Drugs List

Therapeutic Indications

Uses

After MI,prophylaxis of CCF in stable pts.with left ventricular dysfunction
Congestive heart failure (adjunct)
Diabetic nephropathy
Hypertension

Hypertension
Mild/moderate essential hypertension alone or with thiazide therapy and severe hypertension when standard therapy is inappropriate.

Congestive heart failure
Treatment of chronic heart failure with reduction of systolic ventricular function (with diuretics and where indicated digitalis and beta-blockers).

Myocardial infarction
Short term (4 weeks) treatment of myocardial infarction within 24 hours of the event in clinically stable individuals or Long term prophylaxis of symptomatic heart failure in clinically stable patients with asymptomatic left ventricular dysfunction (ejection fraction below or equal to 40%).

Type I Diabetic nephropathy
Treatment of macroproteinuric diabetic nephropathy in patients with type 1 diabetes mellitus.

Unlicensed Uses

Proteinuria in nephritis

Contraindications

Within 36 hours of discontinuing a sacubitril containing product
Cardiogenic shock
Galactosaemia
Haemodialysis with high flux membranes
Hereditary angioneurotic oedema
Idiopathic angioneurotic oedema
Pregnancy
Renal artery stenosis

Precautions and Warnings

Children under 18 years
Desensitisation therapy
Elderly
Immunosuppression
Aortic stenosis
Atherosclerosis
Breastfeeding
Cerebral ischaemia
Collagen vascular disease
Diabetes mellitus
Glucose-galactose malabsorption syndrome
Hepatic impairment
History of angioedema
Hyperkalaemia
Hypertrophic obstructive cardiomyopathy
Hyponatraemia
Hypotension
Hypovolaemia
Ischaemic heart disease
Lactose intolerance
Left ventricular outflow obstruction
Mitral stenosis
Peripheral vascular disease
Renal impairment
Renovascular disorder
Systemic lupus erythematosus
Uncontrolled cardiac failure

Adjustment of hypoglycaemic therapy may be necessary in diabetes mellitus
Anaesthetist should be made aware patient is taking this medication
Anaphylactoid reactions possible with haemofiltration or LDL apheresis
Reduce dose in patients with renal impairment
Advise ability to drive/operate machinery may be affected by side effects
Advise patient that first dose hypotension may occur
Afro-Caribbean or black patients may show reduced response
Consider stopping diuretic 2-3 days prior to therapy if appropriate
Correct volume and/or salt depletion before initiating therapy
Not all available brands are licensed for all indications
Reduce initial dose in the elderly
Contains lactose
Place patient in supine position if severe hypotension occurs
Evaluate renal function before and during treatment
Monitor serum electrolytes before and during treatment
Consider monitoring white blood cell counts in collagen vascular disease
Monitor blood glucose closely in patients with diabetes mellitus
Monitor for protein in urine
Advise patient to report symptoms of infection immediately
Higher incidence of angioedema in black patients
Increased risk of hyperkalaemia with K+ suppl. and K+ sparing diuretic
May cause hyperkalaemia
May cause false positive urine test for acetone
Withdraw before apheresis
Withdraw before desensitisation
Advise patient to seek advice at first indications of pregnancy
Discontinue if jaundice or other evidence of hepatic impairment occurs
Discontinue if laryngeal stridor/angioedema of face/tongue or glottis
Discontinue or interrupt treatment if neutropenia develops
Advise patient not to take NSAIDs unless advised by clinician
Hypotensive effect enhanced by alcohol
Advise on problems of salt substitutes/high intake of potassium-rich food
Female: Ensure adequate contraception during treatment

Renal function must be monitored before and during treatment in all patients. Renal function should be stabilised before treatment with an ACE inhibitor is started. A specialist should be consulted if renal impairment is significantly reduced as a result of treatment with captopril.

Captopril should be initiated under specialist supervision and with close monitoring in patients receiving high or multiple dose diuretics (e.g. more than 80 mg furosemide daily or its equivalent), or with hypovolaemia, hyponatraemia (plasma sodium concentration below 130 mmol/litre), hypotension (systolic blood pressure below 90 mmHg), unstable heart failure ( not recommended in untreated decompensated heart failure: insufficient therapeutic experience), receiving high dose vasodilator therapy or known/suspected renovascular disease (use only if essential and monitor renal function).

