BNF for Children 2011-2012

102 2.5.5 Drugs affecting the renin-angiotensin system BNFC 2011–20122 Cardiovascular systemrecommended that ACE inhibitors are avoided wheneverpossible, particularly in preterm neonates.CAPTOPRILCautions see notes above; acute porphyria (section9.8.2)Contra-indications see notes aboveRenal impairment see notes abovePregnancy see notes aboveBreast-feeding avoid in first few weeks after delivery,particularly in preterm infants—risk of profoundneonatal hypotension; can be used in older infant ifessential but monitor infant’s blood pressureSide-effects see notes above; tachycardia, serumsickness, weight loss, stomatitis, maculopapular rash,photosensitivity, flushing and acidosisLicensed use not licensed for use in children under18 yearsIndication and doseHypertension, heart failure, proteinuria innephritis (under specialist supervision). By mouthNeonate (caution, see neonatal informationabove) test dose, 10–50 micrograms/kg (10 micrograms/kgin neonate less than 37 weeks postmenstrualage), monitor blood pressure carefullyfor 1–2 hours; if tolerated give 10–50 micrograms/kg 2–3 times daily increased as necessary to max.2 mg/kg daily in divided doses (max. 300 micrograms/kgdaily in divided doses in neonate lessthan 37 weeks postmenstrual age)Child 1 month–12 years test dose, 100 micrograms/kg(max. 6.25 mg), monitor blood pressurecarefully for 1–2 hours; if tolerated give 100–300 micrograms/kg 2–3 times a day, increased asnecessary to max. 6 mg/kg daily in divided doses(max. 4 mg/kg daily in divided doses for child 1month–1 year)Child 12–18 years test dose, 100 micrograms/kgor 6.25 mg, monitor blood pressure carefully for 1–2 hours; if tolerated give 12.5–25 mg 2–3 times aday, increased as necessary to max. 150 mg dailyin divided dosesDiabetic nephropathy (under specialist supervision). By mouthChild 12–18 years test dose, 100 micrograms/kgor 6.25 mg, monitor blood pressure carefully for 1–2 hours; if tolerated, give 12.5–25 mg 2–3 times aday, increased as necessary to max. 150 mg dailyin divided dosesAdministration Administer under close supervision,see notes above. Give test dose whilst child supine.Tablets can be dispersed in waterCaptopril (Non-proprietary) ATablets, captopril 12.5 mg, net price 56-tab pack =£1.51; 25 mg, 56-tab pack = £1.56; 50 mg, 56-tab pack= £1.96Brands include Ecopace c , Kaplon cLiquid, various strengths available from ‘specialorder’manufacturers or specialist importing companies,see p. 809Capoten c (Squibb) ATablets, captopril 25 mg, net price 28-tab pack =£5.26; 50 mg (scored), 56-tab pack = £17.96Extemporaneous formulations available seeExtemporaneous Preparations, p. 6ENALAPRIL MALEATECautions see notes aboveContra-indications see notes aboveHepatic impairment monitor closelyRenal impairment see notes abovePregnancy see notes aboveBreast-feeding avoid in first few weeks after delivery,particularly in preterm infants—risk of profoundneonatal hypotension; can be used in older infant ifessential but monitor infant’s blood pressureSide-effects see notes above; also dyspnoea; depression,asthenia; blurred vision; less commonly drymouth, peptic ulcer, anorexia, ileus; arrhythmias,palpitation, flushing; confusion, nervousness, drowsiness,insomnia, vertigo; impotence; muscle cramps;tinnitus; alopecia, sweating; hyponatraemia; rarelystomatitis, glossitis, Raynaud’s syndrome, pulmonaryinfiltrates, allergic alveolitis, abnormal dreams,gynaecomastia, Stevens-Johnson syndrome, toxicepidermal necrolysis, exfoliative dermatitis, pemphigus;very rarely gastro-intestinal angioedemaLicensed use not licensed for use in children forcongestive heart failure, proteinuria in nephritis ordiabetic nephropathy; not licensed for use in childrenless than 20 kg for hypertensionIndication and doseHypertension, congestive heart failure, proteinuriain nephritis (under specialist supervision). By mouthNeonate (limited information) initially 10 micrograms/kgonce daily, monitor blood pressurecarefully for 1–2 hours, increased as necessary upto 500 micrograms/kg daily in 1–3 divided dosesChild 1 month–12 years initially 100 micrograms/kgonce daily, monitor blood pressurecarefully for 1–2 hours, increased as necessary upto max. 1 mg/kg daily in 1–2 divided dosesChild 12–18 years initially 2.5 mg once daily,monitor blood pressure carefully for 1–2 hours,usual maintenance dose 10–20 mg daily in 1–2divided doses; max. 40 mg daily in 1–2 divideddoses if body-weight over 50 kgDiabetic nephropathy (under specialist supervision). By mouthChild 12–18 years initially 2.5 mg once daily,monitor blood pressure carefully for 1–2 hours,usual maintenance dose 10–20 mg daily in 1–2divided doses; max. 40 mg daily in 1–2 divideddoses if body-weight over 50 kgAdministration tablets may be crushed and suspendedin water immediately before useEnalapril Maleate (Non-proprietary) ATablets, enalapril maleate 2.5 mg, net price 28-tabpack = £1.05; 5 mg, 28-tab pack = 96p; 10 mg, 28-tabpack = £1.05; 20 mg, 28-tab pack = £1.24Brands include Ednyt c