ACE Inhibitors An ACE inhibitor (or angiotensin converting enzyme inhibitor) is a medication used primarily for the treatment of heart, blood vessel, and kidney problems. How does an ACE inhibitor work? ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance that affects your cardiovascular system by narrowing your blood vessels and releasing hormones that can raise your blood pressure. This narrowing can cause high blood pressure and force your heart to work harder. ACE inhibitors also increase blood flow, which helps to decrease the amount of work your heart has to do and can help protect your kidneys from the effects of hypertension (high blood pressure). What are the different types of ACE inhibitors? There are many different names and brands of ACE inhibitors. Examples of ACE inhibitors include: Benazepril (Lotensin) Captopril Enalapril (Vasotec) Fosinopril Lisinopril (Prinivil, Zestril) Moexipril (Univasc) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) For what conditions are ACE inhibitors used? Doctors prescribe ACE inhibitors to prevent, treat or improve symptoms in conditions such as: High blood pressure Coronary artery disease Heart failure Diabetes Certain chronic kidney diseases (Primary Nephrotic Syndrome) Heart attacks Migraines In studies, individuals with hypertension (high blood pressure), heart failure or prior heart attacks that were treated with an ACE inhibitor lived longer than patients who did not take an ACE inhibitor. However, some individuals with hypertension do not respond sufficiently to ACE inhibitors alone. In these cases, other drugs are used in combination with ACE inhibitors. ACE inhibitors are regularly prescribed for patients diagnosed with primary (idiopathic) Nephrotic Syndrome in order to manage high blood pressure as a result of malfunctioning kidneys leading to fluid retention or overload. Are there any differences among the different types of ACE inhibitors? ACE inhibitors are very similar. However, they differ in how they are eliminated from the body and their doses. Some ACE inhibitors need to be converted into an active form in the body before they work. In addition, some ACE inhibitors may work more on the ACE (angiotensin converting enzyme) that is present in tissues than on ACE that is present in the blood. The importance of this difference or whether one ACE inhibitor is better than another has not been determined. Many seem to work equally as well. Your physician will prescribe what he/she thinks will work best for your condition based on experience. Side effects may vary for different ones. How is an ACE inhibitor administered? ACE inhibitors are pills that you take by mouth. ACE inhibitors are usually taken once daily, and many people take them in the morning. Try to take your medications at the same time, or times, each day. Do not stop taking your medicines without talking with your doctor first. Other important tips: Before taking ibuprofen (Advil, Motrin) or aspirin, talk to your doctor. Tell your doctor what other medicines you are taking. This includes over the counter drugs, diuretics (water pills), potassium pills, or herbal or dietary supplements. Do not take ACE inhibitors if you are pregnant or breastfeeding. Do not take these medicines if you are planning to become pregnant. Call your doctor if you become pregnant when you are taking these medicines. What are the side effects of ACE inhibitors? ACE inhibitors are well-tolerated by most individuals. Nevertheless, they are not free of side effects, and some patients should not use ACE inhibitors. You should discuss the benefits and risks of all medications with your physician. ACE inhibitors usually are not prescribed for pregnant patients because they may cause birth defects. Individuals with bilateral (two-sided) renal artery stenosis (narrowing of blood vessels in the kidneys) may experience worsening of kidney function. People who have had a severe reaction to ACE inhibitors should avoid them. The most common side effects are: Chronic cough Elevated blood potassium levels Low blood pressure Dizziness Headache Drowsiness Weakness Abnormal taste (metallic or salty taste) Rash It may take up to a month for coughing to subside, and if one ACE inhibitor causes a cough it is likely that the others will too. The most serious, but rare, side effects of ACE inhibitors are: Kidney failure Allergic reactions Decrease in white blood cells Marked swelling of tissues (angioedema) With which drugs do ACE inhibitors interact? ACE inhibitors have few interactions with other drugs. Since ACE inhibitors may increase blood levels of potassium, the use of potassium supplements, salt substitutes (which often contain potassium), or other drugs that increase the body’s potassium may result in excessive blood potassium levels. There have been reports that aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil, Children’s Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever etc.), indomethacin (Indocin, Indocin-SR), and naproxen (Anaprox, Naprelan, Naprosyn, Aleve) may reduce the effects of ACE inhibitors. ACE inhibitors also may increase the blood concentration of lithium (Eskalith) and lead to an increase in side effects from lithium. *Note: The decision to prescribe a medication is the responsibility of your physician/primary care provider based on his/her evaluation of your condition. The above is meant for informational purposes only. Discuss this information and all information about drugs/medications with your physician before starting or stopping any medication.