Captopril

ACE inhibitor

ATC code: C09AA01

Brand names: Capoten, Captoril, Acepril

Updated 24 Sep 2026 · Methodology

Indications

Diabetic nephropathy

First line

ACE inhibitors slow the progression of diabetic nephropathy in patients with type 1 diabetes and albuminuria, as shown in the Lewis trial (1993) of captopril 75 mg daily: 48 percent reduction in creatinine doubling. KDIGO 2022 recommends ACE inhibitors or ARBs at the maximally tolerated dose in patients with diabetes and A2–A3 albuminuria. In current practice captopril has been displaced by lisinopril and ramipril, which are dosed once daily.

Sources

ICD-10: N08.3 · ICD-11: GB61

Hypertension

Second line

Captopril lowers blood pressure in adults, with efficacy established by large ACE-inhibitor trials. 2024 and NG136 keep ACE inhibitors as first-line therapy for hypertension in patients under 55 years and not of Black ancestry. Among ACE inhibitors, captopril has been displaced by enalapril, lisinopril, and perindopril because of the need for 2–3 daily doses and the relatively high rate of skin rash. Today captopril is used mainly for sublingual treatment of hypertensive emergencies at 25 mg.

Not used during pregnancy. Contraindicated in bilateral renal artery stenosis. Patients over 75 are started at the lowest dose because of orthostatic hypotension risk.

Sources

ICD-10: I10 · ICD-11: BA00

Heart failure with reduced ejection fraction

Adjunct

Captopril reduces mortality and hospitalization in chronic heart failure with reduced ejection fraction, as shown in the SAVE trial (1992) in post-MI patients with EF 40 percent or below. 2023 and NG106 include ACE inhibitors as a baseline component of quadruple therapy (with a beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor). Captopril is rarely used in this role because of 2–3 daily dosing; enalapril, lisinopril, and ramipril are preferred.

In patients with eGFR below 30 mL/min/1.73 m² the dose is reduced; with potassium above 5.5 mmol/L the drug is held until corrected.

Sources

ICD-10: I50.1 · ICD-11: BD11.2

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

Anti-aging and longevity

Not recommended

Captopril is a short-acting angiotensin-converting enzyme (ACE) inhibitor. It is prescribed for hypertension and heart failure ( 2023, SEH-LELHA, 2017). In anti-aging regimens, captopril is used in healthy normotensives as a quick vasodilator to protect vessels from aging. In people with normal blood pressure, captopril does not work: no clinical studies of such use exist, and a vessel-rejuvenating effect has not been demonstrated. The drug causes a dry cough (10–20% of patients), elevated blood potassium, angioedema in predisposed people (life-threatening), and acute kidney injury in renal artery stenosis. If captopril was prescribed to a person with normal blood pressure, consider seeking a second opinion.

Sources

How to read tiers A–F

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit

Mechanism of action

Inhibits angiotensin-converting enzyme, reduces angiotensin II formation and bradykinin breakdown. Used for hypertension and heart failure; short half-life requires 2–3 daily doses.

Safety

Boxed warning

FDA boxed warning: when pregnancy is detected, ACE inhibitors are discontinued immediately. Use in the second and third trimesters is associated with oligohydramnios, pulmonary hypoplasia, limb contractures, neonatal hypotension, and renal failure.

Contraindications

History of angioedema with ACE inhibitors
Pregnancy (second and third trimester)
Bilateral renal artery stenosis or stenosis of a solitary kidney artery
Hyperkalemia above 5.5 mmol/L
Concomitant aliskiren in patients with diabetes or eGFR below 60 mL/min/1.73 m²
Combination with sacubitril/valsartan (36-hour washout required)

Serious adverse effects

Angioedema (incidence 0.1–0.7 percent, higher in patients of African descent)
Acute kidney injury in patients with renal artery stenosis

Common adverse effects

Dry cough (5–20 percent of patients, common cause of discontinuation)
Hypotension, especially after the first dose
Hyperkalemia
Taste disturbance (metallic taste, dysgeusia)
Skin rash (more frequent than with other ACE inhibitors, linked to the sulfhydryl group)

Uncommon adverse effects

Serum creatinine increase
Proteinuria
Neutropenia (linked to the sulfhydryl group)

Pregnancy: can you take Captopril?

