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Co-zidocapt (hydrochlorothiazide and captopril) oral


Oral formulations of hydrochlorothiazide and captopril

Drugs List

  • co-zidocapt (hydrochlorothiazide 12.5mg and captopril 25mg) tablets
  • co-zidocapt (hydrochlorothiazide 25mg and captopril 50mg) tablets
  • Therapeutic Indications


    Essential hypertension when stabilised on same same proportions


    Combined tablets are to be administered in a single or two divided doses per day after dosage titration using individual components.

    A maximum daily dose of 50 mg captopril/25 mg hydrochlorothiazide should not be exceeded.


    The usual maintenance dose is 50 mg captopril/25 mg hydrochlorothiazide once a day in the morning.


    The usual starting dose is 25 mg captopril/12.5 mg hydrochlorothiazide once a day in the morning.

    The dose should be kept as low as possible to achieve adequate blood pressure control.

    Patients with Renal Impairment

    Creatinine clearance 30 to 80 ml/minute
    The usual starting dose is 25 mg captopril/12.5 mg hydrochlorothiazide once a day in the morning.

    Additional Dosage Information

    For salt/ volume depleted patients and diabetic patients the usual starting dose is 25 mg captopril/12.5 mg hydrochlorothiazide once a day.


    Children under 18 years
    Within 36 hours of discontinuing a sacubitril containing product
    Addison's disease
    Cardiogenic shock
    Haemodialysis with high flux membranes
    Hereditary angioneurotic oedema
    Idiopathic angioneurotic oedema
    Refractory hypokalaemia
    Renal artery stenosis
    Renal impairment - creatinine clearance below 30 ml/minute
    Severe hepatic impairment
    Symptomatic hyperuricaemia

    Precautions and Warnings

    Desensitisation therapy
    Restricted sodium intake
    Aortic stenosis
    Cerebrovascular disorder
    Collagen vascular disease
    Diabetes mellitus
    Glucose-galactose malabsorption syndrome
    Hepatic cirrhosis
    Hepatic impairment
    History of angioedema
    History of skin cancer
    Hypertrophic obstructive cardiomyopathy
    Ischaemic heart disease
    Lactose intolerance
    Left ventricular outflow obstruction
    Mitral stenosis
    Nephrotic syndrome
    Peripheral vascular disease
    Renal impairment - creatinine clearance 30-80ml/minute
    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
    Anaphylaxis possible with concomitant hyposensitisation to wasp/bee venom
    Reduce dose in patients with renal impairment
    Advise ability to drive/operate machinery may be affected by side effects
    Afro-Caribbean or black patients may show reduced response
    Correct volume and/or salt depletion before initiating therapy
    Contains lactose
    Place patient in supine position if severe hypotension occurs
    Evaluate renal function 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
    Monitor patients with renovascular disease
    Monitor periodically for signs of fluid or electrolyte imbalance
    Monitor serum potassium regularly
    Advise patient of increased risk of non-melanoma skin cancer
    Advise patient to monitor for and report any skin changes
    Advise patients at risk of neutropenia to report any signs of infection
    Excess consumption of liquorice may increase the risk of hypokalaemia
    Higher incidence of angioedema in black patients
    Increased risk of hyperkalaemia with K+ suppl. and K+ sparing diuretic
    May cause hyperkalaemia
    May precipitate diabetes mellitus
    May precipitate gout
    Withdraw and consider hyperparathyroidism if frank hypercalcaemia develops
    Discontinue before parathyroid function tests
    May affect results of some laboratory tests
    Discontinue temporarily in LDL apheresis or desensitisation therapy
    Advise patient to seek advice at first indications of pregnancy
    Discontinue if angioedema occurs
    Discontinue if clinical/laboratory evidence of neutropenia
    Discontinue if jaundice or other evidence of hepatic impairment occurs
    Discontinue if symptoms of acute angle closure glaucoma occur
    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
    Advise pt. to minimise exposure to sunlight & avoid sunlamps during therapy

    Angioedema of the extremities, face, lips, tongue, glottis and/or larynx may occur during treatment with ACE inhibitors. This may occur at any time during the treatment. If angioedema develops, treatment should be discontinued promptly and condition managed appropriately.

    A persistent, non-productive cough may occur which usually resolves after therapy is discontinued.

