Drug Comparisons

Angiotensin Converting Enzyme (ACE) Inhibitors are used to treat heart failure. ACE Inhibitors are known as "vasodilators," which means the blood vessels dilate or open up. By dilating the blood vessels, ACE Inhibitors help to reduce the workload of the failing heart muscle commonly seen with heart failure.

Drugs in this Class
Captopril (Capoten)
Fosinopril Tablets (Monopril Tablets)
Ramipril Capsules (Altace Capsules)
Benazepril (Lotensin)
Enalapril Tablets (Vasotec Tablets)
Perindopril (Aceon)
Lisinopril Tablets (Prinivil Tablets, Zestril Tablets)
Moexipril Tablets (Univasc Tablets)
Quinapril (Accupril)
Trandolapril Tablets (Mavik)
Enalaprilat Solution for Injection ()

Summarizing the Evidence

• Captopril, enalapril, fosinopril, lisinopril, quinapril, ramipril and trandolapril have each been well studied in clinical trials and have been shown to reduce the rate of death and hospitalizations in individuals with heart failure. Each of these drugs is FDA approved for the treatment of heart failure.

• While the above ACE Inhibitors have each been shown to reduce the rate of death and hospitalizations, the question still remains as to what the most optimal doses of these ACE Inhibitors are. Your healthcare provider is the best person to determine what dose is right for you.

• Limited data is available for the use of benazepril, moexipril, and perindopril in heart failure. However, because it is thought that all ACE Inhibitors work in the same manner, these ACE Inhibitors are sometimes used in the treatment heart failure.

• Common side effects of the ACE-Inhibitors include nausea, vomiting, diarrhea, cough, low blood pressure, headache and dizziness. A dry non-productive cough is one of the most frequently reported side effects 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 is usually taken three times daily for heart failure. 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, lisinopril, moexipril, quinapril, ramipril, and trandolapril are available generically and therefore may be less expensive than the brand name ACE-Inhibitor or the similar Angiotensin II Receptor Blockers which are still all brand name. The only ACE-Inhibitor that is not generically available is perindopril.

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

1. Johnson JA, Parker RB, Patterson JH. Heart Failure. In: DiPiro JT, Talbert RL, Yee GC, et al., (Eds). Pharmacotherapy: a pathophysiologic approach. 6th ed. New York: McGraw-Hill, 2005:219-260.
2. Capoten [package insert]. Princeton, NJ: Brisol-Myers Squibb; Last updated: 5/7/2004.
3. Vasotec [package insert]. Bridgewater, NJ. Bioavail; Last updated: 10/31/2007.
4. Prinivil [package insert]. Whitehouse Station, NJ: Merck & Co.; Last updated: 2/2/2007.
5. Zestril [package insert]. Wilmington, DE: AstraZeneca; Last updated: 10/4/2007.
6. Lotensin [package insert]. East Hanover, NJ: Novartis; Last updated: 2/2/2007.
7. Monopril [package insert]. Princeton, NJ: Bristol-Myers Squibb; Last updated: 10/29/2003.
8. Accupril [package insert]. Morris Plains, NJ: Parke-Davis; Last updated: 10/29/2003.
9. Altace [package insert]. Bristol, TN: King Pharmaceuticals; Last updated: 2/27/2007.
10. Univasc [package insert]. Milwaukee, WI: Schwarz Pharma; Last updated: 10/29/2003.
11. Mavik [package insert]. North Chicago, IL: Abbott Laboratories; Last updated: 2/6/2004.
12. Aceon [package insert]. Marietta, GA: Solvay Pharmaceuticals; Last updated: 8/23/2005.
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Last Updated: April 2008
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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.