AEMPS summary of product characteristics (section 4.6): captopril is not recommended in the first trimester and is contraindicated in the second and third trimesters. Evidence on the teratogenicity of ACE inhibitors after first-trimester exposure is inconclusive, but a small increase in risk cannot be excluded; preterm birth, patent ductus arteriosus and other cardiac malformations have recently been reported with exposure limited to the first trimester. Unless ACE inhibitor treatment is considered essential, patients planning a pregnancy should switch to an antihypertensive with an established safety profile in pregnancy, and once pregnancy is confirmed, captopril is stopped immediately. Prolonged exposure in the second and third trimesters causes fetal toxicity (reduced renal function, oligohydramnios with long-bone contractures, craniofacial deformity, lung hypoplasia, preterm birth, delayed skull ossification and intrauterine growth, patent ductus arteriosus) and neonatal toxicity (renal failure, hypotension, skeletal hypoplasia, anuria, hyperkalaemia, even death). After second-trimester exposure, an ultrasound check of renal function and ossification is advised, and newborns are closely watched for hypotension.

Breastfeeding: can you take Captopril?

Hale L2 · Probably compatible

Fully compatible. Hale L2. RID 0.02% – lowest among ACE inhibitors. Drug of choice for HTN in nursing per ACOG 2020 alongside enalapril. Contraindicated in pregnancy.

RID, infant dose via milk: 0.02%
Maternal half-life: 2 h
Maternal peak time: 1 h
Peak milk concentration: 0.01 mg/L
Milk-to-plasma ratio: 0.03

Calculate RID Safe feeding window Full profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Timing and administration

Taken 1 hour before meals or 2 hours after: food reduces captopril bioavailability by 30–40 percent. Standard schedule is 2–3 times daily. The first dose is given at bedtime so any orthostatic hypotension is slept through in the supine position.

Dose titration

Starting dose for hypertension is 12.5 mg twice daily. After 1–2 weeks the dose is raised to 25 mg 2–3 times daily, and up to a maximum 150 mg/day if needed. For HFrEF the start is 6.25 mg three times daily with slow titration to the target 50 mg three times daily.

Monitoring

Before initiation and 1–2 weeks after start or dose increase, check serum creatinine, potassium, and sodium. A creatinine rise of up to 30 percent from baseline is acceptable and reflects hemodynamic adaptation. With a rise above 30 percent or potassium above 5.5 mmol/L the drug is held and the cause is investigated (volume status, NSAIDs, spironolactone).

Special situations

Sublingual 25 mg is used for uncomplicated hypertensive urgency: onset in 15–30 minutes, duration 4–6 hours. Avoided in MI with cardiogenic shock, in systolic BP below 100 mm Hg, and in suspected aortic dissection.

Common myths

Myth: “captopril causes tongue cancer due to metallic taste”. Fact: dysgeusia reflects a temporary change in taste receptor sensitivity, resolves spontaneously or after withdrawal, and is not associated with malignancy.

Myth: “ACE inhibitors should not be combined with diuretics”. Fact: the combination is standard in hypertension and HFrEF. It requires monitoring of potassium and creatinine.

Myth: “lifelong therapy means addiction”. Fact: ACE inhibitors do not cause dependence. Long-term use reflects the chronic nature of hypertension and heart failure, not a drug effect.

Drug–drug interactions

10 pairs found. Sorted from critical to minor.

MajorAllopurinolXanthine oxidase inhibitors

Mechanism

The combination raises risk of hypersensitivity reactions and severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis, angioedema). The mechanism is not fully established; presumed to be an immune reaction to metabolites of both drugs in chronic kidney disease.

Symptoms

Rash, fever, eosinophilia, lymphadenopathy (DRESS syndrome). Severe cases: bullous rash with skin sloughing (Stevens-Johnson syndrome), angioedema of face and tongue. Symptoms appear 1–8 weeks into the combination.

Management

Avoid the combination, especially in chronic kidney disease (higher risk). Alternative to ACE-I: an ARB (losartan) for antihypertensive needs. If rash or fever emerges, stop both drugs immediately.

Sources

Pair details →Allopurinol →

MajorCo-trimoxazoleSulfonamide-trimethoprim combination

Mechanism

Trimethoprim (a co-trimoxazole component) blocks sodium channels in the collecting duct epithelium (amiloride-like mechanism) and reduces potassium secretion. Captopril (ACE-I) additionally retains potassium via aldosterone suppression.

Symptoms

Muscle weakness, paraesthesia in the limbs, slowed pulse, arrhythmias. ECG shows peaked T waves and widened QRS. Severe cases progress to cardiac arrest. Symptoms typically appear within 1–2 weeks of starting the combination.

