Hyperthyroidism and acromegaly due to a thyrotropin- and growth hormone-secreting pituitary tumor. Lack of hormonal response to bromocriptine

antlhypertensrve agents that cause renr” release. Agents Aftecf!ng SympalheOc Actfnfy - The sympathetic nervous systerr may be especfally Important fn supportfng blood pressure fn palfents receivfng captoprn alone or with dfurelfcs Beta-acfrenergfc blockrng drugs add some further anlrhypertensrve effect to captoprn but the overall response IS less fhan additive Therefore. use agents alfectfng sympathetrc acrfvfty (e g gangltonrc blockfngagentsoradrenergfc neuronblocktngagents)wrthcaution Agenfs )ncreasfng Serum Porasswm - Gwe polassfum-spanng dfurehcsor polasslum supplements only for documented hypokalemfa, and then with taut on. srnce lhey may lead to a slgnffrcant Increase of serum potassfum Drug/Laboratory Test Interaction: Captoprfl may cause a false-posftive urine test ‘or acetone Carcinogenesis, Mutegenesis, and Impairment of Fertility: Two-year studies w!th doses of 50 to 1350 mgrkgrday rn rmce and rats faflea to show any evrdence of carcrnogenrc potentrat Studies in rats have revealed no fmparrment of fertility Usage in Pregnancy: There are no adequate and well-controlled studres fn pregnant women Embryocfdal effects were observed fn rabbits Therelore. captopril should be used durmg pregnancy only If the potentral benefit outwerghs the potentfal rusk to the fetus Nursing Mothers: Captopn IS secreted III human milk Exercrse cautfon when admInIsterIng captoprrl to a nursmg wornal. and fn general, nursfng should be Interrupted Pedialric Use: Safety and effectrveness fn chfldren have not been establtshed although there IS limfted experrence wfth use of captopril in chfldren from 2 months to 15 years 01 age Dosage, on a weight basis. was comparable to that xed rn adults Captopr~l should he used fn chfldren only if other measures for controllrng blood pressure have not been effective ADVERSE REACTIONS: Reported fnctdences are based on clfnfcai trials rnvolvfng about 4000 patfents Renal - One lo 2 of 100 patients developed protefnurfa (see WARNINGS). Renal Insufflclency, renal failure. polyurla. olfguria and urfnary frequency rn 1 to 2 of 1000 patients. Hemalolog/c ~ Neutropenfalagranulocytosrs occurred fn about 0.3% of caotopril treated patrents (see WARNINGS) Two of these patientsdeveloped sepsfs and died Dermatologic - Rash (usually mild, maculopapular, rarely urticanal). often wrlh orurrtus and sometrmes wrth fever and eosinophrlfa. fn about 10 of 100 patrents, usually during the 1st 4 weeks of therapy.‘Pruritus, without rash, in about 2 of 100 patients. A reversfble assocfated pemphfgofd-like lesion, and photosensftrvfty have also been reported Angfoedema of the face, mucous membranes of the mouth, or of the extremfties in about 1 of 100 patfents reversfhle on drsconhnuance of captoprrl therapy One case of laryngeal edema reported Flushtng or pallor in 2 to 5 of 1000 patients. Cardfovascular - Hypotensfon fn about 2 of 100 patfents. See WARNINGS (Hypotensron) and PRECAUTIONS (Drug Interactions) for discussron of hypotensron on rnftratron of captopril therapy Tachycardra, chest pawn. and palpltalfons each fn about 1 of 100 pahents Angina pectons. myocardfal infarctron, Raynaud’s syndrome, and congestfve heart faflure each fn 2 to 3 of 1000 patients Dysgeusia ~ About 7 of 100 patfents developeda dfmfnutionor loss of taste perceptton taste fmpafrment IS teverstble and usually self-lfmfted even with conlrnued drug use (2 to 3 months). Gastrtc frrifatfon. abdomtnal pawn,nausea. vomlttng. diarrhea, anorexia, constipallon. aphthous ulcers, peptic ulcer, dzzrness headache, malarse. fahgue, rnsomnfa. dry mouth, dyspnea. and pares lhesras reported fn about 0 5 to 2% of patfents but drd not appear at Increased frequency compared to placebo or other treatments used in controlled trfals. Altered Laboratory Findings: Elevatfons of liver enzymes fn a few patfents although no causal relatfonshfp has been established. Rarely cholestatfc faundrce and heoatocellular infurv wfth secondarv cholestasfs have been reported A lransfenl elevatfon’ oi BUN and serum creatfnlne may occur, especrally fn volume-depleted or renovascular hypertensfve patfenls In instances of rapfd reductron of longstandfng or severely elevated blood pressure, thegfomerular trltratlon ratemaydecrease transfently. also resultfng fn !ranslenl rfses in serum creat~nlne and BUN Small Increases fn serum potassrum concentration frequently occur, especrally in patients wrth renal fmpairment (see PRECAUTIONS) OVERDOSAGE: Primary concern fn correction of hypotensfon Volume expansion with an I V fnfuslon of normal Salrne IS the treatment of choice for restoratron of blood oressure Caotoorfl mav, be removed from the aeneral crrculatron by hemod;alysrs. DOSAGE AND ADMINISTRATION: CAPOTEN should be taken one hour before meals Dosage must be indrvidualized. see DOSAGE AND ADMINISTRATION sectton of package Insert for detafled fntormatfon regardmg dosage rn hypertensfon and fn heart taflure Because CAPOTEN (captopril) IS excreted prrmarrly by the krdneys. dosage adfustments are recommended for patfents with Impaired renal functfon. Consult package insert before prascriblng CAPOTEN (captopril). HOW SUPPLIED: Available fn tablets of 25, 50. and 100 mg fn bottles of 100. and rn UNIMATIC” unrt-dose packsof 100 tablers

Abstracts of papers in this issue

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SQUlih INNOVATORS

IN CARDIOVASCULAR

MEDICINE

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