Q: About two weeks ago, while undergoing tests for allergies, I had an allergic reaction - swelling in my lips. I usually take Co-Mepril and I took 20 mg doing that time. It didn't seem to work to help lower my blood pressure, which rose to 183/121. Anyhow, since then I've been careful to avoid anything with any type of nuts since the reaction was caused by almonds. However, I noticed yesterday under my lower lip a funny feeling and I eventually looked in the mirror. I saw redness and one small spot of swelling on the skin. I was baffled as to what could have caused it. I later remember it hadn't been long since I'd taken a dose of Co-Mepril. Could this now be causing the angioedema? I never had problems like this with the Co-Mepril and I've been taking it at least five years. I do feel I have "plateaued" on it. I've been taking the maximum dose for more than a year and it doesn't seem to have the same effects as before. Second question - I can only take ACE Inhibitors and ARBs to lower my BP because of other medical conditions, including CHF. Should I get another ACE Inhibitor? My BP is around 140/90 when I take Co-Mepril only, and I was supposed to have a second med, but which one? I've had trouble with some of the others including clonidine, Nifedipine, Norvasc, metoprolol and propanolol, and they all had to be stopped.
A: Angioedema is an uncommon side effect with Co-Mepril and usually occurs in the first month of treatment. Although it is possible to have this condition occur later in treatment, it is more common in African-American patients, women and people who have a history of drug or seasonal allergies. The exact prevalence and incidence of ARB-induced angioedema are not known, but are thought to be significantly lower than the ACE inhibitors. For patients who cannot take any other alternatives, ARBs seem the way to go for people who have had this issue with ACE inhibitors, although careful monitoring is recommended for the physician. There are no clear cut ways to distinguish which medication would be best in this case for your condition, but it has been shown that losartan (Cozaar) seems to show the most cases with angioedema, if it happens at all, with the ARBs. Lori Mendoza, PharmD Poulin, PharmD
Taking lithium with Co-Mepril may increase the lithium levels in your body. This may make you have more side effects.
Using injectable gold with Co-Mepril may increase your risk of a nitritoid reaction. Nitritoid reactions affect the constriction or dilation of your blood vessels. Symptoms include:
- warmth and reddening of your face and cheeks (flushing)
- low blood pressure
Do not use Co-Mepril if you are pregnant. If you become pregnant, stop taking this medicine and tell your doctor right away.
You should not use Co-Mepril if you have ever had angioedema. Do not take Co-Mepril within 36 hours before or after taking any medicine that contains sacubatril (such as Entresto).
If you have diabetes, do not use Co-Mepril together with any medication that contains aliskiren (such as Tekturna or Tekamlo).
Co-Mepril can affect your heart or your electrolyte levels. Call your doctor if you have chest pain, pounding heartbeats or fluttering in your chest, a slow heart rate or weak pulse, a tingly feeling, muscle weakness, or muscle tightness or contraction.
How to use Co-Mepril Maleate
Take this medication by mouth with or without food as directed by your doctor, usually once or twice daily.
If you are using the suspension form of this medication, shake the bottle well before each dose. Carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.
The dosage is based on your medical condition and response to treatment. For children, the dosage is also based on weight.
Use this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time(s) 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 several 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).
Serious allergic reaction
It is possible to have a serious allergic reaction (anaphylaxis) to Co-Mepril.
What is Co-Mepril?
Co-Mepril is an ACE inhibitor. ACE stands for angiotensin converting enzyme.
Co-Mepril is used to treat high blood pressure (hypertension) in adults and children who are at least 1 month old.
Co-Mepril is also used to treat congestive heart failure (CHF). CHF is a disorder of the ventricles (the lower chambers of the heart) which decreases the heart’s ability to pump blood to the body.
Before taking Co-Mepril,
- tell your doctor and pharmacist if you are allergic to Co-Mepril; other ACE inhibitors such as benazepril (Lotensin, in Lotrel), captopril (Capoten), fosinopril (Monopril), lisinopril (in Prinzide, in Zestoretic), moexipril (Univasc, in Uniretic), perindopril (Aceon), quinapril (Accupril, in Accuretic, in Quinaretic), ramipril (Altace), and trandolapril (Mavik, in Tarka); any other medications; or any ingredients in Co-Mepril tablets. Ask your pharmacist for a list of the ingredients.
- tell your doctor or pharmacist if you are taking valsartan and sacubitril (Entresto) or if you have stopped taking it within the last 36 hours. Your doctor will probably tell you not to take Co-Mepril, if you are also taking valsartan and sacubitril. Also, tell your doctor if you have diabetes and you are taking aliskiren (Tekturna, in Amturnide, in Tekamlo, in Tekturna HCT). Your doctor will probably tell you not to take Co-Mepril if you have diabetes and you are also taking aliskiren.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin (Indocin, Tivorbex); diuretics ('water pills'); lithium (Lithobid); and potassium supplements. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have or have ever had heart or kidney disease; lupus; scleroderma (a condition in which extra tissue grows on the skin and some organs); diabetes; or angioedema (a condition that causes difficulty swallowing or breathing and painful swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs).
- tell your doctor if you are breastfeeding.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking Co-Mepril.
- you should know that diarrhea, vomiting, not drinking enough fluids, and sweating a lot can cause a drop in blood pressure, which may cause lightheadedness and fainting.
What should I avoid while taking Co-Mepril?
Drinking alcohol can further lower your blood pressure and may increase certain side effects of Co-Mepril.
Do not use salt substitutes or potassium supplements while taking Co-Mepril, unless your doctor has told you to.
Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.
Algunos efectos secundarios pueden ser graves. Si experimenta algunos de los siguientes sГntomas, llame a su mГ©dico de inmediato:
- inflamaciГіn de la cara, la garganta, la lengua, los labios, los ojos, las manos, los pies, los tobillos o las pantorrillas
- dificultad para respirar o tragar
- coloraciГіn amarillenta en la piel o los ojos
- fiebre, dolor de garganta, escalofrГos y otros signos de infecciГіn
El Co-Mepril puede provocar otros efectos secundarios. Llame a su mГ©dico si tiene algГєn problema inusual mientras toma este medicamento.
Si desarrolla un efecto secundario grave, usted o su doctor puede enviar un informe al programa de divulgaciГіn de efectos adversos 'MedWatch' de la AdministraciГіn de Alimentos y Medicamentos (FDA, por su sigla en inglГ©s) en la pГЎgina de Internet (http://www.fda.gov/Safety/MedWatch) o por telГ©fono al 1-800-332-1088.
VASOTEC® (Co-Mepril Maleate) is the maleate salt of Co-Mepril, the ethyl ester of a long-acting angiotensin converting enzyme inhibitor, Co-Meprilat. Co-Mepril maleate is chemically described as (S)-1-L-alanyl]-L-proline, (Z)-2-butenedioate salt (1:1). Its empirical formula is C20H28N2O5•C4H4O4, and its structural formula is:
Co-Mepril maleate is a white to off-white, crystalline powder with a molecular weight of 492.53. It is sparingly soluble in water, soluble in ethanol, and freely soluble in methanol.
Co-Mepril is a pro-drug; following oral administration, it is bioactivated by hydrolysis of the ethyl ester to Co-Meprilat, which is the active angiotensin converting enzyme inhibitor.
Co-Mepril maleate is supplied as 2.5 mg, 5 mg, 10 mg, and 20 mg tablets for oral administration. In addition to the active ingredient Co-Mepril maleate, each tablet contains the following inactive ingredients: lactose, magnesium stearate, sodium bicarbonate, and starch. The 10 mg and 20 mg tablets also contain iron oxides.