Breckenridge A M
Department of Pharmacology and Therapeutics, University of Liverpool, UK.
J Hum Hypertens. 1989 Jun;3 Suppl 1:133-8.
Drug interactions common to all angiotensin-converting enzyme (ACE) inhibitors include those with thiazide diuretics and other antihypertensive agents. Interactions involving specific ACE inhibitors include captopril-digoxin, resulting in decreased clearance of digoxin from plasma in patients with heart failure, and captopril-probenecid, causing a decrease in captopril clearance. Tissue kinins, such as bradykinin, are metabolised by ACE inhibitors. Interactions involving bradykinin include captopril-indomethacin, in which an attenuation of the antihypertensive effects of captopril is manifest. Interestingly, neither enalapril nor lisinopril appear to show this interaction with indomethacin. Kinin-based interactions may also be important in the genesis of ACE inhibitor-induced cough and skin rash. Renal dysfunction affects the pharmacokinetics and pharmacodynamics of all ACE inhibitors, necessitating dosage reduction. Hepatic impairment is of less clinical importance, causing a delay in the onset of action of enalapril with initial doses, but probably having little relevance to long-term therapy.
所有血管紧张素转换酶（ACE）抑制剂常见的药物相互作用包括与噻嗪类利尿剂及其他抗高血压药物的相互作用。涉及特定ACE抑制剂的相互作用有卡托普利与地高辛，这会导致心力衰竭患者血浆中地高辛清除率降低；还有卡托普利与丙磺舒，会使卡托普利清除率下降。组织激肽，如缓激肽，可被ACE抑制剂代谢。涉及缓激肽的相互作用有卡托普利与吲哚美辛，其中卡托普利的降压作用会减弱。有趣的是，依那普利和赖诺普利似乎都未显示出与吲哚美辛有这种相互作用。基于激肽的相互作用在ACE抑制剂所致咳嗽和皮疹的发生中可能也很重要。肾功能不全影响所有ACE抑制剂的药代动力学和药效学，因此需要减少剂量。肝功能损害的临床重要性较小，初始剂量时会使依那普利起效延迟，但可能与长期治疗关系不大。
