• Tensostad indications
• Uses of Tensostad in details
• Tensostad description
• Tensostad dosage
• Tensostad interactions
• Tensostad side effects
• Tensostad contraindications

What is Tensostad?

Tensostad is used alone or together with other medicines to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys resulting in a stroke, heart failure, or kidney failure. Lowering blood pressure can reduce the risk of strokes and heart attacks.

Tensostad works by blocking a substance in the body that causes blood vessels to tighten. As a result, the blood vessels relax. This lowers blood pressure and increases the supply of blood and oxygen to the heart.

Tensostad is also used to help treat heart failure. It is also used in some patients after a heart attack. After a heart attack, some of the heart muscle is damaged and weakened. The heart muscle may continue to weaken as time goes by. This makes it more difficult for the heart to pump blood. Tensostad may be started within the first few days after a heart attack to increase survival rate.

Tensostad is also used to treat kidney problems caused by diabetes (diabetic nephropathy).

Tensostad is available only with your doctor's prescription.

Tensostad indications

Hypertension

Tensostad (Tensostad tablets, USP) is indicated for the treatment of hypertension.

In using Tensostad, consideration should be given to the risk of neutropenia/agranulocytosis.

Tensostad may be used as initial therapy for patients with normal renal function, in whom the risk is relatively low. In patients with impaired renal function, particularly those with collagen vascular disease, Tensostad should be reserved for hypertensives who have either developed unacceptable side effects on other drugs, or have failed to respond satisfactorily to drug combinations.

Tensostad is effective alone and in combination with other antihypertensive agents, especially thiazidetype diuretics. The blood pressure lowering effects of Tensostad and thiazides are approximately additive.

Heart Failure

Tensostad is indicated in the treatment of congestive heart failure usually in combination with diuretics and digitalis. The beneficial effect of Tensostad in heart failure does not require the presence of digitalis, however, most controlled clinical trial experience with Tensostad has been in patients receiving digitalis, as well as diuretic treatment.

Left Ventricular Dysfunction After Myocardial Infarction

Tensostad is indicated to improve survival following myocardial infarction in clinically stable patients with left ventricular dysfunction manifested as an ejection fraction ≤ 40% and to reduce the incidence of overt heart failure and subsequent hospitalizations for congestive heart failure in these patients.

Diabetic Nephropathy

Tensostad is indicated for the treatment of diabetic nephropathy (proteinuria > 500 mg/day) in patients with type I insulin-dependent diabetes mellitus and retinopathy. Tensostad decreases the rate of progression of renal insufficiency and development of serious adverse clinical outcomes (death or need for renal transplantation or dialysis).

In considering use of Tensostad, it should be noted that in controlled trials ACE inhibitors have an effect on blood pressure that is less in black patients than in non-blacks. In addition, ACE inhibitors (for which adequate data are available) cause a higher rate of angioedema in black than in non-black patients.

How should I use Tensostad?

Use Tensostad as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take Tensostad by mouth on an empty stomach 1 hour before meals.
• Tensostad works best if it is taken at the same time each day.
• Drink plenty of fluids while taking Tensostad. Not drinking enough fluids or excessive sweating, diarrhea, or vomiting can lead to light-headedness or fainting.
• Continue to take Tensostad even if you feel well. Do not miss any doses.
• If you miss a dose of Tensostad, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Tensostad.

Uses of Tensostad in details

Tensostad is used to treat high blood pressure (hypertension). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. It is also used to treat heart failure, protect the kidneys from harm due to diabetes, and to improve survival after a heart attack.

Tensostad is an ACE inhibitor and works by relaxing blood vessels so that blood can flow more easily.

How to use Tensostad

Take this medication by mouth on an empty stomach (at least 1 hour before meals) as directed by your doctor, usually two to three times a day.

The dosage is based on your medical condition and response to treatment.

Use this medication regularly in order to get the most benefit from it. To help you remember, take it at the same times each day. It is important to continue taking this medication even if you feel well. Most people with high blood pressure do not feel sick.

For the treatment of high blood pressure, it may take up to 2 weeks before you get the full benefit of this medication. For the treatment of heart failure, it may take weeks to months before you get the full benefit of this medication. Tell your doctor if your condition does not improve or if it worsens (such as your blood pressure readings remain high or increase).

