Captopril Viatris
ACE Inhibitor for Blood Pressure, Heart Failure & Diabetic Kidney Disease
Captopril Viatris contains captopril, an angiotensin-converting enzyme (ACE) inhibitor that lowers blood pressure by preventing the formation of a hormone that causes blood vessels to constrict. It is prescribed for hypertension, chronic heart failure, recovery after heart attack, and kidney damage in patients with diabetes. This is a prescription-only medication that requires regular medical monitoring.
Quick Facts
Key Takeaways
- Captopril Viatris is an ACE inhibitor that relaxes blood vessels and reduces the workload on the heart, prescribed for high blood pressure, heart failure, post-heart attack recovery, and diabetic kidney disease.
- The usual starting dose for hypertension is 12.5–25 mg taken twice daily, with a maximum daily dose of 150 mg. Your doctor will adjust the dose to suit your individual needs.
- A dry, persistent cough is the most common side effect and typically resolves when the medication is stopped. Seek immediate medical help if you experience swelling of the face, lips, or throat (angioedema).
- Do not use during pregnancy (especially second and third trimester) as it may cause serious harm to the unborn child. Discuss alternatives with your doctor if you are planning a pregnancy.
- Certain medications such as sacubitril/valsartan, potassium supplements, NSAIDs, and lithium can interact dangerously with captopril. Always inform your doctor of all medications you are taking.
What Is Captopril Viatris and What Is It Used For?
Quick Answer: Captopril Viatris is an ACE inhibitor containing captopril, which lowers blood pressure by blocking the enzyme that produces angiotensin II—a substance that narrows blood vessels. It is used to treat hypertension, heart failure, post-myocardial infarction recovery, and diabetic nephropathy.
Captopril Viatris belongs to a group of medicines known as angiotensin-converting enzyme (ACE) inhibitors. The active substance, captopril, works by inhibiting the enzyme responsible for converting angiotensin I into angiotensin II, a powerful vasoconstrictor. By blocking this conversion, captopril causes blood vessels to dilate and blood pressure to decrease. At the same time, the excretion of sodium and water through the kidneys normalizes, further contributing to blood pressure reduction.
These combined effects also significantly reduce the workload on the heart, making captopril particularly beneficial for patients with impaired heart muscle function (chronic heart failure). In patients with diabetes who have developed kidney damage (diabetic nephropathy), captopril decreases the excretion of protein in the urine (proteinuria) and slows the progression of kidney disease. This nephroprotective effect has been demonstrated in landmark clinical trials and is recognized by major international guidelines, including those from the European Society of Cardiology (ESC) and the American Heart Association (AHA).
Approved Indications
Captopril Viatris is approved for the following clinical uses:
- Hypertension (high blood pressure): Captopril is used alone or in combination with other antihypertensives to reduce elevated blood pressure. Sustained blood pressure control reduces the risk of stroke, heart attack, and kidney damage. The World Health Organization (WHO) lists ACE inhibitors as essential medicines for hypertension management.
- Chronic heart failure: When the heart cannot pump blood efficiently, captopril reduces peripheral vascular resistance and improves cardiac output. It is typically prescribed alongside diuretics and, in many cases, beta-blockers. Multiple randomized controlled trials have shown that ACE inhibitors reduce mortality in heart failure patients.
- Post-myocardial infarction: Following a heart attack, captopril helps improve the heart's pumping capacity, prevents adverse cardiac remodeling, and reduces the risk of further cardiovascular events. Treatment is usually initiated within the first few days after the infarction.
- Diabetic nephropathy: In patients with type 1 diabetes and evidence of kidney damage (proteinuria), captopril slows the progression of renal impairment. The landmark CAPTOPRIL trial demonstrated a 50% reduction in the risk of end-stage renal disease in these patients.
Captopril was the first ACE inhibitor to be developed and has been used clinically since the early 1980s. It remains one of the most studied cardiovascular medications, with decades of clinical evidence supporting its efficacy and safety profile. While newer ACE inhibitors (such as enalapril, lisinopril, and ramipril) offer longer durations of action, captopril's rapid onset makes it valuable in situations where quick blood pressure reduction is needed.
What Should You Know Before Taking Captopril Viatris?
