BenazeprilBenazepril Hydrochloride

About Benazepril

Benazepril blocks the enzyme that makes angiotensin II, a hormone that tightens blood vessels, so vessels relax and blood pressure falls; the label notes that lowering blood pressure reduces the risk of strokes and heart attacks. Adults not taking a diuretic start at 10 mg once a day, and the usual range is 20 to 40 mg a day, once or split into two doses; a low dose of diuretic can be added if blood pressure is not controlled. Someone already on a diuretic starts at 5 mg, as does anyone with severely reduced kidney function. Children 6 and older start at 0.2 mg per kg once a day, up to 0.6 mg per kg (doses above 40 mg a day have not been studied in them); it is not recommended under 6.

The boxed warning is fetal toxicity: drugs acting on the renin-angiotensin system can injure and kill a developing baby, so benazepril is stopped as soon as pregnancy is detected. Angioedema, swelling of the face, lips, tongue or throat that has sometimes been fatal, can occur; it is reported more often in Black patients, mTOR inhibitors and neprilysin inhibitors raise the risk, and swelling of the intestine can show up as stomach pain. It must not be taken by anyone allergic to it or to another ACE inhibitor, after any angioedema, within 36 hours of switching to or from sacubitril and valsartan (Entresto), or with aliskiren in diabetes. It can drop blood pressure too far, especially with heart failure, fluid loss or high-dose diuretics, raise potassium and change kidney function, so these are checked; ACE inhibitors have been linked to jaundice that can progress to severe liver injury, so it is stopped if jaundice appears. Headache, dizziness and sleepiness were seen more often than with placebo, and headache and cough were the most common reasons people stopped it.

The FDA lists Lotensin 5 mg as discontinued and has determined that this was not for safety or effectiveness reasons; generic 5 mg tablets are still marketed. The label also tells pharmacists how to make a 2 mg per mL suspension from 20 mg tablets, kept in the refrigerator for up to 30 days. Only small amounts pass into breast milk. People with diabetes on insulin or diabetes pills watch for low blood sugar, especially in the first month. The combinations with amlodipine (generic capsules; the Lotrel brand is discontinued) and with hydrochlorothiazide (Lotensin HCT) are separate products with their own labels.

Taking Benazepril

How to take it

Once or twice a day as prescribed, with or without food, at about the same times each day. Keep taking it even if you feel well; tell the prescriber about vomiting, diarrhea or heavy sweating, which can drop blood pressure too far, and if you faint, stop it until you have talked with the prescriber.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

Tablets at or below 86°F (30°C), protected from moisture, in a tightly closed container, not in a bathroom and out of reach of children; a pharmacy-made suspension in the refrigerator for up to 30 days.

Interactions to know about

Potassium supplements, potassium salt substitutes and potassium-sparing diuretics can raise potassium too high, and it raises lithium levels. NSAIDs such as ibuprofen and naproxen can blunt its effect and strain the kidneys. It is not taken within 36 hours of sacubitril and valsartan or with aliskiren in diabetes; mTOR inhibitors add to the risk of angioedema, insulin and diabetes pills can lower blood sugar further, and rare reactions have occurred with injectable gold.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Benazepril differs from pharmacy to pharmacy

Generic benazepril has many makers and costs pharmacies little, so much of a quote is the dispensing fee and markup, which differ between pharmacies. A prescription that names Lotensin and blocks substitution is priced as a brand.

A suspension a pharmacy prepares from tablets keeps for up to 30 days in the refrigerator, so it is filled more often than tablets.

Ways to pay less for Benazepril without insurance

• Ask for generic benazepril, and make sure the prescription does not block substitution.
• Ask whether benazepril is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• If you take 40 mg once a day, ask the prescriber to write it as one 40 mg tablet rather than two 20 mg tablets.
• Once your dose is stable, ask for a ninety-day supply.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Benazepril

1. 1.Which swelling, breathing or stomach symptoms mean I should stop it and get help?
2. 2.Is it safe with my diuretic, lithium or diabetes medicines?
3. 3.Should I avoid potassium supplements, salt substitutes or ibuprofen with it?
4. 4.What should I do if I become pregnant or plan to?

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