Collagen vascular disease (e.g. systemic lupus erythematosus or scleroderma) and therapy with immunosuppressive agents: may lead to increased risk of neutropenia. Serious infections, unresponsive to antibiotic may develop. Instruct patients to report signs of infection (e.g. sore throat, fever). Agranulocytosis, anaemia and thrombocytopenia have also been reported in association with captopril therapy. Monitor differential blood counts prior to therapy, every 2 weeks during the first 3 months and periodically after that. Discontinue treatment if neutropenia is detected or suspected. In most patients neutrophil counts rapidly return to normal on discontinuing therapy.

History of idiopathic or hereditary angioedema. Discontinue treatment and initiate appropriate therapy in patients that develop angioedema of the face, lips, mucous membranes, tongue, glottis and/or larynx. The patient should be hospitalised and observed for at least 12 to 24 hours and should not be discharged until complete resolution of symptoms has occurred. In rare cases severe angioedema may develop in long term treatment.

Pregnancy and Lactation

Pregnancy

Captopril is contraindicated in pregnancy.

The use of ACE inhibitors is not recommended during the first trimester of pregnancy. Captopril is embryocidal in animals and has caused stillbirths in some species. Evidence of a risk of teratogenicity after first trimester exposure is conflicting, however, the MHRA recommends that a risk cannot be excluded. ACE inhibitors are contraindicated during the second and third trimesters of pregnancy as exposure during these trimesters is known to induce human foetal toxicity (decreased renal function, oligohydramnios and skull ossification retardation) and neonatal toxicity (renal failure, hypotension and hyperkalaemia). Other effects include hypoxia, renal tubular dysgenesis and prematurity. Severe and sometimes fatal anuria in the foetus and in the newborn has been observed and is thought to be caused by the compromise of the foetal renal system. Captopril may lead to in utero renal failure due to the prevention of conversion of angiotensin l to angiotensin ll. The MHRA states that the use of ACE inhibitors in late pregnancy has been associated with adverse effects on the kidney and other congenital anomalies, therefore ACE inhibitors should not be used at any stage during of pregnancy unless absolutely necessary and only then after the potential risks and benefits have been discussed with the patient.

If exposure has occurred in the first trimester a detailed ultrasound diagnosis is advisable. Should exposure to an ACE inhibitor have occurred from the second trimester, an ultrasound check of renal function and the skull is recommended. Exposure to an ACE inhibitor during pregnancy is not an indication for either invasive diagnostic procedures or termination of pregnancy. In cases involving long term prenatal therapy in the second and/ or third trimesters, the foetus should be monitored for the potential development of oligohydramnios, and foetal growth should be assessed with detailed ultrasound scans (Schaefer, 2007). If oligohydramnios occurs, stopping captopril may resolve the problem by may not improve infant outcome because of irreversible foetal damage. Infants whose mothers have taken ACE inhibitors should be closely monitored for hypotension and renal function.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use captopril with caution in breastfeeding.

Captopril is excreted in breast milk in low concentrations and the amount ingested by the infant is small. The manufacturers states captopril should be avoided in breastfeeding. The MHRA states that use in breastfeeding is not recommended in the first few weeks after delivery because of the possibility of profound neonatal hypotension. If ACE inhibitor therapy is considered essential for the mother the use of captopril may be considered when the infant is older. The infant should be carefully followed up for signs of hypotension should ACE inhibitor treatment be deemed necessary. Schaefer (2007) recommends monitoring for oedema and a possible increase in infant's weight as indicators for renal impairment. Women who still need antihypertensive treatment in the post natal period should be advised that captopril would not be expected to cause adverse effects in breastfed infants.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal pain
Accelerated erythrocyte sedimentation
Acidosis
Allergic alveolitis
Alopecia
Anaemia
Angina pectoris
Angioedema
Anorexia
Aphthous ulcers
Arrhythmias
Arthralgia
Autoimmune disorders
Blurred vision
Bronchospasm
Cardiac arrest
Cardiogenic shock
Cerebrovascular accident
Chest pain
Cholestasis
Confusion
Constipation
Cough
Decrease in haematocrit
Decrease in haemoglobin
Depression
Diarrhoea
Dizziness
Drowsiness
Dry mouth
Dyspnoea
Eosinophilia
Eosinophilic pneumonia
Erythema multiforme
Exfoliative dermatitis
Fatigue
Fever
Flushing
Gastro-intestinal disturbances
Glossitis
Gynaecomastia
Headache
Hepatic failure
Hepatic impairment
Hepatic necrosis
Hepatitis
Hyperkalaemia
Hypoglycaemia
Hypotension
Impotence
Increase in blood urea nitrogen
Increases in hepatic enzymes
Jaundice
Leucopenia
Lymphadenopathy
Malaise
Myalgia
Myocardial infarction
Nausea
Nephrotic syndrome
Neutropenia
Oliguria
Pallor
Palpitations
Pancreatitis
Pancytopenia
Paraesthesia
Pemphigoid reaction
Peptic ulceration
Photosensitivity
Polyuria
Positive ANA titre
Proteinuria
Pruritus
Rash
Raynaud's syndrome
Renal failure
Renal impairment
Rhinitis
Serum bilirubin increased
Serum creatinine increased
Sleep disturbances
Stevens-Johnson syndrome
Stomatitis
Stroke
Syncope
Tachyarrhythmia
Tachycardia
Taste disturbances
Thrombocytopenia
Urinary frequency
Urticaria
Vasculitis
Vomiting
Weight loss

