Benazepril

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Benazepril

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Medically reviewed

Marina Burgos

Last updated on 10/01/2026

This page provides general, reference-level information compiled from official medical sources. It is not a substitute for professional medical advice, diagnosis, or treatment. For decisions about your health, please consult a qualified healthcare professional.

Overview of Benazepril

What is Benazepril?

Benazepril is a medication belonging to the class of drugs known as angiotensin-converting enzyme (ACE) inhibitors. It is primarily used in the management of cardiovascular conditions, specifically to help lower high blood pressure and reduce the workload on the heart.

Mechanism of Action

Benazepril works by inhibiting the activity of the angiotensin-converting enzyme. This enzyme is responsible for the production of angiotensin II, a potent chemical in the body that causes blood vessels to tighten and narrow. By reducing the production of angiotensin II, benazepril allows blood vessels to relax and widen, which facilitates smoother blood flow and lowers overall blood pressure.

In addition to dilating blood vessels, benazepril decreases the secretion of aldosterone, a hormone that promotes the retention of salt and water by the kidneys. By lowering aldosterone levels, the medication helps the body eliminate excess fluid, further assisting in the reduction of blood pressure.

Primary Uses

Benazepril is commonly prescribed for the following purposes:

  • Hypertension: To lower blood pressure in individuals with hypertension, which helps prevent long-term complications such as strokes and heart attacks.
  • Heart Failure Management: To assist in the treatment of heart failure, often in combination with other medications, by improving the heart's ability to pump blood effectively.
  • Renal Protection: To help protect kidney function in certain patients, particularly those with conditions that may lead to progressive kidney damage.

Chemical Properties

Benazepril is typically administered as benazepril hydrochloride. It is a prodrug, meaning that after ingestion, it is converted by the liver into its active metabolite, benazeprilat. Benazeprilat is the substance responsible for the therapeutic effects associated with the medication.

Regulatory References

  1. Benazepril - LiverTox - NCBI Bookshelf

What side effects are possible with Benazepril?

Possible Side Effects and Safety Information

Benazepril's official safety profile, as documented in regulatory sources, classifies possible side effects based on their frequency and the system-organ-class affected. Reactions classified as Common, affecting 1 to 10 users in 100, typically include headache, dizziness, fatigue, and a characteristic dry cough, which is a known class effect of ACE Inhibitors. Other common effects include hypotension (low blood pressure) and related orthostatic effects.

Adverse reactions involving the gastrointestinal system, such as nausea, vomiting, diarrhea, and constipation, are generally documented as uncommon.

Serious Adverse Reactions and Safety Constraints

Certain reactions, although rare or very rare, are explicitly defined as serious safety concerns. The most critical is Angioedema, a severe swelling of the face, lips, tongue, or throat, which mandates immediate and permanent cessation of therapy. Other very rare serious events documented in regulatory labeling include Hepatic Failure and Agranulocytosis.

Safety notes specify patterns tied to exposure: Hypotension is most likely to occur at the initiation of treatment or during dose escalation. Furthermore, Benazepril is contraindicated during the second and third trimesters of pregnancy and in individuals with a history of angioedema related to previous ACE inhibitor use. Monitoring of kidney function is also noted in patients with renal impairment.

Overdose and Emergency Response

Overdose and when to seek help

A Benazepril overdose is characterized by predictable physiological effects, requiring specific and immediate emergency response actions as defined in regulatory documents. The most likely and expected clinical presentation is Severe Hypotension (profoundly low blood pressure), which may lead to symptoms such as dizziness and syncope (fainting). Other documented manifestations include changes in heart rhythm, such as tachycardia or bradycardia, and potentially central nervous system effects like stupor or drowsiness.

Overdose carries the risk of serious outcomes, including progression to circulatory shock and critical laboratory abnormalities. These include the risk of Hyperkalemia (high potassium) and potential Acute Renal Failure. Due to these risks, individuals must seek immediate medical attention for any suspected overdose or if severe symptoms are present.

