A 2015 systematic comparison of all clinically used angiotensin-converting enzyme (ACE) inhibitors found that most ACE inhibitors are rapidly absorbed with maximum bioavailability being reached within 0.5 to 6 hours depending on the specific ACE inhibitor and dose.1 Elimination half-life ranges from about two to 24 hours.
|
ACE Inhibitor
|
tmax
h
|
t1/2
h
|
Tablets available (mg)
|
Starting Dose (mg)
|
|
Benazepril/Benazeprilat
|
0.5/1.5
|
10
|
5, 10, 20, and 40
|
10
|
|
Captopril
|
1-1.5
|
<2
|
12.5, 25, 50, and 100
|
25
|
|
Enalapril/Enalaprilat
|
1/3-4
|
11
|
2.5, 5, 10, and 20
|
5
|
|
Fosinopril/Fosinoprilat
|
2.8
|
11
|
10, 20, and 40
|
10
|
|
Lisinopril
|
7
|
13
|
2.5, 5, 10, 20, 30, and 40
|
10
|
|
Moexipril/Moexiprilat
|
1/1.5
|
2-9
|
7.5 and 15
|
7.5
|
|
Perindopril/Perindoprilat
|
2/2.4
|
10
|
2, 4, and 8
|
4
|
|
Quinapril
|
0.63
|
2
|
5, 10, 20, and 40
|
10
|
|
Ramipril/Ramiprilat
|
0.7/2.1
|
17
|
1.25, 2.5, 5, and 10
|
2.5-20
|
|
Trandolapril/Trandolaprilat
|
0.5/6
|
24
|
1, 2, and 4
|
1-2
|
Table 1: ACE inhibitor maximum bioavailability and elimination half-life1; Tablets available and dosing from each manufacturer, respectively.2-12
Most of the ACE inhibitors control blood pressure for 24 hours with a once or twice daily dosing one hour before meals.2-12 After oral dosing, ACE inhibitors are absorbed rapidly (time for peak plasma levels are 0.5 – 6 hours) with a wide range of bioavailability (10% for trandolapril to 75% for captopril).1
Most ACE inhibitors can be taken with or without food, including benazepril, enalapril, fosinopril, lisinopril, quinapril, ramipril, and trandolapril.2-4,7-9,12
Three ACE inhibitors, captopril, moexipril, and perindopril, should be taken on an empty stomach at least one hour before a meal or two hours after a meal to maximize bioavailability.5,6,11
References
- Regulski M, Regulska K, Stanisz BJ, et al. Chemistry and pharmacology of angiotensin-converting enzyme inhibitors. Curr Pharm Des 2015; 21 (13): 1764-1775.
- Prinivil [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp.; 2016.
- Trandolapril [package insert]. Laurelton, NY: Epic Pharma, LLC; 2017.
- Fosinopril sodium [package insert]. Miami, FL: Ciplo USA Inc; 2015.
- Moexipril hydrochloride [package insert]. Teva Pharmaceuticals USA Inc; 2016.
- Aceon [package insert]. North Chicago, IL: Abbot Laboratories; 2011.
- Altace [package insert]. New York, NY: Pfizer Laboratories; 2017.
- Lotensin [package insert]. Parsippany, NJ: Validus Pharmaceuticals LLC; 2014.
- Vasotec [package insert]. Bridgewater, NJ: Valeant Pharmaceuticals North America LLC; 2015.
- Zestril [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP 2014.
- Capoten [package insert]. Spring Valley, NY: Par Pharmaceutical Companies, Inc.; 2012.
- Accupril [package insert]. New York, NY: Parke Davis, Pfizer; 2017.
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