Presentation

Oral formulations of captopril

Drugs List

Therapeutic Indications

Uses

After MI,prophylaxis of CCF in stable pts.with left ventricular dysfunction
Congestive heart failure (adjunct)
Diabetic nephropathy
Hypertension

Hypertension
Mild/moderate essential hypertension alone or with thiazide therapy and severe hypertension when standard therapy is inappropriate.

Congestive heart failure
Treatment of chronic heart failure with reduction of systolic ventricular function (with diuretics and where indicated digitalis and beta-blockers).

Myocardial infarction
Short term (4 weeks) treatment of myocardial infarction within 24 hours of the event in clinically stable individuals or Long term prophylaxis of symptomatic heart failure in clinically stable patients with asymptomatic left ventricular dysfunction (ejection fraction below or equal to 40%).

Type I Diabetic nephropathy
Treatment of macroproteinuric diabetic nephropathy in patients with type 1 diabetes mellitus.

Unlicensed Uses

Proteinuria in nephritis

Dosage

The first dose should usually be given at bedtime to avoid the effects of first dose hypotension.
Dose should be adjusted according to the individual's profile and blood pressure response.
The maximum daily dose recommended is 150mg.

Adults

Elderly

Children

Neonates

Patients with Renal Impairment

Additional Dosage Information

Contraindications

Within 36 hours of discontinuing a sacubitril containing product
Cardiogenic shock
Galactosaemia
Haemodialysis with high flux membranes
Hereditary angioneurotic oedema
Idiopathic angioneurotic oedema
Pregnancy
Renal artery stenosis

Precautions and Warnings

Children under 18 years
Desensitisation therapy
Elderly
Immunosuppression
Aortic stenosis
Atherosclerosis
Breastfeeding
Cerebral ischaemia
Collagen vascular disease
Diabetes mellitus
Glucose-galactose malabsorption syndrome
Hepatic impairment
History of angioedema
Hyperkalaemia
Hypertrophic obstructive cardiomyopathy
Hyponatraemia
Hypotension
Hypovolaemia
Ischaemic heart disease
Lactose intolerance
Left ventricular outflow obstruction
Mitral stenosis
Peripheral vascular disease
Renal impairment
Renovascular disorder
Systemic lupus erythematosus
Uncontrolled cardiac failure

Adjustment of hypoglycaemic therapy may be necessary in diabetes mellitus
Anaesthetist should be made aware patient is taking this medication
Anaphylactoid reactions possible with haemofiltration or LDL apheresis
Reduce dose in patients with renal impairment
Advise ability to drive/operate machinery may be affected by side effects
Advise patient that first dose hypotension may occur
Afro-Caribbean or black patients may show reduced response
Consider stopping diuretic 2-3 days prior to therapy if appropriate
Correct volume and/or salt depletion before initiating therapy
Not all available brands are licensed for all indications
Reduce initial dose in the elderly
Contains lactose
Place patient in supine position if severe hypotension occurs
Evaluate renal function before and during treatment
Monitor serum electrolytes before and during treatment
Consider monitoring white blood cell counts in collagen vascular disease
Monitor blood glucose closely in patients with diabetes mellitus
Monitor for protein in urine
Advise patient to report symptoms of infection immediately
Higher incidence of angioedema in black patients
Increased risk of hyperkalaemia with K+ suppl. and K+ sparing diuretic
May cause hyperkalaemia
May cause false positive urine test for acetone
Withdraw before apheresis
Withdraw before desensitisation
Advise patient to seek advice at first indications of pregnancy
Discontinue if jaundice or other evidence of hepatic impairment occurs
Discontinue if laryngeal stridor/angioedema of face/tongue or glottis
Discontinue or interrupt treatment if neutropenia develops
Advise patient not to take NSAIDs unless advised by clinician
Hypotensive effect enhanced by alcohol
Advise on problems of salt substitutes/high intake of potassium-rich food
Female: Ensure adequate contraception during treatment

Renal function must be monitored before and during treatment in all patients. Renal function should be stabilised before treatment with an ACE inhibitor is started. A specialist should be consulted if renal impairment is significantly reduced as a result of treatment with captopril.

