Drug Comparisons

Prevention of further heart attacks is one of the main goals of treatment after an initial heart attack. Preventing the development of heart failure, which commonly develops after a heart attack, is another goal of treatment. Angiotensin Converting Enzyme (ACE) Inhibitors are one class of medications that may be used after a heart attack to prevent heart failure (HF). ACE-Inhibitors are known as vasodilators, which means that they work in the body by dilating or opening blood vessels. By dilating the blood vessels, ACE Inhibitors help to reduce the workload of the weakened heart muscle after a heart attack. They also help repair the damaged heart muscle after a heart attack.

Drugs in this Class
Benazepril ( Lotensin )
Captopril ( Capoten )
Enalapril Tablets ( Enalapril Maleate Tablets, Vasotec Tablets )
Fosinopril Tablets ( Fosinopril Sodium Tablets, Monopril Tablets )
Lisinopril Tablets ( Prinivil Tablets, Zestril Tablets )
Moexipril Tablets ( Moexipril Hydrochloride Tablets, Univasc Tablets )
Perindopril Tablets ( Aceon Tablets, Perindopril Erbumine Tablets )
Quinapril ( Accupril )
Ramipril Capsules ( Altace Capsules )
Trandolapril ( Mavik )

Summarizing the Evidence

• Captopril, enalapril, lisinopril, ramipril and trandolapril have been studied in clinical trials and have been shown to reduce the rate of death and hospitalizations in individuals who have had a heart attack. Limited data is available for benazepril, fosinopril, moexipril, quinapril and perindopril when used following a heart attack.

• The American College of Cardiology and American Heart Association (ACC/AHA) guidelines for treatment of a heart attack recommend that heart attack patients with decreased heart function, especially patients with diabetes, should receive an ACE-Inhibitor because they are at high risk for developing congestive heart failure. No specific ACE-Inhibitor is recommended, although experience is the greatest with captopril, lisinopril, ramipril, and trandolapril. A recent trial showed that ramipril reduced the numbers of heart attacks, strokes, and heart death in patients with established heart or vessel disease, and/or diabetes. However, it is generally thought that each drug in this class is effective in preventing and treating coronary heart disease because the ACE-Inhibitors all work in the same manner.

• The arteries and veins in the body have to maintain certain elasticity (the ability to move and bend) in order for blood to properly move through the body. Certain diseases can cause those arteries and veins to become stiff, making it harder for the blood to flow through, resulting in the heart having to work harder. Trandolapril has been proven in one study to help reduce this stiffness in the arteries, allowing the heart to work more effectively without working as hard.

• Perindopril has been shown to help slow the progression of ventricular wall thickening that can occur after a heart attack. (The heart contains two ventricles, which are also known as chambers, that pump blood out into the body.) After a heart attack, the ventricle walls become weaker and thicker as the heart works harder to pump the blood out into the body. Perindopril has been shown in studies to help slow this progression of the ventricle wall thickening, easing the workload of the heart.

• Common side effects of the ACE-Inhibitors include nausea, vomiting, diarrhea, cough, low blood pressure, headache and dizziness. A dry non-productive cough is the most frequently reported side effect with this drug class. While it appears as though the incidence of cough is similar amongst all ACE-Inhibitors, some patients who experience a cough while taking one ACE-Inhibitor will not necessarily experience a cough when they switch to another ACE-Inhibitor. A few studies have demonstrated that patients taking fosinopril may have the least incidence of cough. If your cough becomes bothersome, you should contact your doctor.

Dosing and Administration

• The ACE-Inhibitors can be dosed once or twice daily, except for captopril, which can be taken up to three times daily. Captopril and moexipril need to be taken on an empty stomach, because food can decrease the absorption of these drugs.

Generic Availability

• Currently, benazepril, captopril, enalapril, fosinopril, moexipril, quinapril, trandolapril, and lisinopril are available generically and therefore may be less expensive than the other ACE-Inhibitors.

Drug Interactions

Some interactions between medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how the drugs interact and the severity of the interaction, please use our Drug Interactions Checker.

Side Effects

To view specific side effect information, please use our Side Effect Checker.

Additional Information

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2. Capoten [package insert]. Princeton, NJ: Brisol-Myers Squibb; June 2003
3. Vasotec [package insert]. Morrisville, NC. Bioavail; August 2002.
4. Prinivil [package insert]. Whitehouse Station, NJ: Merck & Co.; August 2006.
5. Zestril [package insert]. Wilmington, DE: AstraZeneca; December 2005.
6. Lotensin [package insert]. East Hanover, NJ: Novartis; June 2007.
7. Monopril [package insert]. Princeton, NJ: Bristol-Myers Squibb; July 2003.
8. Accupril [package insert]. Morris Plains, NJ: Parke-Davis; February 2003.
9. Altace [package insert]. Bristol, TN: Monarch Pharmaceuticals; September 2005.
10. Univasc [package insert]. Milwaukee, WI: Schwarz Pharma; May 2003.
11. Mavik [package insert]. North Chicago, IL: Abbott Laboratories; July 2003.
12. Aceon [package insert]. Marietta, GA: Solvay Pharmaceuticals; May 2005.
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    Last Updated: April 2008
    This content was created by members of the DrugDigest team of experts and is solely under DrugDigest's editorial control.

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    Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It should not be construed to indicate that the use of the product is safe, appropriate, or effective for you. Consult your healthcare professional before taking any medication.