Autonomic Dysreflexia

Captopril

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

Author Year; Country Score Research Design Sample Size	Methods	Outcome
Esmail et al. 2002; Canada Pre-post N=7	Population: 26 consecutive patients older than 15 years with SCI above T6. Treatment: administration of a) captopril 25mg sublingually if systolic blood pressure (SBP) was at or above 150mmHg, b) 5mg of immediate-release nifedipine if SBP remained elevated 30 minutes after captopril administration. Outcome Measures: SBP	A total of 33 autonomic dysreflexia episodes were documented in 7 patients. The 18 episodes documented in 5 patients were treated with drug therapy. Captopril alone was effective in reducing SBP in 4 of 5 the patients (80%). The mean SBPs at baseline and 30 minutes after captopril were 178(18) mmHg and 133(28)mmHg, respectively. The addition of nifedipine successfully reduced blood pressure from 170/108 to 110/80 after 30 minutes in the one patient who did not respond to the administration of captopril.

Discussion

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).

Conclusion

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.

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