Capozide

Name: Capozide

What is captopril and hydrochlorothiazide, and how does it work (mechanism of action)?

Capozide is a combination of captopril (Capoten) and hydrochlorothiazide (HCTZ), an angiotensin converting enzyme (ACE) inhibitor and a diuretic (water pill), respectively, and is used in the treatment of high blood pressure. ACE is an enzyme in the body that causes the formation of angiotensin II. Angiotensin II causes the arteries in the body to narrow, thereby elevating blood pressure. ACE inhibitors, such as captopril, lower blood pressure by preventing the formation of angiotensin II thereby relaxing the arteries. HCTZ is a diuretic (water pill) used for treating high blood pressure (hypertension) and accumulation of fluid. It works by blocking salt and fluid reabsorption in the kidneys, causing increased urine output (diuresis). The mechanism of its action in lowering high blood pressure is not well understood. The combination of captopril and HCTZ reduces blood pressure better than either drug alone. Captopril increases potassium levels while HCTZ reduces potassium levels; the combination of both drugs has less effect on potassium levels. The FDA approved captopril/HCTZ in October 1984.

Side effects

Dizziness, lightheadedness, drowsiness, headache, tiredness, blurred vision, loss of taste, or dry cough may occur as your body adjusts to the medication. You may also experience decreased sexual ability or increased sensitivity to the sun. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This product may cause a loss of too much body water (dehydration) and salt/minerals. Tell your doctor right away if you have any symptoms of dehydration or mineral loss, including: extreme thirst, very dry mouth, muscle cramps/weakness, fast/slow/irregular heartbeat, confusion, decreased urination.Tell your doctor immediately if any of these unlikely but serious side effects occur: signs of infection (e.g., fever, chills, persistent sore throat), easy bruising/bleeding, symptoms of a high potassium blood level (such as muscle weakness, slow/irregular heartbeat), numbness/tingling/swelling of the hands/feet, muscle/joint aches, decrease in vision, eye pain.This drug may rarely cause serious (possibly fatal) liver problems. Seek immediate medical attention if you notice any of the following rare but very serious side effects: yellowing eyes/skin, dark urine, severe stomach/abdominal pain, persistent tiredness, persistent nausea/vomiting.Seek immediate medical attention if this rare but very serious side effect occurs: unusual change in the amount of urine (not including the normal increase in urine when you first start this drug).A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash, itching/swelling (especially of the face/tongue/throat/arms/legs), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Notes

Do not share this medication with others.Lifestyle changes such as stress reduction programs, exercise, and dietary changes may increase the effectiveness of this medicine. Talk to your doctor or pharmacist about lifestyle changes that might benefit you.Laboratory and/or medical tests (e.g., sodium and potassium blood levels, kidney function) should be performed from time to time to monitor your progress or check for side effects. Consult your doctor for more details.Check your blood pressure regularly while taking this medication, especially when you first start this drug or when your dose is changed. Learn how to monitor your own blood pressure at home, and share the results with your doctor.

Overdose

Captopril

Correction of hypotension would be of primary concern. Volume expansion with an intravenous infusion of normal saline is the treatment of choice for restoration of blood pressure.

While captopril may be removed from the adult circulation by hemodialysis, there is inadequate data concerning the effectiveness of hemodialysis for removing it from the circulation of neonates or children. Peritoneal dialysis is not effective for removing captopril; there is no information concerning exchange transfusion for removing captopril from the general circulation.

Hydrochlorothiazide

In addition to the expected diuresis, overdosage of thiazides may produce varying degrees of lethargy which may progress to coma within a few hours, with minimal depression of respiration and cardiovascular function and without evidence of serum electrolyte changes or dehydration. The mechanism of thiazide-induced CNS depression is unknown. Gastrointestinal irritation and hypermotility may occur. Transitory increase in BUN has been reported, and serum electrolyte changes may occur, especially in patients with impaired renal function.

In addition to gastric lavage and supportive therapy for stupor or coma, symptomatic treatment of gastrointestinal effects may be needed. The degree to which hydrochlorothiazide is removed by hemodialysis has not been clearly established. Measures as required to maintain hydration, electrolyte balance, respiration, and cardiovascular and renal function should be instituted.

Uses of Capozide

Capozide is a prescription medication used to treat high blood pressure.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information. 

Capozide Precautions

Serious side effects have been reported with Capozide or its ingredients including the following:

  • protein in your urine (proteinuria)
  • lowered white blood cell count (neutropenia/agranulocytosis) increasing the risk of infections
  • low red blood cell count (anemia)
  • low amount of platelets in the blood which causes bleeding into the tissues, bruising, and slow blood clotting after injury (thrombocytopenia)
  • deficiency of all three cellular components of the blood (red cells, white cells, and platelets) called pancytopenia
  • angioedema (a severe allergic reaction). Tell your healthcare provider right away if you have signs or symptoms of angioedema, which include the following:
    • swelling of face, eyes, lips, tongue, larynx and extremities
    • difficulty in swallowing or breathing
    • hoarseness (having difficulty making sounds when trying to speak)
  • liver, pancreas, and kidney damage
  • inflammation of a saliva gland (sialadenitis)
  • allergic reactions. Tell your healthcare provider right away if you have some or all of the following symptoms:
    • swelling of the face, limbs, lips, tongue, throat
    • difficulty breathing
    • stomach (abdominal) pain (intestinal angioedema) with or without nausea or vomiting
  • excessive low blood pressure
  • harm to an unborn baby (fetal toxicity). Do not take Capozide if you are pregnant or will become pregnant.
  • an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue (systemic lupus erythematosus)
  • imbalances in the levels of salts and fluids in your body (electrolyte and fluid imbalance). Tell your healthcare provider right away if you have some or all of the following symptoms:
    • dry mouth
    • thirst
    • weakness
    • drowsiness
    • restlessness
    • muscle pains or cramps
    • low blood pressure
    • low output of urine
    • fast heart rate
    • nausea
    • vomiting

Capozide can cause dizziness. Do not drive or operate heavy machinery until you know how Capozide affects you.

