MG TABLET Generic $0.25 each
ENALAPRIL-HYDROCHLOROTHIAZIDE 10-25 MG TABLET Generic $0.17 each
ENALAPRIL-HYDROCHLOROTHIAZIDE 5-12.5 MG TAB Generic $0.15 each
fosinopril (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
FOSINOPRIL SODIUM 10 MG TAB Generic $0.14 each
FOSINOPRIL SODIUM 20 MG TAB Generic $0.13 each
FOSINOPRIL SODIUM 40 MG TAB Generic $0.19 each
FOSINOPRIL-HYDROCHLOROTHIAZIDE 10-12.5 MG TAB Generic $0.74 each
FOSINOPRIL-HYDROCHLOROTHIAZIDE 20-12.5 MG TAB Generic $0.83 each
moexipril (on 3/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
MOEXIPRIL HCL 15 MG TABLET Generic $0.82 each
MOEXIPRIL HCL 7.5 MG TABLET Generic $0.71 each
MOEXIPRIL-HYDROCHLOROTHIAZIDE 15-12.5 MG TAB Generic $0.86 each
MOEXIPRIL-HYDROCHLOROTHIAZIDE 15-25 MG TABLET Generic $0.83 each
MOEXIPRIL-HYDROCHLOROTHIAZIDE 7.5-12.5 MG TAB Generic $0.69 each
perindopril (on 4/19/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
PERINDOPRIL ERBUMINE 4 MG TAB Generic $0.49 each
PERINDOPRIL ERBUMINE 8 MG TAB Generic $0.57 each
quinapril (on 3/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
QUINAPRIL 10 MG TABLET Generic $0.15 each
QUINAPRIL 20 MG TABLET Generic $0.14 each
QUINAPRIL 40 MG TABLET Generic $0.14 each
QUINAPRIL 5 MG TABLET Generic $0.14 each
QUINAPRIL-HYDROCHLOROTHIAZIDE 10-12.5 MG TAB Generic $0.52 each
QUINAPRIL-HYDROCHLOROTHIAZIDE 20-12.5 MG TAB Generic $0.55 each
QUINAPRIL-HYDROCHLOROTHIAZIDE 20-25 MG TAB Generic $0.37 each
accupril (on 6/1/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
ACCUPRIL 10 MG TABLET Generic $0.15 each
ACCUPRIL 20 MG TABLET Generic $0.14 each
ACCUPRIL 40 MG TABLET Generic $0.14 each
ramipril (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
RAMIPRIL 1.25 MG CAPSULE Generic $0.18 each
RAMIPRIL 10 MG CAPSULE Generic $0.08 each
RAMIPRIL 2.5 MG CAPSULE Generic $0.08 each
RAMIPRIL 5 MG CAPSULE Generic $0.08 each
altace (on 6/1/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
ALTACE 10 MG CAPSULE Generic $0.08 each
ALTACE 2.5 MG CAPSULE Generic $0.08 each
ALTACE 5 MG CAPSULE Generic $0.08 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

Ontology: Angiotensin-Converting Enzyme Inhibitors (C0003015)

