Benazepril

Boxed warning

Do not use benazepril if you are pregnant. Doing so can cause injury or death to a developing fetus.

If you find out you are pregnant while taking benazepril, speak to your doctor immediately. They will tell you how to stop taking the drug safely.

What is benazepril?

Benazepril is a prescription-only medication that belongs to a class of drugs called angiotensin-converting enzyme (ACE) inhibitors.

Benazepril is a generic drug. It is also available under the brand name Lotensin.

What is benazepril used to treat?

Benazepril is a medication that has been FDA approved to be taken on its own or with other drugs to treat high blood pressure (hypertension). The medication can improve your condition when combined with lifestyle changes (weight management, exercise, and others).¹

High blood pressure adds to the workload of your arteries and heart. Over time, this can damage the blood vessels and cause health problems like stroke, vision loss, kidney failure, and heart failure. Lowering your blood pressure to the normal range can help reduce your risk of developing these health conditions.

Benazepril blocks the production of an enzyme that tightens the blood vessels, improving blood flow.

Dosage forms and strengths

Benazepril is available as an oral tablet in the following strengths:

• 5mg, 10mg, 20mg, and 40mg.²

How do you take benazepril?

Benazepril is available as a tablet to be taken orally (by mouth) with or without food.

Take your medication at the same time each day. You can set an alarm to remind you to take it on time.

Follow your doctor’s and pharmacist’s instructions carefully.

Seeing results

Benazepril starts to work within one hour, but it will take 2–4 hours to reach its full effect.³

The drug may not have optimal blood-lowering effects for several weeks. You will know this medication is working if your blood pressure comes down. You can check it with a home blood pressure monitor or have it checked in your doctor’s office.

Tell your doctor if your blood pressure does not improve after one week of taking benazepril or you start feeling unwell.

Who should not take benazepril

This drug might not be suitable for you if:⁴

• You have a history of angioedema (an allergy-triggered swelling under the skin), particularly if it was caused by taking ACE inhibitors.

• You have had a past reaction to ACE inhibitors, including benazepril.

• You have taken valsartan and sacubitril (Entresto) in the last 36 hours.

• You have diabetes and are taking medication containing aliskiren (a blood pressure medicine).

Potential side effects of benazepril

Like all medicines, benazepril can cause some adverse effects, most of which may improve as your body adjusts to the drug.

Common side effects

In clinical trials, benazepril has been seen to cause the following common side effects:⁵ ²

• Headache

• Dizziness

• Fatigue or feeling sleepy and drowsy (somnolence)

• Postural dizziness (dizziness that occurs when standing after lying or sitting down)

• Nausea

• Cough

Talk to your doctor if these symptoms persist, worsen, or bother you.

Severe adverse effects

The FDA has added a black box warning about the risk of fetal toxicity when taking benazepril while pregnant. The warning states it should be discontinued as soon as possible when a pregnancy is detected. A boxed warning is the most serious advisory about the potential side effects of a drug.

Using benazepril while pregnant can cause harm to the fetus, including skeletal anomalies, poor lung development, low blood pressure, kidney failure, and death.

Serious and rare adverse effects

In some cases, benazepril can cause the severe adverse effects listed below:

• Symptomatic low blood pressure (hypotension) — speak to your doctor if you feel lightheaded, especially during the first few days of taking your medication. Stop taking benazepril if you faint and speak to your doctor right away.

• Effects on organs, including organ failure:

  • Liver (hepatic) failure, which can be fatal — seek immediate medical care if you develop jaundice, a yellowing of the eyes and skin.

  • Impaired kidney function, including acute kidney failure. Patients with dehydration, a recent heart attack, chronic kidney disease, congestive heart failure, and narrowing of the arteries to the kidneys may be at heightened risk for kidney failure when taking benazepril.

• Allergic effects, including:

  • Angioedema (swelling) of the head and neck — may cause swelling of the face, lips, tongue, or eyes and trouble breathing.

  • Life-threatening anaphylactoid reactions (may affect people undergoing dialysis or desensitization treatment for allergies) — symptoms may include itchy skin, hives, low blood pressure, wheezing or difficulty breathing, angioedema (especially swelling of the larynx), irregular heartbeat, stomach pain, diarrhea, nausea, vomiting, or uterine contractions.⁶

• Dermatologic effects, including:

  • Stevens-Johnson syndrome — this serious skin condition may cause flu-like symptoms at the start, including cough, sore throat, fever, and joint pain. A few days later, you may notice a rash made up of circular patches that are darker in the middle and lighter around the edges. This may be followed by sores and blisters that appear on your mouth, lips, or eyes. You may experience pain when swallowing, eye pain or vision problems, and pain when urinating.⁷

  • Pemphigus — this rare autoimmune disease may cause blisters and sores on your throat, the inside of your mouth, eyes, nose, and genitals.⁸

  • Hypersensitivity reactions — symptoms may include dermatitis, itchy skin, or rash.

