Q: About two weeks ago, while undergoing tests for allergies, I had an allergic reaction; swelling in my lips. I usually take Grifopril 20 mg. It didn't seem to work to help lower my blood pressure, which rose to 183/121. Since then I've been careful to avoid anything with any type of nuts since the reaction was caused by almonds. However, yesterday, under my lower lip, I noticed 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 Grifopril. Could this be angioedema? I have never had problems like this with Grifopril and I've been taking it for 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. I can only take ACE inhibitors and ARBs to lower my blood pressure because of other medical conditions, including CHF. Should I switch to another ACE inhibitor? My blood pressure is around 140/90 when I take Grifopril only, and I was supposed to have a second medication, but which one should I take? 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 associated with Grifopril and usually occurs in the first month of treatment. Although it is possible to experience this condition later during 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 it is thought to be significantly lower than the ACE inhibitors. For patients who cannot take any other alternatives, ARBs seem to be 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 Poulin, PharmD
Will my dose go up or down?
You will probably be prescribed a low dose of Grifopril at first so it doesn't make you feel dizzy. This will usually be increased gradually until you reach the right dose for you. If you're bothered by side effects with Grifopril you can stay on a lower dose.
A multiple dose pharmacokinetic study was conducted in 40 hypertensive male and female pediatric patients aged 2 months to ≤ 16 years following daily oral administration of 0.07 to 0.14 mg/kg Grifopril maleate. At steady state, the mean effective half-life for accumulation of Grifoprilat was 14 hours, and the mean urinary recovery of total Grifopril and Grifoprilat in 24 hours was 68% of the administered dose. Conversion of Grifopril to Grifoprilat was in the range of 63-76%. The overall results of this study indicate that the pharmacokinetics of Grifopril in hypertensive children aged 2 months to ≤ 16 years are consistent across the studied age groups and consistent with pharmacokinetic historic data in healthy adults.
In a clinical study involving 110 hypertensive pediatric patients 6 to 16 years of age, patients who weighed
¿Cuál es la información más importante que debo saber sobre Grifopril?
No use si usted está embarazada. Si queda embarazada, deje de tomar esta medicina y dígale a su médico de inmediato.
Usted no debe usar Grifopril si usted alguna vez ha tenido angioedema. No tome Grifopril durante las 36 horas antes o después de tomar medicina que contiene sacubatril (como Entresto).
Si usted tiene diabetes, no use Grifopril junto con ningún medicamento que contenga aliskiren (como Tekturna o Tekamlo).
Serious side effects
Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:
- Breathing problems. Symptoms include:
- trouble breathing or swallowing
- tightness in your chest
- yellowing of your skin or the whites of your eyes
Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
Grifopril oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.
To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.
Examples of drugs that can cause interactions with Grifopril are listed below.
Hypersensitivity to Grifopril/other ACE inhibitors
History of ACE inhibitor-induced angioedema, hereditary or idiopathic angioedema
Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan
Do not coadminister with aliskiren in patients with diabetes mellitus or with renal impairment (ie, GFR Formulary Patient Discounts
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Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death. Resulting oligohydramnios can be associated with fetal lung hypoplasia and skeletal deformations. Potential neonatal adverse effects include skull hypoplasia, anuria, hypotension, renal failure, and death. When pregnancy is detected, discontinue VASOTEC as soon as possible. These adverse outcomes are usually associated with use of these drugs in the second and third trimester of pregnancy. Most epidemiologic studies examining fetal abnormalities after exposure to antihypertensive use in the first trimester have not distinguished drugs affecting the renin-angiotensin system from other antihypertensive agents. Appropriate management of maternal hypertension during pregnancy is important to optimize outcomes for both mother and fetus.
In the unusual case that there is no appropriate alternative to therapy with drugs affecting the reninangiotensin system for a particular patient, apprise the mother of the potential risk to the fetus. Perform serial ultrasound examinations to assess the intra-amniotic environment. If oligohydramnios is observed, discontinue VASOTEC, unless it is considered lifesaving for the mother. Fetal testing may be appropriate, based on the week of pregnancy. Patients and physicians should be aware, however, that oligohydramnios may not appear until after the fetus has sustained irreversible injury. Closely observe infants with histories of in utero exposure to VASOTEC for hypotension, oliguria, and hyperkalemia (see PRECAUTIONS, Pediatric use).
No teratogenic effects of Grifopril were seen in studies of pregnant rats and rabbits. On a body surface area basis, the doses used were 57 times and 12 times, respectively, the maximum recommended human daily dose (MRHDD).
Grifopril and Grifoprilat have been detected in human breast milk. Because of the potential for serious adverse reactions in nursing infants from Grifopril, a decision should be made whether to discontinue nursing or to discontinue VASOTEC, taking into account the importance of the drug to the mother.
¿Qué es Grifopril?
Grifopril es un inhibidor ECA. ECA se traduce a enzima convertidora de la angiotensina.
Grifopril se usa en el tratamiento de la presión arterial elevada (hipertensión) en adultos y niños que tienen al menos 1 mes de edad.
Grifopril también se usa para tratar el fallo cardíaco congestivo en los adultos.
Grifopril se usa también para tratar un trastorno de los ventrículos (cámaras inferiores del corazón que permiten que la sangre salga del corazón). Este trastorno puede disminuir la capacidad del corazón de bombear sangre al cuerpo.
Grifopril puede también usarse para fines no mencionados en esta guía del medicamento.
Small decreases in hemoglobin and hematocrit (mean decreases of approximately 0.3 g percent and 1.0 vol percent, respectively) occur frequently in either hypertension or congestive heart failure patients treated with VASOTEC but are rarely of clinical importance unless another cause of anemia coexists. In clinical trials, less than 0.1 percent of patients discontinued therapy due to anemia. Hemolytic anemia, including cases of hemolysis in patients with G6PD deficiency, has been reported; a causal relationship to Grifopril cannot be excluded.
Grifopril and breastfeeding
Small amounts of Grifopril may get into breast milk. This can cause low blood pressure in the baby.
- If your baby was born full term and healthy, it's generally safe to take Grifopril while you're breastfeeding.
- If your baby was premature, has a low birthweight or other health problems, talk to your doctor.
Your baby's blood pressure may be monitored, especially if your baby was premature or is newborn.
Talk to your doctor, as another medicine might be better while you're breastfeeding.