Cilazapril belongs to the family of medications known as angiotensin converting enzyme (ACE) inhibitors. It is used to treat high blood pressure and congestive heart failure (CHF). Cilazapril controls blood pressure and reduces symptoms of congestive heart failure by relaxing blood vessels and making the heart pump more efficiently.

To treat high blood pressure, cilazapril may be used alone or in combination with diuretics (water pills) known as thiazide diuretics (e.g., hydrochlorothiazide) when one medication has not been found to sufficiently control blood pressure.

Cilazapril is used in addition to digoxin, thiazide diuretics, or both, for the treatment of CHF when these medications have not produced enough of a response.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The usual recommended dose depends on the condition being treated as well as other medications you may be taking, and other medical conditions. Your doctor may gradually increase the dose based on how well the medication is working for you and whether you are experiencing side effects.

The usual dose range for treatment of high blood pressure is 2.5 mg to 5 mg once daily, depending on kidney and liver function.

The usual dose range for congestive heart failure is 1 mg to 2.5 mg taken once daily, depending on kidney and liver function.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

For the greatest benefit of this medication, cilazapril should be taken at the same time each day, either with or without food.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not take this medication if you:

• are allergic to cilazapril or any ingredients of this medication
• are pregnant or plan to become pregnant
• are breast-feeding
• are not producing urine
• have been diagnosed with hereditary angioedema
• have a history of angioedema (a serious allergic reaction which causes the area around the throat and tongue to swell) after taking any ACE inhibitors
• have ascites (swollen abdomen due to liver problems)
• have diabetes and/or kidney disease and are taking the medication aliskiren or an angiotensin receptor blocker (ARB)
• have galactose intolerance or glucose malabsorption (a rare hereditary disease)
• are taking any medication containing sacubitril

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• abdominal pain
• constipation
• cough (dry, persistent)
• decreased appetite
• diarrhea
• dizziness
• drowsiness
• flushing
• headache
• increased sweating
• joint pain
• muscle cramps
• nausea
• pins and needles sensation
• runny or stuffed nose
• trouble sleeping
• unusual tiredness
• vomiting
• weakness (loss of energy)

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• dizziness, lightheadedness, or fainting (signs of low blood pressure)
• increased heart rate
• lupus-like symptoms (e.g., fever, fatigue, joint and muscle pain, general feeling of being unwell)
• signs of anemia (low red blood cells; e.g., pale skin, unusual tiredness or weakness)
• signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don't stop bleeding)
• signs of infection (e.g., fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
• signs of kidney or urinary tract problems (e.g., difficulty urinating, pain when urinating, decreased amount of urine passed)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• signs of too much potassium in the body (e.g., confusion; irregular heartbeat; nervousness; numbness or tingling in hands, feet, or lips; shortness of breath or difficulty breathing; weakness or heaviness of legs)
• skin rash (with or without itching, fever, or joint pain)
• symptoms of irregular heartbeat (e.g., chest pain, dizziness, rapid, pounding heartbeat, shortness of breath)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• chest pain
• difficulty swallowing or breathing (sudden)
• signs of angioedema (e.g., swelling of face, mouth, hands, or feet)
• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• signs of a heart attack (e.g., chest pain or pressure, pain extending through shoulder and arm, nausea and vomiting, sweating)
• signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)
• signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort
• signs of stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Angioedema: Angioedema is a serious allergic reaction that causes the area around the face, throat, and tongue to swell. Angioedema may also affect the digestive system. It may occur with use of cilazapril. If you experience swelling of the face, tongue, or throat, or you experience unexpected abdominal pain that may be accompanied by nausea or vomiting, stop taking cilazapril at once and get immediate medical attention. Do not take other ACE inhibitors in the future. If you have had angioedema caused by other substances, you may be at increased risk of angioedema while receiving cilazapril.

Cough: ACE inhibitors such as this medication may cause you to develop a dry, persistent cough within hours of the first dose to weeks or months after starting therapy. The cough usually resolves within 4 weeks of stopping this medication. Talk to your doctor if you develop a persistent, intolerable cough.

Diabetes: Cilazapril may cause a decrease in blood sugar levels and increased effects from medications used to reduce blood glucose. You may find it necessary to monitor your blood sugar more frequently while using this medication.

If you have diabetes or are at risk for developing diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Drowsiness/reduced alertness: Cilazapril may cause drowsiness or dizziness, particularly when you are starting the medication or increasing your dose. This can affect your ability to drive or operate machinery. Avoid driving, operating machinery, or performing other potentially hazardous tasks until you have determined how you are affected by this medication.

Fluid and electrolyte balance: Increases in blood levels of potassium occur for some people who take this medication. This rarely causes problems, but potassium levels should be monitored by your doctor. If you have kidney disease or diabetes there is a higher risk of having increased blood potassium while taking cilazapril. Discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Infection: Cilazapril can reduce the number of cells that fight infection in the body (white blood cells). This makes you more likely to experience infections.

Tell your doctor if you notice signs of an infection such as fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness. Your doctor should do blood tests periodically, to monitor the number of specific types of blood cells in your blood.

Kidney function: Decreased kidney function or kidney disease can cause this medication to build up in the body, causing side effects.

Changes in kidney function have been noticed in people with narrowed blood vessels in their kidneys, or those with severe congestive heart failure. The use of diuretics (water pills), nonsteroidal anti-inflammatory drugs (NSAIDs), or aliskiren may further increase risk of kidney problems in those at risk for this problem. Let your doctor know if you notice any decreases in urine output or increases in the swelling of lower limbs, suggesting accumulation of fluid due to decreased urination.

Liver function: Decreased liver function or liver disease can cause this medication to build up in the body, causing side effects. This medication may also worsen liver disease or cause reduced liver function. If you have liver disease or decreased liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Low blood pressure: Occasionally, blood pressure drops too low after taking cilazapril. This usually happens after the first or second dose, or when the dose is increased. It is more likely to occur for people who take water pills, have a salt-restricted diet, are on dialysis, are suffering from diarrhea or vomiting, or have been sweating excessively and not drinking enough liquids. If low blood pressure causes you to faint or feel lightheaded, contact your doctor.

Surgery: Cilazapril may interact with medications used during surgery. If you are scheduled for surgery, let your doctor know that you are taking this medication.

Pregnancy: Like other ACE inhibitors, cilazapril may cause harm to an unborn fetus and should not be used during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if this medication passes into breast milk. If you are breast-feeding and are taking cilazapril, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of cilazapril have not been established for children. Its use by this age group is not recommended.

Seniors: People over the age of 65 are more likely to experience the side effects of cilazapril. Lower doses may be appropriate for these people.

There may be an interaction between cilazapril and any of the following:

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.