Do not take Capozide if you:

  • are allergic to Capozide or to any of its ingredients, other sulfonamide-derived drugs, or other ACE inhibitors
  • kidneys are unable to produce urine (anuric)
  • history of a type of swelling that affects deeper layers in your skin, often around your eyes and lips (angioedema) with other ACE inhibitors

What is the most important information i should know about hydrochlorothiazide and captopril (capozide 25/15, capozide 25/25, capozide 50/15, capozide 50/25)?

You should not use this medication if you are allergic to hydrochlorothiazide or captopril, or if you have a history of asthma or allergies, or you are unable to urinate.

You should not use this medication if you are allergic to any other ACE inhibitor, such as benazepril (Lotensin), fosinopril (Monopril), enalapril (Vasotec), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), or trandolapril (Mavik).

Before taking hydrochlorothiazide and captopril, tell your doctor if you have kidney disease (or are on dialysis), liver disease, glaucoma, congestive heart failure, gout, lupus, diabetes, or an allergy to sulfa drugs or penicillin.

Do not use hydrochlorothiazide and captopril if you are pregnant. It could harm the unborn baby.

Do not use potassium supplements or salt substitutes while you are taking hydrochlorothiazide and captopril, unless your doctor has told you to.

Conditions that may cause very low blood pressure include: vomiting, diarrhea, heavy sweating, heart disease, dialysis, a low-salt diet, or taking diuretics (water pills). Follow your doctor's instructions about the type and amount of liquids you should drink while taking hydrochlorothiazide and captopril. Tell your doctor if you have a prolonged illness that causes diarrhea or vomiting.

Overdosage

Captopril

Correction of hypotension would be of primary concern. Volume expansion with an intravenous infusion of normal saline is the treatment of choice for restoration of blood pressure.

While captopril may be removed from the adult circulation by hemodialysis, there is inadequate data concerning the effectiveness of hemodialysis for removing it from the circulation of neonates or children. Peritoneal dialysis is not effective for removing captopril; there is no information concerning exchange transfusion for removing captopril from the general circulation.

Hydrochlorothiazide

In addition to the expected diuresis, overdosage of thiazides may produce varying degrees of lethargy which may progress to coma within a few hours, with minimal depression of respiration and cardiovascular function and without evidence of serum electrolyte changes or dehydration. The mechanism of thiazide-induced CNS depression is unknown. Gastrointestinal irritation and hypermotility may occur. Transitory increase in BUN has been reported, and serum electrolyte changes may occur, especially in patients with impaired renal function.

In addition to gastric lavage and supportive therapy for stupor or coma, symptomatic treatment of gastrointestinal effects may be needed. The degree to which hydrochlorothiazide is removed by hemodialysis has not been clearly established. Measures as required to maintain hydration, electrolyte balance, respiration, and cardiovascular and renal function should be instituted.

For the Consumer

Applies to captopril / hydrochlorothiazide: oral tablet

Along with its needed effects, captopril / hydrochlorothiazide may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking captopril / hydrochlorothiazide:

More common
  • Black, tarry stools
  • chest pain
  • chills
  • cough
  • fever
  • painful or difficult urination
  • shortness of breath
  • sore throat
  • sores, ulcers, or white spots on lips or in mouth
  • swollen glands
  • unusual bleeding or bruising
  • unusual tiredness or weakness
Less common
  • Blurred vision
  • cloudy urine
  • confusion
  • dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
  • fast, pounding, or irregular heartbeat or pulse
  • sweating
Rare
  • Arm, back or jaw pain or discomfort
  • bloody urine
  • chest discomfort
  • chest tightness or heaviness
  • decreased blood pressure
  • decreased frequency or amount of urine
  • dilated neck veins
  • increased need to urinate
  • increased thirst
  • irregular breathing
  • large, hive-like swelling on face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • loss of appetite
  • lower back or side pain
  • nausea
  • paleness or cold feeling in fingertips and toes
  • passing urine more often
  • problems in urination or increase in amount of urine
  • swelling of face, fingers, feet or lower legs
  • tingling or pain in fingers or toes when exposed to cold
  • troubled breathing
  • vomiting
  • weight gain
  • wheezing

Some side effects of captopril / hydrochlorothiazide may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Difficulty in moving
  • itching skin
  • muscle pain or stiffness
  • pain in joints
  • rash
Less common
  • Change in taste
  • loss of taste

Captopril / hydrochlorothiazide Pregnancy Warnings

Animal studies have revealed craniofacial malformations. In humans, use of drugs that act on the renin angiotensin system (RAS) during the second and third trimesters increases fetal and neonatal morbidity and death. There are no controlled data in human pregnancy. US FDA pregnancy category D: There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. US FDA pregnancy category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

UK: Use is not recommended during the first trimester of pregnancy and is contraindicated during the second and third trimesters. US: This drug should not be used during pregnancy unless there are no alternatives and the benefit outweighs the risk to the fetus. US FDA pregnancy category: D (second and third trimesters); C (first trimester) Comments: Adequate methods of contraception should be encouraged.

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