  • Photosensitivity — an increased sensitivity of the skin to sunlight with a greater risk of sunburn.

  • Flushing

• Gastrointestinal effects, including:

  • Intestinal angioedema (swelling of the bowel walls caused by an allergic reaction) — may cause abdominal pain and cramps, nausea, vomiting, trouble breathing, and dizziness.⁹

  • Constipation

  • Gastritis

  • Pancreatitis (inflammation of the pancreas) — can cause pain in the abdomen that radiates to the back with or without vomiting.

  • Dark black or tarry stools as a result of gastrointestinal bleeding (melena)

• Hematologic effects, including:

  • Thrombocytopenia (low blood platelet count) — symptoms may include long-lasting bleeding, bleeding from your gums, nosebleeds, heavy menstrual bleeding, blood in your urine or stool, small, flat red spots under the skin (petechiae), and bleeding under the skin (purpura), which causes purple, red, or brownish-yellow spots.¹⁰

  • Hemolytic anemia — symptoms may include weakness, dizziness, or tiredness.¹¹

  • High blood eosinophil levels

• Neurologic/psychiatric effects, including:

  • Anxiety

  • Decreased libido

  • Excess muscle tone (hypertonia)

  • Insomnia

  • Nervousness

  • A burning or prickling sensation (paresthesia)

• Metabolic effects, including:

  • Elevated blood potassium levels (hyperkalemia) — do not use potassium supplements or salt substitutes that contain potassium while taking benazepril.

  • Low blood sodium levels (hyponatremia)

  • High blood levels of:

    • Uric acid 

    • Glucose

    • Bilirubin

    • Liver enzymes

Other adverse effects may include:

• Asthma

• Bronchitis

• Shortness of breath (dyspnea)

• Sinusitis

• Urinary tract infection (UTI)

• Frequent urination

• High levels of protein in the urine (proteinuria)

• Other infection

• Arthritis

• Impotence

• Hair loss (alopecia)

• Joint stiffness (arthralgia)

• Muscle aches and pains (myalgia)

• Muscle weakness (asthenia)

• Sweating

• Electrocardiographic changes

Overdose

Benazepril is a prescription-only drug. Take it as directed by your doctor.

If you have taken too much benazepril, you will most likely experience low blood pressure (hypotension). Signs include dizziness and fainting.⁵

If you suspect that you or someone you know has overdosed on this drug, seek immediate emergency medical assistance. You can also reach out to the poison control helpline at 1-800-222-1222.

Allergy information

Benazepril can cause an allergic reaction in some people. Symptoms include:¹²

• Hives

• Severe stomach pain

• Difficulty breathing

• Swelling in your face or throat

• Severe skin reaction (red/purple skin rash with blistering or peeling, skin pain, fever, sore throat, burning in your eyes)

If you notice any of these symptoms, seek emergency medical assistance or call 911.

Long-term use of benazepril

Benazepril is used for the long-term treatment of high blood pressure. You must take it exactly as prescribed by your doctor. Do not take less or more than prescribed.

Your doctor will regularly monitor your condition and alter the dosage according to your needs and how you respond to treatment.

Pregnancy category

Benazepril is a pregnancy category D drug. This means research has shown that benazepril can cause adverse or fatal effects on the fetus.¹³

Benazepril and pregnancy

Before starting benazepril, tell your doctor if you are pregnant. If you plan to conceive while taking benazepril, talk to your doctor about alternative drugs.

You must immediately inform your doctor if you become pregnant while taking this drug. Benazepril is not safe to take during pregnancy and must be discontinued as soon as possible.

Benazepril and breastfeeding

Benazepril can pass into breast milk in small amounts and would not be expected to affect a nursing baby.⁴

You should discuss the risks and benefits of taking this medication with your doctor.

Missed doses

The drug will not have the desired effects if you miss doses.

Take a missed dose as soon as you remember unless it is close to the time of your next dose. If that happens, skip the missed dose and take your next dose as scheduled.

Do not double up on this medication to make up for a missed dose.

Ask your doctor or pharmacist for advice if you have missed several doses.

Drug interactions

Benazepril is known to interact with some drugs to change how your medicines work or cause harmful side effects.

Taking benazepril with the following medications is not advised (note this is not a complete list of drug interactions):⁴ ⁵

• Aliskiren (Tekturna) — aliskiren is a direct renin inhibitor used to treat high blood pressure.