Quick Answer: Do not use Captopril Viatris if you are pregnant (especially after the first trimester), if you have a history of angioedema, or if you are taking sacubitril/valsartan or aliskiren with diabetes or renal impairment. Inform your doctor about all medical conditions and medications before starting treatment.
Contraindications
Captopril Viatris must not be used in the following situations:
- Allergy to captopril or other ACE inhibitors: If you have previously experienced a hypersensitivity reaction to captopril, any other ACE inhibitor, or any of the excipients in the tablet, you must not take this medication.
- History of angioedema: If you have ever experienced swelling of the face, lips, tongue, or throat (angioedema) during previous ACE inhibitor treatment, or if you have hereditary or idiopathic angioedema, this medication is strictly contraindicated.
- Concomitant use with sacubitril/valsartan: Do not take Captopril Viatris if you are currently taking or have recently taken sacubitril/valsartan (a medicine for chronic heart failure), as this significantly increases the risk of angioedema. A washout period of at least 36 hours is required before switching between these medications.
- Pregnancy (second and third trimester): ACE inhibitors can cause serious fetal harm including renal failure, hypotension, and skull defects. Use during early pregnancy is also not recommended.
- Aliskiren combination in diabetes or renal impairment: If you have diabetes mellitus or moderate-to-severe renal impairment, the combination of captopril with aliskiren is contraindicated due to increased risks of hypotension, hyperkalemia, and renal dysfunction.
Warnings and Precautions
Talk to your doctor or pharmacist before taking Captopril Viatris, especially if any of the following apply to you:
If you experience swelling of the tongue, throat, or face, difficulty breathing, or severe abdominal pain while taking captopril, stop the medication immediately and seek emergency medical care. These may be signs of angioedema, a potentially life-threatening allergic reaction.
- Dual renin-angiotensin system (RAS) blockade: Taking captopril together with an angiotensin II receptor blocker (ARB, such as valsartan, telmisartan, or irbesartan) or with aliskiren increases the risk of hypotension, hyperkalemia, and acute kidney injury. This combination should generally be avoided, particularly in patients with diabetic nephropathy.
- Increased risk of angioedema: The risk of angioedema may be elevated if you are also taking racekadotril (for diarrhea), mTOR inhibitors (such as temsirolimus, sirolimus, or everolimus used in transplant or cancer medicine), or vildagliptin (for diabetes).
- Hypotension: Captopril may cause symptoms of low blood pressure (dizziness, lightheadedness, fainting), especially at the start of treatment, after a dose increase, or in patients who are volume-depleted from diuretic therapy or restricted salt intake. Your first dose should ideally be taken while lying down or sitting.
- Surgery and anesthesia: If you are scheduled for surgery under general anesthesia, inform the anesthetist that you are taking captopril, as it may cause a significant drop in blood pressure during the procedure.
- Renal impairment: Patients with kidney disease require dose adjustment and more frequent monitoring of renal function and electrolytes, especially serum potassium levels.
- Hepatic events: If you develop jaundice (yellowing of the skin or eyes) or marked elevation of liver enzymes, discontinue captopril and contact your doctor promptly.
- Connective tissue disease or immunosuppressive therapy: Patients with conditions such as systemic lupus erythematosus (SLE) or scleroderma, or those taking immunosuppressants, allopurinol, or procainamide concurrently with captopril, have an increased risk of developing severe neutropenia or agranulocytosis (dangerously low white blood cell counts). Regular blood count monitoring is essential in these patients.
- Diabetes: Blood glucose should be monitored closely during the first month of treatment, as captopril may enhance the blood sugar-lowering effects of insulin and oral antidiabetic agents.
- Persistent cough: A dry, non-productive cough is a well-known class effect of ACE inhibitors, occurring in up to 10% of patients. The cough resolves after discontinuation of the medication.
Pregnancy and Breastfeeding
Captopril Viatris must not be used during the second and third trimesters of pregnancy. Use during the first trimester is not recommended. If you suspect you are pregnant or are planning to become pregnant, contact your doctor immediately to switch to an alternative medication.