Definition (CHV) a class of drugs mainly used for hypertension treatment
Definition (CHV) a class of drugs mainly used for hypertension treatment
Definition (CHV) a class of drugs mainly used for hypertension treatment
Definition (NCI_NCI-GLOSS) A drug that is used to lower blood pressure. An ACE inhibitor is a type of antihypertensive agent.
Definition (NCI) Any substance that inhibits angiotensin-converting enzyme (ACE), an enzyme that catalyzes the conversion of angiotensin I to angiotensin II. Inhibition of ACE results in a reduction in angiotensin II and angiotensin II-induced aldosterone secretion, causing vasodilation and natriuresis.
Definition (CSP) class of antihypertensive agents which act by inhibiting the proteolytic activation of angiotensin.
Definition (MSH) A class of drugs whose main indications are the treatment of hypertension and heart failure. They exert their hemodynamic effect mainly by inhibiting the renin-angiotensin system. They also modulate sympathetic nervous system activity and increase prostaglandin synthesis. They cause mainly vasodilation and mild natriuresis without affecting heart rate and contractility.
Concepts Pharmacologic Substance (T121)
MSH D000806
SnomedCT 41549009, 372733002
LNC LP31444-0
English ACE Inhibitors, Angiotensin Converting Enzyme Antagonists, Angiotensin Converting Enzyme Inhibitors, Angiotensin-Converting Enzyme Antagonists, Angiotensin-Converting Enzyme Inhibitors, Antagonists, Angiotensin Converting Enzyme, Antagonists, Angiotensin-Converting Enzyme, Antagonists, Kininase II, Enzyme Antagonists, Angiotensin-Converting, Enzyme Inhibitors, Angiotensin-Converting, Inhibitors, ACE, Inhibitors, Angiotensin Converting Enzyme, Inhibitors, Angiotensin-Converting Enzyme, Inhibitors, Kininase II, Kininase II Antagonists, Kininase II Inhibitors, Angiotensin I-Converting Enzyme Inhibitors, KININASE II INHIB, INHIB ACE, ACE INHIB, ANGIOTENSIN I CONVERTING ENZYME INHIB, ANTAG ANGIOTENSIN CONVERTING ENZYME, ANGIOTENSIN CONVERTING ENZYME ANTAG, INHIB ANGIOTENSIN CONVERTING ENZYME, ANTAG KININASE II, INHIB KININASE II, KININASE II ANTAG, ACE INHIBITORS, Angiotensin-Converting Enzyme Inhibitor, angiotensin converting enzyme inhibitor, ACE inhibitors, angiotensin-converting enzyme inhibitors (medication), angiotensin-converting enzyme inhibitors, [CV800] ACE INHIBITORS, ace inhibitors, angiotensin-converting enzyme (ACE) inhibitors, ace inhibitor, Angiotensin I Converting Enzyme Inhibitors, Angiotensin converting enzyme--Inhibitors, angiotensin-converting enzyme inhibitor, ACE inhibitor, Angiotensin-converting enzyme inhibitor, Angiotensin-converting enzyme inhibitor agent (product), Angiotensin-converting enzyme inhibitor agent (substance), Angiotensin-converting enzyme inhibitor agent, ACE inhibitor, NOS, Angiotensin-converting enzyme inhibitor agent, NOS, ACE Inhibitor, Angiotensin-converting Enzyme (ACE) Inhibitors
Swedish ACE-hämmare
Finnish Angiotensiinikonvertaasin estäjät
Italian Antagonosti dell'enzima convertitore di angiotensina, Inibitori della chinasi II, Antagonisti della chinasi II, Inibitori ACE, Inibitori dell'enzima convertitore di angiotensina I, Inibitori dell'enzima convertitore di angiotensina
Russian ANGIOTENZIN-PREVRASHCHAIUSHCHEGO FERMENTA INGIBITORY, KININAZY II INGIBITORY, АНГИОТЕНЗИН-ПРЕВРАЩАЮЩЕГО ФЕРМЕНТА ИНГИБИТОРЫ, КИНИНАЗЫ II ИНГИБИТОРЫ
Japanese ACE阻害剤, アンギオテンシン変換酵素阻害剤, アンジオテンシン変換酵素抑制剤, キニナーゼ2阻害剤, ACE阻害薬, Angiotensin変換酵素阻害薬, アンギオテンシン変換酵素阻害薬, アンジオテンシン変換酵素阻害剤, アンジオテンシン変換酵素阻害薬, キニナーゼII阻害剤
Croatian ANGIOTENZIN, DJELOVANJE ENZIMSKIH INHIBITORA
French IEC (Inhibiteurs de l'Enzyme de Conversion), Inhibiteurs ACE, Inhibiteurs de la kininase II, Inhibiteurs de l'angiotensin converting enzyme, Inhibiteurs de l'enzyme de conversion de l'angiotensine, Inhibiteurs de l'enzyme de conversion, Inhibiteurs ECA
Polish Inhibitory enzymu konwertującego angiotensynę, Inhibitory ACE, Inhibitory kinazy II, Inhibitory konwertazy angiotensyny
Czech inhibitory angiotensin-konvertujícího enzymu, enzym konvertující angiotensin - inhibitory, inhibitory angiotensin konvertujícího enzymu, inhibitory angiotenzin konvertujícího enzymu, ACE-I, ACE inhibitory, inhibitory ACE
Spanish IECA, agente inhibidor de la enzima convertidora de angiotensina (producto), agente inhibidor de la enzima convertidora de angiotensina (sustancia), agente inhibidor de la enzima convertidora de angiotensina, droga inhibidora de la enzima convertidora de angiotensina, inhibidor de la ECA, inhibidor de la convertasa, Inhibidores de ACE, Inhibidores de la Enzima Convertidora de Angiotensina, Inhibidores de Quininasa II
German ACE-Hemmer, Angiotensin-Converting-Enzym-Hemmer, Kininase-II-Blocker, Angiotensin-Konversionsenzym-Inhibitoren
Portuguese Inibidores da ACE, Inibidores da Enzima Conversora da Angiotensina, Inibidores da Quininase II
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Captopril (C0006938)