Captopril should be initiated under specialist supervision and with close monitoring in patients receiving high or multiple dose diuretics (e.g. more than 80 mg furosemide daily or its equivalent), or with hypovolaemia, hyponatraemia (plasma sodium concentration below 130 mmol/litre), hypotension (systolic blood pressure below 90 mmHg), unstable heart failure ( not recommended in untreated decompensated heart failure: insufficient therapeutic experience), receiving high dose vasodilator therapy or known/suspected renovascular disease (use only if essential and monitor renal function).

Collagen vascular disease (e.g. systemic lupus erythematosus or scleroderma) and therapy with immunosuppressive agents: may lead to increased risk of neutropenia. Serious infections, unresponsive to antibiotic may develop. Instruct patients to report signs of infection (e.g. sore throat, fever). Agranulocytosis, anaemia and thrombocytopenia have also been reported in association with captopril therapy. Monitor differential blood counts prior to therapy, every 2 weeks during the first 3 months and periodically after that. Discontinue treatment if neutropenia is detected or suspected. In most patients neutrophil counts rapidly return to normal on discontinuing therapy.

History of idiopathic or hereditary angioedema. Discontinue treatment and initiate appropriate therapy in patients that develop angioedema of the face, lips, mucous membranes, tongue, glottis and/or larynx. The patient should be hospitalised and observed for at least 12 to 24 hours and should not be discharged until complete resolution of symptoms has occurred. In rare cases severe angioedema may develop in long term treatment.

Pregnancy and Lactation

Pregnancy

Captopril is contraindicated in pregnancy.

The use of ACE inhibitors is not recommended during the first trimester of pregnancy. Captopril is embryocidal in animals and has caused stillbirths in some species. Evidence of a risk of teratogenicity after first trimester exposure is conflicting, however, the MHRA recommends that a risk cannot be excluded. ACE inhibitors are contraindicated during the second and third trimesters of pregnancy as exposure during these trimesters is known to induce human foetal toxicity (decreased renal function, oligohydramnios and skull ossification retardation) and neonatal toxicity (renal failure, hypotension and hyperkalaemia). Other effects include hypoxia, renal tubular dysgenesis and prematurity. Severe and sometimes fatal anuria in the foetus and in the newborn has been observed and is thought to be caused by the compromise of the foetal renal system. Captopril may lead to in utero renal failure due to the prevention of conversion of angiotensin l to angiotensin ll. The MHRA states that the use of ACE inhibitors in late pregnancy has been associated with adverse effects on the kidney and other congenital anomalies, therefore ACE inhibitors should not be used at any stage during of pregnancy unless absolutely necessary and only then after the potential risks and benefits have been discussed with the patient.

If exposure has occurred in the first trimester a detailed ultrasound diagnosis is advisable. Should exposure to an ACE inhibitor have occurred from the second trimester, an ultrasound check of renal function and the skull is recommended. Exposure to an ACE inhibitor during pregnancy is not an indication for either invasive diagnostic procedures or termination of pregnancy. In cases involving long term prenatal therapy in the second and/ or third trimesters, the foetus should be monitored for the potential development of oligohydramnios, and foetal growth should be assessed with detailed ultrasound scans (Schaefer, 2007). If oligohydramnios occurs, stopping captopril may resolve the problem by may not improve infant outcome because of irreversible foetal damage. Infants whose mothers have taken ACE inhibitors should be closely monitored for hypotension and renal function.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use captopril with caution in breastfeeding.

