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OTHER CONSIDERATIONS
Please consider:
- Rarely,
ACE inhibitors have been associated with a syndrome that starts
with cholestatic jaundice and progresses to fulminant hepatic
necrosis and (sometimes) death
-- The mechanism of this syndrome is not understood
-- Patients receiving ACE inhibitors who develop jaundice or
marked elevations of hepatic enzymes should discontinue
the ACE inhibitor and receive appropriate medical follow-up
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Intestinal angioedema has been reported in patients treated with ACE inhibitors. It
should be included in the differential diagnosis of patients on ACE inhibitors, including
ZESTRIL, presenting with abdominal pain.
- Consideration
should be given to the fact that another ACE inhibitor, captopril,
has caused agranulocytosis, particularly in patients with renal
impairment and collagen vascular disease
-- Available data are insufficient to show that ZESTRIL does not
have a similar risk
- Dosage in Elderly:
-- In general, blood pressure response and adverse experiences
were similar in younger and older patients given similar
doses of ZESTRIL. Pharmacokinetic studies, however, indicate that
maximum blood levels and area under the plasma concentration
time curve (AUC) are doubled in older patients, so that dosage
adjustments should be made with particular caution.
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Evaluation of patients with hypertension, heart failure, or MI should always include assessment of renal function (see DOSAGE AND ADMINISTRATION).
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