Captopril

CAPOTEN

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Pronunciation: KAP-toe-pril

Captopril ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Captopril ballicule

Captopril CAPOTEN mascot mnemonic cartoon — Visual mnemonic: Captopril mascot
**“Captain April”**
Easter/April theme → ACE inhibitor = -pril (aPril)
Bananas in bunches → ↑ serum potassium

What it isThe first ACE inhibitor; hypertension and heart failure.

Why this oneIts very short action makes it useful as a test dose and in renovascular scintigraphy.

What limits itThree-times-daily dosing, and the sulfhydryl group causes more rash and taste disturbance than later agents. Take on an empty stomach.

Captopril molecular structure (skeletal formula) — Molecular structure: Captopril

FDA-approved for

hypertension (1981)
heart failure (~1984)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Fetal toxicity — discontinue as soon as pregnancy is detected

FDA dosing	Population	Start	Target	Max
Hypertension	Adults	25 mg BID–TID	25–150 mg BID–TID	450 mg/day
Heart failure	Adults	25 mg TID (6.25–12.5 mg TID if volume/salt-depleted)	50–100 mg TID	450 mg/day
LV dysfunction after MI	Adults	6.25 mg once, then 12.5 mg TID	50 mg TID
Diabetic nephropathy	Adults	25 mg TID	25 mg TID

Titration Increase at 1–2 week intervals; in heart failure delay increases ≥2 weeks once at 50 mg TID

Renal Reduce initial dose and titrate slowly (smaller/less frequent doses) in significant renal impairment

Hepatic Undefined

Instructions

Take 1 hour before meals

Available strengths

tab 12.5, 25, 50, 100 mg

Contraindications

Prior angioedema with any ACE inhibitor
Concomitant aliskiren in patients with diabetes
Concomitant neprilysin inhibitor (e.g., sacubitril); do not use within 36 h of sacubitril/valsartan

Cautions

Angioedema (head/neck and intestinal)
Neutropenia/agranulocytosis
Hypotension (esp. volume/salt-depleted)
Hyperkalemia
Proteinuria/renal insufficiency
Persistent dry cough

Adverse reactions

Rash/pruritus
Dysgeusia (taste loss)
Cough
Hypotension
Proteinuria
Angioedema
Neutropenia

Pregnancy Can cause fetal injury/death; discontinue as soon as pregnancy is detected (boxed)

Lactation Undefined

Cost

Captopril (CAPOTEN)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	CostPlus
12.5 mg	tab	60 BID	$13.70	offered
25 mg	tab	60 BID	$10.37	offered
50 mg	tab	60 BID	$22.14	offered
100 mg	tab	60 BID	$19.38	offered

Generic entry1995

⚠ BOXED WARNING

Fetal toxicity

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk4 / 4

Legacy pregnancy categoryD

Defining liabilityHyperkalemia, kidney injury, angioedema, fetal toxicity and increased lithium exposure.

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Memory aids: interaction avatars

Box: minimal PK interactions

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