Definition (NCI_NCI-GLOSS) A drug used to treat high blood pressure that is also being studied in the prevention of side effects caused by radiation therapy used in the treatment of cancer. It belongs to the family of drugs called ACE inhibitors.
Definition (NCI) A sulfhydryl-containing analog of proline with antihypertensive activity and potential antineoplastic activity. Captopril competitively inhibits angiotensin converting enzyme (ACE), thereby decreasing levels of angiotensin II, increasing plasma renin activity, and decreasing aldosterone secretion. This agent may also inhibit tumor angiogenesis by inhibiting endothelial cell matrix metalloproteinases (MMPs) and endothelial cell migration. Captopril may also exhibit antineoplastic activity independent of effects on tumor angiogenesis. (NCI04)
Definition (MSH) A potent and specific inhibitor of PEPTIDYL-DIPEPTIDASE A. It blocks the conversion of ANGIOTENSIN I to ANGIOTENSIN II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the RENIN-ANGIOTENSIN SYSTEM and inhibits pressure responses to exogenous angiotensin.
Definition (CSP) potent and specific inhibitor of peptidyl dipeptidase A; it acts to suppress the renin-angiotensin system and inhibits blood pressure responses to exogenous angiotensin.
Definition (PDQ) A sulfhydryl-containing analog of proline with antihypertensive activity and potential antineoplastic activity. Captopril competitively inhibits angiotensin converting enzyme (ACE), thereby decreasing levels of angiotensin II, increasing plasma renin activity, and decreasing aldosterone secretion. This agent may also inhibit tumor angiogenesis by inhibiting endothelial cell matrix metalloproteinases (MMPs) and endothelial cell migration. Captopril may also exhibit antineoplastic activity independent of effects on tumor angiogenesis. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=37824&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=37824&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C340" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116)
MSH D002216
SnomedCT 29439004, 387160004
LNC LP32689-9, LP18914-9, MTHU006862
English captopril, (S)-1-(3-Mercapto-2-methyl-1-oxopropyl)-L-proline, L-Proline, 1-(3-mercapto-2-methyl-1-oxopropyl)-, (S)-, captopril (medication), CAPTOPRIL, Captopril [Chemical/Ingredient], Captopril (product), Captopril (substance), CPT, Captopril
Swedish Kaptopril
Czech kaptopril
Finnish Kaptopriili
Russian KAPTOPRIL, SQ 14225, КАПТОПРИЛ
Japanese カプトプリル
French (S)-1-(3-Mercapto-2-méthyl-1-oxopropyl)-L-proline, Captopril
Croatian KAPTOPRIL
Polish Kaptopryl
Spanish captopril (producto), captopril (sustancia), captoprilo, captopril, Captopril
German Captopril
Italian Captopril
Portuguese Captopril
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Enalapril (C0014025)