ACE inhibitors, including captopril, can cross the placenta and cause severe fetal harm when used during the second and third trimesters. Documented fetal and neonatal toxicity includes renal failure, oligohydramnios (reduced amniotic fluid), skull ossification defects, hypotension, and death. If pregnancy is detected, captopril should be discontinued as soon as possible and an alternative antihypertensive without known teratogenic effects should be initiated.
Regarding breastfeeding, captopril is excreted in human breast milk at very low concentrations. Breastfeeding of newborns, especially premature infants, is not recommended while taking captopril. For older infants, the decision to breastfeed should be made in consultation with your doctor, weighing the benefits of breastfeeding against the potential risks to the child.
Driving and Operating Machinery
Captopril may impair your ability to drive or operate machinery, particularly at the start of treatment or when the dose is adjusted. Symptoms such as dizziness and lightheadedness can occur. The combination of captopril with alcohol may further impair your alertness. Do not drive or operate dangerous machinery until you know how this medication affects you.
Captopril Viatris tablets contain lactose. If you have been told by your doctor that you have an intolerance to some sugars, consult your doctor before taking this medicine. The tablets also contain less than 1 mmol (23 mg) of sodium per tablet, meaning they are essentially sodium-free.
How Does Captopril Viatris Interact with Other Drugs?
Quick Answer: Captopril has clinically significant interactions with sacubitril/valsartan (contraindicated), potassium-sparing diuretics, NSAIDs, lithium, and aliskiren. Always inform your doctor of all medications, supplements, and herbal products you take.
Drug interactions with captopril can be clinically significant and potentially dangerous. Some interactions increase the risk of serious adverse effects such as hyperkalemia (dangerously high potassium levels), hypotension, renal impairment, or angioedema. Others may reduce captopril's effectiveness. Below is a comprehensive overview of the most important interactions.
Major Interactions (Avoid or Use with Extreme Caution)
| Interacting Drug/Class | Effect | Clinical Advice |
|---|---|---|
| Sacubitril/Valsartan | Greatly increased risk of angioedema | Contraindicated. Wait at least 36 hours after the last dose of sacubitril/valsartan before starting captopril. |
| Aliskiren | Increased risk of hypotension, hyperkalemia, and renal impairment | Contraindicated in patients with diabetes or moderate-to-severe renal impairment. Avoid in all other patients. |
| Potassium supplements / K+-sparing diuretics (spironolactone, eplerenone, amiloride, triamterene) | Risk of life-threatening hyperkalemia | Monitor serum potassium frequently. Avoid potassium supplements unless directed by a physician. |
| Lithium | Increased serum lithium levels with risk of toxicity | Combination not recommended. If unavoidable, monitor lithium levels closely. |
| mTOR inhibitors (sirolimus, everolimus, temsirolimus) | Increased risk of angioedema | Use with extreme caution and monitor closely for signs of angioedema. |
Moderate Interactions
| Interacting Drug/Class | Effect | Clinical Advice |
|---|---|---|
| NSAIDs (ibuprofen, naproxen, diclofenac) | Reduced antihypertensive effect; increased risk of hyperkalemia and renal impairment | Use the lowest NSAID dose for the shortest duration. Monitor renal function and potassium levels. |
| Diuretics (thiazides, loop diuretics) | Enhanced blood pressure-lowering effect; risk of first-dose hypotension | Consider reducing the diuretic dose or temporarily discontinuing it before starting captopril. |
| Antidiabetic agents (insulin, sulfonylureas, metformin) | Enhanced blood glucose-lowering effect; increased risk of hypoglycemia | Monitor blood glucose closely, especially during the first month of combined treatment. |
| Allopurinol, cytostatics, immunosuppressants, procainamide | Increased risk of leukopenia (low white blood cell count) | Regular blood count monitoring is required. |
| Trimethoprim / sulfamethoxazole (co-trimoxazole) | Increased risk of hyperkalemia | Monitor serum potassium levels during concurrent use. |
| Racekadotril | Increased risk of angioedema | Use with caution, monitor for signs of swelling. |
| Vildagliptin | Increased risk of angioedema | Monitor closely for swelling of face, lips, or throat. |
Drugs That May Reduce Captopril's Effectiveness
Certain medications may attenuate the blood pressure-lowering effect of captopril, requiring dose adjustment or alternative treatment strategies:
- Non-steroidal anti-inflammatory drugs (NSAIDs): In addition to the renal and potassium risks described above, NSAIDs can directly reduce the antihypertensive effect of ACE inhibitors.
