Captopril and Enalapril, what are the differences

The development of drugs for the treatment of hypertension lasts several decades. Specialists are looking for more effective and reliable drugs to lower and control blood pressure.

The pharmaceutical market offers a wide range of products for this purpose. Drugs have a different mechanism of action, effectiveness, indications and contraindications. Cost is also an important criterion.

For each patient suffering from hypertension, the doctor selects an individual therapeutic regimen, having previously understood the possible causes of its occurrence.

Hypertension is a disease accompanied by an increase in blood pressure. There is no single reason for the occurrence of the disease, they are different in each case. Therefore, the doctor always selects an individual therapeutic regimen for each specific case.

The most popular categories of drugs used to lower blood pressure:

1. Diuretics – help eliminate excess fluid, reducing congestion of the heart and blood vessels.
2. Calcium antagonists – to some extent reduce the permeability of calcium channels, increasing the lumen of blood vessels.
3. Betabocators – reduce the frequency of contractions of the heart and reduce their power.
4. Selective agonists of imidazoline receptors – lower blood pressure and moderate appetite, ideal for the treatment of hypertension against the background of obesity.
5. Angiotensin II receptor antagonists – reduce the synthesis of ACE, which stimulates a decrease in vascular lumen.
6. ACE inhibitors – work as angiotensin antagonists, but have more contraindications.

Let’s talk about two representatives of the last category of drugs – Captopril and Enalapril.

Captopril

ACE blocker. It affects the renin-angiotensin-aldosterone system, reducing the concentration of the angiotensin-converting enzyme and increasing the vascular lumen. The active ingredient is a derivative of the amino acids L-alanine and L-proline.

The tool has hypotensive, vasodilating, natriuretic, cardioprotective pharmacological effects.

It is made by domestic and foreign companies. There are in the form of tablets of 10, 20, 30, 40, 50 and 100 pcs. in dosages of 25 and 50 mg.

Enalapril

ACE blocker, reduces post – and preload on the heart muscle, inhibits the formation of aldosterone in the adrenal glands. The active ingredient is enalapril.

It has a vasodilator and hypotensive pharmacological effect. Available in the form of tablets of 20, 30, 50 and 100 pcs. in a dosage of 5, 10 and 20 mg. It is made by several domestic and foreign companies.

General characteristics

• Both drugs are ACE blockers – reduce its synthesis and widen the lumen of blood vessels.
• Captopril and Enalapril are produced by domestic and foreign manufacturers.
• Produced in tablet form.
• They are included in the list of vital and important medicines.
• Available with a prescription.
• The mechanism of action is based on competitive blocking of ACE activity.
• Means are indicated for the list of diseases: arterial hypertension; heart failure; dysfunction of the left ventricle after heart surgery in patients in a stable state;
• For each of the drugs, the following adverse reactions are characteristic: dizziness, excessive fatigue; orthostatic collapse; urges to nausea; decrease in the number of neutrophils in the blood; unproductive cough; allergic skin rashes.
• Contraindications : period of pregnancy and lactation; age up to 18 years, individual intolerance of the active component.
• Interaction with drugs of other groups. The simultaneous use of ACE blockers with certain categories of drugs leads to the following conditions: leukopenia (immunosuppressants, cytostatics, procainamide); hyperkalemia (potassium-sparing diuretics, potassium preparations, salt analogues and dietary supplements with potassium, trimethoprim); renal failure (NSAIDs); severe arterial hypotension (“loop” or thiazide diuretics, interleukin-3); severe arterial hypotension (anesthetics); anemia (azathioprine); hematological malfunctions (allopurinol); weakening of the antihypertensive effect (acetylsalicylic acid in high doses, indomethacin, ibuprofen, erythropoietins); increased antihypertensive efficacy (minoxidil, sodium nitroprusside, orlistat, pergolide).
• The cost of funds is in the lower price range, they are widely distributed in pharmacies, due to the fact that they are vital and important medicines.

Differences

1. Dosage. Captopril is available in two dosages – 25 and 50 mg. Enalapril has three dosages: 5, 10 and 20 mg.
2. Pharmacokinetics. Captopril absorption is faster and more effective than enalapril, but taking the drug at the same time as food reduces its absorption by a third. Captopril acts bypassing the metabolic stage. Its half-life is approximately 2.5 hours, in a patient suffering from renal failure, an increase in the period of more than 7 times is possible. It is able to accumulate in the body. Eating does not affect the absorption of enalapril. It is biotransformed in the liver. Enalaprilat formed after hydrolysis provides hypotensive activity. The half-life of the drug is 11 hours, in patients with renal failure, the period can be stretched more than 1.5 times.
3. Indications. Enalapril is also used in patients with essential hypertension, Captopril – with renal failure in the presence of type 1 diabetes.
4. Permissible maximum daily dose. 150 mg for captopril, 80 mg for enalapril.
5. Adverse reactions. When taking Captopril, there is a loss of appetite, a distortion of taste perception; the development of anemia, thrombocytopenia; hyperkalemia, acidosis; proteinuria, renal failure. Enalapril receptions cause fainting, palpitations, pain in the heart; in high doses – impotence and hair loss.
6. Contraindications. Additionally, for enalapril – the presence of angioedema in the history of the disease, narrowing of the renal arteries, hyperkalemia, liver failure. Co-administration of aliskiren in patients with diabetes mellitus or renal failure is prohibited.
7. Cost. Both funds have an affordable price, but the cost of Enalapril, especially foreign production, is several times higher than the price of Captopril.

In patients with diabetes, captopril increases insulin susceptibility better than enalapril.

Captopril acts without being metabolized. The antihypertensive effect of the drug manifests itself 15-25 minutes after use and lasts up to 10 hours. When taken under the tongue, it is effective after 5-10 minutes. Due to its ability to quickly reduce pressure, it is used to stop hypertensive crises. Captopril bioavailability reaches 80-90%, so a partial decrease in absorbability when taken with food does not particularly affect its therapeutic effectiveness.

Captopril’s disadvantage is its short-term action – the drug is prescribed 2-3 times a day. Enalapril is effective within 24 hours. The severity of its antihypertensive effect is directly proportional to the dose and is enhanced while taking with diuretic drugs. The short duration of the effect makes Captopril safer than Enalapril for patients with variable hemodynamics, for example, with exacerbation of myocardial infarction or in the treatment of chronic heart failure, accompanied by optimal or reduced pressure.