a. Captopril (Capoten)
Supplied: Tablets: 12.5 mg, 25 mg, 50 mg, and 100 mg. Dosage: Withdraw diuretics and other antihypertensives for 12 h, then give a test dose of 6.5 mg daily, increasing to 12.5 mg twice or three times daily, preferably one hour before meals. The maximum suggested daily dose for heart failure is 75–100 mg. This drug is excreted by the kidneys. If kidney failure is present, the dose interval is increased; for example, 25 mg three times daily can be reduced to 25 mg twice daily or to 12.5 mg twice daily. With kidney failure less drug is needed at longer intervals. Advice and Adverse Effects: ACE inhibitors are not advisable in patients with severe anemia or severe renal failure. Do not combine with potassium in any form or with water pills that retain potassium. Captopril may cause a dry cough and severe itching of the skin. Increased pro¬tein in the urine and reduction in white blood cells may also occur.
b. Enalapril (Vasotec)
Supplied: Tablets: 2.5 mg, 5 mg, 10 mg.
Dosage: 5 mg once or twice daily up to 40 mg daily.
Enalapril is an ACE inhibitor, and its effects are similar to those of captopril, as outlined above.
Other vasodilators used in the management of heart failure include hydralazine, but its effects are variable and only rarely helpful. Hydralazine is not an ACE inhi¬bitor and it is used in heart failure only when ACE inhibitors or ARBs are contraindicated (see the chapter Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers).

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