Summary
Captopril (Lopirin, Squibb, von Heyden) is an inhibitor of the angiotensin-I converting enzyme. In congestive heart failure angiotensin mediated vasoconstriction and aldosterone secretion is reversed by captopril. Both effects of captopril induce reduction of cardiac preload and afterload. The clinical state of patients with congestive heart failure therefore improves since cardiac output increases and pulmonary pressures decrease.
Captopril acts orally and the dosage used for the treatment of congestive heart failure ranges from 50 to 150 mg daily.
After oral ingestion of a single dose the maximum haemodynamic effect is observed after 45–90 min. No tolerance induction or tachyphylaxis has been observed during maintenance therapy over a period of 18 months.
There are some reversible adverse reactions like pruritus, skin rash and partial or complete taste loss which are dose related. Serious side effects include leucopenia, agranulocytosis, renal failure and membranous glomerulonephritis. Therefore regular urinary and blood analysis is necessary during captopril therapy.
Zusammenfassung
Captopril (Lopirin Squibb, von Heyden) ein Hemmer des Angiotensin-Converting-Enzyms blockiert bei herzinsuffizienten Patienten, die durch Angiotensin II vermittelte Vasokonstriktion und Aldosteron-Stimulation. Daraus resultiert eine hochsignifikante Reduktion des kardialen Preloads und des Afterloads. Dieser Effekt führt zu einem Anstieg des Herzzeitvolumens und zum Druckabfall im Lungenkreislauf. Captopril vereinigt damit die Wirkung von arteriellen und venösen Gefäßerweiterern und entspricht in seinem vasodilatierenden Effekt etwa dem des Nitroprussid Natrium.
Einheitliche Dosierungsrichtlinien für herzinsuffiziente Patienten liegen noch nicht vor. Die bisher verwendeten Dosierungen schwanken zwischen 3 × 12,5 mg täglich und 3 × 150 mg täglich. Eine Tachyphylaxie bzw. Toleranzentwicklung unter Captopril wird nicht beschrieben. Sowohl in Akutuntersuchungen als auch bei Langzeittherapie bis zu einem Jahr führt Captopril bei Patienten mit schwerer Herzinsuffizienz zu einer deutlichen Verbesserung der Hämodynamik und des klinischen Schweregrades der Herzinsuffizienz, unabhängig von deren Ätiologie.
Unter den Nebenwirkungen ist besonders auf das Auftreten einer Proteinurie, Leukopenie und Verschlechterung der Nierenfunktion zu achten. Unter den leichteren dosisabhängigen Nebenwirkungen werden Geschmacksveränderungen, Hauterscheinungen, Hypotonie und orthostatische Beschwerden beschrieben.
Nach den bislang vorliegenden Erfahrungen stellt Captopril eine Bereicherung für die Vasodilatantientherapie der schweren Herzinsuffizienz dar. Ebenso wie die anderen Gefäßerweiterer ersetzt Captopril bei diesen Patienten nicht die Basistherapie mit Diuretika und Digitalis. Vielmehr stellt es eine wichtige additive Therapie in Kombination mit diesen Präparaten dar.
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Liebau, G. Captopril bei Herzinsuffizienz. Klin Wochenschr 60, 107–113 (1982). https://doi.org/10.1007/BF01711274
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DOI: https://doi.org/10.1007/BF01711274