Official regulatory information states that no specific antidote is known for Benazepril overdose. Therefore, management is strictly symptomatic and supportive. Required interventions include continuous monitoring of vital signs, serum electrolytes, and renal function. Treatment for marked hypotension involves volume expansion, typically through the intravenous infusion of physiological saline solution. Patients who are volume-depleted may face a heightened risk of complications.

Therapeutic Uses of Benazepril

Quick Facts: Therapeutic Domains

  • High Blood Pressure (Hypertension): Used to facilitate the management of high blood pressure, either as a stand-alone option or as part of a combination regimen.
  • Heart Conditions: Utilized in the treatment protocols for congestive heart failure.
  • Kidney Health: May be used to support kidney health in certain patients with chronic kidney disease (nephropathy).

What Benazepril Treats: Main Uses and Benefits

Benazepril is an authorized prescription medication that helps in the management of hypertension (high blood pressure). When used for this purpose, its goal is to help reduce elevated blood pressure readings. This reduction is understood to help lower the potential risk for major cardiovascular and cerebrovascular events, such as a myocardial infarction or stroke.

The medication is also utilized as part of a therapeutic regimen for patients diagnosed with congestive heart failure. In this setting, it may be used to help support cardiac function and alleviate associated symptoms. Furthermore, in non-diabetic individuals with specific kidney issues (nephropathy), benazepril may be considered as a treatment option to help slow the progression of chronic kidney disease and help reduce the presence of protein in the urine. The healthcare provider determines the appropriate use of this medication based on a complete health evaluation.

Regulatory References

  1. NIH MedlinePlus guidance

Eligibility and Restrictions for Use

Benazepril is an Angiotensin-Converting Enzyme (ACE) inhibitor approved primarily for treating high blood pressure (hypertension) in adults and children aged 6 years and older. It may also be used for certain other heart and kidney conditions as determined by a healthcare provider.

Contraindications (Who Should NOT Use Benazepril)

Benazepril is contraindicated (should not be used) in patients with specific medical conditions or those taking certain medications, due to the risk of serious side effects:

  • Pregnancy: Benazepril can cause injury or death to the developing fetus, especially during the second and third trimesters. It must be discontinued immediately if pregnancy is detected.
  • History of Angioedema: Patients who have a history of angioedema (severe swelling of the face, lips, tongue, or throat), whether related to previous ACE inhibitor use or hereditary/idiopathic, should not use benazepril.
  • Hypersensitivity: Known allergy to benazepril or any other ACE inhibitor (such as lisinopril, enalapril, or ramipril).
  • Concomitant Use with Specific Drugs:
    • Sacubitril/Valsartan (Entresto): Benazepril is contraindicated within 36 hours of taking a neprilysin inhibitor like sacubitril, due to an increased risk of angioedema.
    • Aliskiren: It is contraindicated in combination with aliskiren (another blood pressure medication) in patients who have diabetes or moderate-to-severe kidney impairment.

Other Considerations

Caution and dosage adjustment may be necessary in patients with existing kidney impairment, liver disease, severe heart failure, or those who are on dialysis or have low blood volume/dehydration (e.g., from high-dose diuretics, vomiting, or diarrhea). Use in children under 6 years of age is not recommended. Always discuss your complete medical history and all current medications with your doctor before starting benazepril.

What should I know about interactions with other medicines?

Interactions with other medicines and products

Benazepril, an Angiotensin-Converting Enzyme (ACE) inhibitor, has documented interactions that primarily relate to affecting blood pressure, potassium balance, and the risk of angioedema. This information is based on official regulatory labeling.


Contraindicated and High-Risk Combinations

Interaction Type Interacting Agent(s) Official Constraint
Dual RAS Blockade Aliskiren Contraindicated in patients with diabetes mellitus or renal impairment (GFR < 60 mL/min/1.73m^2).
Angioedema Risk Neprilysin Inhibitors (e.g., sacubitril) Contraindicated. Must not be administered within 36 hours of benazepril.

