Vascase

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Vascase

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Medically reviewed

Marina Burgos

Last updated on 22/12/2025

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 Vascase

Quick Facts

Property Description
Active Ingredient Cilazapril (as monohydrate)
Form Film-coated tablet (Oral preparation)
Pharmacological Class Angiotensin-Converting Enzyme (ACE) Inhibitor
Common Use Management of high blood pressure
Origin Synthetic compound (Prodrug)

What Type of Medicine is Vascase?

Vascase is the trade name for a prescription-only medicine (POM) containing the active ingredient Cilazapril, which is classified as an Angiotensin-Converting Enzyme (ACE) inhibitor. This drug belongs to the large pharmacological class of antihypertensive agents, specifically modulating the Renin-Angiotensin-Aldosterone System (RAAS) to manage pressure within the circulatory system. Pharmacological action involves a targeted systemic effect in reducing high blood pressure, positioning it as an agent in cardiovascular therapy for adult patients.


Composition, Form, and Origin (Cilazapril)

The medication is supplied as an oral preparation, specifically a film-coated tablet, containing Cilazapril monohydrate. Cilazapril is a synthetic compound that is structurally classified as a prodrug. The prodrug design is a distinctive feature: the compound is biologically inactive upon swallowing and must be converted by the body to its metabolite, Cilazaprilat, before its therapeutic physiological action begins. This two-step activation process is part of its systemic delivery and action.


General Purpose and Systemic Benefit

The medicine's general purpose is achieved through the inhibition of ACE, which blocks the formation of Angiotensin II, a natural constrictor of blood vessels. This effect leads to vasodilation, which is the widening of blood vessels, and a consequent reduction of peripheral vascular resistance. This mechanism translates into the general benefit of supporting blood flow and maintaining lower blood pressure, thereby easing the cardiovascular workload and reducing strain on the heart muscle.

Regulatory References

  1. NIH MeSH entry for Cilazapril

What side effects are possible with Vascase?

Possible Side Effects and Safety Information

The safety profile of Vascase, which contains the ACE inhibitor Cilazapril, is established by government regulatory bodies based on frequency classifications (e.g., Common, Uncommon, Rare) and documented effects across various organ systems.

Frequency-Classified Adverse Reactions

The most frequently documented side effects, classified as Common, include Headache, Dizziness, and a persistent Cough. Reactions classified as Uncommon include Hypotension (low blood pressure), Palpitations, and Sleep disturbances. Rarer, but clinically significant effects, include certain Hepatobiliary Disorders and Pancreatitis.

System-Organ Class Involvement

Adverse effects are categorized by the physiological system affected. The key categories include Vascular Disorders (e.g., Hypotension), Respiratory, Thoracic and Mediastinal Disorders (Cough), Nervous System Disorders, and Gastrointestinal Disorders (Nausea, Diarrhea).

Serious Safety Considerations

The most critical adverse reactions documented in official labeling include Angioedema (swelling of the face, tongue, or throat), which requires immediate attention, and Severe Symptomatic Hypotension. The label also notes risks associated with Hepatic Failure and certain changes in Blood and Lymphatic System Disorders.

Population-Specific Constraints

Vascase is officially Contraindicated during the second and third trimesters of Pregnancy due to the risk of fetal harm or death. Caution and monitoring are also required for Older Adults and individuals with existing Renal Impairment or a history of Angioedema from previous ACE inhibitor therapy. Symptomatic hypotension and dizziness are explicitly noted as being more common following the initial dose or during dose escalation.

Overdose and Emergency Response

The official regulatory profile for Vascase (Cilazapril) overdosage describes a clinical presentation dominated by severe hypotension, a profound drop in systemic blood pressure, and associated hemodynamic consequences. This condition can rapidly progress to life-threatening states, including circulatory shock and acute renal failure. Immediate medical attention must be sought when overdose is suspected, given the high severity classification of these documented outcomes. Officially listed clinical manifestations also include cardiovascular disturbances such as tachycardia, palpitations, and bradycardia, alongside central nervous system effects like dizziness and anxiety. Critical laboratory findings documented are significant electrolyte disturbances, specifically hyperkalaemia and hyponatraemia, in addition to metabolic acidosis. Regulatory guidance mandates that treatment for overdosage should be mainly symptomatic and supportive due to the confirmed statement that no specific antidote is known. Supportive measures often involve intravenous infusion of saline solution and continuous monitoring of blood pressure, serum electrolytes, and renal function. Regulatory documentation notes that limited data are available with regard to overdosage in humans.

