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Captopril is a specific competitive inhibitor of angiotensin I-converting enzyme (ACE).  During an episode of AD, 25mg of captopril is recommended for sublingual administration.

Table 16: Captopril


From one pre-post study (n=26) (Esmail et al. 2002), captopril was safe and effective in 4 out of 5 episodes for AD management.  This prospective open labelled study and numerous experts’ opinion suggest the use of the captopril as a primary medication in management of AD (Consortium for Spinal Cord Medicine 2001; Frost 2002; Anton & Townson 2004).


  • There is level 4 evidence (from one pre-post study) (Esmail et al. 2002) for the use of captopril in the acute management of AD in SCI.
  • Preliminary evidence suggests that captopril is effective for the management of AD in SCI.