Definition (CHV) a drug used to treat hypertension
Definition (NCI) A dicarbocyl-containing peptide and angiotensin-converting enzyme (ACE) inhibitor with antihypertensive activity. As a prodrug, enalapril is converted by de-esterification into its active form enalaprilat. Enalaprilat competitively binds to and inhibits ACE, thereby blocking the conversion of angiotensin I to angiotensin II. This prevents the potent vasoconstrictive actions of angiotensin II and results in vasodilation. Enalapril also decreases angiotensin II-induced aldosterone secretion by the adrenal cortex, which leads to an increase in sodium excretion and subsequently increases water outflow.
Definition (NCI_NCI-GLOSS) An antihypertensive agent that can also be used to slow or prevent the progression of heart disease in people with childhood cancer treated with drugs that may be harmful to the heart.
Definition (CSP) 1-carboxy-3-phenylpropyl-L-alanyl- L-proline (as 1'-ethyl ester, maleate 1:1), is an ACE inhibitor used as an antihypertensive.
Definition (MSH) One of the ANGIOTENSIN-CONVERTING ENZYME INHIBITORS that is used to treat hypertension.
Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116)
MSH D004656
SnomedCT 15222008, 372658000
LNC LP171394-2
English Enalapril, L-Proline, 1-(N-(1-(ethoxycarbonyl)-3-phenylpropyl)-L-alanyl)-, (S)-, Enalapril [Chemical/Ingredient], ENALAPRIL, enalapril, Enalapril (product), Enalapril (substance)
Swedish Enalapril
Czech enalapril
Finnish Enalapriili
Russian ANALAPRILA MALEAT, ENALAPRIL, MK-421, АНАЛАПРИЛА МАЛЕАТ, ЭНАЛАПРИЛ
Japanese エナラート, レリート, エナリン, ラリルドン, レニベース, レニベーゼ, レニメック, エナラプリルMEEK, レノペント, エナラプリルM, エナラメルク, カルネート, シンベノン, ファルプリル, スパシオール, マレイン酸エナラプリル, ザクール, セリース, レビンベース, エナラプリルマレイン酸塩, アリカンテ, エナラプリル
Croatian ENALAPRIL
Spanish enalaprilo, enalapril (producto), enalapril (sustancia), enalapril, Enalapril
Polish Enalapryl
French Énalapril
German Enalapril
Italian Enalapril
Portuguese Enalapril
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Lisinopril (C0065374)

Definition (CHV) a drug used to treat hypertension and congestive heart failure
Definition (CHV) a drug used to treat hypertension and congestive heart failure
Definition (NCI) An orally bioavailable, long-acting angiotensin-converting enzyme (ACE) inhibitor with antihypertensive activity. Lisinopril, a synthetic peptide derivative, specifically and competitively inhibits ACE, which results in a decrease in the production of the potent vasoconstrictor angiotensin II and, so, diminished vasopressor activity. In addition, angiotensin II-stimulated aldosterone secretion by the adrenal cortex is decreased which results in a decrease in sodium and water retention and an increase in serum potassium.
Definition (NCI_NCI-GLOSS) A drug used to treat high blood pressure and certain heart conditions. It is also being studied in the prevention and treatment of side effects caused by some anticancer drugs. It blocks certain enzymes that cause blood vessels to constrict (narrow). It is a type of angiotensin-converting enzyme (ACE) inhibitor.
Definition (MSH) One of the ANGIOTENSIN-CONVERTING ENZYME INHIBITORS (ACE inhibitors), orally active, that has been used in the treatment of hypertension and congestive heart failure.
Definition (CSP) lysine derivative of the active form of enalapril; an angiotensin converting enzyme inhibitor used in the treatment of hypertension.
Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116)
MSH D017706
SnomedCT 108575001, 386873009
LNC LP171618-4
English Lisinopril, Lysinopril, L-Proline, 1-(N2-(1-carboxy-3-phenylpropyl)-L-lysyl)-, dihydrate, (S)-, lisinopril, lisinopril (medication), LISINOPRIL, Lisinopril [Chemical/Ingredient], lysinopril, N2-[(1S)-1-Carboxy-3-phenylpropyl]-L-lysyl-L-proline, Dihydrate, Lisinopril (product), Lisinopril (substance)
Swedish Lisinopril
Czech lisinopril
Finnish Lisinopriili
Russian LIZINOPRIL, ЛИЗИНОПРИЛ
Japanese リシノプリル, リジノプリル
Croatian LIZINOPRIL
Spanish lisinoprilo, lisinopril (producto), lisinopril (sustancia), lisinopril, Lisinopril
Polish Lizynopryl
French Lisinopril
German Lisinopril
Italian Lisinopril
Portuguese Lisinopril
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: moexipril (C0066685)

Definition (NCI) A non-sulfhydryl angiotensin converting enzyme (ACE) inhibitor with antihypertensive activity. As a prodrug, moexipril is hydrolyzed into its active form moexiprilat, which competitively inhibits ACE, thereby blocking the conversion of angiotensin I to angiotensin II. This prevents the actions of the potent vasoconstrictor angiotensin II and leads to vasodilation. It also prevents angiotensin II-induced aldosterone secretion by the adrenal cortex, thereby promoting diuresis and natriuresis.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C058302
SnomedCT 108566003, 373442003
English 2-((1-ethoxycarbony)-3-phenylpropylamino-1-oxopropyl)-6,7-dimethoxy-1,2,3,4-tetrahydroisoquinoline-3-carboxylic acid, moexipril, MOEXIPRIL, moexipril [Chemical/Ingredient], Moexipril, Moexipril (product), Moexipril (substance)
Spanish moexipril (producto), moexipril (sustancia), moexiprilo, moexipril
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: quinapril (C0072857)

