enalapril and Neutropenia

The safety profiles of the angiotensin converting enzyme inhibitors, captopril and enalapril, are the focus of this review. Adverse effects are reviewed as those associated with sulfhydryl compounds and as those considered class-specific adverse effects of angiotensin converting enzyme inhibitors. Specifically discussed are the incidences of the adverse effects of rash, taste disturbance, neutropenia, and proteinuria, which are characteristic of compounds containing sulfhydryl moieties, such as captopril. It is concluded from the review of these safety data that enalapril is well tolerated, has few class-specific adverse effects, and may offer a potential advantage over captopril by having fewer sulfhydryl-related adverse effects.

Topics: Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Captopril; Clinical Trials as Topic; Dizziness; Dose-Response Relationship, Drug; Enalapril; Half-Life; Headache; Humans; Hypertension; Kidney Diseases; Neutropenia; Oligopeptides; Skin Diseases; Sulfhydryl Compounds; Taste Disorders; Teprotide

Topics: Angiotensin II; Angiotensin-Converting Enzyme Inhibitors; Animals; Antihypertensive Agents; Captopril; Dipeptides; Drug Eruptions; Drug Interactions; Enalapril; Heart Failure; Humans; Hyperaldosteronism; Hypertension; Hypertension, Renal; Kidney Diseases; Neutropenia; Proline; Taste Disorders

The safety profiles of the angiotensin converting enzyme inhibitors, captopril and enalapril, are the focus of this review. Adverse effects are reviewed as those associated with sulfhydryl compounds and as those considered class-specific adverse effects of angiotensin converting enzyme inhibitors. Specifically discussed are the incidences of the adverse effects of rash, taste disturbance, neutropenia, and proteinuria, which are characteristic of compounds containing sulfhydryl moieties, such as captopril. It is concluded from the review of these safety data that enalapril is well tolerated, has few class-specific adverse effects, and may offer a potential advantage over captopril by having fewer sulfhydryl-related adverse effects.

Topics: Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Captopril; Clinical Trials as Topic; Dizziness; Dose-Response Relationship, Drug; Enalapril; Half-Life; Headache; Humans; Hypertension; Kidney Diseases; Neutropenia; Oligopeptides; Skin Diseases; Sulfhydryl Compounds; Taste Disorders; Teprotide

Topics: Angiotensin-Converting Enzyme Inhibitors; Enalapril; Humans; Kidney Transplantation; Male; Middle Aged; Neutropenia; Polycythemia

Topics: Adolescent; Captopril; Enalapril; Female; Humans; Hypertension; Neutropenia

Major developments in the use of angiotensin converting enzyme (ACE) inhibition for the treatment of hypertension and congestive heart failure have occurred since the discovery of captopril in June 1975. Early in the past decade, this oral ACE inhibitor was restricted to refractory and severe cases of hypertension. By July 1985, the Food and Drug Administration approved its use not only for all degrees of hypertension but also for the initial treatment of hypertensive patients with uncomplicated disease. New information has confirmed the effectiveness of twice-daily administration (which favorably influences compliance) and the lack of a need to monitor blood or urine levels to assure safety. The renin-mediated and non-renin-mediated mechanisms of action of captopril-induced ACE inhibition have been fully delineated, as has its side effect profile, which does not include various CNS, sympathetic reflex, and metabolic side effects seen with other antihypertensive agents. As the first vasodilator to prove its efficacy in the acute and chronic treatment of congestive heart failure to the FDA, captopril is now widely used throughout the United States. ACE inhibition reduces symptoms, enhances exercise capacity, and favorably affects sodium, water, and potassium homeostasis in patients with heart failure. Also, recent but as yet unconfirmed evidence suggests that ACE inhibition may prolong survival in these patients. The success of captopril, the first oral agent of this class, promises to hold true for other ACE inhibitors (such as enalapril), which have similar activities but differing pharmacokinetic properties and will soon be available for clinical use. Further information on these newer agents is anxiously awaited. In the near future, the clinician will undoubtedly be able to choose from a large selection of ACE inhibitors for the treatment of hypertension and heart failure. Therefore, it is important to learn about any meaningful differences among ACE inhibitors and to contrast this class of agents with older, standard therapies. This learning process is crucial as we assess whether newer agents offer clinical advantages over the old.

Topics: Adrenergic beta-Antagonists; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Captopril; Enalapril; Erythema; Heart Failure; Humans; Hypotension; Neutropenia; Renin-Angiotensin System; Taste