To help you remember to take your medicine, try to get into the habit of taking it at the same time each day.

For patients taking captopril or moexipril :

• These medicines are best taken on an empty stomach 1 hour before meals, unless you are otherwise directed by your doctor.

For patients taking this medicine for high blood pressure :

• In addition to the use of the medicine your doctor has prescribed, treatment for your high blood pressure may include weight control and care in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.
• Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.
• Remember that this medicine will not cure your high blood pressure but it does help control it. Therefore, you must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life . If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.

Dosing

The dose of the ACE inhibitor will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses. If your dose is different, do not change it unless your doctor tells you to do so.

The number of capsules or tablets that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking the ACE inhibitor.

For benazepril
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults 10 milligrams (mg) once a day at first. Then, your doctor may increase your dose to 20 to 40 mg a day taken as a single dose or divided into two doses.
    • Children Use and dose must be determined by your doctor.

For captopril
• For oral dosage form (tablets):
  • For congestive heart failure:
    • Adults 25 to 100 mg two or three times a day.
    • Children Dose must be determined by your doctor.
  • For high blood pressure:
    • Adults 25 to 50 mg two or three times a day.
    • Children Dose must be determined by your doctor.
  • For kidney problems related to diabetes:
    • Adults 25 mg three times a day.
  • For treatment after a heart attack:
    • Adults 12.5 to 50 mg three times a day.

For cilazapril
• For oral dosage form (tablets):
  • For congestive heart failure:
    • Adults 0.5 mg once a day at first. Then your doctor may increase your dosage up to 5 mg once a day.
    • Children Use and dose must be determined by your doctor.
  • For high blood pressure:
    • Adults 2.5 to 10 mg once a day.
    • Children Use and dose must be determined by your doctor.

For enalapril
• For oral dosage form (tablets):
  • For congestive heart failure:
    • Adults 2.5 mg once a day or two times a day at first. Your doctor may increase your dose to 5 to 40 mg a day taken as a single dose or divided into two doses.
    • Children Use and dose must be determined by your doctor.
  • For high blood pressure:
    • Adults 5 mg once a day at first. Then, your doctor may increase your dose to 10 to 40 mg a day taken as a single dose or divided into two doses.
    • Children Use and dose must be determined by your doctor.
  • For treating weakened heart muscle:
    • Adults 2.5 mg two times a day at first. Then, your doctor may increase your dose up to 20 mg a day taken in divided doses.
• For injection dosage form:
  • For high blood pressure:
    • Adults 1.25 mg every six hours injected into a vein.
    • Children Use and dose must be determined by your doctor.

For fosinopril
• For oral dosage form (tablets):
  • For congestive heart failure:
    • Adults 10 mg once a day at first. Then your doctor may increase your dose to 20 to 40 mg once a day.
  • For high blood pressure:
    • Adults 10 to 40 mg once a day.
    • Children Use and dose must be determined by your doctor.

For lisinopril
• For oral dosage form (tablets):
  • For congestive heart failure:
    • Adults 5 to 20 mg once a day.
    • Children Use and dose must be determined by your doctor.
  • For high blood pressure:
    • Adults 10 to 40 mg once a day.
    • Children Use and dose must be determined by your doctor.
  • For immediate treatment after a heart attack:
    • Adults 5 mg once a day at first. Your doctor may increase the dose to 10 mg once a day.
    • Children Use and dose must be determined by your doctor.

For moexipril
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults 7.5 mg once a day. Then, your doctor may increase your dose up to 30 mg a day taken as a single dose or divided into two doses.
    • Children Use and dose must be determined by your doctor.

For perindopril
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults 4 mg once a day. Then, your doctor may increase your dosage up to 16 mg a day taken as a single dose or divided into two doses.
    • Children Use and dose must be determined by your doctor.

For quinapril
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults 10 to 20 mg once a day at first. Then, your doctor may increase your dosage up to 80 mg a day taken as a single dose or divided into two doses.
    • Children Use and dose must be determined by your doctor.
  • For congestive heart failure:
    • Adults 5 mg twice a day at first. Then, your doctor may increase your dose to 20 to 40 mg a day taken in two divided doses.

For ramipril
• For oral dosage form (capsules):
  • For high blood pressure:
    • Adults 2.5 mg once a day at first. Then, your doctor may increase your dosage up to 20 mg a day taken as a single dose or divided into two doses.
    • Children Use and dose must be determined by your doctor.
  • For congestive heart failure after a heart attack:
    • Adults 2.5 to 5 mg twice a day.
  • For reducing risk of heart attack, stroke or death from cardiovascular causes
    • Adults 2.5 mg once a day for one week. For the next three weeks the dose is 5 mg a day, and then increased as needed to 10 mg a day. The dose may be divided if needed.

      Note:

      For use in people aged 55 and older.