Management

During co-trimoxazole therapy (usually 5–10 days), check potassium 3–5 days after start. In older patients and chronic kidney disease, prefer alternative antibiotics: nitrofurantoin or fosfomycin for urinary tract infection.

Sources

PubMed: Trimethoprim-sulfamethoxazole and risk of sudden death among patients taking spironolactone or ACE inhibitors (2014)

Pair details →Co-trimoxazole →

MajorLosartanAngiotensin II receptor blockers (sartans)

Mechanism

Dual RAAS blockade (ACE-I + ARB). Additive hyperkalaemia, hypotension, and acute kidney injury risk without added benefit.

Symptoms

Weakness, postural dizziness, syncope. Reduced urine output, rising creatinine. Weakness and paraesthesia from hyperkalaemia.

Management

The combination is not prescribed. Choose one: ACE-I if tolerated, ARB if there is a dry cough.

Sources

Pair details →Losartan →

MajorSpironolactonePotassium-sparing diuretics (mineralocorticoid receptor antagonists)

Mechanism

Captopril (ACE-I) reduces aldosterone synthesis, while spironolactone directly blocks aldosterone receptors. Both retain potassium. In chronic kidney disease and older patients, severe hyperkalaemia risk reaches 10–15% in the first weeks.

Symptoms

Management

The combination is appropriate in heart failure. Check potassium and creatinine 1 week after start, then monthly. If potassium exceeds 5.5 mmol/L, reduce the spironolactone dose; above 6.0 mmol/L, stop one of the drugs.

Sources

Pair details →Spironolactone →

MajorTelmisartanAngiotensin II receptor blocker (ARB)

Mechanism

Dual RAAS blockade (ACE-I + ARB). The ONTARGET trial showed increased hyperkalaemia, hypotension, and acute kidney injury without outcome improvement. Contraindicated in most clinical situations.

Symptoms

Muscle weakness, paraesthesia, slowed pulse, arrhythmias. ECG: peaked T waves, widened QRS. Severe cases progress to cardiac arrest.

Management

The combination is not prescribed. Choose one: ACE-I (captopril) if tolerated, ARB (telmisartan) if there is a dry cough.

Sources

Pair details →Telmisartan →

MajorValsartanAngiotensin II receptor blockers (ARBs)

Mechanism

Dual RAAS blockade (ACE-I + ARB). Additive hyperkalaemia, hypotension, and acute kidney injury risk without added benefit.

Symptoms

Weakness, postural dizziness, syncope. Reduced urine output, rising creatinine. Weakness and paraesthesia from hyperkalaemia.

Management

The combination is not prescribed. Choose one: ACE-I if tolerated, ARB if there is a dry cough or intolerance.

Sources

Pair details →Valsartan →

ModerateAcetylsalicylic acidAntiplatelet agents (low dose) / NSAIDs (analgesic dose)

Mechanism

At analgesic doses (above 1 g/day), aspirin suppresses vasodilator prostaglandins and weakens the ACE-I's hypotensive effect. At cardioprotective doses (75–100 mg), the effect is minimal.

Symptoms

Gradual blood pressure rise at high aspirin doses. At cardioprotective doses, no significant changes.

Management

Cardioprotective aspirin doses (75–100 mg) are acceptable without adjustment. At high doses, monitor blood pressure and increase captopril if needed. Alternative analgesic: paracetamol.

Sources

Pair details →Acetylsalicylic acid →

ModerateAlprazolamBenzodiazepines. Short-to-medium-acting anxiolytics

Mechanism

Additive hypotension. Alprazolam sedation may mask early orthostatic symptoms.

Symptoms

Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.

Management

In older patients, check standing and sitting blood pressure 1–2 weeks after start. Alternative anxiolytic: hydroxyzine or a short lorazepam course.

Sources

FDA: Xanax (alprazolam) prescribing information (2016)

Pair details →Alprazolam →

ModerateAmitriptylineTricyclic antidepressants (TCA)

Mechanism

Additive orthostatic hypotension via different mechanisms. Captopril (ACE-I) dilates vessels; amitriptyline blocks α1-adrenoceptors and reduces compensatory response.

Symptoms

Postural dizziness, syncope, fatigue. Older patients: fall and fracture risk.

Management

In older patients, check standing and sitting blood pressure 1–2 weeks after starting amitriptyline. For neuropathic pain, alternative: gabapentin or pregabalin.