Other Significant Interactions

  • Potassium-Sparing Agents: Co-administration with potassium-sparing diuretics (e.g., spironolactone) or potassium supplements can lead to an increased risk of hyperkalemia (high serum potassium). Other agents that increase serum potassium, such as trimethoprim and heparin, pose a similar risk.
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These may reduce the blood pressure lowering effect of benazepril. Concomitant use increases the risk of worsening kidney function, particularly in elderly or volume-depleted patients.
  • Lithium: Benazepril can reduce the renal clearance of lithium, potentially leading to increased lithium concentrations and toxicity.
  • Food: Food intake slows the rate of absorption of the active metabolite, benazeprilat, but does not significantly affect the total amount absorbed.

Mechanism of Action

Benazepril is an angiotensin-converting enzyme (ACE) inhibitor and an inactive prodrug. Following absorption, the ethyl ester moiety undergoes hydrolysis in vivo, primarily in the liver, catalyzed by esterase enzymes, converting Benazepril into its active metabolite, Benazeprilat. Benazeprilat is a competitive, reversible inhibitor of the zinc metalloenzyme ACE, also known as kininase II, which is membrane-bound and highly concentrated in the pulmonary and renal endothelium. This interaction sterically hinders the active site of ACE, preventing its enzymatic function. The primary molecular consequence is the suppression of the ACE-catalyzed conversion of the inactive angiotensin I decapeptide into the potent vasoconstrictor angiotensin II octapeptide. Furthermore, Benazeprilat inhibits the breakdown of the vasoactive peptide bradykinin by kininase II, thereby increasing local bradykinin levels. The intracellular cascade resulting from reduced Angiotensin II signaling includes decreased activation of the angiotensin type 1 ( AT1) receptor and subsequent reduction in aldosterone secretion from the adrenal cortex. The system-level physiological consequence of decreased Angiotensin II and increased bradykinin is peripheral vasodilation and a reduction in systemic vascular resistance.

Dosage and Administration Information

How Benazepril is Used

Benazepril is administered via the oral route, primarily as a film-coated tablet that is swallowed whole. Its use is based on a structured, long-term protocol involving initiation and titration.


Administration Patterns and Dosing Regimens

The standard frequency for Benazepril is once daily, although the total daily dose may be given in two equally divided doses if blood pressure control is inadequate at the end of the 24-hour interval. The tablets can be taken with or without food, as the presence of a meal does not significantly alter the drug’s absorption.

The treatment process begins with a specific starting dose that is subsequently adjusted (titrated) based on the patient's blood pressure response until the target control is achieved.

Usage Context Dosing Rule Maximum Daily Dose
Initial Dose (Standard) 10 mg once daily 80 mg
Initial Dose (Diuretic Use or Renal Impairment) 5 mg once daily 40 mg (Renal Impairment)
Maintenance Range (Adults) 20 mg to 40 mg daily 80 mg

Specific Population Instructions

There are specific dose reductions for certain groups. For adults with significant renal impairment (serum creatinine >3 mg/dL), the initial dose is 5 mg daily, and the maximum is limited to 40 mg. Pediatric patients 6 years of age and older receive a starting dose based on body weight (0.2 mg/kg daily). Additionally, for patients who cannot swallow tablets, the medication may be administered as an extemporaneous oral suspension that must be specially compounded by a pharmacist.

Recent Clinical Evidence

Research exploring Benazepril for elevated blood pressure was conducted using substantial Randomized Controlled Trials (RCTs) designed to measure changes in Systolic and Diastolic Blood Pressure. Studies monitored patients for long-term changes in intermediate outcomes like Left Ventricular Mass (LVM) and researched the medication's relation to the frequency of composite cardiovascular events (e.g., nonfatal myocardial infarction and stroke). The data show patterns related to measured changes in blood pressure, and long-term analyses reported measured differences in the occurrence of cardiovascular events.