Captopril is excreted in breast milk in low concentrations and the amount ingested by the infant is small. The manufacturers states captopril should be avoided in breastfeeding. The MHRA states that use in breastfeeding is not recommended in the first few weeks after delivery because of the possibility of profound neonatal hypotension. If ACE inhibitor therapy is considered essential for the mother the use of captopril may be considered when the infant is older. The infant should be carefully followed up for signs of hypotension should ACE inhibitor treatment be deemed necessary. Schaefer (2007) recommends monitoring for oedema and a possible increase in infant's weight as indicators for renal impairment. Women who still need antihypertensive treatment in the post natal period should be advised that captopril would not be expected to cause adverse effects in breastfed infants.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal pain
Accelerated erythrocyte sedimentation
Acidosis
Allergic alveolitis
Alopecia
Anaemia
Angina pectoris
Angioedema
Anorexia
Aphthous ulcers
Arrhythmias
Arthralgia
Autoimmune disorders
Blurred vision
Bronchospasm
Cardiac arrest
Cardiogenic shock
Cerebrovascular accident
Chest pain
Cholestasis
Confusion
Constipation
Cough
Decrease in haematocrit
Decrease in haemoglobin
Depression
Diarrhoea
Dizziness
Drowsiness
Dry mouth
Dyspnoea
Eosinophilia
Eosinophilic pneumonia
Erythema multiforme
Exfoliative dermatitis
Fatigue
Fever
Flushing
Gastro-intestinal disturbances
Glossitis
Gynaecomastia
Headache
Hepatic failure
Hepatic impairment
Hepatic necrosis
Hepatitis
Hyperkalaemia
Hypoglycaemia
Hypotension
Impotence
Increase in blood urea nitrogen
Increases in hepatic enzymes
Jaundice
Leucopenia
Lymphadenopathy
Malaise
Myalgia
Myocardial infarction
Nausea
Nephrotic syndrome
Neutropenia
Oliguria
Pallor
Palpitations
Pancreatitis
Pancytopenia
Paraesthesia
Pemphigoid reaction
Peptic ulceration
Photosensitivity
Polyuria
Positive ANA titre
Proteinuria
Pruritus
Rash
Raynaud's syndrome
Renal failure
Renal impairment
Rhinitis
Serum bilirubin increased
Serum creatinine increased
Sleep disturbances
Stevens-Johnson syndrome
Stomatitis
Stroke
Syncope
Tachyarrhythmia
Tachycardia
Taste disturbances
Thrombocytopenia
Urinary frequency
Urticaria
Vasculitis
Vomiting
Weight loss

Effects on Laboratory Tests

May cause a false positive urine test for acetone.

Further Information

Last Full Review Date: February 2014

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

Medications and Mothers' Milk, 14th Edition (2010) Hale, T. Hale Publishing, Amarillo, Texas.

The Renal Drug Handbook. 3rd edition. (2009) ed. Ashley, C and Currie, A. Radcliffe Medical Press, Abingdon.

Summary of Product Characteristics: Capoten tablets 25mg. E.R Squibb & Sons Ltd. Revised August 2013.

Summary of Product Characteristics: Captopril 12.5 mg tablets. Accord Healthcare Ltd. Revised November 2012.
Summary of Product Characteristics: Captopril 25 mg tablets. Accord Healthcare Ltd. Revised November 2012.
Summary of product characteristics: Captopril 50 mg tablets. Accord Healthcare Ltd. Revised November 2012.

Summary of Product Characteristics: Captopril 12.5 mg tablets and/or Ecopace 12.5mg. The Co-operative Pharmacy National Distribution Centre Ltd. Revised February 2013.
Summary of Product Characteristics: Captopril 25 mg tablets and/or Ecopace 25mg. The Co-operative Pharmacy National Distribution Centre Ltd. Revised March 2012.
Summary of Product characteristics: Captopril 50 mg tablets and/or Ecopace 50mg. The Co-operative Pharmacy National Distribution Centre Ltd. Revised March 2012.

Summary of Product Characteristics: Noyada 5mg/5ml oral solution. Martindale Pharmaceuticals Ltd. Revised May 2013.
Summary of Product Characteristics: Noyada 25mg/5ml oral solution. Martindale Pharmaceuticals Ltd. Revised May 2013.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 22 June 2017

MHRA Drug Safety Update: Volume 2, Issue 10, May 2009.
Available at: https://www.mhra.gov.uk
Last accessed: February 17, 2014.

National Institute for Health and Care excellence (NICE) clinical guidance 107: Hypertension in pregnancy. Issue date August 2010
Available at: https://guidance.nice.org.uk/CG107
Last accessed: February 17, 2014.

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Captopril Last revised: September 7, 2013.
Last accessed: February 17, 2014.