Sources

FDA: Amitriptyline HCl tablets prescribing information (2014)

Pair details →Amitriptyline →

ModerateBudesonideInhaled corticosteroids (ICS)

Mechanism

Systemic budesonide retains sodium and water via mineralocorticoid effect (weaker than prednisolone), antagonising the ACE inhibitor's antihypertensive effect. Inhaled budesonide does not clinically affect BP.

Symptoms

On long-term therapy: return or rise of blood pressure, leg oedema. Hyperkalaemia possible with reduced renal function.

Management

For short systemic budesonide courses (3–7 days), no specific adjustment needed. For long-term therapy, check BP weekly in the first month. If BP rises, intensify antihypertensives or switch to an oral corticosteroid with less mineralocorticoid activity (methylprednisolone). Inhaled budesonide with captopril is unproblematic.

Sources

FDA: Captopril tablet (Amici Pharma, Inc.) – Prescribing Information (2012)

Pair details →Budesonide →

Label mentions35 mentions

Verbatim lines from the interaction sections, in the language of the label

From this drug’s label

MajorARA IIclass named in the label
«Bloqueo dual del sistema renina-angiotensina-aldosterona (SRAA): No se deben utilizar de forma concomitante los inhibidores de la enzima convertidora de angiotensina y los antagonistas de los…»
AEMPS, section 4.4 · Open on CIMA
MajorLithium
«Bloqueo dual del sistema renina-angiotensina-aldosterona (SRAA): Litio: durante la administración concomitante de litio con inhibidores de la ECA se han detectado incrementos reversibles de los…»
AEMPS, section 4.5 · Open on CIMA
ModerateAINEclass named in the label
«Bloqueo dual del sistema renina-angiotensina-aldosterona (SRAA): Antiinflamatorios no esteroideos : se ha descrito que los fármacos antiinflamatorios no esteroideos (AINEs) y los inhibidores de la…»
AEMPS, section 4.5 · Open on CIMA
ModerateAllopurinol
«Bloqueo dual del sistema renina-angiotensina-aldosterona (SRAA): En pacientes con enfermedad vascular del colágeno (por ejemplo, lupus eritematoso sistémico o esclerodermia) y función renal…»
AEMPS, section 4.4 · Open on CIMA
Moderateantagonistas del calcioclass named in the label
«Otros agentes antihipertensivos: captopril se ha administrado de forma segura con otros agentes antihipertensivos utilizados comúnmente (betabloqueantes y bloqueantes de los canales de calcio de…»
AEMPS, section 4.5 · Open on CIMA
Moderateantidiabéticosclass named in the label
«Bloqueo dual del sistema renina-angiotensina-aldosterona (SRAA): Antidiabéticos: estudios farmacológicos han demostrado que los inhibidores de la ECA, captopril incluido, pueden potenciar los efectos…»
AEMPS, section 4.5 · Open on CIMA
Moderateantidiabéticos oralesclass named in the label
«Bloqueo dual del sistema renina-angiotensina-aldosterona (SRAA): Antidiabéticos: estudios farmacológicos han demostrado que los inhibidores de la ECA, captopril incluido, pueden potenciar los efectos…»
AEMPS, section 4.5 · Open on CIMA
Moderatebetabloqueantesclass named in the label
«Otros agentes antihipertensivos: captopril se ha administrado de forma segura con otros agentes antihipertensivos utilizados comúnmente (betabloqueantes y bloqueantes de los canales de calcio de…»
AEMPS, section 4.5 · Open on CIMA
Moderatediuréticos ahorradores de potasioclass named in the label
«Diuréticos ahorradores de potasio o suplementos de potasio: los inhibidores de la ECA atenúan la pérdida de potasio inducida por los diuréticos. Los diuréticos ahorradores de potasio…»
AEMPS, section 4.5 · Open on CIMA
Moderateinmunosupresoresclass named in the label
«Bloqueo dual del sistema renina-angiotensina-aldosterona (SRAA): En pacientes con enfermedad vascular del colágeno (por ejemplo, lupus eritematoso sistémico o esclerodermia) y función renal…»
AEMPS, section 4.4 · Open on CIMA
ModerateInsulin
