2.5.1 Angiotensin-converting enzyme inhibitors

First Choice:
captopril
Second Choice:
enalapril maleate
Dose
  • captopril
  • tablets 2mg (named patient), 12.5mg, 25mg, 50mg; solution 5mg/ml (imported via IDIS)
    Test dose (with patient supine;monitor blood pressure for 1-2 hours)
    • Birth-1 month, 10-50 microgram/kg as a single dose.
    • 1 month-18 years, 100 microgram/kg (max. 6.25mg) as a single dose.
    Maintenance dose (start low and titrate up as necessary)
    • Birth-1 month, 10-50microgram/kg three times a day. Max. 2mg/kg/day.
    • 1 month-1 year, 100microgram-300microgram/kg three times a day. Max. 4mg/kg/day.
    • 1-12 years, 100microgram-300microgram/kg three times a day. Max. 6mg/kg/day or 75mg daily.
    • 12-18 years, 12.5-50mg two to three times a day.
  • enalapril maleate tablets 2.5mg, 5mg, 10mg, 20mg
    • 1 month-12 years, initially 100micrograms/kg once daily, monitor blood pressure carefully for 1-2 hours, increased as necessary up to max. 1mg/kg daily in 1-2 divided doses.
    • 12-18 years, initially 2.5mg once daily, monitor blood pressure carefully for 1-2 hours, usual maintenance dose 10-20mg daily in 1-2 divided doses. Max. 40mg daily.
Prescribing Notes
  • Tablets can be halved and will disperse in water.
  • For heart failure the dose of the ACE inhibitor should be titrated to a ‘target’ dose (or to the maximum tolerated dose if lower). See BNF.
  • ACE inhibitors should be considered first–line antihypertensives in children with diabetes.
  • Urea and electrolytes and renal function should be checked before and within 1 week of commencing therapy and monitored during treatment.
  • Other ACE inhibitors such as lisinopril may be prescribed on an individual basis, especially in older children.