How does it work?
Vascace tablets contain the active ingredient cilazapril, which is a type of medicine called an ACE inhibitor.
ACE inhibitors work by blocking the action of a compound in the body called angiotensin converting enzyme (ACE). Normally ACE produces another compound called angiotensin II, as part of the body's natural control of blood pressure. Angiotensin II causes blood vessels to constrict and narrow, which increases the pressure within the blood vessels.
As cilazapril blocks the action of ACE, it reduces the production of angiotensin II. This means that the blood vessels are allowed to relax and widen. The overall effect of this is a drop in blood pressure, hence cilazapril can be used to lower high blood pressure.
The reduced pressure within the blood vessels means that the heart doesn't have to work as hard to pump the blood around the body. This means that ACE inhibitors such as cilazapril can also be used to improve the symptoms of heart failure, where the heart is not pumping as efficiently as it should be.
What is it used for?
- High blood pressure with no known cause (essential hypertension).
- Heart failure.
- Some people may experience dizziness caused by low blood pressure in the first few days of taking this medicine and in particular the first dose. For this reason, the first dose should preferably be taken at bedtime. Your doctor may want you to take the first dose of this medicine under medical supervision in hospital if you are aged over 70 years, have low blood pressure, low levels of fluids or salt in your blood (eg due to dehydration), severe or unstable heart failure, kidney problems, or are taking high doses of diuretic medicines, multiple diuretic medicines, or certain other medicines that dilate your blood vessels.
- If you feel dizzy during treatment this can be relieved by lying down until the symptoms pass. If affected you should avoid performing potentially hazardous tasks such as driving or operating machinary. If you frequently feel dizzy you should let your doctor know, as your dose of this medicine may need reducing.
- Alcohol may enhance the blood pressure lowering effect of this medicine, which can increase dizziness and may increase the risk of fainting.
- ACE inhibitors can sometimes cause an allergic reaction called angioedema. Stop taking this medicine and consult your doctor immediately if you experience difficulty breathing or swallowing, or swelling of your face, lips, tongue, throat, hands, feet or ankles while taking this medicine. This type of allergic reaction has been reported more frequently in people of Afro-Caribbean origin.
- Your blood pressure, kidney function and the amount of potassium in your blood should be regularly monitored while you are taking this medicine.
Use with caution in
- Elderly people.
- Decreased liver function.
- Decreased kidney function.
- Narrowing of the arteries that supply blood to the kidneys (renal artery stenosis).
- People with hardening of the arteries (athersclerosis), eg in the heart (cardiovascular disease), brain (cerebrovascular disease) or legs (peripheral vascular disease).
- People with low fluid volume or salt levels in the body, eg due to diuretic therapy, low-sodium diet, diarrhoea or vomiting.
- People taking other medicines for high blood pressure, particularly diuretics (see end of factsheet).
- Narrowing of the main artery of the body (aortic stenosis).
- Heart disease characterised by thickening of the internal heart muscle and a blockage inside the heart (hypertrophic obstructive cardiomyopathy).
- Severe heart failure.
- Diseases affecting connective tissue, eg scleroderma, systemic lupus erythematosus or rheumatoid arthritis (collagen vascular diseases).
- People with kidney failure requiring a certain type of haemodialysis (high-flux membrane).
- People receiving therapy to remove certain types of fat from the blood using a machine (LDL apheresis).
- People undergoing therapy to decrease allergy to bee or wasp stings (desensitisation).
Not to be used in
- Allergy to other ACE inhibitor medicines.
- History of swelling of the lips, face or tongue (angioedema) caused by previous use of an ACE inhibitor medicine.
- People with fluid accumulation in the abdomen (ascites).
- Rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption (Vascace tablets contain lactose).
- This medicine is not recommended for children.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine must not be used during pregnancy as it may be harmful to the developing baby. Seek further medical advice from your doctor. If you get pregnant while taking this medicine, stop taking it and consult your doctor immediately.
- It is not known if this medicine passes into breast milk. The manufacturer states that it should not be taken by women who are breastfeeding. Seek further medical advice from your doctor.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
- Dry cough.
