Lotensin HCT

Lotensin HCT is a combination of two drugs, benazepril and hydrochlorothiazide. Benazepril is an angiotensin converting enzyme (ACE) inhibitor that is used for treating high blood pressure. Other ACE inhibitors include enalapril (Vasotec), quinapril (Accupril), captopril (Capoten), fosinopril (Monopril), ramipril (Altace), moexipril (Univasc) and trandolapril (Mavik). ACE is an enzyme in the body which is important for the formation of angiotensin II.

Angiotensin II causes constriction of arteries in the body, thereby elevating blood pressure. ACE inhibitors (for example, benazepril) lower blood pressure by inhibiting the formation of angiotensin II, thus relaxing the arteries. Relaxing the arteries not only lowers blood pressure, but the lower blood pressure also reduces the heart's work and improves the output of blood from the heart in patients with heart failure.

Hydrochlorothiazide (HCTZ) is a diuretic (water pill) used for treating high blood pressure (hypertension) and accumulation of fluid. It works by blocking salt and fluid reabsorption in the kidneys, causing increased output of salt and water in the urine (diuresis). The mechanism of its action in lowering high blood pressure is not well understood.

The combination of benazepril and HCTZ reduces blood pressure better than either drug alone. Lotensin was approved by the FDA in May 1992.

Lotensin HCT has side effects of its individual components. The most common side effects are:

• dizziness,
• fatigue,
• low blood pressure,
• rash,
• muscle pain,
• stomach upset,
• sexual dysfunction, and
• decreased or increased potassium blood levels.

A dry, persistent cough has been reported with the use of benazepril and other ACE inhibitors. Coughing resolves after discontinuing the medication.

In rare instances,liver dysfunction and skin yellowing (jaundice) have been reported with ACE inhibitors. Benazepril should not be taken by people with a known allergy to ACE inhibitors. Swelling of the facial tissues and even the upper airways has been reported with ACE inhibitors on very rare occasions, and can lead to serious breathing difficulties.

Benazepril may reduce kidney function in some patients and should not be used by patients who have bilateral renal artery stenosis (narrowing of both arteries supplying the kidneys). Rare cases of rhabdomyolysis (muscle breakdown), reduced number of platelets, and pancreatitis have been reported. Hydrochlorothiazide may increase blood glucose levels.

The dose of Lotensin HCT is tailored to the patient's needs. The recommended dose when switching from benazepril or hydrochlorothiazide to Lotensin HCT is 10 mg/12.5 mg once daily. Dosage may be increased every 2 to 3 weeks, and the maximum dose is 20 mg /25 mg.

Combining benazepril with potassium supplements, potassium containing salt substitutes, and potassium conserving diuretics such as amiloride (Moduretic), spironolactone (Aldactone), and triamterene (Dyazide, Maxzide), can lead to dangerously high blood levels of potassium.

Combining benazepril or other ACE inhibitors with nonsteroidal anti-inflammatory drugs (NSAIDs) in patients who are elderly, fluid-depleted (including those on diuretic therapy), or with poor kidney function may result in reduced kidney function, including kidney failure. These effects usually are reversible.

There have been reports that aspirin and other NSAIDs such as ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, and many others), indomethacin (Indocin, Indocin-SR), and naproxen (Anaprox, Naprelan, Naprosyn, Aleve) may reduce the effects of ACE inhibitors.

When taken with lithium (Eskalith, Lithobid), benazepril can increase lithium to toxic levels in the blood.

Nitritoid reactions (symptoms include facial flushing, nausea, vomiting, and hypotension) may occur when injectable gold (sodium aurothiomalate), used in the treatment of rheumatoid arthritis, is combined with ACE inhibitors, including benazepril. Hydrochlorothiazide reduces the elimination of lithium (Lithobid, Eskalith) by the kidneys and can lead to lithium toxicity. Nonsteroidal anti-inflammatory drugs, for example, ibuprofen, may reduce the blood pressure lowering effects of hydrochlorothiazide. Blood sugar levels can be elevated by HCTZ necessitating adjustments in the doses of medications that are used for treating diabetes.

Combining HCTZ with corticosteroids may increase the risk for low levels of blood potassium and other electrolytes. Low blood potassium can increase the toxicity of digoxin (Lanoxin). Cholestyramine (Questran, Questran Light) and colestipol (Colestid) bind to hydrochlorothiazide and reduce its absorption from the gastrointestinal tract by 43% to 85%.

When used in the second or third trimester of pregnancy ACE inhibitors can cause injury and even death to the fetus. Lotensin HCT should not be used during pregnancy.

Both benazepril and HCTZ are excreted in breast milk and may potentially affect nursing infants.

What preparations of benazepril and hydrochlorothiazide are available?

Tablets (mg benazepril/mg HCTZ); 5/6.25, 10/12.5, 20/12.5, and 20/25.

How should I keep benazepril and hydrochlorothiazide stored?

Lotensin HCT should be stored at 59 F to 86 F (15 C to 30 C) and be protected from excessive light and humidity. It should be kept in a tight, light-resistant container.