For trandolapril
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults 1 to 2 mg once a day at first. Then, your doctor may increase your dose to 2 to 4 mg a day taken as a single or divided into two doses.
    • Children Use and dose must be determined by your doctor.
  • For treatment after a heart attack:
    • Adults 1 mg once a day at first. Then, your doctor may increase your dose up to 4 mg a day taken as a single or divided into two doses.

Missed dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For the angiotensin-converting enzyme (ACE) inhibitors, the following should be considered:

Allergies Tell your doctor if you have ever had any unusual or allergic reaction to benazepril, captopril, cilazapril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, or trandolapril. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy Use of ACE inhibitors during pregnancy, especially in the second and third trimesters (after the first three months) can cause low blood pressure, severe kidney failure, too much potassium, or even death in the newborn. Therefore, it is important that you check with your doctor immediately if you think that you may be pregnant. Be sure that you have discussed this with your doctor before taking this medicine. In addition, if you are taking:

• Benazepril Benazepril has not been shown to cause birth defects in animals when given in doses more than 3 times the highest recommended human dose.
• Captopril Studies in rabbits and rats at doses up to 400 times the recommended human dose have shown that captopril causes an increase in deaths of the fetus and newborn. Also, captopril has caused deformed skulls in the offspring of rabbits given doses 2 to 70 times the recommended human dose.
• Enalapril Studies in rats at doses many times the recommended human dose have shown that use of enalapril causes the fetus to be smaller than normal. Studies in rabbits have shown that enalapril causes an increase in fetal death. Enalapril has not been shown to cause birth defects in rats or rabbits.
• Fosinopril Studies in rats have shown that fosinopril causes the fetus to be smaller than normal. Studies in rabbits have shown that fosinopril causes fetal death, probably due to extremely low blood pressure. In rats, birth defects such as skeletal and facial deformities were seen. However, it is not clear that the deformities were related to fosinopril. Birth defects were not seen in rabbits.
• Lisinopril Studies in mice and rats at doses many times the recommended human dose have shown that use of lisinopril causes a decrease in successful pregnancies, a decrease in the weight of infants, and an increase in infant deaths. It has also caused a decrease in successful pregnancies and abnormal bone growth in rabbits. Lisinopril has not been shown to cause birth defects in mice, rats, or rabbits.
• Moexipril Studies in rats given up to 90 times the recommended human dose, and studies in rabbits given up to 0.7 times the recommended human dose, did not show that moexipril causes birth defects in animals.
• Perindopril Studies in rabbits given up to 50 times the recommended human dose, and monkeys given up to 17 times the recommended human dose, did not show that perindopril causes birth defects in animals.
• Quinapril Studies in rats have shown that quinapril causes lower birth weights and changes in kidney structure of the fetus. However, birth defects were not seen in rabbits given quinapril.
• Ramipril Studies in animals have shown that ramipril causes lower birth weights.
• Trandolapril Studies in rabbits, rats, and monkeys did not show that trandolapril causes any birth defects in animals.

Breast-feeding Breast-feeding

• Benazepril, captopril, enalapril enalaprilat, and fosinopril These medicines pass into breast milk.
• Cilazapril, lisinopril, moexipril, perindopril, quinapril, ramipril, and trandolapril It is not known whether these medicines pass into breast milk. However, these medicines have not been reported to cause problems in nursing babies.

Children Children may be especially sensitive to the blood pressure?lowering effect of ACE inhibitors. This may increase the chance of side effects or other problems during treatment. Therefore, it is especially important that you discuss with the child's doctor the good that this medicine may do as well as the risks of using it.

Older adults This medicine has been tested in a limited number of patients 65 years of age or older and has not been shown to cause different side effects or problems in older people than it does in younger adults.

Other medicines Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking or receiving ACE inhibitors it is especially important that your health care professional know if you are taking any of the following:

• Alcohol or
• Diuretics (water pills) Effects on blood pressure may be increased. In addition, some diuretics make the increase in potassium in the blood caused by ACE inhibitors even greater

• Potassium-containing medicines or supplements or
• Salt substitutes or
• Low-salt milk Use of these substances with ACE inhibitors may result in an unusually high potassium level in the blood, which can lead to heart rhythm and other problems

• Diabetes mellitus (sugar diabetes) Increased risk of potassium levels in the body becoming too high, or increased effect of insulin on control of blood sugar

• Heart or blood vessel disease or
• Low sodium diet Lowering blood pressure may make problems resulting from these conditions worse

• Kidney disease or
• Liver disease ACE inhibitors' effects may be increased because of slower removal of medicine from the body

• Kidney transplant Increased risk of kidney disease caused by ACE inhibitors

• Systemic lupus erythematosus (SLE) Increased risk of blood problems caused by ACE inhibitors

• Previous reaction to any ACE inhibitor or previous occurrence involving hoarseness; swelling of face, mouth, hands, or feet; or sudden trouble in breathing Reaction is more likely to occur again