«Bloqueo dual del sistema renina-angiotensina-aldosterona (SRAA): Antidiabéticos: estudios farmacológicos han demostrado que los inhibidores de la ECA, captopril incluido, pueden potenciar los efectos…»
AEMPS, section 4.5 · Open on CIMA
Moderateinsulinaclass named in the label
«Bloqueo dual del sistema renina-angiotensina-aldosterona (SRAA): Antidiabéticos: estudios farmacológicos han demostrado que los inhibidores de la ECA, captopril incluido, pueden potenciar los efectos…»
AEMPS, section 4.5 · Open on CIMA
Moderatenitratosclass named in the label
«Otros agentes antihipertensivos: captopril se ha administrado de forma segura con otros agentes antihipertensivos utilizados comúnmente (betabloqueantes y bloqueantes de los canales de calcio de…»
AEMPS, section 4.5 · Open on CIMA
ModerateNitroglycerin
«Otros agentes antihipertensivos: captopril se ha administrado de forma segura con otros agentes antihipertensivos utilizados comúnmente (betabloqueantes y bloqueantes de los canales de calcio de…»
AEMPS, section 4.5 · Open on CIMA
Moderatesimpaticomiméticosclass named in the label
«Bloqueo dual del sistema renina-angiotensina-aldosterona (SRAA): Simpaticomiméticos: pueden reducir los efectos antihipertensivos de los inhibidores de la ECA; se debe vigilar cuidadosamente a los…»
AEMPS, section 4.5 · Open on CIMA
ModerateSpironolactone
«Diuréticos ahorradores de potasio o suplementos de potasio: los inhibidores de la ECA atenúan la pérdida de potasio inducida por los diuréticos. Los diuréticos ahorradores de potasio…»
AEMPS, section 4.5 · Open on CIMA
Moderatesulfonilureasclass named in the label
«Bloqueo dual del sistema renina-angiotensina-aldosterona (SRAA): Antidiabéticos: estudios farmacológicos han demostrado que los inhibidores de la ECA, captopril incluido, pueden potenciar los efectos…»
AEMPS, section 4.5 · Open on CIMA
Moderatesuplementos de potasioclass named in the label
«Diuréticos ahorradores de potasio o suplementos de potasio: los inhibidores de la ECA atenúan la pérdida de potasio inducida por los diuréticos. Los diuréticos ahorradores de potasio…»
AEMPS, section 4.5 · Open on CIMA
MinorAcetylsalicylic acid
«Bloqueo dual del sistema renina-angiotensina-aldosterona (SRAA): Tratamientos para el infarto agudo de miocardio : en pacientes con infarto de miocardio, captopril se puede utilizar concomitantemente…»
AEMPS, section 4.5 · Open on CIMA
antidepresivos tricíclicosclass named in the label
«Bloqueo dual del sistema renina-angiotensina-aldosterona (SRAA): Antidepresivos tricíclicos/antipsicóticos: los inhibidores de la ECA pueden potenciar los efectos hipotensores de ciertos…»
AEMPS, section 4.5 · Open on CIMA
antineoplásicosclass named in the label
«Bloqueo dual del sistema renina-angiotensina-aldosterona (SRAA): Alopurinol, procainamida, agentes citostáticos o inmunosupresores: su administración concomitante con inhibidores de la ECA puede…»
AEMPS, section 4.5 · Open on CIMA
antipsicóticosclass named in the label
«Bloqueo dual del sistema renina-angiotensina-aldosterona (SRAA): Antidepresivos tricíclicos/antipsicóticos: los inhibidores de la ECA pueden potenciar los efectos hipotensores de ciertos…»
AEMPS, section 4.5 · Open on CIMA
diuréticos del asaclass named in the label
«Diuréticos (tiazídicos o diuréticos del asa): el tratamiento previo con dosis elevadas de diuréticos puede producir depleción de volumen y riesgo de hipotensión al inicio del tratamiento con…»
AEMPS, section 4.5 · Open on CIMA
Furosemide
«Diuréticos (tiazídicos o diuréticos del asa): el tratamiento previo con dosis elevadas de diuréticos puede producir depleción de volumen y riesgo de hipotensión al inicio del tratamiento con…»
AEMPS, section 4.5 · Open on CIMA
Hydrochlorothiazide
«Diuréticos (tiazídicos o diuréticos del asa): el tratamiento previo con dosis elevadas de diuréticos puede producir depleción de volumen y riesgo de hipotensión al inicio del tratamiento con…»
AEMPS, section 4.5 · Open on CIMA

