Comprehensive Guide to Benazepril: Uses, Dosage, Side Effects, and More

What is Benazepril?

Overview of Benazepril

Generic Name: Benazepril

Brand Name: Lotensin, generics

Drug Group: ACE inhibitor

Commonly Used For

• Treat hypertension.
• Manage heart failure.
• Protect kidneys in diabetic nephropathy.

Key Characteristics

Form: Oral tablets (5 mg, 10 mg, 20 mg, 40 mg) (detailed in Dosage section).

Mechanism: Inhibits ACE to decrease angiotensin II and increase bradykinin levels.

Approval: FDA-approved (1991) and EMA-approved for hypertension and heart failure.

Indications and Uses of Benazepril

Benazepril is indicated for a variety of cardiovascular and renal conditions, leveraging its vasodilatory effects:
Hypertension: Lowers blood pressure in essential hypertension, effective as monotherapy or with diuretics, reducing stroke and heart attack risk.

Heart Failure: Improves symptoms and survival in heart failure (NYHA Class II-IV) by decreasing preload and afterload, often combined with beta-blockers.

Diabetic Nephropathy: Slows progression of kidney damage in type 2 diabetes with proteinuria, preserving renal function through reduced glomerular pressure.

Post-Myocardial Infarction: Used off-label to prevent left ventricular dysfunction post-MI, under cardiologist supervision.

Chronic Kidney Disease (CKD): Manages non-diabetic CKD with proteinuria, reducing albuminuria and delaying end-stage renal disease.

Off-Label Uses: Includes treatment of Raynaud’s phenomenon to improve peripheral circulation, management of scleroderma renal crisis, and adjunctive therapy in resistant hypertension, supported by clinical studies and expert guidelines.

Left Ventricular Hypertrophy: Reduces myocardial mass in hypertensive patients, lowering arrhythmia risk, based on echocardiographic evidence.

Dosage of Benazepril

Dosage for Adults

Hypertension: Initial: 5–10 mg once daily, titrated to 20–40 mg/day (max 80 mg/day) in 1–2 doses, based on response.

Heart Failure: Initial: 2.5–5 mg once daily, increased to 10–20 mg/day, combined with diuretics, with a max of 40 mg/day.

Diabetic Nephropathy: 10–20 mg once daily, adjusted to 40 mg/day if proteinuria persists, alongside glycemic control.

Combination Therapy: 10 mg with hydrochlorothiazide (12.5 mg) for enhanced BP control, not exceeding 40 mg Benazepril.

Dosage for Children

6–16 years (Hypertension): 0.2 mg/kg once daily, max 0.6 mg/kg or 40 mg/day, under pediatric nephrologist supervision.

Under 6 years: Not recommended; safety not established.

Special Consideration: Adjust for low body weight, starting at 0.1 mg/kg.

Dosage for Pregnant Women

Dosage Adjustments

Renal Impairment: CrCl 30–60 mL/min: 5 mg/day, max 40 mg; CrCl <30 mL/min: 2.5 mg/day, max 20 mg.

Hepatic Impairment: No adjustment needed, but monitor for reduced metabolism.

Elderly: Start with 2.5–5 mg once daily; increase cautiously to 20–40 mg/day.

Volume Depletion: Reduce initial dose to 2.5 mg if on diuretics.

Additional Considerations

• Take this active ingredient consistently, preferably in the morning, with or without food.
• Avoid abrupt discontinuation; taper over 1–2 weeks to prevent rebound hypertension.

How to Use Benazepril

Administration:

• Swallow tablets whole with a glass of water, with or without food; take with a meal to reduce stomach upset if present.
• Split doses (e.g., morning and evening) for 20–40 mg/day to maintain 24-hour coverage.

Timing: Use once or twice daily as prescribed, aligning with other antihypertensive medications.

Monitoring: Watch for dizziness, swelling, or persistent cough; check for signs of hyperkalemia (e.g., muscle weakness).

Additional Tips:

• Store at 20–25°C (68–77°F), protecting from moisture.
• Avoid high-potassium foods (e.g., bananas) in excess during therapy.
• Report severe fatigue, chest pain, or facial swelling immediately.

Contraindications for Benazepril

Hypersensitivity: Patients with a known allergy to Benazepril or other ACE inhibitors (e.g., lisinopril).

Pregnancy (Second/Third Trimester): Due to fetal risk (e.g., renal dysplasia).

History of Angioedema: Contraindicated with prior ACE inhibitor-related angioedema.

Bilateral Renal Artery Stenosis: Risk of acute kidney injury due to reduced glomerular filtration.

Severe Aortic Stenosis: Avoid due to potential hypotension worsening outflow obstruction.

Warnings & Precautions for Benazepril

General Warnings

Angioedema: Rare but serious swelling (face, throat, tongue); discontinue immediately if occurs.

Hyperkalemia: Elevated potassium levels (>5.5 mmol/L) with renal impairment or potassium supplements.

Cough: Dry, persistent cough (5–20%) due to bradykinin; consider alternative therapy if severe.

Renal Impairment: Risk of acute kidney injury, especially in bilateral renal artery stenosis.

Use in Specific Populations

Pregnancy: Category D; fetal toxicity in later trimesters; avoid use.

Breastfeeding: Excreted in breast milk; use with caution or consider alternatives.

Elderly: Higher risk of hypotension and renal effects; start with lower doses.

