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.


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 2001Frost 2002Anton & 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.