- Sympathomimetics: Drugs that stimulate the sympathetic nervous system (found in some decongestants and bronchodilators) may counteract the blood pressure-lowering effects of captopril.
Drugs That May Enhance Captopril's Effect
The following drug classes may amplify the blood pressure-lowering effect of captopril, increasing the risk of hypotension:
- Diuretics (water pills)
- Other antihypertensive agents
- Vasodilators (such as nitrates)
- Tricyclic antidepressants and antipsychotics
What Is the Correct Dosage of Captopril Viatris?
Quick Answer: The typical starting dose for hypertension is 12.5–25 mg twice daily, gradually increasing as needed up to a maximum of 150 mg per day. Always follow your doctor's specific dosing instructions, as the dose is individually tailored.
Captopril Viatris should always be taken exactly as prescribed by your doctor. Do not change your dose without medical advice. The tablets can be taken before, with, or after meals. Your doctor will start with a low dose and gradually increase it to find the optimal dose for your condition, while monitoring your blood pressure, kidney function, and electrolyte levels.
Adults
| Indication | Starting Dose | Maintenance Dose | Maximum Daily Dose |
|---|---|---|---|
| Hypertension | 12.5–25 mg twice daily | 25–50 mg twice daily | 150 mg/day (in 2 divided doses) |
| Heart failure | 6.25–12.5 mg 2–3 times daily | 25–50 mg 2–3 times daily | 150 mg/day (in divided doses) |
| Post-myocardial infarction | 6.25 mg test dose | Gradual increase to 75–150 mg/day | 150 mg/day (in divided doses) |
| Diabetic nephropathy | 25 mg 2–3 times daily | 75–100 mg/day in divided doses | 100 mg/day |
Children
The use of captopril in children should be initiated and supervised by a pediatric specialist. The usual starting dose is 0.3 mg per kilogram of body weight, given in divided doses. For premature infants and neonates, the recommended starting dose is lower at 0.15 mg/kg. The dose is then adjusted by the physician based on the child's clinical response, blood pressure readings, and kidney function.
Elderly Patients and Those with Renal Impairment
Elderly patients and individuals with impaired kidney function may be more sensitive to the effects of captopril. A lower starting dose is typically recommended in these populations, with more gradual dose titration and more frequent monitoring of renal function, serum potassium, and blood pressure. In patients with significant renal impairment, the dosing interval may also need to be extended.
Missed Dose
If you forget to take a dose of Captopril Viatris, take it as soon as you remember. However, if it is nearly time for your next scheduled dose, skip the missed dose entirely. Do not take a double dose to compensate for a forgotten one. Maintaining a consistent dosing schedule is important for optimal blood pressure control.
Overdose
If you accidentally take too many tablets, or if a child accidentally ingests this medication, contact your local poison control center or seek emergency medical attention immediately.
Symptoms of a captopril overdose include severe hypotension (very low blood pressure causing lightheadedness or fainting), shock, lethargy, bradycardia (abnormally slow heart rate), electrolyte disturbances (particularly hyperkalemia), and kidney failure. Treatment is primarily supportive and may include intravenous fluid resuscitation, vasopressors, and in severe cases, hemodialysis to remove the drug from the bloodstream.
What Are the Side Effects of Captopril Viatris?
Quick Answer: Common side effects include dry cough, dizziness, taste disturbance, nausea, and skin rash. Serious but uncommon side effects include angioedema (swelling of the face or throat), severe blood pressure drop, and blood disorders. Stop the medication and seek emergency care if you experience difficulty breathing or swelling.
Like all medicines, Captopril Viatris can cause side effects, although not everyone experiences them. The side effects are organized below by frequency. If you experience any of the serious side effects described below, stop taking Captopril Viatris immediately and seek urgent medical attention.
