RESUMEN
En el Hospital de La Samaritana, durante el período comprendido entre el 1§ de abril de 1992 y el 30 de octubre de 1993, se tomaron 79 pacientes con Diagnóstico de Pre- eclampsia grave y Eclampsia. 71 de ellos recibieron Captopril sublingual en dosis de 25 mg cada 30 minutos hasta un máximo de 3 dosis: las 8 restantes recibieron Hidralazina 5 mg IV hasta un máximo de 4 dosis en intervalos de 20 minutos. De las 71 pacientes tratadas con Captopril, 52 (73.3 por ciento) de ellas respondieron exitosamente (disminuciónde la Preseión arterial en 25 por ciento). 20 pacientes (38 por ciento) requirieron una sola dosis, 26 (50 por ciento) requirieron dos dosis y 6 (11 por ciento) requirieron 3 dosis. No se observaron efectos adversos importantes en las pacientes ni alteraciones en la diuresis o niveles de creatinina del neonato. Se recomienda el uso de Captopril sublingual para el manejo de la crisis hipertensiva inducida por el embarazo
Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Captopril/normas , Captopril/uso terapéutico , Preeclampsia/diagnóstico , Preeclampsia/terapiaRESUMEN
OBJECTIVES: To evaluate the effectiveness of systemic captopril therapy. DESIGN: Randomized double-blind study. SETTING: Andrology Unit at the Department of Dermatology, University of Munich, Munich, Germany. PATIENTS: Infertile men suffering from oligozoospermia (5-20 x 10(6) spermatozoa/mL) and/or asthenozoospermia. INTERVENTIONS: Captopril was given orally; samples of seminal plasma were collected twice before treatment and 4 and 12 weeks after captopril administration. MAIN OUTCOME MEASURE: Semen parameters, pregnancy rate, ACE activity, and kinin levels. RESULTS: After 4 weeks of therapy, significant differences between verum group and placebo group were found concerning ACE activity and kinin levels. Sperm density improved significantly after 12 weeks of captopril therapy. All other semen parameters remained unchanged. The pregnancy rate was not improved. CONCLUSIONS: The suitability of captopril in the therapy of oligozoospermia and/or asthenozoospermia for improvement of male infertility seems to be limited.
Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Infertilidad Masculina/tratamiento farmacológico , Adolescente , Adulto , Inhibidores de la Enzima Convertidora de Angiotensina/normas , Captopril/normas , Captopril/uso terapéutico , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Humanos , Infertilidad Masculina/etiología , Cininas/análisis , Masculino , Persona de Mediana Edad , Oligospermia/complicaciones , Oligospermia/tratamiento farmacológico , Peptidil-Dipeptidasa A/análisis , Semen/química , Recuento de EspermatozoidesRESUMEN
Microdose (1 mg) captopril therapy is commonly used for the initial dose titration in patients with congestive heart failure. Since this dosage form is not commercially available, it has to be extemporaneously compounded. Quality control of each batch is commonly evaluated using the weight variation technique described in the USP. Despite careful titration with microdose, captopril capsules variability in patient's response has been observed. In order to explain this fluctuation, the actual content of extemporaneously compounded microdose captopril capsules was evaluated using a high pressure liquid chromatographic assay. Microdose captopril capsules were prepared by triturating 25 mg tablets with lactose in a mortar using standard geometric dilution technique and a Sharpe-Dohme hand-operated capsule filling machine. Forty-eight microdose captopril capsules were randomly selected from the compounded batch and were individually assayed for captopril amount. The mean +/- standard deviation (SD) amount of captopril in each capsule was 1.27 g +/- 0.31 mg with a range of 0.84 g to 1.96 mg. The coefficient of variation was 24.5%. Ten captopril capsules were randomly selected from the compounded batch and were individually weighed. The capsules had a mean weight +/- SD of 198.3 g +/- 21.2 mg and a coefficient of variation of 7.3%. Even though the extemporaneously prepared microdose captopril capsules were within acceptable limits for weight variation described in the USP, the actual dose administered to the patients could vary by as much as 24.5%.
Asunto(s)
Captopril/normas , Composición de Medicamentos/normas , Cápsulas , Captopril/administración & dosificación , Captopril/análisis , Cromatografía Líquida de Alta Presión , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Control de Calidad , Distribución AleatoriaRESUMEN
Decision analysis is applied to the group of angiotensin-converting enzyme inhibitors, in order to select those which should be included in the hospital formulary and to establish a research method which allows the reproduction of the process with new, related drugs. Captopril, enalapril and lisinopril were the alternatives considered. Evaluation criteria were efficacy, clinical experience, safety, dosage interval, hepatic bioactivation, interactions, dosage forms and cost. A relative weight was assigned through a survey among the hospital's staff. Each alternative was evaluated in relation to all criteria. Sensitivity analysis was applied to validate the method. Enalapril obtained the highest score, followed by lisinopril and captopril. The sensitivity analysis confirms this result. Enalapril is selected for the hospital formulary due to its higher score, although the differences between the three are very small.
Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/normas , Técnicas de Apoyo para la Decisión , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Captopril/normas , Utilización de Medicamentos/normas , Enalapril/normas , Humanos , Lisinopril/normasAsunto(s)
Captopril/normas , Diuresis/fisiología , Furosemida/normas , Hepatopatías/tratamiento farmacológico , Espironolactona/normas , Anciano , Captopril/administración & dosificación , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Femenino , Furosemida/uso terapéutico , Humanos , Riñón/fisiología , Hepatopatías/fisiopatología , Espironolactona/uso terapéuticoRESUMEN
The renin-angiotensin-aldosterone system is activated by diuretics and involved in the diuretic resistance of cirrhotic patients with ascites and oedema. In previous studies relatively high doses of captopril (25-400 mg daily) were unsuccessful in promoting diuresis and natriuresis in these patients. We analyzed the efficacy of a low dose of captopril in eight patients with massive ascites resistant to therapy of salt/fluid restriction and increasing doses of spironolactone and furosemide. Mean duration of diuretic use was 73 days (range 7-240 days). After at least 3 days of observation on 80 mg furosemide and 100 mg spironolactone only, captopril was added. Four out of eight patients responded with an increase in natriuresis and diuresis; daily dose of captopril was 20.6 mg in responders and 26.5 mg in non-responders. After the addition of captopril the mean weight change was -7.5 kg in responders and +0.25 kg in non-responders. Mean urinary sodium output in responders increased from 72.8 (S.D. = 35.2) to 128.5 (63.5) mmol within 10 days. Increased diuresis in responders made diuretic reduction necessary: mean furosemide from 80 to 53.3 mg, and mean spironolactone from 100 to 68.1 mg. Creatinine clearances remained stable. High levels of plasma renin activity, plasma aldosterone and angiotensin-II were found in all patients. Non-responders showed more severe hyponatremia and higher vasopressin levels. Natriuretic atrial factor (NAF) was in the upper-normal range or slightly elevated in both groups. In non-responders we noticed low levels of cGMP in 24-h urine, compared with responders.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Captopril/normas , Diuresis/fisiología , Furosemida/normas , Cirrosis Hepática/tratamiento farmacológico , Espironolactona/normas , Adulto , Anciano , Aldosterona/sangre , Angiotensina II/sangre , Factor Natriurético Atrial/sangre , Captopril/efectos adversos , Creatinina/sangre , GMP Cíclico/orina , Diuresis/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Furosemida/efectos adversos , Humanos , Riñón/efectos de los fármacos , Riñón/fisiología , Hígado/efectos de los fármacos , Hígado/fisiología , Cirrosis Hepática/sangre , Cirrosis Hepática/epidemiología , Masculino , Persona de Mediana Edad , Diálisis Renal , Renina/sangre , Sodio/orina , Espironolactona/efectos adversosRESUMEN
To examine predictors for the efficacy of antihypertensive agents, we investigated the effects of nifedipine and captopril on blood pressure (BP) and humoral factors in patients with essential hypertension. Eleven essential hypertensive patients (mean age: 54) were treated with long acting nifedipine at 20 to 40 mg/day for 8 weeks and 25 essential hypertensives (mean age: 51) were treated with captopril at 37.5 to 75 mg/day. Blood pressure was measured every 2 weeks. Plasma renin activity (PRA), and plasma concentrations of aldosterone, epinephrine and norepinephrine were determined before and at the end of treatment. Both nifedipine and captopril decreased BP (nifedipine: mean BP 119 +/- 3 to 101 +/- 2 mm Hg, captopril: 124 +/- 2 to 100 +/- 2, P less than .01 for each), whereas neither of them affected heart rate. The 8-week treatment of nifedipine showed no significant effect on humoral factors. Captopril increased PRA by 63% (P less than .05) and decreased plasma epinephrine by 42% (P less than .01) and norepinephrine by 35% (P less than .01). The change in mean BP was positively correlated with pretreatment PRA (r = 0.68, P less than .01) in nifedipine-treated patients and inversely with pretreatment norepinephrine (r = -0.53, P less than .01) in captopril treatment. The results suggest that both nifedipine and captopril were effective antihypertensive agents and that the long term treatment of nifedipine is more effective in essential hypertensives with lower PRA, while captopril is more effective in those with higher plasma norepinephrine concentration.