From other drugs’ labels

MajorValsartan
«Infarto de miocardio reciente (solo 40 mg, 80 mg y 160 mg): La combinación de captopril y valsartán no ha demostrado ningún beneficio clínico adicional, en cambio se observó un aumento del riesgo de…»
AEMPS, section 4.4 · Open on CIMA
ModerateChlortalidone
«Inhibidores de la ECA (por ejemplo, captopril, enalapril): La toma de inhibidores de la ECA (por ejemplo, captopril, enalapril) durante el tratamiento clortalidona crea el riesgo de una caída grave…»
AEMPS, section 4.5 · Open on CIMA
ModerateGliclazide
«Se puede potenciar el efecto reductor de glucosa en sangre y en consecuencia en algunos casos puede producirse hipoglucemia, cuando se toma uno de los siguientes fármacos,: otros tratamientos…»
AEMPS, section 4.5 · Open on CIMA
ModerateHydrochlorothiazide
«Inhibidores de la ECA (p.ej., captopril, enalapril): Cuando se administra de forma concomitante con inhibidores de la ECA (p.ej., captopril, enalapril) se puede desarrollar una grave hipotensión de…»
AEMPS, section 4.5 · Open on CIMA
ModerateLithium
«Interacciones que aumentan los niveles de litio: Fármacos que actúan sobre el sistema renina-angiotensina (IECAs, antagonistas del receptor de angiotensina II). Inhibidores de la enzima convertidora…»
AEMPS, section 4.5 · Open on CIMA
Allopurinol
«Inhibidores de la enzima convertidora de angiotensina (ECA): El riesgo de reacciones cutáneas puede aumentar con la administración concomitante de alopurinol y captopril, especialmente en casos de…»
AEMPS, section 4.5 · Open on CIMA
Digoxin
«Pharmacokinetic Drug Interactions: Captopril 58% 39%»
FDA, section 7 · Open on DailyMed
Doxylamine
«Medicamentos fotosensibilizantes: El uso concomitante de antihistamínicos con otros agentes fotosensibilizantes como amiodarona, quinidina, imipramina, doxepina, amitriptilina, griseofulvina…»
AEMPS, section 4.5 · Open on CIMA
Insulin lispro
«Los requerimientos de insulina pueden disminuir en presencia de medicamentos con actividad hipoglucemiante, tales como los hipoglucemiantes orales, salicilatos (por ejemplo, ácido acetilsalicílico)…»
AEMPS, section 4.5 · Open on CIMA
Metamizole sodium
«Inducción farmacocinética de enzimas metabolizantes: Las pirazolonas también pueden interaccionar con anticoagulantes orales, captopril, litio y triamtereno. La eficacia de los antihipertensivos y…»
AEMPS, section 4.5 · Open on CIMA

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Frequently asked

What is Captopril used for?

Captopril is evaluated for the following indications with varying evidence strength: Hypertension (evidence tier A), Diabetic nephropathy (evidence tier A), Heart failure with reduced ejection fraction (evidence tier B). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Captopril?

Common side effects of Captopril (≥ 1 in 100): Dry cough (5–20 percent of patients, common cause of discontinuation), Hypotension, especially after the first dose, Hyperkalemia, Taste disturbance (metallic taste, dysgeusia), Skin rash (more frequent than with other ACE inhibitors, linked to the sulfhydryl group). See the Safety section for uncommon and serious reactions.

Is Captopril safe during pregnancy?

Is Captopril compatible with breastfeeding?

Fully compatible. Hale L2. RID 0.02% – lowest among ACE inhibitors. Drug of choice for HTN in nursing per ACOG 2020 alongside enalapril. Contraindicated in pregnancy.

Who should not take Captopril?

Captopril is contraindicated in: History of angioedema with ACE inhibitors; Pregnancy (second and third trimester); Bilateral renal artery stenosis or stenosis of a solitary kidney artery; Hyperkalemia above 5.5 mmol/L; Concomitant aliskiren in patients with diabetes or eGFR below 60 mL/min/1.73 m². Full list in the Safety section.

Does Captopril carry an FDA boxed warning?

“captopril causes tongue cancer due to metallic taste”

dysgeusia reflects a temporary change in taste receptor sensitivity, resolves spontaneously or after withdrawal, and is not associated with malignancy.

“ACE inhibitors should not be combined with diuretics”

the combination is standard in hypertension and HFrEF. It requires monitoring of potassium and creatinine.

“lifelong therapy means addiction”

ACE inhibitors do not cause dependence. Long-term use reflects the chronic nature of hypertension and heart failure, not a drug effect.

Official sources

Direct links to regulator labels. Open in a new tab.

AEMPS / CIMALabel dated 03/21/2026
FDA / DailyMedLabel dated 05/20/2026
GRLS

Other drugs in this group

Enalapril, Enalapril + Hydrochlorothiazide, Irbesartan, Irbesartan + Hydrochlorothiazide, Lisinopril, Perindopril + Indapamide, Valsartan, Amlodipine + Valsartan + Hydrochlorothiazide