Sounds like 'sil-az-ah-pril'

Cilazapril is used to treat high blood pressure and heart failure and to prevent kidney problems in people with diabetes. Find out how to take it safely and possible side effects. Cilazapril is also called Zapril.

Type of medicine Also called
  • Belongs to a group of medicines called ACE inhibitors
  • Zapril®
  • Cilazapril-AFT®
  • Apo-Cilazapril®
  • Apo-Cilazapril/Hydrochlorothiazide® (combination of cilazapril and hydrochlorothiazide)

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 serious side effect. In New Zealand cilazapril is available as tablets.


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

Date Dose

How to take cilazapril

  • Timing: Cilazapril is usually taken once a day. 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.
  • Missed dose: 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.

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.

Things to consider 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. 

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.

Examples of diuretics Examples of NSAIDs
  • Bendroflumetazide (Arrow-Bendrofluazide)
  • Chlortalidone (Hygroton)
  • Indapamide (Dapa-Tabs)
  • Metolazone (Zaroxolyn)
  • Furosemide (Lasix)
  • Bumetanide (Burinex)
  • Spironolactone (Spiractin)
  • Ibuprofen (Ibugesic, I-Profen, Nurofen)
  • Diclofenac (Voltaren)
  • Naproxen (Noflam, Naprosyn)
  • Mefenamic acid (Ponstan)
  • Celecoxib (Celebrex)
  • Tenoxicam (Tilcotil)

What are the side effects of cilazapril?

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.

Side effects What should I do?
  • Dizziness
  • Feeling lightheaded
  • Feeling faint when you stand up
  • This is quite common when you first start taking cilazapril and usually goes way with time.
  • Be careful when getting up from either lying down or sitting to avoid falls. These effects put you at risk of falls and injuries, especially if you are an older adult.
  • Stand up slowly. If you do feel dizzy, sit or lie down for a few moments.
  • Tell your doctor if this continues.
  • Tickle in your throat
  • Dry, irritating cough

  • This is quite common when you first start taking cilazapril and usually goes away with time.
  • Tell your doctor if the cough is troublesome and persistent.
  • Allergic reaction such as skin rash, itching, swelling of your lips, face, and mouth, or difficulty breathing, such as chest tightness or wheezing
  • Tell your doctor immediately or ring HealthLine 0800 611 116.
  • Signs of problems with your liver, such as yellowing of your skin or eyes, dark pee (urine) or pain in your abdomen (tummy)
  • Tell your doctor immediately or ring HealthLine 0800 611 116.
Did you know that you can report a side effect to a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product


  • 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.

Cilazapril (Māori) New Zealand Formulary Patient Information
Zapril Apo-Cilazapril Medsafe Consumer Information


  1. Cilazapril New Zealand Formulary

Additional resources for healthcare professionals

Cilazapril and hydrochlorothiazide NZ Formulary
Zapril Medsafe, NZ
Apo-Cilazapril/Hydrochlorothiazide Medsafe, NZ
Medicines and hyperkalaemia Medsafe, NZ, 2015
Hypertension in adults – the silent killer BPAC, NZ, 2013
Guide for initiation and up-titration of ACE inhibitors in patients with heart failure SafeRx Waitematā DHB, NZ, 2015
How low can the potassium and sodium go with commonly prescribed blood pressure medications? Tools for Practice, Alberta College of Family Physicians (ACFP), May 2016

Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 30 Oct 2018