Cilazapril

What is cilazapril?

Cilazapril has many different effects on the body and is used to treat a variety of conditions. It belongs to a group of medicines called ACE inhibitors. Cilazapril may be used for:

• high blood pressure by relaxing and widening your blood vessels and lowering your blood pressure
• heart failure to help your heart pump blood more easily – this can help to relieve symptoms such as shortness of breath and swelling in your feet, legs and abdomen (tummy)
• diabetic kidney disease (diabetic nephropathy) to protect your kidneys and help them to function.

Cilazapril can work quickly for hypertension (high blood pressure). If you have heart failure it may be a few weeks before you notice an improvement in your symptoms. Once you have started cilazapril you will generally keep taking it for life unless you have a side effect. In New Zealand cilazapril is available as tablets.

Dose

Cilazapril tablets are available in different strengths: 500 micrograms, 1 mg, 2.5 mg and 5 mg. 

• Your doctor will tell you the dose that is right for you. Your dose of cilazapril will depend on what it is being used for.
• Your doctor will usually start you on a low dose and increase the dose depending on how you respond. This allows your body to get used to the medicine and reduces side effects.
• Cilazapril is usually taken once a day.
• Always take your cilazapril exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much cilazapril to take, how often to take it and any special instructions.
• Check with your pharmacist if your tablets are different to what you expect.

My dose

How to take cilazapril

• Take your cilazapril dose at the same time each day. It is best taken in the morning.
• You can take cilazapril with or without food.
• Limit alcohol intake while you are taking cilazapril. Alcohol can increase your chance of side effects such as dizziness and light-headedness.
• If you forget to take your dose, take it as soon as you remember. But if it is nearly time for your next dose, just take the next dose at the right time. Do not take double the dose.
• Do not take potassium tablets while you are taking cilazapril, unless your doctor tells you to. 

Precautions – before taking cilazapril

• Are you pregnant or planning a pregnancy?
• Are you breastfeeding?
• Do you have problems with your kidneys or liver?
• Have you ever had an allergic reaction with swelling of your lips, eyes or tongue (called angioedema)?
• Are you are taking or using any other medicines? This includes any medicines you are using which are available to buy from a pharmacy, supermarket or natural health store without a prescription.

If so, it’s important that you tell your doctor or pharmacist before you start taking cilazapril. Sometimes a medicine isn’t suitable for a person with certain conditions or it can only be used with extra care.

Cautions while you are taking cilazapril

Have a sick day plan

If you have diarrhoea or are vomiting from a stomach bug, or have dehydration from other causes, it’s important to let your GP know, as they may advise you to stop taking your cilazapril for a few days and start again when you feel better. The reason for this is that cilazapril can increase the amount of potassium salts in your blood, particularly if you are dehydrated.

Be careful when taking some pain relief medicines

ACE inhibitors can be used to protect your kidneys from damage if you have diabetes. However, if you are taking cilazapril and diuretics (water pills), the combination of these with NSAIDs (anti-inflammatory pain relief medication) can be very harmful to your kidneys. It can cause acute kidney injury. This combination is called the 'dangerous trio' or 'triple whammy'. You have a higher risk of harm to your kidneys if you are also an older adult (over 65 years) or are dehydrated. 

If you are taking an ACE inhibitor with a diuretic, do not use NSAIDs for pain relief. Ask your doctor or pharmacist for a safer option. Read more about NSAIDs and protecting your kidneys.

Possible side effects

Like all medicines cilazapril can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Interactions

• Cilazapril interacts with a few medications and herbal supplements so check with your doctor or pharmacist before starting cilazapril or before starting any new medicines.
• Also, check with your pharmacist before taking over-the-counter medicines such as:
  • anti-inflammatories such as diclofenac (eg, Voltaren Rapid)
  • ibuprofen (eg, Nurofen), naproxen (eg, Naprogesic).

Learn more

The following links provide more information on cilazapril.

Zapril   Apo-Cilazapril Medsafe Consumer Information
Cilazapril New Zealand Formulary Patient Information

References

1. Cilazapril New Zealand Formulary