Therapeutic Uses of Vascase

What Vascase Treats: Main Uses and Benefits

Vascase is used in situations involving certain distressing symptoms and is relevant in contexts marked by increased discomfort or tension. It is commonly used when short-term symptomatic assistance is needed and supports the patient during difficult episodes by easing distress. The medicine is commonly used to help with symptoms related to physical discomfort, episodic or fluctuating manifestations, and conditions where symptoms may intensify temporarily.

Vascase is applied in clinical settings that involve acute or unstable symptom patterns, relevant when supportive symptom management is appropriate. The primary goal of use is to help manage symptoms associated with conditions characterized by periods of heightened symptoms, and conditions presenting with systemic or localized discomfort. It provides support that helps ease the overall burden of symptoms, and contributes to improved comfort during periods of heightened symptoms.

Quick Fact: Supports management of Noticeable Physiological Strain

Eligibility and Restrictions for Use

Vascase, containing the ACE inhibitor Cilazapril, is officially indicated for use in adults with essential hypertension or chronic heart failure.


Contraindicated Populations

Use of Vascase is absolutely contraindicated by regulatory authorities for the following groups:

  • Patients with a history of angioedema related to any prior ACE inhibitor or hereditary/idiopathic angioedema.
  • Women in the second and third trimesters of pregnancy.
  • Patients with hypersensitivity to cilazapril or any other ACE inhibitor.
  • Patients with diabetes mellitus or renal impairment (GFR < 60 ml/min/1.73 m²) who are concurrently taking Aliskiren-containing products.
  • Patients taking drug products containing a neprilysin inhibitor (e.g., sacubitril/valsartan).

Age and Physiological Restrictions

Category Regulatory Status
Pediatrics (Under 18) Not recommended; safety and efficacy are not established [Source 1.1, 1.4].
Pregnancy Contraindicated in 2nd/3rd trimesters; not recommended in 1st trimester [Source 1.4].
Lactation (Nursing) Not recommended [Source 1.3].

Conditional Use and Organ Function

Eligibility is restricted for patients with certain medical conditions, requiring close medical supervision and special consideration:

  • Renal Impairment: Requires dosage reduction and adjustment based on creatinine clearance [Source 1.4].
  • Hepatic Impairment: Patients with liver cirrhosis (without ascites) must be initiated with great caution and a very low starting dose [Source 1.4].
  • Older Adults: Use is permitted, but a low starting dose is required due to possible greater sensitivity [Source 1.4].

What should I know about interactions with other medicines?

Interactions with other medicines and products

Vascase is a combination medication containing an Angiotensin-Converting Enzyme (ACE) inhibitor and a calcium channel blocker. The known drug interactions for its components are typically related to their respective pharmacologic classes and mechanisms of action, primarily concerning blood pressure, electrolyte balance, and drug metabolism.

Potential Interacting Drug Classes

Drug/Product Class Interaction Concern Mechanistic Basis
Potassium-Sparing Diuretics, Potassium Supplements, Salt Substitutes Increased risk of hyperkalemia (high potassium levels). ACE inhibitor component can decrease potassium excretion.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Reduced blood pressure-lowering effect; potential for worsening kidney function (including acute renal failure). Antagonism of the antihypertensive effect and renal effects.
Other Antihypertensive Agents Increased risk of symptomatic hypotension (low blood pressure). Additive blood pressure-lowering effects.
CYP3A4 Inhibitors (e.g., certain antifungals, macrolide antibiotics) Increased systemic exposure of the calcium channel blocker component. Inhibition of metabolism via the CYP3A4 enzyme pathway.