- Swelling of the face, tongue, or throat; difficulty swallowing or breathing (angioedema)
- Severe skin reactions with blistering (Stevens-Johnson syndrome)
- Severe abdominal and back pain with nausea (pancreatitis)
- Signs of stroke, cardiac arrest, or cardiogenic shock
Common
May affect up to 1 in 10 people
- Sleep disturbances (insomnia)
- Taste disturbance (dysgeusia) or loss of taste
- Dizziness
- Dry, persistent, irritating cough
- Shortness of breath (dyspnea)
- Nausea, vomiting, stomach irritation, abdominal pain
- Diarrhea or constipation
- Dry mouth
- Itching (pruritus), skin rash
- Hair loss (alopecia)
Uncommon
May affect up to 1 in 100 people
- Fast or irregular heartbeat, chest pain (angina pectoris), palpitations
- Low blood pressure (hypotension)
- Raynaud's phenomenon (cold, white fingers and toes)
- Flushing or paleness
- Fatigue, malaise
- Angioedema (swelling of face, lips, tongue, or throat)
Rare
May affect up to 1 in 1,000 people
- Loss of appetite
- Drowsiness, headache
- Tingling or numbness (paresthesia)
- Mouth ulcers
- Kidney failure, abnormally increased or decreased urine output
- Intestinal angioedema (abdominal pain, cramping, nausea, vomiting)
Very Rare
May affect up to 1 in 10,000 people
- Blood disorders: neutropenia, agranulocytosis, anemia, thrombocytopenia, eosinophilia, pancytopenia
- Lymphadenopathy (swollen glands), autoimmune diseases
- Elevated potassium levels (hyperkalemia), low blood sugar (hypoglycemia)
- Confusion, depression, syncope (fainting)
- Blurred vision
- Bronchospasm, nasal congestion, rhinorrhea, allergic pneumonitis
- Glossitis (tongue inflammation), peptic ulcer
- Hepatic dysfunction, cholestasis, jaundice, elevated liver enzymes
- Urticaria (hives), photosensitivity, erythroderma, pemphigus-like rash
- Muscle and joint pain (myalgia, arthralgia)
- Nephrotic syndrome
- Impotence, gynecomastia (breast enlargement)
- Fever
- Stevens-Johnson syndrome, erythema multiforme
- Stroke, cardiac arrest, cardiogenic shock
- Pancreatitis
If you experience any side effects, including those not listed above, talk to your doctor or pharmacist. You can also report side effects directly to your national medicines regulatory authority. By reporting side effects, you help provide more information on the safety of this medicine.
How Should You Store Captopril Viatris?
Quick Answer: Store at room temperature, away from children. No special storage conditions required. Do not use after the expiry date printed on the packaging.
Keep Captopril Viatris out of the sight and reach of children at all times. Store the tablets at room temperature. No special storage conditions are required for this medicine.
Do not use the tablets after the expiry date stated on the label or carton after "EXP." The expiry date refers to the last day of the stated month. Once expired, return unused tablets to your pharmacy for proper disposal.
Do not dispose of medicines in household waste or via the sewage system. Ask your pharmacist about how to properly dispose of medicines that are no longer needed. These measures help to protect the environment and prevent accidental exposure.
What Does Captopril Viatris Contain?
Quick Answer: The active substance is captopril (25 mg per tablet). Inactive ingredients include microcrystalline cellulose, maize starch, stearic acid, sodium starch glycolate, and lactose (25 mg).
Active Substance
Each tablet contains captopril 25 mg as the active pharmaceutical ingredient.
Inactive Ingredients (Excipients)
The other ingredients that make up the tablet are:
- Microcrystalline cellulose
- Maize starch
- Stearic acid
- Sodium starch glycolate
- Lactose (25 mg per tablet)
Appearance and Packaging
Captopril Viatris 25 mg tablets are available in plastic bottles containing 100 or 200 tablets, and in blister packs of 100 x 1 (unit dose). Not all pack sizes may be marketed in your country.
Marketing Authorization Holder
Viatris Limited
Damastown Industrial Park, Mulhuddart, Dublin 15, Ireland
Frequently Asked Questions About Captopril Viatris
Captopril Viatris is an ACE inhibitor used to treat four main conditions: high blood pressure (hypertension), chronic heart failure, recovery after a heart attack (myocardial infarction), and kidney damage in patients with diabetes (diabetic nephropathy). It works by inhibiting the enzyme that produces angiotensin II, a substance that causes blood vessels to narrow and blood pressure to rise. By blocking this enzyme, captopril relaxes blood vessels, lowers blood pressure, and reduces the workload on the heart.