Tensostad description

Tensostad is a potent, competitive inhibitor of angiotensin-converting enzyme (ACE), the enzyme responsible for the conversion of angiotensin I (ATI) to angiotensin II (ATII). ATII regulates blood pressure and is a key component of the renin-angiotensin-aldosterone system (RAAS). Tensostad may be used in the treatment of hypertension.

Tensostad dosage

Tensostad Dosage

Generic name: Tensostad 12.5mg

Dosage form: tablet

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Tensostad should be taken one hour before meals. Dosage must be individualized.

Hypertension:Initiation of therapy requires consideration of recent antihypertensive drug treatment, the extent of blood pressure elevation, salt restriction, and other clinical circumstances. If possible, discontinue the patient’s previous antihypertensive drug regimen for one week before starting Tensostad.

The initial dose of Tensostad (Tensostad tablets, USP) is 25 mg b.i.d. or t.i.d. If satisfactory reduction of blood pressure has not been achieved after one or two weeks, the dose may be increased to 50 mg b.i.d. or t.i.d. Concomitant sodium restriction may be beneficial when Tensostad is used alone.

The dose of Tensostad in hypertension usually does not exceed 50 mg t.i.d. Therefore, if the blood pressure has not been satisfactorily controlled after one to two weeks at this dose, (and the patient is not already receiving a diuretic), a modest dose of a thiazide-type diuretic (e.g., hydrochlorothiazide, 25 mg daily), should be added. The diuretic dose may be increased at one- to two-week intervals until its highest usual antihypertensive dose is reached.

If Tensostad is being started in a patient already receiving a diuretic, Tensostad therapy should be initiated under close medical supervision, with dosage and titration of Tensostad as noted above.

If further blood pressure reduction is required, the dose of Tensostad may be increased to 100 mg b.i.d. or t.i.d. and then, if necessary, to 150 mg b.i.d. or t.i.d. (while continuing the diuretic). The usual dose range is 25 to 150 mg b.i.d. or t.i.d. A maximum daily dose of 450 mg Tensostad should not be exceeded.

For patients with severe hypertension (e.g., accelerated or malignant hypertension), when temporary discontinuation of current antihypertensive therapy is not practical or desirable, or when prompt titration to more normotensive blood pressure levels is indicated, diuretic should be continued but other current antihypertensive medication stopped and Tensostad dosage promptly initiated at 25 mg b.i.d. or t.i.d., under close medical supervision.

When necessitated by the patient’s clinical condition, the daily dose of Tensostad may be increased every 24 hours or less under continuous medical supervision until a satisfactory blood pressure response is obtained or the maximum dose of Tensostad is reached. In this regimen, addition of a more potent diuretic, e.g., furosemide, may also be indicated.

Beta-blockers may also be used in conjunction with Tensostad therapy, but the effects of the two drugs are less than additive.

Heart Failure:Initiation of therapy requires consideration of recent diuretic therapy and the possibility of severe salt/volume depletion. In patients with either normal or low blood pressure, who have been vigorously treated with diuretics and who may be hyponatremic and/or hypovolemic, a starting dose of 6.25 or 12.5 mg t.i.d. may minimize the magnitude or duration of the hypotensive effect; for these patients, titration to the usual daily dosage can then occur within the next several days.

For most patients the usual initial daily dosage is 25 mg t.i.d. After a dose of 50 mg t.i.d. is reached, further increases in dosage should be delayed, where possible, for at least two weeks to determine if a satisfactory response occurs. Most patients studied have had a satisfactory clinical improvement at 50 or 100 mg t.i.d. A maximum daily dose of 450 mg of Tensostad should not be exceeded.

Tensostad should generally be used in conjunction with a diuretic and digitalis.

Tensostad therapy must be initiated under very close medical supervision.

Left Ventricular Dysfunction After Myocardial Infarction:The recommended dose for long-term use in patients following a myocardial infarction is a target maintenance dose of 50 mg t.i.d.

Therapy may be initiated as early as three days following a myocardial infarction. After a single dose of 6.25 mg, Tensostad therapy should be initiated at 12.5 mg t.i.d. Tensostad should then be increased to 25 mg t.i.d. during the next several days and to a target dose of 50 mg t.i.d. over the next several weeks as tolerated.

Tensostad may be used in patients treated with other post-myocardial infarction therapies, e.g., thrombolytics, aspirin, beta blockers.