Research exploring Benazepril in studies assessing renal outcomes was conducted primarily in patients with non-diabetic renal disease. RCTs monitored important endpoints related to the rate of progression of renal disease, including changes in Proteinuria and the time to doubling of serum creatinine. Findings indicate that the medication was associated with measured differences in proteinuria levels, and this evidence is relevant to the broader ACE inhibitor drug class.


For congestive heart failure, Benazepril was observed in clinical research as part of a therapeutic regimen. Studies monitored changes in indices of cardiac function and patient-reported outcomes related to symptoms. Trial results documented patterns relevant to the research of the ACE inhibitor drug class in heart failure. Regulatory documentation notes that evidence establishment has not been fully achieved for use in patients with renovascular hypertension in the context of heart failure.


Long-term follow-up data contributes to understanding the sustained nature of measured patterns, with the largest cardiovascular outcomes research exploring follow-up durations of up to 36 months. However, key limitations remain: the follow-up durations were limited in some studies, and certainty remains low for populations outside the key trial criteria, such as children under 6 years of age. Research suggests that the measured change in blood pressure from monotherapy may also be different across certain patient populations.

Key Studies & References

  1. Executive summary of the KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease
  2. Benazepril (Oral Route) - MedlinePlus Drug Information

Frequently Asked Questions (FAQ)

Common questions about Benazepril (FAQ)


Q: How long does it take for Benazepril to start working for blood pressure?

Official studies indicate that Benazepril begins to lower blood pressure within 1 hour of a single dose, with the peak reduction typically occurring 2 to 4 hours after intake. For sustained management, the full expected blood pressure effect is generally observed after 1 to 2 weeks of taking the medication regularly.


Q: Can Benazepril affect kidney function test results?

Because of how the medicine works, official product information indicates the need for periodic monitoring of kidney function and serum potassium levels. Official guidance recommends this monitoring due to the risk of worsening kidney function or causing hyperkalemia (high potassium levels) in some patients.


Q: What happens if you stop taking Benazepril suddenly?

Regulatory documents state that abrupt withdrawal of Benazepril has not been associated with a rapid or uncontrolled increase in blood pressure. It is established that patients should follow the instructions provided by their healthcare provider regarding when and how to cease taking this medication.


Q: Do you have to take Benazepril at the same time every day?

Benazepril is typically prescribed to be taken once daily. Official guidance indicates that taking the medication at consistent times each day supports consistent blood pressure control throughout the 24-hour period.


Q: Is there a generic version of Benazepril available?

Yes, the compound Benazepril hydrochloride is available as a generic drug. This means the active ingredient is presented in various tablet forms equivalent to the original brand name medication.


Q: Are there certain foods or drinks to avoid while taking Benazepril?

Official information states that the absorption of Benazepril is not affected by food. Official labeling suggests consultation regarding the use of potassium-containing salt substitutes or a high-salt diet, as these may affect efficacy and safety.


Q: Can Benazepril be safely used in older adults?

Studies suggest that Benazepril is handled by the body (pharmacokinetics) in a similar way regardless of age. Because older adults are more likely to have decreased kidney function, official labeling notes that monitoring of kidney function may be useful for this population.


Q: Does Benazepril interact with dietary supplements?

Yes, official labeling specifically documents an interaction risk with potassium supplements. Taking these alongside Benazepril can increase the risk of hyperkalemia, which means having high levels of potassium in the blood.


Q: If I miss a dose of Benazepril, what am I supposed to do?

If a dose is missed, regulatory guidance suggests taking it as soon as possible. However, if it is almost time for your next scheduled dose, the typical instruction is to skip the missed dose and continue with your regular schedule. It is typically advised that patients do not double the dose to compensate for a missed one.


Q: Can Benazepril affect blood sugar levels?

Official drug interaction information states that when Benazepril is taken with antidiabetic medicines (like insulin or oral agents), it may increase the risk of hypoglycemia (low blood sugar). Regulatory documents advise that patients using both medications should be monitored.


Q: Does Benazepril interact with alcohol consumption?

