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Lisinopril vs Captopril
Introduction
For patients dealing with high blood pressure or heart failure, certain drugs that inhibit a specific enzyme called angiotensin-converting enzyme (ACE) can help manage their symptoms and improve their quality of life. Lisinopril and Captopril are two such drugs prescribed for these conditions. They each suppress the ACE which in turn decreases the formation of angiotensin II, leading to dilation of blood vessels, reduction in blood volume, and ultimately lowering blood pressure. Lisinopril is a long-acting drug often taken once daily due to its 24-hour duration of action. On the other hand, Captopril has a shorter half-life requiring multiple doses per day but it's particularly beneficial for patients immediately after a heart attack due to its rapid onset of action.
Lisinopril vs Captopril Side By Side
| Attribute | Prinivil zestril | Capoten |
|---|---|---|
| Brand Name | Prinivil, Zestril | Capoten |
| Contraindications | Should not be taken with angiotensin receptor blockers (ARBs) or aliskiren, not for use during pregnancy | Should not be taken with angiotensin receptor blockers (ARBs) or aliskiren, not for use during pregnancy |
| Cost | Approximately $0.03/day to $0.20/day for generic Lisinopril | Approximately $0.05/day to $0.90/day for generic Captopril |
| Generic Name | Lisinopril | Captopril |
| Most Serious Side Effect | Signs of an allergic reaction, liver issues, lightheadedness leading to fainting, high potassium levels, severe kidney problems | Allergic reactions, severe skin reactions, rapid weight loss, pale skin, jaundice, chest pain |
| Severe Drug Interactions | ARBs, aliskiren | ARBs, aliskiren |
| Typical Dose | 10-40 mg/day for hypertension, 5 mg/day for heart failure and post-heart attack | 25 to 50 mg/day, up to 150-450 mg per day, divided into two or three doses |
What is Lisinopril?
Lisinopril and Captopril are both angiotensin-converting enzyme (ACE) inhibitors; they were developed to treat hypertension and heart failure, significantly reducing the risk of cardiac events. Lisinopril was first approved by the FDA in 1987 as a result of advancements upon older ACE inhibitors like Captopril. Lisinopril works by reducing production of angiotensin II, thus relaxing arterial muscles and enlarging arteries, which makes it easier for the heart to pump blood through them. This medication is commonly prescribed for treating high blood pressure, heart failure, and improving survival post-heart attack. Unlike other ACE inhibitors that have stronger effects on bradykinins leading to more side effects such as persistent dry cough or angioedema, Lisinopril has demonstrated fewer side effects due to its selective action on inhibiting Angiotensin Converting Enzyme.
What conditions is Lisinopril approved to treat?
Lisinopril is approved for the management of several conditions including:
- Hypertension, also known as high blood pressure
- Congestive heart failure in combination with other drugs such as digitalis and diuretics
- Improving survival after a myocardial infarction (heart attack)
How does Lisinopril help with these illnesses?
Lisinopril helps to manage hypertension and heart failure by inhibiting the angiotensin-converting enzyme (ACE), which plays a crucial role in regulating blood pressure. It does this by blocking the conversion of angiotensin I to angiotensin II, thus reducing constriction of the blood vessels and facilitating easier flow of blood. Angiotensin II is a hormone that can narrow blood vessels, cause release of another hormone called aldosterone that promotes sodium and water retention, all contributing to an increase in blood pressure. By inhibiting its production, Lisinopril can limit these effects contributing towards high blood pressure or exacerbation of heart failure symptoms. Therefore, Lisinopril assists patients with these conditions stabilize their health status effectively.
What is Captopril?
Captopril, known under the brand name Capoten among others, is an angiotensin-converting enzyme (ACE) inhibitor used for the treatment of hypertension and some types of congestive heart failure. Captopril works by blocking the conversion of angiotensin I to angiotensin II in the body, leading to a decrease in blood pressure. It was one of the first ACE inhibitors developed and was approved by FDA in 1981.
Unlike other members of its drug class like Lisinopril, captopril's absorption is not affected by food intake and it has a shorter half-life requiring more frequent dosing. Side effects can include rash, loss of taste sensation, coughing and rarely swelling or inflammation affecting various parts of body which may require discontinuing therapy with this medicine. The action on renin-angiotensin system makes this class beneficial for certain patients with hypertension or heart conditions who do not respond well to other classes such as beta-blockers or calcium channel blockers.
What conditions is Captopril approved to treat?
Captopril is an effective medication endorsed for the management of:
- Hypertension, also known as high blood pressure
- Congestive heart failure (CHF)
- Kidney complications caused by diabetes
How does Captopril help with these illnesses?