Specific Interacting Agents and Constraints

Specific contraindicated combinations include use with Aliskiren in patients with diabetes or kidney impairment. Additionally, the ACE inhibitor component must not be used concurrently with a Neprilysin Inhibitor (e.g., sacubitril/valsartan combination) or within 36 hours of switching to or from such a product, due to a significantly increased risk of angioedema (severe swelling).

Other clinically relevant interactions involve agents that may be metabolized by CYP3A4, such as certain statins (e.g., simvastatin), where the calcium channel blocker component can increase their concentration, potentially raising the risk of myopathy/rhabdomyolysis. Careful monitoring and dose adjustments are necessary when taking Vascase with any of the above-mentioned agents.

Mechanism of Action

Vascase, containing the active substance cilazapril, functions as a competitive inhibitor of the angiotensin-converting enzyme (ACE), which is also known as kininase II. The primary site of action is the circulating and tissue-based Renin-Angiotensin-Aldosterone System (RAAS).

Following administration, cilazapril is rapidly hydrolyzed to its active metabolite, cilazaprilat, which binds to and blocks the active site of the ACE enzyme. This inhibition prevents the conversion of the decapeptide angiotensin I into the potent octapeptide vasoconstrictor, angiotensin II.

The resulting reduction in circulating angiotensin II decreases its interaction with the AT1 receptors located on vascular smooth muscle cells, causing systemic arteriolar vasodilation. Simultaneously, the decreased angiotensin II levels reduce the stimulus for aldosterone secretion from the adrenal cortex, leading to a diminished reabsorption of sodium and water in the renal collecting ducts. Furthermore, the inhibition of kininase II impedes the degradation of the vasodilator peptide bradykinin, leading to its accumulation. The combined molecular and intracellular consequences—reduced vasoconstriction, decreased volume retention, and amplified bradykinin activity—result in a system-level decrease in total peripheral vascular resistance and a reduction in extracellular fluid volume.

Dosage and Administration Information

Vascase is an oral medicine provided as film-coated tablets in strengths of 1 mg, 2.5 mg, and 5 mg. Standard administration is structured around a once-daily (OD) schedule, and the tablet should be ingested at approximately the same time each day. The medicine may be taken independently of meals, meaning administration is permissible with or without food.


The dosing regimen is based on titration to achieve an effective maintenance dose. For the management of high blood pressure, the typical starting dose for adults is 1.0 mg once daily. For chronic heart failure, the initial dose is lower, starting at 0.5 mg once daily. In both major use contexts, the maximum recommended daily dose for adults is 5.0 mg. The 1 mg tablet is scored, which allows for division into two equal doses, facilitating the required low starting doses and adjustments.


Specific dosage modifications are utilized for certain populations. Older adults typically initiate treatment at a lower dose of 0.5 mg to 1.0 mg once daily for hypertension. Patients with impaired kidney function require significant dose reduction: for creatinine clearance between 10 and 40 mL/min, the initial dose is 0.5 mg and the maximum daily dose is 2.5 mg. Use is generally not recommended for more severe renal impairment. Similarly, patients with hepatic impairment require cautious initiation, with the maximum dose for hypertension in liver cirrhosis capped at 0.5 mg once daily.

Recent Clinical Evidence

Research Evidence / Overview of Studies for Vascase

Evidence for use in Essential Hypertension

The clinical evaluation of Vascase was primarily based on Randomized Controlled Trials (RCTs). These studies was evaluated in adults with mild to moderate essential hypertension—a condition where blood pressure is consistently high. Research examined outcomes related to physiological strain or stress, focusing on objective measurements of blood pressure.

In these trials, researchers focused on monitoring changes in both Systolic and Diastolic Blood Pressure over defined time intervals. Findings describe patterns observed in the studies that included measurements of blood pressure variables. Some research compared Vascase to other known medications and against inactive placebos, focusing on measured changes. These comparative studies examined patterns in the measured changes in blood pressure.

However, the core double-blind trials had limited follow-up durations (often only four to eight weeks). Research provides insight into short-term changes, but the results apply only to the populations studied and the specific conditions under which they were conducted.


Evidence for use in Congestive Heart Failure

Vascase was studied for use as an adjunctive treatment for Congestive Heart Failure (CHF). This research was evaluated in patients with conditions marked by functional limitations. The studies examined symptom patterns when the medicine was co-administered with other standard therapies like diuretics.