Diabetic Nephropathy:The recommended dose of Tensostad for long term use to treat diabetic nephropathy is 25 mg t.i.d.

Other antihypertensives such as diuretics, beta blockers, centrally acting agents or vasodilators may be used in conjunction with Tensostad if additional therapy is required to further lower blood pressure.

Dosage Adjustment in Renal Impairment:Because Tensostad is excreted primarily by the kidneys, excretion rates are reduced in patients with impaired renal function. These patients will take longer to reach steady-state Tensostad levels and will reach higher steady-state levels for a given daily dose than patients with normal renal function. Therefore, these patients may respond to smaller or less frequent doses.

Accordingly, for patients with significant renal impairment, initial daily dosage of Tensostad should be reduced, and smaller increments utilized for titration, which should be quite slow (one- to two-week intervals). After the desired therapeutic effect has been achieved, the dose should be slowly back-titrated to determine the minimal effective dose. When concomitant diuretic therapy is required, a loop diuretic (e.g., furosemide), rather than a thiazide diuretic, is preferred in patients with severe renal impairment.

More about Tensostad (Tensostad)

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Professional resources

• Tensostad (AHFS Monograph)
• Tensostad (FDA)

Related treatment guides

• High Blood Pressure
• Cystinuria
• Diabetic Kidney Disease
• Heart Failure
• Hypertensive Emergency
• More (1) »

Tensostad interactions

See also:
What other drugs will affect Tensostad?

Dual Blockade Of The Renin-Angiotensin System (RAS)

Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren is associated with increased risks of hypotension, hyperkalemia, and changes in renal function (including acute renal failure) compared to monotherapy. Most patients receiving the combination of two RAS inhibitors do not obtain any additional benefit compared to monotherapy. In general, avoid combined use of RAS inhibitors. Closely monitor blood pressure, renal function and electrolytes in patients on Tensostad and other agents that block the RAS.

Do not coadminister aliskiren with Tensostad in patients with diabetes. Avoid use of aliskiren with Tensostad in patients with renal impairment (GFR < 60 ml/min).

Non-Steroidal Anti-Inflammatory Agents including Selective Cyclooxygenase – 2 Inhibitors (COX-2 Inhibitors)

In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of NSAIDs, including selective COX-2 inhibitors, with ACE inhibitors, including Tensostad, may result in deterioration of renal function, including possible acute renal failure. These effects are usually reversible. Monitor renal function periodically in patients receiving Tensostad and NSAID therapy. The antihypertensive effect of ACE inhibitors, including Tensostad, may be attenuated by NSAIDs.

Hypotension - Patients on Diuretic Therapy: Patients on diuretics and especially those in whom diuretic therapy was recently instituted, as well as those on severe dietary salt restriction or dialysis, may occasionally experience a precipitous reduction of blood pressure usually within the first hour after receiving the initial dose of Tensostad.

The possibility of hypotensive effects with Tensostad can be minimized by either discontinuing the diuretic or increasing the salt intake approximately one week prior to initiation of treatment with Tensostad (Tensostad tablets, USP) or initiating therapy with small doses (6.25 or 12.5 mg). Alternatively, provide medical supervision for at least one hour after the initial dose. If hypotension occurs, the patient should be placed in a supine position and, if necessary, receive an intravenous infusion of normal saline. This transient hypotensive response is not a contraindication to further doses which can be given without difficulty once the blood pressure has increased after volume expansion.

Agents Having Vasodilator Activity: Data on the effect of concomitant use of other vasodilators in patients receiving Tensostad for heart failure are not available; therefore, nitroglycerin or other nitrates (as used for management of angina) or other drugs having vasodilator activity should, if possible, be discontinued before starting Tensostad. If resumed during Tensostad therapy, such agents should be administered cautiously, and perhaps at lower dosage.

Agents Causing Renin Release: Tensostad's effect will be augmented by antihypertensive agents that cause renin release. For example, diuretics (e.g., thiazides) may activate the renin-angiotensinaldosterone system.

Agents Affecting Sympathetic Activity: The sympathetic nervous system may be especially important in supporting blood pressure in patients receiving Tensostad alone or with diuretics. Therefore, agents affecting sympathetic activity (e.g., ganglionic blocking agents or adrenergic neuron blocking agents) should be used with caution. Beta-adrenergic blocking drugs add some further antihypertensive effect to Tensostad, but the overall response is less than additive.