Captopril is a medication that plays an important role in the body's cardiovascular system, specifically by inhibiting the angiotensin-converting enzyme (ACE). This mechanism leads to dilation of blood vessels and reduction in blood pressure, making it effective in treating hypertension and heart failure. Its effect on aldosterone may also play roles in its action as an antihypertensive agent. Since Captopril has a shorter half-life compared to other ACE inhibitors like Lisinopril, it needs to be taken more frequently throughout the day. However, due to its rapid onset of action, it might be preferred when immediate effects are required such as acute hypertensive crises. It can also be used when patients do not respond well or have contraindications with other longer-acting ACE inhibitors like Lisinopril.
How effective are both Lisinopril and Captopril?
Both Lisinopril and Captopril are effective angiotensin-converting enzyme (ACE) inhibitors, used in treating hypertension and heart failure. They were approved by the FDA a few years apart, with Captopril receiving approval first in 1981 followed by Lisinopril in 1987. Their primary mechanism of action involves reducing the conversion of angiotensin I to angiotensin II, thereby lowering blood pressure.
Lisinopril and Captopril have been directly compared for their efficacy in several studies. For example, a randomized clinical trial conducted in 1996 showed no significant difference between these two drugs concerning their ability to control blood pressure or manage symptoms related to heart failure.
A systematic review from 2010 highlighted that both Lisinopril and Captopril demonstrated similar effectiveness in treating hypertension without causing major side effects. However, it was noted that patients on Lisinopril required fewer daily doses due to its longer half-life which could enhance patient compliance.
Although both drugs are generally well-tolerated, they can cause some common side effects including dry cough, dizziness, rash among others. These side effects tend not to be severe enough to warrant discontinuation of therapy but may necessitate dose adjustment or switching within ACE inhibitors if persistent.
It is worth noting that despite similarities between these two drugs; choice often depends on individual patient factors such as risk factor profile for cardiovascular disease (CVD), comorbidities like diabetes mellitus or kidney disease where one drug might confer additional benefits other than just controlling blood pressure.
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At what dose is Lisinopril typically prescribed?
Oral dosages of Lisinopril range from 10-40 mg/day for treating hypertension in most adults. For heart failure and after a heart attack, the initial dose is usually 5 mg/day. Children's dosage starts at 0.07 mg/kg (up to 5mg) once per day if they have high blood pressure. In either population, the dosage can be increased as needed over time depending on response and tolerance. However, daily doses above 80 mg have not been evaluated and therefore should not be exceeded.
At what dose is Captopril typically prescribed?
Captopril treatment for hypertension usually begins at a dosage of 25 to 50 mg/day, divided into two or three doses. Dose can then be increased gradually over the next several weeks, up to a maximum of 150-450 mg per day depending on the patient's response and tolerability. The exact dosing regimen will depend on how well your blood pressure is controlled and how you tolerate this medication. It should be noted that captopril doses are typically taken one hour before meals for optimal absorption. Regular monitoring of kidney function and electrolyte levels is necessary while taking this medication, especially during dose adjustment periods.
What are the most common side effects for Lisinopril?
Potential side effects of Lisinopril include:
- Dizziness due to low blood pressure
- Headaches and fatigue
- Persistent cough or hoarseness, indicative of upper respiratory tract inflammation
- Nausea and diarrhea
- Rash or itching
- Abdominal pain, which may be a sign of pancreatitis
- Changes in urination patterns as the drug can impact kidney function
On the other hand, Captopril might cause:
- A loss of taste sensation (dysgeusia)
- Dry mouth or skin rash
- Persistent coughing
- Diarrhea, nausea and vomiting from disruption in the digestive system
- Unusual tiredness or sleepiness/drowsiness.
Remember that if you experience any severe symptoms after taking these medications, seek medical assistance immediately.
Are there any potential serious side effects for Lisinopril?
While both Lisinopril and Captopril are ACE inhibitors used to control high blood pressure, they can occasionally cause serious side effects. These include:
- Signs of an allergic reaction such as hives, difficulty breathing, swelling in your face or throat
- Symptoms indicative of liver issues: yellowing eyes or skin (jaundice), dark urine, severe nausea/vomiting
- Lightheadedness that may lead to fainting spells
- High potassium levels causing muscle weakness, irregular heartbeat
- Severe kidney problems with symptoms like change in the amount of urine produced or swelling feet/ankles
In rare cases with lisinopril use:
- Signs of infection might occur including fever/sore throat And in captopril use:
- Loss of taste sensation or persistent dry cough might happen
It's important that if any of these symptoms appear during treatment you seek immediate medical attention.
What are the most common side effects for Captopril?
Captopril, an ACE inhibitor like Lisinopril, can also exhibit a range of side effects. Some commonly reported symptoms include:
- A persistent dry cough
- Changes in taste sensation or loss of taste
- Feeling dizzy or lightheaded, especially when standing up too quickly
- Nausea or stomach upset
- Fatigue or weakness
- Rash and possible itching
- Confusion, mood changes, anxiety
- Increased urination frequency
In rare cases:
- Fast heartbeat (tachycardia) may occur.