Definition (NCI) A prodrug and non-sulfhydryl angiotensin converting enzyme (ACE) inhibitor with antihypertensive activity. Quinapril is hydrolized into its active form quinaprilat, which binds to and inhibits ACE, thereby blocking the conversion of angiotensin I to angiotensin II. This abolishes the potent vasoconstrictive actions of angiotensin II and leads to vasodilatation. Quinapril also causes a decrease in angiotensin II-induced aldosterone secretion by the adrenal cortex, thereby promoting diuresis and natriuresis, and increases bradykinin levels.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C041125
SnomedCT 108578004, 386874003
LNC LP171631-7
English 2-(2-((1-(ethoxycarbonyl)-3-phenylpropyl)amino)-1-oxopropyl)-1,2,3,4-tetrahydro-3-isoquinolinecarboxylic acid, 3-Isoquinolinecarboxylic acid, 2-(2-((1-(ethoxycarbonyl)-3-phenylpropyl)amino)-1-oxopropyl)-1,2,3,4-tetrahydro-, monohydrochloride, (3S-(2(R*(R*)),3R*))-, quinapril, quinapril (medication), quinapril [Chemical/Ingredient], QUINAPRIL, Quinapril, Quinapril (product), Quinapril (substance)
Spanish quinaprilo, quinapril (producto), quinapril (sustancia), quinapril
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Ramipril (C0072973)

Definition (NCI) A prodrug and nonsulfhydryl angiotensin converting enzyme (ACE) inhibitor with antihypertensive activity. Ramipril is converted in the liver by de-esterification into its active form ramiprilat, which inhibits ACE, thereby blocking the conversion of angiotensin I to angiotensin II. This abolishes the potent vasoconstrictive actions of angiotensin II and leads to vasodilatation. This agent also causes an increase in bradykinin levels and a decrease in angiotensin II-induced aldosterone secretion by the adrenal cortex, thereby promoting diuresis and natriuresis.
Definition (MSH) A long-acting angiotensin-converting enzyme inhibitor. It is a prodrug that is transformed in the liver to its active metabolite ramiprilat.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D017257
SnomedCT 108564000, 386872004
LNC LP171634-1
English Ramipril, Cyclopenta(b)pyrrole-2-carboxylic acid, 1-(2-((1-(ethoxycarbonyl)-3-phenylpropyl)amino)-1-oxopropyl)octahydro-, (2S-(1(R*(R*)),2alpha,3abeta,6abeta))-, ramipril, ramipril (medication), RAMIPRIL, Ramipril [Chemical/Ingredient], Ramipril (product), Ramipril (substance)
Swedish Ramipril
Czech ramipril
Finnish Ramipriili
Russian RAMIPRIL, РАМИПРИЛ
Japanese ラミプリル
Croatian RAMIPRIL
Polish Ramipryl
Spanish ramipril (producto), ramipril (sustancia), ramiprilo, ramipril, Ramipril
French Ramipril
German Ramipril
Italian Ramiprile
Portuguese Ramipril
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Fosinopril (C0118168)

Definition (NCI) A phosphinic acid-containing angiotensin-converting enzyme (ACE) inhibitor with antihypertensive activity. As an ester prodrug, fosinopril is hydrolysed by esterases to its active metabolite fosinoprilat. Fosinoprilat specifically and competitively inhibits angiotensin-converting enzyme thereby decreasing the formation of the potent vasoconstrictor angiotensin II, resulting in diminished vasopressor activity. In addition, angiotensin II-mediated aldosterone secretion by adrenal cortex is decreased, which results in a decrease of sodium retention and an increase in water outflow.
Definition (MSH) A phosphinic acid-containing angiotensin-converting enzyme inhibitor that is effective in the treatment of hypertension. It is a prodrug that is converted to its active metabolite fosinoprilat.
Concepts Pharmacologic Substance (T121) , Organophosphorus Compound (T115)
MSH D017328
SnomedCT 108569005, 372510000
LNC LP171400-7
English Fosenopril, Fosinopril, L-Proline, 4-cyclohexyl-1-(((2-methyl-1-(1-oxopropoxy)propoxy)(4-phenylbutyl)phosphinyl)acetyl)-, (1(S*(R*)),2alpha,4beta)-, fosinopril, Fosinopril [Chemical/Ingredient], FOSINOPRIL, Fosinopril (product), Fosinopril (substance)
Swedish Fosinopril
Czech fosinopril
Finnish Fosinopriili
Russian FOSENOPRIL, FOSINOPRIL, ФОСЕНОПРИЛ, ФОСИНОПРИЛ
Japanese ホセノプリル, ホシノプリル
Italian Fosenopril, Fosinopril
Polish Fozynopryl, Fosenopryl
Spanish fosinopril (producto), fosinopril (sustancia), fosinoprilo, fosinopril, Fosenopril, Fosinopril
French Fosénopril, Fosinopril
German Fosenopril, Fosinopril
Portuguese Fosenopril, Fosinopril
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Perindopril (C0136123)