Agents Increasing Serum Potassium: Since Tensostad decreases aldosterone production, elevation of serum potassium may occur. Potassium-sparing diuretics such as spironolactone, triamterene, or amiloride, or potassium supplements should be given only for documented hypokalemia, and then with caution, since they may lead to a significant increase of serum potassium. Salt substitutes containing potassium should also be used with caution.

Lithium: Increased serum lithium levels and symptoms of lithium toxicity have been reported in patients receiving concomitant lithium and ACE inhibitor therapy. These drugs should be coadministered with caution and frequent monitoring of serum lithium levels is recommended. If a diuretic is also used, it may increase the risk of lithium toxicity.

Cardiac Glycosides: In a study of young healthy male subjects no evidence of a direct pharmacokinetic Tensostad-digoxin interaction could be found.

Loop Diuretics: Furosemide administered concurrently with Tensostad does not alter the pharmacokinetics of Tensostad in renally impaired hypertensive patients.

Allopurinol: In a study of healthy male volunteers no significant pharmacokinetic interaction occurred when Tensostad and allopurinol were administered concomitantly for 6 days.

Gold

Nitritoid reactions (symptoms include facial flushing, nausea, vomiting and hypotension) have been reported rarely in patients on therapy with injectable gold (sodium aurothiomalate) and concomitant ACE inhibitor therapy including Tensostad.

Drug/Laboratory Test Interaction

Tensostad may cause a false-positive urine test for acetone.

Tensostad side effects

See also:
What are the possible side effects of Tensostad?

Applies to Tensostad: oral liquid, oral tablet

In addition to its needed effects, some unwanted effects may be caused by Tensostad (the active ingredient contained in Tensostad). In the event that any of these side effects do occur, they may require medical attention.

Major Side Effects

You should check with your doctor immediately if any of these side effects occur when taking Tensostad:

Less common:

• Chest pain
• cloudy urine
• fast, pounding, or irregular heartbeat or pulse

Rare

• Arm, back, or jaw pain
• bloody urine
• chest discomfort
• chest tightness or heaviness
• decreased blood pressure
• decreased or increased frequency or amount of urine
• dilated neck veins
• increased thirst
• irregular breathing
• large, hive-like swelling on face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
• loss of appetite
• low blood pressure
• lower back or side pain
• nausea
• paleness or cold feeling in fingertips and toes
• sweating
• swelling of face, fingers, feet, or lower legs
• tingling or pain in fingers or toes when exposed to cold
• troubled breathing or wheezing
• unusual tiredness or weakness
• vomiting
• weight gain

Incidence not known:

• Bleeding gums
• bloody, black, or tarry stools
• blurred vision
• chills
• confusion
• cough
• dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
• high fever
• painful or difficult urination
• pale skin
• pinpoint red spots on skin
• sore throat
• sores, ulcers, or white spots on lips or in mouth
• swollen glands
• unusual bleeding or bruising

Minor Side Effects

Some of the side effects that can occur with Tensostad may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

Less common:

• Change in taste
• feeling of warmth
• itching skin
• loss of taste
• rash
• redness of the face, neck, arms, and occasionally, upper chest

Tensostad contraindications

See also:
What is the most important information I should know about Tensostad?

Do not use Tensostad if you are pregnant. Tensostad can cause injury or death to the unborn baby if you take the medicine during your second or third trimester.

You should not use this medication if you are allergic to Tensostad or to any other ACE inhibitor, such as benazepril (Lotensin), fosinopril (Monopril), enalapril (Vasotec), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), or trandolapril (Mavik).

If you have kidney disease or diabetes, you should not take Tensostad if you are also taking aliskiren (Tekturna, Tekamlo, Valturna, Amturnide).

Drinking alcohol can further lower your blood pressure and may increase certain side effects of Tensostad.

Do not use salt substitutes or potassium supplements while taking Tensostad, unless your doctor has told you to.

Conditions that may cause very low blood pressure include: vomiting, diarrhea, heavy sweating, heart disease, dialysis, a low salt diet, or taking diuretics (water pills). Follow your doctor's instructions about the type and amount of liquids you should drink while taking Tensostad. Tell your doctor if you have a prolonged illness that causes diarrhea or vomiting.

Active ingredient matches for Tensostad:

Captopril in Germany.