Children: Use only under specialist supervision due to limited data.

Additional Precautions

• Inform your doctor about kidney disease, diabetes, or prior angioedema before starting this medication.
• Monitor renal function and electrolytes regularly during therapy.

Overdose and Management of Benazepril

Overdose Symptoms

• Severe hypotension, dizziness, or fainting.
• Bradycardia or shock in extreme cases.
• Hyperkalemia (muscle cramps, arrhythmias).
• Nausea or weakness as early signs.

Immediate Actions

Contact the Medical Team: Seek immediate medical help.

Supportive Care: Administer IV fluids and place in Trendelenburg position if hypotensive.

Specific Treatment: Use vasopressors (e.g., norepinephrine) for shock, insulin with glucose for hyperkalemia; monitor ECG.

Monitor: Check blood pressure, potassium, and renal function for 12–24 hours.

Additional Notes

• Overdose risk increases with polypharmacy; store securely.
• Report persistent symptoms (e.g., confusion, irregular heartbeat) promptly.

Side Effects of Benazepril

Common Side Effects

• Cough (5–20%, bradykinin-mediated)
• Dizziness (3–10%, dose-dependent)
• Fatigue (2–8%, improved with hydration)
• Headache (2–6%, transient)
• Nausea (1–5%, reduced with food)

These effects may subside with dose adjustment.

Serious Side Effects

• Allergic: Angioedema, rash, or anaphylaxis.
• Cardiovascular: Severe hypotension or chest pain.
• Renal: Oliguria, elevated creatinine, or acute kidney injury.
• Electrolyte: Hyperkalemia or hyponatremia.
• Neurological: Confusion or syncope.

Additional Notes

• Regular monitoring for renal and electrolyte changes is advised.
• Report any unusual symptoms (e.g., swelling, severe weakness) immediately.

Drug Interactions with Benazepril

This active ingredient may interact with:

Potassium-Sparing Diuretics (e.g., Spironolactone): Increases hyperkalemia risk; monitor potassium levels weekly and avoid if >5.5 mmol/L.

Aliskiren: Raises risk of acute kidney injury and hyperkalemia, especially in diabetics; contraindicated if eGFR <60 mL/min.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs, e.g., Ibuprofen): May worsen hypertension or kidney function; ensure hydration and monitor creatinine.

Lithium: Reduces lithium clearance, risking toxicity; monitor levels weekly.

Antidiabetic Agents (e.g., Insulin): May enhance hypoglycemia; monitor glucose regularly.

Patient Education or Lifestyle

Pharmacokinetics of Benazepril

Absorption: Rapidly absorbed (peak at 1–2 hours); 37% bioavailability due to first-pass metabolism.

Distribution: Volume of distribution ~0.7 L/kg; 95% protein-bound.

Metabolism: Hepatic to active metabolite benazeprilat via esterases.

Excretion: Primarily renal (90% as benazeprilat); half-life 10–11 hours.

Half-Life: 10–11 hours, with prolonged effects in renal impairment.

Pharmacodynamics of Benazepril

Inhibiting ACE to reduce angiotensin II, lowering blood pressure and cardiac workload.

Increasing bradykinin levels, enhancing vasodilation and natriuresis.

Protecting kidneys by reducing glomerular pressure in diabetic nephropathy.

Demonstrating dose-dependent hypotension, with potential for hyperkalemia at higher doses.

Storage of Benazepril

• Temperature: Store at 20–25°C (68–77°F); protect from moisture.
• Protection: Keep in original container, away from light.
• Safety: Store out of reach of children.
• Disposal: Dispose of unused tablets per local regulations or consult a pharmacist.

Frequently Asked Questions (FAQs) About Benazepril

Q: What does Benazepril treat?
A: This medication treats hypertension and heart failure.

Q: Can this active ingredient cause swelling?
A: Yes, angioedema is a rare risk; seek help if it occurs.

Q: Is Benazepril safe for children?
A: Yes, for 6+ years with a doctor’s guidance.

Q: How is this drug taken?
A: Orally as tablets, as directed.

Q: How long is Benazepril treatment?
A: Long-term for hypertension; consult a doctor.

Q: Can I stop Benazepril suddenly?
A: No, taper off to avoid rebound effects.

Regulatory Information for Benazepril

This medication is approved by:

U.S. Food and Drug Administration (FDA): Approved in 1991 (Lotensin) for hypertension and heart failure.

European Medicines Agency (EMA): Approved for cardiovascular indications.

Other Agencies: Approved globally for hypertension; consult local guidelines.

References

1. U.S. Food and Drug Administration (FDA). (2023). Lotensin (Benazepril) Prescribing Information.
   • Official FDA documentation detailing the drug’s approved uses, dosage, and safety.
2. European Medicines Agency (EMA). (2023). Benazepril Summary of Product Characteristics.
   • EMA’s comprehensive information on the medication’s indications and precautions in Europe.
3. National Institutes of Health (NIH). (2023). Benazepril: MedlinePlus Drug Information.
   • NIH resource providing detailed information on the drug’s uses, side effects, and precautions.
4. World Health Organization (WHO). (2023). WHO Model List of Essential Medicines: Benazepril.
   • WHO’s consideration of Benazepril for hypertension.
5. Journal of the American College of Cardiology. (2022). Benazepril in Heart Failure Management.
   • Peer-reviewed article on Benazepril efficacy (note: access may require a subscription).