Clinical Pharmacology of Captopril in Infants and Children - Abstract
Captopril is a potent angiotensin-converting enzyme inhibitor with a Ki of 1.7 nM. Captopril may be administered orally or intravenously and the oral bioavailability is about 75%. Most of the drug is eliminated in urine, 40 to 50% as captopril, and the rest as captopril disulphide dimers and captopril-cysteine disulphide. Captopril may be used in the treatment of congestive cardiac failure, and in moderate to severe hypertension in infants and children. The oral test dose of captopril is 10, 10 to 50, or 100 µg/kg thrice-daily in preterm infants, term infants, and older infants, respectively, and in children the oral test dose is 100 to 300 µg/kg twice-daily or thrice-daily. Captopril has been found efficacy and safe in treating heart failure in infant and in reducing hypertension in infants and children. The effects of captopril are: reduction of blood pressure, decrease pulmonary-to-systemic blood flow ratio, decrease systemic vascular resistance, and reduce aldosterone and natriuretic peptide blood concentrations in infants and children. Captopril causes different adverse-effects. The elimination of captopril is about 3 hours in infants and children. Captopril interacts with allopurinol, carnosine, potassium-sparing diuretics, or verapamil. Captopril treats infantile haemangioma, is a systemic vasodilator and reduces the blood pressure in hypertensive infants and children, and captopril poorly migrates into the breastmilk. The aim of this study is to review the published data of captopril dosing, efficacy and safety, effects, adverse-effect, pharmacokinetics, interaction with drugs, and treatments in infants and children, and the migration of captopril into the breast-milk.