Unit description / dosage (Manufacturer)	Price, USD
Tablet; Oral; Captopril 12.5 mg
Tablet; Oral; Captopril 25 mg
Tablet; Oral; Captopril 50 mg
List of Tensostad substitutes (brand and generic names):
Tensoril (Philippines)
Tensoril tab 25 mg 100's (Hizon)	$ 15.00
Terry White Chemists Captopril (Australia)
Tablet; Oral; Captopril 12.5 mg
Tablet; Oral; Captopril 25 mg
Tablet; Oral; Captopril 50 mg
Teva-Captopril (Canada)
Teva-captopril tablet 12.5 mg (Teva Canada Limited (Canada))
Teva-captopril tablet 25 mg (Teva Canada Limited (Canada))
Teva-captopril tablet 50 mg (Teva Canada Limited (Canada))
Teva-captopril tablet 100 mg (Teva Canada Limited (Canada))
Tompril (Brazil)
Topace (Australia)
Tablet; Oral; Captopril 12.5 mg (Fawns & mcallan)
Tablet; Oral; Captopril 25 mg (Fawns & mcallan)
Tablet; Oral; Captopril 50 mg (Fawns & mcallan)
Toprifar (Mexico)
Topril (Bangladesh, India)
TOPRIL Capsule/ Tablet / 5mg / 10 units (Torrent Pharmaceuticals Ltd.)	$ 0.84
TOPRIL Capsule/ Tablet / 2.5mg / 10 units (Torrent Pharmaceuticals Ltd.)	$ 0.47
TOPRIL Capsule/ Tablet / 1.25mg / 10 units (Torrent Pharmaceuticals Ltd.)	$ 0.28
Topril 1.25mg CAP / 10 (Torrent Pharmaceuticals Ltd.)	$ 0.28
Topril 2.5mg CAP / 10 (Torrent Pharmaceuticals Ltd.)	$ 0.47
Topril 5mg CAP / 10 (Torrent Pharmaceuticals Ltd.)	$ 0.85
1.25 mg x 10's (Torrent Pharmaceuticals Ltd.)	$ 0.28
2.5 mg x 10's (Torrent Pharmaceuticals Ltd.)	$ 0.47
5 mg x 10's (Torrent Pharmaceuticals Ltd.)	$ 0.85
Topril 2.5 mg Capsule (Torrent Pharmaceuticals Ltd.)	$ 0.05
Topril 1.25 mg Capsule (Torrent Pharmaceuticals Ltd.)	$ 0.03
Topril 5 mg Capsule (Torrent Pharmaceuticals Ltd.)	$ 0.08
TOPRIL 5MG CAPSULE 1 strip / 10 capsules each (Torrent Pharmaceuticals Ltd.)	$ 0.84
TOPRIL cap 1.25 mg x 10's (Torrent Pharmaceuticals Ltd.)	$ 0.28
TOPRIL cap 2.5 mg x 10's (Torrent Pharmaceuticals Ltd.)	$ 0.47
TOPRIL cap 5 mg x 10's (Torrent Pharmaceuticals Ltd.)	$ 0.85
Topril 1.25mg Capsule (Torrent Pharmaceuticals Ltd.)	$ 0.03
Topril 2.5mg Capsule (Torrent Pharmaceuticals Ltd.)	$ 0.05
Topril 5mg Capsule (Torrent Pharmaceuticals Ltd.)	$ 0.08
Toprilem (Mexico)
Tropisol (Mexico)
Tropix
Unihype (Philippines)
Vapril (Indonesia)
Vapril 12.5 mg x 10 x 10's (Phapros)	$ 2.40
Vapril 25 mg x 10 x 10's (Phapros)	$ 4.66
Varaxil (Mexico)
Tablet; Oral; Captopril 25 mg (Merck)
Vasostad (Philippines)
Vasostad 25 mg x 100's (Stada)	$ 30.67
Venopril (Brazil)
Vero-Captopril
Tablet; Oral; Captopril 25 mg
See 1005 substitutes for Tensostad

References

1. DailyMed. "CAPTOPRIL: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
2. PubChem. "captopril". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
3. DrugBank. "captopril". http://www.drugbank.ca/drugs/DB01197 (accessed September 17, 2018).

Reviews

The results of a survey conducted on ndrugs.com for Tensostad are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Tensostad. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.

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Information checked by Dr. Sachin Kumar, MD Pharmacology