• Sacubitril (Entresto) — sacubitril is a neprilysin inhibitor used to treat high blood pressure. It is combined with valsartan and sold under the brand name Entresto.

Other drugs that interact with benazepril include:

• Other ACE inhibitors, such as captopril, enalapril (Vasotec), fosinopril, moexipril, perindopril (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik)

• Angiotensin receptor blockers (ARBs), such as irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), and valsartan (Diovan or Prexxartan)

• Diuretics (water pills) — can cause excessively low blood pressure

• Potassium-sparing diuretics, like amiloride (Midamor), spironolactone (Aldactone or CaroSpir), and triamterene (Dyrenium) — can cause high blood potassium levels (hyperkalemia)

• Mammalian target of rapamycin (mTOR) inhibitors (transplant medicines), such as everolimus (Afinitor or Zortress), temsirolimus (Torisel), or sirolimus (Rapamune) — may increase the risk of an allergic reaction called angioedema

• Diabetic drugs, such as metformin, rosiglitazone (Avandia), and insulin

• Non-steroidal anti-inflammatory drugs (NSAIDs), such as meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn, and others), indomethacin (Indocin or Tivorbex), diclofenac (Zipsor, Zorvolex, or Cambia), and ibuprofen (Advil, Motrin, Midol, and others)

• Lithium (Lithobid)

• Gold injection (sodium aurothiomalate)

Can I drink alcohol while taking benazepril?

Alcohol is not thought to affect how benazepril works in the body. However, you should discuss the risks and benefits with your doctor to determine what is best considering the medical condition being treated.

What to discuss with your doctor before starting benazepril

Before taking benazepril, speak to your doctor about the following things if they apply to you:

• Drug allergies: Tell your doctor about any drug allergies and allergies to ACE inhibitors, including if you’ve had a previous allergic reaction to benazepril.

• Medications: Benazepril interacts with several drugs. Give your doctor a list of your current prescription and non-prescription medications. Also, make sure to mention any vitamins, supplements, and herbal remedies you take. Don’t start taking a new drug, vitamin, or herbal remedy without first consulting your doctor.

• Medical conditions: Inform your doctor of your medical history, especially if you have diabetes, kidney disease, heart failure, scleroderma, lupus, or have had an organ transplant.

• Pregnancy/breastfeeding: Do not take this drug if you are pregnant. Let your doctor know if you are pregnant or think you might be pregnant. Tell them if you are planning to conceive while taking this drug. Tell them if you are breastfeeding.

Stopping benazepril

You have been prescribed this drug because your doctor believes your condition is serious enough that you can benefit from it.

Don’t stop taking this drug without first consulting your doctor. In some cases, such as pregnancy or liver failure, your doctor will advise you on how to stop taking this drug immediately.

If you want to stop taking this drug because of side effects, let your doctor know about your concerns. They may suggest alternative medicine to treat your condition and will need to monitor your blood pressure closely during the transition.

Drug approval history

1991: The US Food and Drug Administration (the FDA) first approved benazepril hydrochloride tablets to be sold under the brand name Lotensin.¹⁴

The drug is now available as a generic medication.

Tips for taking benazepril

The following tips and advice can help you take benazepril safely and effectively:

• Be transparent with your doctor regarding any other medical conditions you may have and any drugs (prescription or non-prescription), vitamins, supplements, or herbal remedies you take.

• Keep this drug away from sunlight and store it in a cool (< 86°F) and dry place.

• Keep this drug away from children.

• Do not freeze this drug.

• Attend all appointments with your doctor for regular blood pressure testing. Your doctor may also check your kidney function and electrolyte levels.

• Drink plenty of water when taking this medicine to stay hydrated.

Benazepril frequently asked questions

Is benazepril the same as lisinopril?

Benazepril and lisinopril (Zestril and Prinivil) are two different prescription medications. They both belong to the class of medications called angiotensin-converting enzyme (ACE) inhibitors.

Lisinopril is prescribed to treat high blood pressure. It may also be used in cases of heart failure as it can increase a person’s chances of survival after a heart attack.

What is benazepril used for?

Benazepril is prescribed to treat high blood pressure.

What should not be taken with benazepril?

Do not take benazepril with aliskiren (Tekturna) or sacubitril (Entresto).

Benazepril interacts with other drugs, including other ACE inhibitors, angiotensin receptor blockers (ARBs), and diuretics. Before taking benazepril, tell your doctor about all other drugs, natural remedies, and supplements you are taking to avoid potentially harmful interactions.