The studies focused on outcomes reflecting daily functioning or activity level, such as changes in functional capacity, as well as monitoring parameters related to the heart's function. Studies report how symptoms evolved in the observed populations. Research also describes the parameters related to the circulatory system that were observed in some studies.


Long-term Studies and Durability of Effect

When investigating any medicine for chronic conditions, the duration of the available research is important. Longer, open-label studies and extension phases collected data over longer durations in the observed populations. However, it is important to note that long-term effects are not fully established by the same rigorous double-blind, controlled comparisons used in the short-term trials.


Research Gaps and Areas of Uncertainty

The research landscape for Vascase has some areas where further clarity is needed. As noted, follow-up durations were limited in the most controlled trials, meaning the full picture of long-term effects are not fully established. Also, while the medicine's activity is well-documented via blood pressure measurements, the comparative evidence is lacking for certain hard outcomes, like reducing stroke or heart attack, specifically for this compound when compared to the data available for the overall drug class.

Key Studies & References NICE Guideline: Chronic heart failure in adults: diagnosis and management (supports evidence context for CHF as adjunctive therapy)

Frequently Asked Questions (FAQ)

Common questions about Vascase (FAQ)


Q: Can Vascase make me feel dizzy or tired?

A: Official documents indicate that common side effects can include dizziness and a feeling of tiredness or drowsiness. These effects are noted in the product's safety information, which categorizes them as known adverse reactions.


Q: What foods or supplements should be avoided when taking Vascase?

A: The product information advises caution with certain dietary supplements. Specifically, it is noted that salt substitutes and potassium products should be discussed with a doctor before use, as the medication can affect potassium levels. Official regulatory guidance suggests that discussion with a healthcare provider is appropriate before using over-the-counter products that may increase blood pressure.


Q: Is it common to have headaches when first starting Vascase?

A: Headache is listed in the official safety documents as a common adverse reaction associated with this medication. While headache is generally categorized as a frequently reported side effect, patients are sometimes advised to be aware of effects when starting treatment.


Q: Does Vascase interact with herbal supplements like St. John's Wort?

A: Information regarding drug interactions notes that the medication may be affected by products that influence certain enzyme pathways in the body. Specific regulatory documents do not always mention every herbal supplement, but official guidance emphasizes discussing all supplements with your healthcare provider due to the potential for clinically important interactions.


Q: Is it normal to feel a change in my heart rate after starting Vascase?

A: Official safety information notes that feeling an increased heart rate or experiencing palpitations (a pounding heartbeat) are classified as uncommon side effects. These effects are documented in the official regulatory profile of the medicine.


Q: Can Vascase be crushed or split if it is hard to swallow?

A: Regulatory guidance states that the tablets should generally be swallowed whole. Official guidance generally states that the tablets should not be chewed or crushed.


Q: Can Vascase interact with grapefruit or grapefruit juice?

A: While a specific, explicit warning regarding grapefruit or its juice may not be present in the core official label, this highlights the importance of discussing all potential dietary interactions with a healthcare provider.


Q: Do clinical trials of Vascase include people of all ages?

A: Official documents state that the safety and efficacy of the active ingredient have not been established in children and adolescents under 18 years of age. Clinical research and approved use of the medication are primarily focused on the adult population.


Q: What happens if I miss taking Vascase one day?

A: According to the official product information, if a dose is missed, patients should not double the next dose to make up for the one that was missed. Official guidance indicates patients should continue with the regular medication schedule by taking the next dose at the usual time.


Q: How long does it usually take to notice the effects of Vascase?

A: The official documents describe the potential for a sudden drop in blood pressure, known as 'first-dose hypotension,' following the initial use of the medication. Regulatory information notes the potential for close medical monitoring during the initial dose period.


Q: Is Vascase considered a blood thinner?

A: No, the medicine is not classified as a blood thinner (anticoagulant). It belongs to the pharmacological class of Angiotensin-Converting Enzyme (ACE) Inhibitors. Its purpose is to help manage high blood pressure and chronic heart failure.


Q: Why is Vascase only available by prescription?

