There have not been enough studies addressing the course of action for a patient who accidentally took an extra dose of an angiotensin-converting enzyme (ACE) inhibitor. The recommendation found in this article was developed by doctors at Weill Cornell Medicine in consultation with experts in the field.
ACE inhibitors are rapidly absorbed with maximum bioavailability being reached within 30 minutes to 7 hours depending on the specific ACE inhibitor and dose. Elimination half-life ranges from between one to 12 hours. 1-14
Table 1: ACE inhibitor maximum bioavailability and elimination half-life1-14
|
ACE Inhibitor
|
Tmax (h)
|
t1/2 (h)
|
|
Benazepril (Lotensin)
|
0.5-1
|
10-11
|
|
Captopril (Capoten*)
|
1
|
<2
|
|
Enalapril oral solution (Epaned)
|
4-6
|
11
|
|
Enalapril (Vasotec)
|
1
|
11
|
|
Enalaprilat injection (Vasotec injection*)
|
1-4
|
11
|
|
Fosinopril (Monopril*)
|
3
|
12
|
|
Lisinopril oral solution (Qbrelis)
|
6
|
12
|
|
Lisinopril (Prinivil*, Zestril)
|
6
|
12
|
|
Moexipril (Univasc*)
|
1.5
|
12
|
|
Perindopril (Aceon*)
|
3-7
|
1
|
|
Quinapril (Accupril)
|
2
|
3
|
|
Ramipril (Altace)
|
1
|
2-4
|
|
Trandolapril (Mavik*)
|
1
|
6
|
*Brand names with asterisks beside them have been discontinued in the US. The generic versions of these drugs continue to be FDA approved and are available in the US.
Abrupt withdrawal of ACE inhibitors is not associated with rapid or significant increase in blood pressure compared to pretreatment levels, so missing one dose should not adversely impact overall blood pressure control.1-17
References
- Lotensin [package insert]. Parsippany, NJ: Validus Pharmaceuticals LLC; 2019.
- Capoten [package insert]. Chestnut Ridge, NY: Par Pharmaceutical; 2017.
- Epaned [package insert]. Wilmington, MA: Azurity Pharmaceuticals, Inc.; 2020.
- Vasotec [package insert]. Bridgewater, NJ: Bausch Health US LLC; 2018.
- Enalaprilat [package insert]. Lake Forest, IL: Hospira, Inc.; 2021.
- Monopril [package insert]. Princeton, NJ: Bristol-Myers Squibb Company; 2003.
- Qbrelis [package insert]. Wilmington, MA: Azurity Pharmaceuticals, Inc.; 2020.
- Prinivil [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp.; 2021.
- Zestril [package insert]. Morristown, NJ: Almatica Pharma LLC; 2020.
- Univasc [package insert]. Smyrna, GA: USB, Inc; 2012.
- Aceon [package insert]. Cincinnati, OH: Patheon Pharmaceuticals, Inc.; 2017.
- Accupril [package insert]. New York, NY: Parke Davis, Pfizer; 2021.
- Altace [package insert]. New York, NY: Pfizer Laboratories; 2022.
- Mavik [package insert]. Whippany, NJ: Halo Pharmaceutical Inc.; 2017.
- Stephan D, Grima M, Welsch M, Barthelmebs M, Vasmant D, Imbs J. Interruption of prolonged ramipril treatment in hypertensive patients: Effects on the renin-angiotensin system. Fundam Clin Pharmacol 1996; 10 (5): 474-483.
- Choo PW, Rand CS, Inui TS, Lee ML, Ma CC, Platt R. A pharmacodynamic assessment of the impact of antihypertensive non-adherence on blood pressure control. Pharmacoepidemiol Drug Saf 2000; 9 (7): 557-563.
- Vaur L, Dutrey-Dupagne C, Boussac J, et al. Differential effects of a missed dose of trandolapril and enalapril on blood pressure control in hypertensive patients. J Cardiovasc Pharmacol 1995; 26 (1): 127-131.
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