Definition (NCI) A non-sulfhydryl angiotensin converting enzyme (ACE) inhibitor with antihypertensive activity. Upon hydrolysis, perindopril is converted to its active form perindoprilat, inhibiting ACE and the conversion of angiotensin I to angiotensin II; consequently, angiotensin II-mediated vasoconstriction and angiotensin II-stimulated aldosterone secretion from the adrenal cortex are inhibited and diuresis and natriuresis ensue.
Definition (MSH) An angiotensin-converting enzyme inhibitor. It is used in patients with hypertension and heart failure.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D020913
SnomedCT 350606002, 129486004, 372916001
English perindopril, Perindopril, 1H-Indole-2-carboxylic acid, 1-(2-((1-(ethoxycarbonyl)butyl)amino)-1-oxopropyl)octahydro-, Pirindopril, (2S,3aS,7aS)-1-((S)-N-((S)-1-Carboxybutyl)alanyl)hexahydro-2-indolinecarboxylic Acid, 1-ethyl Ester, Perindopril [Chemical/Ingredient], pirindopril, PERINDOPRIL, Perindopril (product), Perindopril (substance)
Swedish Perindopril
Czech perindopril
Finnish Perindopriili
Russian PERINDOPRIL, ПЕРИНДОПРИЛ
Japanese ペリンドプリル
Spanish perindopril (producto), perindoprilo (producto), perindoprilo, perindopril (sustancia), perindoprilo (sustancia), perindopril, Perindopril
Polish Peryndopryl
French Périndopril
German Perindopril
Italian Perindopril
Portuguese Perindopril
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Accupril (C0244580)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C041125
English Accupril, accupril
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Capoten (C0591224)

Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116)
MSH D002216
English capoten, Capoten
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Zestril (C0678140)

Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116)
MSH D017706
English zestril, Zestril
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Prinivil (C0701176)

Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116)
MSH D017706
English prinivil, Prinivil
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Lotensin (C0721436)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C044946
English Lotensin, lotensin, Cibacen, Cibacène, Novartis brand of benazepril hydrochloride
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Mavik (C0721596)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C052035
English Mavik, mavik, Gopten, Knoll brand of trandolapril, Abbott brand of trandolapril
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Univasc (C0724125)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH C058302
English univasc, Perdix, Moex, Schwarz brand of moexipril hydrochloride, Univasc
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Vasotec (C0728763)

Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116)
MSH D015773
English Vasotec, vasotec, Biovail Brand of Enalaprilat Anhydrous, Merck Frosst Brand of Enalaprilat Anhydrous
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Monopril (C0728957)

Concepts Amino Acid, Peptide, or Protein (T116) , Organophosphorus Compound (T115) , Pharmacologic Substance (T121)
MSH D017328
English monopril, Monopril, Staril, Bristol Myers Squibb Brand of Fosinopril Sodium, Bristol-Myers Squibb Brand of Fosinopril Sodium, Fosinorm, Newace
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Aceon (C0875950)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
English Aceon, aceon
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Altace (C0878061)

Definition (CHV) brand name of a high blood pressure medication
Definition (CHV) brand name of a high blood pressure medication
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D017257
English Altace, tritace, altace [brand name], altace, triatec, Triatec, Tritace, Astra Brand of Ramipril, Aventis Brand of Ramipril, Aventis Pharma Brand of Ramipril, Delix, Hoechst Brand of Ramipril, Monarch Brand of Ramipril, Ramace, Zabien, Acovil
Derived from the NIH UMLS (Unified Medical Language System)

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