ZANTIPRES 30 mg

Indications

• Hypertension
• Heart failure
• Left ventricular dysfunction following myocardial infarction
• Diabetic nephropathy

Dosage

Children: Zofenopril is not generally recommended for use in children. Refer to the BNF for Children for specific guidance on any potential pediatric use.

Adults: The usual starting dose for hypertension is 15 mg once daily, which may be adjusted based on the patient's response. For heart failure, the initial dose may be lower, around 7.5 mg once daily, titrated as necessary.

Mechanism of action

Zofenopril inhibits the enzyme ACE, which is responsible for the conversion of angiotensin I to angiotensin II. This inhibition results in decreased levels of angiotensin II, a potent vasoconstrictor, leading to vasodilation, reduced secretion of aldosterone, and ultimately lower blood pressure. Additionally, it enhances bradykinin levels, which also contributes to vasodilation.

Pharmacodynamics

The pharmacodynamic effects of zofenopril include significant reductions in systemic vascular resistance and blood pressure. It also improves cardiac output in patients with heart failure by reducing afterload and preload. The onset of action is typically observed within a few hours, with peak effects occurring within 2 to 4 weeks of therapy.

Pharmacokinetics

Zofenopril is well absorbed after oral administration. It undergoes hepatic metabolism to its active metabolite, zofenoprilat, which has a longer half-life. The elimination half-life of zofenoprilat ranges from 8 to 12 hours. Both the drug and its metabolites are primarily excreted via the kidneys. Renal impairment may necessitate dosage adjustments.

Contra-indications

• Hypersensitivity to zofenopril or any of its excipients
• History of angioedema associated with previous ACE inhibitor therapy
• Severe renal impairment
• Pregnancy
• Concomitant use with aliskiren in patients with diabetes

Adverse effects

• Cough
• Dizziness
• Fatigue
• Hypotension
• Hyperkalemia
• Renal impairment
• Angioedema
• Rash
• Gastrointestinal disturbances

Interactions

• Potassium-sparing diuretics may increase the risk of hyperkalemia
• Non-steroidal anti-inflammatory drugs (NSAIDs) may reduce the antihypertensive effect
• Lithium levels may increase, requiring monitoring
• Concomitant use of other antihypertensives may enhance hypotensive effects

Precautions

• Monitor renal function before and during treatment
• Use with caution in patients with hepatic impairment
• Caution in patients with a history of angioedema
• Consider risk factors for hypotension in volume-depleted patients

Pregnancy

Zofenopril is contraindicated in pregnancy due to potential harm to the fetus.

Breast-feeding

It is not known whether zofenopril is excreted in human milk. Caution is advised.

Storage

Store at room temperature, away from moisture and light.

Formulations

• Tablets: 7.5 mg, 15 mg, 30 mg