A: The medicine is classified as a prescription-only medicine (POM) because it is used to manage serious medical conditions, such as high blood pressure and heart failure. Treatment with this class of medication often requires regular medical monitoring and supervision to ensure appropriate use and dosage adjustment.


Q: What if I drink alcohol while I am on Vascase?

A: Official regulatory guidance related to blood pressure medicines generally suggests caution regarding the use of alcohol. This is due to the potential for alcohol consumption to increase the risk of side effects such as low blood pressure (hypotension) and dizziness.


Q: Is there a generic version of Vascase available?

A: The active ingredient in this medicine, Cilazapril, has been approved in many global markets for several decades. Official information indicates that generic versions are available in many of the countries where the drug is authorized for sale.


Q: Are there any warnings about Vascase and driving or operating machinery?

A: Regulatory documents contain explicit warnings regarding functional impairment. Because the medicine may cause dizziness, particularly when starting treatment or adjusting the dose, official guidance warns against driving or operating machinery if this effect occurs.


Q: How quickly does Vascase leave the body after I stop taking it?

A: Studies indicate that the active form of the medicine, known as Cilazaprilat, has a reported elimination half-life of approximately nine hours. This figure is used to understand how quickly the medicine is processed and removed by the body.


Q: What happens if I accidentally take two doses of Vascase?

A: Taking more than the prescribed amount, or an overdose, may lead to severe adverse effects. These can include severely low blood pressure (hypotension), a slow heart rate, and increased dizziness. This situation requires immediate medical review and assessment.


Q: Is it necessary to have regular blood tests while taking Vascase?

A: Routine monitoring of certain blood parameters is noted as standard medical practice for patients using this class of medication. This often involves checking levels of potassium and creatinine, which are parameters that are monitored during treatment.


Q: Is Vascase known to cause weight gain or loss?

A: Weight change is not consistently listed as a common or severe adverse effect in the primary safety documents. While some research has observed its influence on certain hormones, weight change is not listed as a common or severe adverse effect in the regulatory documentation.


Q: Are there any concerns about taking Vascase with antacids?

A: Official interaction databases list antacids as a drug class that may have clinically important interactions with this medication. Regulatory guidance indicates that patients should inform their healthcare provider if they are taking antacids alongside this medicine.


Q: Will Vascase cure my condition, or only manage the symptoms?

A: According to the official product information, this medicine is used for the management and control of conditions like high blood pressure and chronic heart failure. It is important to note that the medicine does not offer a cure for these conditions.


Q: How long has Vascase been available on the market?

A: The active ingredient, Cilazapril, has a long history, with regulatory approval for use first being granted around 1990. This indicates that the medicine has been available in the market for several decades.


Q: Is Vascase a habit-forming medication?

A: This medication is not classified as a controlled substance in regulatory documents. It is not known to be habit-forming or associated with drug dependency.


Q: Does Vascase have a known 'Black Box' warning?

A: While the specific term 'Black Box' warning is primarily a US regulatory term, the official documentation for this drug class contains severe warnings regarding the risk of fetal harm or death in pregnancy. This critical safety information is highlighted in the product labeling.


Q: How does Vascase affect cholesterol levels?

A: This medication is not indicated for the primary purpose of lowering cholesterol. However, some official information notes that high cholesterol and triglyceride levels have been reported in connection with the overall drug class.

How should Vascase be stored and disposed of?

Storage and Disposal of Vascase (Cilazapril)

Official regulatory labeling dictates specific conditions for storing and disposing of Vascase to maintain its stability and ensure safety.

Storage Conditions

Storage Requirement Specification
Temperature Store most strengths (0.5 mg, 1 mg, 2.5 mg) at a temperature not above 25 °C. The 5 mg strength has no special storage conditions.
Protection Keep the container protected from moisture and tightly closed where specified.
Child Safety Keep out of the sight and reach of children to prevent accidental ingestion.

Disposal Instructions

Unused or expired Vascase must not be thrown away via wastewater or household waste to minimize environmental release. Individuals are instructed to ask a pharmacist how to throw away medicines no longer in use so the product can be managed as pharmaceutical waste according to local requirements.

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

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