A 44-year-old woman, with a history of familial adenomatous polyposis, complicated by carcinoma of the colon, for which a proctocolectomy had been performed, now presented with metastasis located in the pancreas. Treatment consisted of chemotherapy followed by a partial pancreaticoduodenectomy. Due to ischemia, resection of the small intestines was performed the same day. After admission, a transesophageal echocardiography showed an ejection fraction of 40%. Because enteral administration of drugs was impossible, intravenous enalaprilat 2 mg once a day for 1 day followed by sublingual captopril 25 mg twice a day were started. Blood samples were taken before and after administration. After 1 day of sublingual captopril treatment the angiotensin II level decreased with more than 50%, comparable to the decrease seen after intravenous administration of enalaprilat. Sublingual captopril has been used in the treatment of hypertensive crisis and heart failure. Although frequently reported, no study has investigated the effect on angiotensin II levels after sublingual administration in heart failure patients. This case-report demonstrated that sublingual administration of 25 mg captopril twice a day yielded a considerable decrease in angiotensin II plasma levels which was comparable to the effect seen after an intravenous administration of 2 mg enalaprilat.
Angiotensin II Captopril Enalaprilat Plasma level Sublingual administration
This is a preview of subscription content, log in to check access.
al-Furaih TA, McElnay JC, Elborn JS, Rusk R, Scott MG, McMahon J, et al. Sublingual captopril—a pharmacokinetic and pharmacodynamic evaluation. Eur J Clin Pharmacol 1991;40:393-CrossRefPubMedGoogle Scholar
Castro del Castillo A, Rodriguez M, Gonzalez E, Rodriguez F, Estruch J. Dose-response effect of sublingual captopril in hypertensive crises. J Clin Pharmacol 1998;28:667-0Google Scholar
Gemici K, Karakoc Y, Ersoy A, Baran I I, Gullulu S, Cordan J. A comparison of safety and efficacy of sublingual captopril with sublingual nifedipine in hypertensive crisis. Int J Angiol 1999;8:147-CrossRefPubMedGoogle Scholar
Gemici K, Baran I, Bakar M, Demircan C, Ozdemir B, Cordan J. Evaluation of the effect of the sublingually administered nifedipine and captopril via transcranial doppler ultrasonography during hypertensive crisis. Blood Press 2003;12:46-PubMedGoogle Scholar
Karachalios GN, Georgiopoulos AN. Treatment of hypertensive crisis with sublingual captopril. Clin Pharm 1989;8:90-PubMedGoogle Scholar
Barbier P, Tamborini G, Alioto G, Pepi M. Acute filling pattern changes of the failing left ventricle after captopril as related to ventricular structure. Cardiology 1996;87:153-0CrossRefPubMedGoogle Scholar
Haude M, Steffen W, Erbel R, Meyer J. Sublingual administration of captopril versus nitroglycerin in patients with severe congestive heart failure. Int J Cardiol 1990;27:351–9CrossRefPubMedGoogle Scholar
Sacchetti A, McCabe J, Torres M, Harris RL. ED management of acute congestive heart failure in renal dialysis patients. Am J Emerg Med 1993;11:644-CrossRefPubMedGoogle Scholar
McElnay JC, al-Furaih TA, Hughes CM, Scott MG, Nicholls DP. A pharmacokinetic and pharmacodynamic evaluation of buffered sublingual captopril in patients with congestive heart failure. Eur J Clin Pharmacol 1996;49:471-CrossRefPubMedGoogle Scholar
Gemici K, Kazazoglu AR, Yesilbursa D, Serdar A, Ener S, Aydifinlar A, et al. The effects of sublingual administration of captopril on parameters of exercise test and neurohormonal activation in patients with stable angina pectoris. Int J Angiol 1998;7:238-3CrossRefPubMedGoogle Scholar