Imidapril hydrochloride

How it works

It is a prodrug converted to imidaprilat, which inhibits ACE and thereby reduces angiotensin II formation, producing vasodilatation and decreased aldosterone-driven sodium and water retention.

Prescribing in practice

• It is contraindicated in pregnancy and in patients with a history of angioedema, and should be discontinued immediately if angioedema develops.
• Use with caution in renal impairment, renovascular disease and volume depletion, and avoid concomitant potassium-sparing agents or potassium supplements unless potassium is monitored.
• First-dose hypotension may occur, particularly in patients who are volume-depleted or already taking a diuretic.

Monitoring

Check renal function and serum potassium before and after starting or adjusting therapy, and monitor blood pressure.

Counselling the patient

• Report any swelling of the face, lips, tongue or throat, or breathing difficulty, urgently.
• A persistent dry cough may occur; mention it to your clinician.
• Tell your clinician if you might be pregnant, and avoid potassium-containing salt substitutes unless advised.

Evidence & guidelines

ACE inhibitors are an established class for hypertension with extensive trial evidence, and NICE recommends them as a core antihypertensive option.