No. Captopril Viatris should not be used during pregnancy, especially during the second and third trimesters, as it can cause serious harm to the developing fetus, including kidney failure, skull defects, and even death. If you become pregnant while taking captopril, contact your doctor immediately. Your doctor will typically recommend switching to a safer alternative, such as methyldopa or labetalol, which have established safety profiles during pregnancy.
The most common side effects of captopril include a dry, persistent cough (affecting up to 1 in 10 users), dizziness, taste disturbance (a metallic or salty taste), nausea, diarrhea, and skin rash with itching. The cough is a well-known class effect of all ACE inhibitors and typically resolves within one to four weeks after stopping the medication. Serious but rare side effects include angioedema (swelling of the face, tongue, or throat), which requires immediate emergency medical attention.
Captopril Viatris tablets can be taken before, with, or after meals. For high blood pressure, the usual starting dose is 12.5 to 25 mg taken twice daily, with gradual increases as needed up to a maximum of 150 mg per day. For heart failure, the starting dose is lower, typically 6.25 to 12.5 mg given two to three times daily. Always follow your doctor's specific dosing instructions. Swallow the tablets with water and try to take them at the same time each day for the best blood pressure control.
Alcohol can enhance the blood pressure-lowering effect of captopril, which may lead to increased dizziness, lightheadedness, or fainting. It is advisable to limit or avoid alcohol consumption while taking captopril, particularly when you first start the medication or after a dose increase. If you do drink, keep your intake moderate and stand up slowly from sitting or lying positions. Always discuss your alcohol intake with your doctor.
If you miss a dose, take it as soon as you remember unless it is nearly time for your next scheduled dose. In that case, skip the missed dose and continue with your regular schedule. Never take a double dose to make up for a forgotten one, as this could cause your blood pressure to drop too low. If you frequently forget doses, consider using a pill organizer or setting a daily alarm as a reminder.
References
- European Medicines Agency (EMA). Captopril – Summary of Product Characteristics. ema.europa.eu.
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List (2023). ACE Inhibitors listed as essential cardiovascular medicines. who.int.
- European Society of Cardiology (ESC). 2023 ESC Guidelines for the Management of Arterial Hypertension. European Heart Journal. 2023;44(38):3480–3550.
- Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342(3):145–153. doi:10.1056/NEJM200001203420301
- Lewis EJ, Hunsicker LG, Bain RP, Rohde RD. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. N Engl J Med. 1993;329(20):1456–1462. doi:10.1056/NEJM199311113292004
- Pfeffer MA, Braunwald E, Moyé LA, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction (SAVE trial). N Engl J Med. 1992;327(10):669–677. doi:10.1056/NEJM199209033271001
- British National Formulary (BNF). Captopril – Indications, dose, and side effects. bnf.nice.org.uk.
- American Heart Association (AHA) / American College of Cardiology (ACC). 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation. 2022;145(18):e895–e1032.
- National Institute for Health and Care Excellence (NICE). Hypertension in adults: diagnosis and management (NG136). Updated 2023. nice.org.uk.
- Dicpinigaitis PV. Angiotensin-converting enzyme inhibitor-induced cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):169S–173S.
Medical Editorial Team
This article was written and reviewed by iMedic's medical editorial team, consisting of board-certified physicians specializing in cardiology, internal medicine, and clinical pharmacology. All content is evidence-based and follows international guidelines from the WHO, ESC, AHA, and NICE. Our editorial process includes fact-checking against peer-reviewed sources and regular content updates to reflect the latest medical evidence.
iMedic Medical Editorial Team – specialists in cardiovascular medicine and clinical pharmacology with extensive experience in patient education.
iMedic Medical Review Board – independent panel of medical experts who verify accuracy, completeness, and adherence to current international guidelines.
Evidence Standards: All medical claims in this article are supported by Level 1A evidence (systematic reviews and randomized controlled trials) or current international clinical guidelines. No commercial funding or pharmaceutical sponsorship influences our content.