1 Low margin of safety - intoxication from overdosing is a potential fatal problem, lethal dose is likely to be only 5-10 times the minimal effective dose.
2 Intoxication is frequently precipitated by depletion of serum K+ due to diuretic therapy & may also occur as a result of:
1 Prolonged administration of corticosteroids
2 Protracted vomiting and diarrhea
Anorexia (often the earliest sign)
Nausea, vomiting, and diarrhea
Headache, fatigue, malaise, neuralgias, and delirium
Vision changes, including abnormal color perception
Cardiac effects: premature ventricular contractions (PVCs) and ventricular tachycardia and fibrillation; A-V dissociation and block; sinus arrhythmia and S-A block
1 KCl is administered orally or by slow, careful IV infusion if hypokalemia is present; K+ is NOT given if severe A-V block is found or if serum K+ levels are high.
2 magnesium replacement
3 Phenytoin can be given for ventricular and atrial arrhythmias
4 Lidocaine and procainamide can be used to treat ventricular arrhythmias
5 cholestyramine binds to cardiac glycosides and has been used to hasten their elimination
Severe persistent cough occasionally occurs
Hypotension and deterioration of renal function can occur with an ACEI-diuretic combination.
A/E associated with captopril such as rash, taste disturbances, proteinuria, and leukopenia, may be related to the sulfhydryl moiety of captopril