    In patients with collagen vascular disease monitor differential blood counts prior to therapy, every 2 weeks during the first 3 months and periodically after that.

    Dilutional hyponatraemia may occur in oedematous patients during hot weather. The effect is usually mild and not requiring treatment.

    Pregnancy and Lactation


    Captopril and hydrochlorothiazide is contraindicated in 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.

    Hydrochlorothiazide is contraindicated in pregnancy.

    Diuretics can reduce plasma volume and lead to a reduced perfusion of the placenta. Schaefer (2007) comments that diuretics are no longer part of the standard therapy for hypertension and oedema during pregnancy; they should only be used for particular indications. In such cases hydrochlorothiazide is the diuretic of choice. Use of hydrochlorothiazide is not an indication for interrupting pregnancy. Briggs (2011) comments that in general, diuretics are not recommended in the treatment of gestational hypertension because of the maternal hypovolaemia characteristic of the disease.

    Thiazides and related diuretics may cause neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte disturbance and hypoglycaemia. Some sources state that hydrochlorothiazide causes stimulation of labour others state hydrochlorothiazide inhibits labour. Uterine inertia and meconium staining have also been reported.

    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 ( ) or if this is unavailable at the backup site ( ).


    Use captopril and hydrochlorothiazide with caution in breastfeeding.

    Captopril should be used 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.

    Hydrochlorothiazide is excreted in small quantities into breast milk. There have been reports of thrombocytopenia in the nursing infants of mothers receiving a thiazide diuretic, however, the risk is considered low by, Hale (2010) and Briggs (2011). Thiazide diuretics have been used in large quantities to suppress lactation. Overall, hydrochlorothiazide is considered safe while breastfeeding (Briggs, 2011), (Schaefer, 2007) and (Hale, 2010).

    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

    Side Effects

    Abdominal pain
    Allergic alveolitis
    Anaphylactic reaction
    Aphthous ulcers
    Autoimmune disorders
    Bone marrow depression
    Cardiac arrest
    Cardiogenic shock
    Cerebrovascular accident
    Changes in erythrocyte sedimentation rate
    Chest pain
    Decrease in haematocrit
    Decrease in haemoglobin
    Decreased appetite
    Decreased serum sodium
    Dry mouth
    Elevated serum potassium
    Elevated triglyceride levels
    Eosinophilic pneumonia
    Erythema multiforme
    Exfoliative dermatitis
    Gastro-intestinal symptoms
    Hepatic impairment
    Increase in blood urea nitrogen
    Increase in creatinine
    Increase in plasma cholesterol
    Increased urinary frequency
    Necrotising angiitis
    Nephrotic syndrome
    Ocular pain
    Pemphigoid reaction
    Peptic ulceration
    Positive ANA titre
    Raynaud's syndrome
    Reduced visual acuity
    Renal failure
    Respiratory distress
    Serum bilirubin increased
    Sleep disturbances
    Stevens-Johnson syndrome
    Taste disturbances
    Toxic epidermal necrolysis

    Effects on Laboratory Tests

    Captopril may cause a false-positive urine test for acetone. Hydrochlorothiazide may cause diagnostic interference of the bentiromide test. Thiazides may decrease serum PBI (Protein Bound Iodine) levels without signs of thyroid disturbance.


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: September 2013

    Reference Sources

    British National Formulary, 66th Edition (September 2013-March 2014) Pharmaceutical Press, London.

    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.

    Summary of Product Characteristics: Capozide Tablets. E.R. Squibb & Sons Ltd. Revised March 2014.

    Summary of Product Characteristics: Co-zidocapt 25/12.5mg Tablets. Tillomed Laboratories. Revised March 2009.
    Summary of Product Characteristics: Co-zidocapt 50/25mg Tablets. Tillomed Laboratories. Revised March 2009.

    MHRA Drug Safety Update: Volume 1, Issue 5, December 2007
    Last accessed: September 18, 2013

    MHRA Drug Safety Update: Volume 2, Issue 10, May 2009.
    Last accessed: September 18, 2013

    MHRA Drug Safety Update November 2018
    Available at:
    Last accessed: 08 January 2019

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Captopril Last revised: September 7, 2013
    Last accessed: September 18, 2013

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Hydrochlorothiazide Last revised: September 7, 2013
    Last accessed: September 18, 2013

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