Benazepril Drug Profile

What is Benazepril?

Benazepril is a prescription medication that belongs to a class of drugs called angiotensin-converting enzyme (ACE) inhibitors. It is primarily used to treat high blood pressure (hypertension) and heart failure by helping blood vessels relax and widen. This medication works by blocking certain enzymes that cause blood vessels to constrict, making it easier for the heart to pump blood throughout the body.

Uses

Benazepril is approved for several cardiovascular conditions:

• Hypertension: The primary use is treating high blood pressure in adults and children over 6 years old, helping reduce the risk of stroke, heart attack, and kidney problems
• Heart failure: Used as part of combination therapy to improve symptoms and reduce hospitalizations in patients with chronic heart failure
• Diabetic nephropathy: Helps protect kidney function in diabetic patients by reducing protein loss in urine and slowing kidney damage progression
• Post-myocardial infarction: May be prescribed after a heart attack to improve survival and reduce the risk of future cardiovascular events
• Chronic kidney disease: Used to slow the progression of kidney disease by reducing pressure within kidney blood vessels

How it works

Benazepril works by inhibiting angiotensin-converting enzyme (ACE), which normally converts angiotensin I to angiotensin II, a powerful substance that narrows blood vessels and increases blood pressure. By blocking this conversion, benazepril allows blood vessels to remain relaxed and dilated, reducing blood pressure and decreasing the workload on the heart. Additionally, ACE inhibitors reduce the breakdown of bradykinin, a substance that helps keep blood vessels open.

Side effects

Common side effects include:

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• Dry, persistent cough
• Dizziness or lightheadedness
• Fatigue or weakness
• Headache
• Nausea
• Low blood pressure (hypotension)
• Elevated potassium levels
• Kidney function changes

Serious side effects requiring immediate medical attention:

• Angioedema (swelling of face, lips, tongue, or throat)
• Severe kidney problems or kidney failure
• Dangerously high potassium levels (hyperkalemia)
• Severe hypotension with fainting
• Allergic reactions with difficulty breathing

Warnings and precautions

• Pregnancy: Benazepril can cause serious harm or death to developing fetuses, especially during the second and third trimesters. Women should inform their doctor immediately if they become pregnant while taking this medication.
• Kidney impairment: Patients with existing kidney disease require careful monitoring and possible dose adjustments, as ACE inhibitors can worsen kidney function in some individuals.
• Angioedema history: Individuals with a previous history of angioedema, particularly related to ACE inhibitor use, should avoid benazepril due to increased risk of life-threatening swelling.
• Surgery considerations: Patients should inform anesthesiologists about benazepril use before surgery, as it may interact with anesthesia and cause excessive blood pressure drops.
• Dehydration risk: Patients who are dehydrated, have low sodium levels, or take diuretics may experience severe hypotension when starting benazepril.

Interactions

• Potassium supplements and salt substitutes: Can cause dangerously high potassium levels when combined with ACE inhibitors
• Diuretics: May enhance blood pressure-lowering effects, potentially causing excessive hypotension, especially when starting treatment
• NSAIDs (ibuprofen, naproxen): Can reduce the effectiveness of benazepril and increase risk of kidney problems
• Lithium: ACE inhibitors can increase lithium blood levels, potentially leading to lithium toxicity
• Diabetes medications: May enhance blood sugar-lowering effects, requiring glucose monitoring adjustments
• Other blood pressure medications: Can cause additive hypotensive effects requiring careful dose monitoring
• Aliskiren: Combination increases risk of kidney problems, high potassium, and low blood pressure, especially in diabetics
• Gold injections: Rare reactions including facial flushing, nausea, and vomiting have been reported with concurrent ACE inhibitor use

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Dosage

For adults with hypertension, the typical starting dose is 10 mg once daily, which may be increased to 20-40 mg daily based on blood pressure response. For heart failure, treatment usually begins with 2.5-5 mg twice daily, gradually increasing as tolerated. In patients with kidney impairment, lower starting doses are recommended. Children over 6 years old may be prescribed 0.2 mg per kilogram of body weight once daily, up to a maximum of 10 mg daily. All dosing should be individualized and determined by a healthcare provider based on the patient’s specific condition, response to treatment, and other medical factors.

Sources: FDA DailyMed drug labels (public domain), BNF, WHO Essential Medicines List. This article is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider before starting or stopping any medication.

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