Yes, official safety information indicates that alcohol may have additive effects in lowering blood pressure. Consuming alcohol while taking Benazepril could potentially lead to symptoms like excessive dizziness or fainting.


Q: Are there any known interactions between Benazepril and cold medicines?

Official interaction summaries warn that certain cough-and-cold products and diet aids may contain ingredients that could increase blood pressure. When taken with Benazepril, this could reduce the expected effect of the blood pressure medicine.


Q: Can Benazepril be crushed or split in half?

The tablet should be swallowed whole. Regulatory information advises against breaking, crushing, or chewing it. If a patient is unable to swallow tablets, official labeling refers to the use of an extemporaneously prepared liquid suspension.


Q: Are there any requirements about Benazepril and driving or operating machinery?

Due to the risk of dizziness or lightheadedness, caution is described as necessary when driving or operating hazardous machinery. This guidance is necessary until the individual understands how the medication may affect their alertness.


Q: How long does the blood pressure lowering effect of Benazepril last?

Studies show that both single and multiple daily doses of Benazepril provide inhibition of the ACE enzyme for at least 24 hours. This ensures that the blood pressure-lowering effect of a single dose is sustained for a full day.


Q: Does Benazepril expire?

Yes, all medications, including Benazepril, have an expiration date. Regulatory guidance mandates that outdated or unused medicine must be disposed of properly by consulting a healthcare professional for specific instructions.


Q: Is Benazepril the same as Lotensin?

Lotensin is the brand name under which the active pharmaceutical ingredient Benazepril hydrochloride is marketed. Therefore, they refer to the same medication.


Q: Can Benazepril cause changes to a person's mood?

While not listed as a common effect, clinical trial documents note adverse reactions related to the nervous system, including insomnia (difficulty sleeping) and nervousness.


Q: What are the typical benefits seen in people taking Benazepril?

The primary documented benefit is to lower elevated blood pressure. In the context of long-term management, this action is associated with a reduced risk of cardiovascular events, particularly strokes and myocardial infarctions, as cited in official information.


Q: How is Benazepril excreted from the body?

Official product information on pharmacokinetics indicates that Benazepril and its active form, Benazeprilat, are primarily cleared from the body through renal excretion, meaning they are eliminated via the kidneys.


Q: What information is available about Benazepril in breastfeeding?

According to official drug information sources, the amounts of Benazepril found in breastmilk are considered low. Based on this data, the amounts ingested by the infant are not expected to cause adverse effects.


Q: What happens if Benazepril is taken with a high-salt meal?

Studies have shown that the blood pressure-lowering effect of Benazepril was not appreciably different in patients receiving either high- or low-sodium diets. However, consultation regarding overall dietary sodium intake is typically noted in general guidance for blood pressure management.


Q: How does Benazepril affect people who have asthma?

Official documentation lists asthma and dyspnea (shortness of breath) as adverse reactions reported during clinical trials.


Q: What are the specific conditions Benazepril is approved to treat?

Benazepril is officially indicated for the treatment of hypertension (high blood pressure). Regulatory bodies also acknowledge its role for certain other heart and kidney conditions, as supported by published research and medical practice.

How should Benazepril be stored and disposed of?

Storage and Disposal of Benazepril

Benazepril tablets must be stored at controlled room temperature, specifically between 20 C to 25 C (68 F to 77 F), and must be kept in a tightly closed container.

Environmental Requirements

It is mandatory to protect the tablets from light and moisture, and the medicine must not be frozen. The extemporaneously prepared liquid suspension has different requirements; it must be stored under refrigeration (2 C to 8 C) and is stable for only 30 days.

All forms of Benazepril must be stored out of the reach and sight of children.

Disposal

Outdated or unused medicine should be disposed of promptly. Regulatory guidance requires consulting a healthcare professional, such as a pharmacist, for specific instructions on how to properly discard the unused product.

Attention! Always consult to a doctor or pharmacist before using pills or medicines.

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