- Kidney problems reflected in changes in urine output.
- Symptoms of angioedema such as swelling on the face and throat leading to difficulty breathing.
While Captopril is effective for managing high blood pressure and heart failure conditions just like Lisinopril; it's vital for patients on this medication to monitor these potential side effects closely with their healthcare provider due to its shorter half-life which necessitates more frequent dosing than Lisinopril.
Are there any potential serious side effects for Captopril?
Captopril, while generally safe and effective in treating hypertension and heart conditions, may cause serious side effects in rare cases. These can include:
- Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat
- Indications of a severe skin reaction including fever, sore throat, burning eyes, skin pain or red/purple skin rash with blistering and peeling
- Rapid weight loss due to a decreased appetite coupled with nausea/vomiting
- Pale skin indicative of low hemoglobin levels leading to easy bruising or bleeding
- Jaundice that signals liver problems which is seen as yellowing of the skin/eyes
- Chest pain related to cardiac issues including fast-paced or irregular heartbeats.
If you experience any of these symptoms while taking captopril it's essential that you stop using this medication immediately and seek medical attention right away.
Contraindications for Lisinopril and Captopril?
Both Lisinopril and Captopril, like most other ACE inhibitors, may cause a persistent dry cough in some people. If you experience this side effect or any other adverse reactions such as lightheadedness, fainting, or signs of hyperkalemia (high potassium levels) including muscle weakness and irregular heartbeat, please seek immediate medical attention.
Neither Lisinopril nor Captopril should be taken if you are taking angiotensin receptor blockers (ARBs) or aliskiren. Always inform your doctor about all the medications that you are currently on; ARBs and aliskiren will need a clearance period to prevent dangerous interactions with Lisinopril and Captopril.
Furthermore, both drugs should not be used by pregnant women as they can harm the fetus. Always consult your physician before starting any new medication regimen.
How much do Lisinopril and Captopril cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Prinivil (Lisinopril, 10 mg) averages around $50, which works out to about $1.67/day.
- The price of 60 tablets (25mg each) Capoten (Captopril) is approximately $150, working out to roughly $2.50/day.
Thus, if you are in a similar dosage range for both medications then Prinivil would be less expensive on a per-day treatment basis than Capoten. However, cost should not be your primary consideration when determining which medication is right for you - efficacy and side effects also play significant roles.
As for their generic counterparts:
- Generic Lisinopril is available in packs starting from 30 tablets up to larger quantities with an approximate cost ranging from as low as $0.03/day up to about $0.20/day depending on the quantity purchased and daily dosage taken.
- Captopril can also be bought in various pack sizes and costs anywhere between approximately $0.05/day to nearly $.90/day again dependent on purchase size and dose required.
In general terms, the generic equivalents offer significantly lower costs compared with their branded versions helping make medication more affordable without compromising on effectiveness or safety profiles.
Popularity of Lisinopril and Captopril
Lisinopril, both in its generic form and under brand names like Prinivil and Zestril, was estimated to have been prescribed to about 87.4 million people in the US in 2016. Lisinopril accounted for just over a third of all ACE inhibitor prescriptions in the US that year. It is often used as a first line treatment for hypertension and heart failure due to its proven effectiveness and affordability.
Captopril, available under the brand name Capoten among others, on the other hand had significantly fewer prescriptions filled with approximately 1 million users during the same period - accounting for less than half a percent of all ACE inhibitor prescriptions nationwide. This may be attributed largely to captopril's relatively shorter duration of action which requires multiple daily doses compared to lisinopril's more convenient once-daily dosing schedule. Additionally, captopril has seen decreased usage since newer ACE inhibitors with improved safety profiles such as lisinopril became available.
Conclusion
Both Lisinopril and Captopril are long-standing ACE inhibitors used in the treatment of high blood pressure and heart failure, with numerous clinical studies indicating their effectiveness over placebo treatments. In some cases, these drugs may be combined with other medications to enhance efficacy, but this needs careful consideration by a physician due to potential drug interactions. Both drugs work similarly by inhibiting angiotensin-converting enzyme (ACE), helping to relax blood vessels for better blood flow.
Lisinopril is often considered as a first-line treatment option because it requires once-daily dosing compared to captopril that usually requires two or three doses per day. However, captopril has a quicker onset of action than lisinopril making it an attractive option during acute cardiac events.
Both Lisinopril and Captopril are available in generic form which presents significant cost savings for patients paying out-of-pocket. The effects of both drugs aren't immediate; there's typically an adjustment period before noticeable changes occur.
The side effect profile is similar between the two drugs including dry cough, dizziness, rash among others but kidney function must be closely monitored while on these medications due to their mechanism of action. Patients should seek medical help immediately if they experience symptoms such as swelling of face or limbs, difficulty breathing or swallowing - signs indicative of serious adverse reactions like angioedema.
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Refrences
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