- Low blood pressure (hypotension).
- Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain.
- Alteration in taste.
- Increased heart rate (tachcardia).
- Awareness of your heart beat (palpitations).
- Chest pain.
- Increased sensitivity of the skin the sunlight (photosensitivity).
- Hair loss.
- Shortness of breath.
- Inflammation of the sinuses or lining of the nose (sinusitis/rhinitis).
- Inflammation of the pancreas (pancreatitis).
- Severe swelling of lips, face, tongue or throat (angioedema - see warning above).
- Problems with kidney function.
- Disturbances in the normal levels of blood cells in the blood (tell you doctor if you get a sore throat, mouth ulcers, high temperature (fever), or feel tired or generally unwell while taking this medicine).
- Problems with liver function, including jaundice or hepatitis (consult your doctor promptly if you develop unexplained itching, yellowing of the skin or eyes, unusually dark urine, nausea and vomiting, abdominal pains, loss of appetite or flu-like symptoms while taking this medicine).
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.
Cilazapril has an additive effect with other medicines that decrease blood pressure, particularly other medicines used to treat high blood pressure (antihypertensives). In people taking antihypertensive medicines it may cause a large drop in blood pressure with the first dose, particularly in people taking diuretic medicines such as furosemide. This may cause dizziness, which can usually be relieved by lying down until the symptoms pass. If you are taking a diuretic medicine, your doctor may reduce your dose or ask you to stop taking it for a few days before starting cilazapril. This is to prevent your blood pressure from dropping too low. If you frequently feel dizzy while taking this medicine in combination with other blood pressure lowering medicines you should let your doctor know, as your doses may need adjusting. Other medicines that decrease blood pressure include the following:
- other ACE inhibitors, eg captopril
- alpha-blockers such as prazosin
- angiotensin II receptor antagonists such as losartan
- benzodiazepines, eg temazepam, diazepam
- beta-blockers such as propranolol
- calcium-channel blockers such as verapamil, nifedipine
- diuretics, eg furosemide, bendroflumethiazide
- dopamine agonists, eg bromocriptine, apomorphine
- MAOI antidepressants, eg phenelzine
- nitrates, eg glyceryl trinitrate
Non-steroidal anti-inflammatory drugs (NSAIDs, eg indometacin, aspirin, diclofenac, ibuprofen) may reduce the blood pressure lowering effect of cilazapril, and may increase the risk of a decline in kidney function. You should avoid taking this type of painkiller unless recommended by your doctor.
There may be a risk of raised potassium levels in the blood (hyperkalaemia) if any of the following medicines are taken with cilazapril, hence these are not normally recommended for use in combination with cilazapril. If you are taking any of the following with this medicine you should have regular blood tests to monitor the amount of potassium in your blood:
- angiotensin II receptor antagonists, eg losartan
- epoetin (this may also oppose the blood pressure lowering effect of enalapril)
- potassium-containing salt substitutes (eg Lo-Salt)
- potassium salts, eg potassium citrate for cystitis
- potassium-sparing diuretics (eg spironolactone, triamterene, amiloride)
- potassium supplements.
Cilazapril may increase the blood level of the medicine lithium and for this reason, it is not normally recommended for people taking lithium. People taking this medicine in combination with lithium should have the level of lithium in their blood closely monitored.
Cilazapril may possibly enhance the blood sugar lowering effect of insulin and oral antidiabetic medicines, and so could increase the risk of low blood sugar (hypoglycaemia). People with diabetes should therefore carefully monitor their blood sugar while taking this medicine, particularly in the first few weeks of treatment.
There may be an increased risk of a drop in the normal numbers of white blood cells in the blood if this medicine is taken in combination with any of the following medicines:
- immunosuppressant therapy
If you are taking any of these in combination with this medicine, you should have regular blood tests to monitor the levels of your blood cells in your blood, particularly if you also have any kidney problems or diseases affecting connective tissue, eg scleroderma, systemic lupus erythematosus or rheumatoid arthritis (collagen vascular diseases). Tell your doctor if you experience any signs of infection, such as fever, sore throat or mouth ulcers, as these could be signs of problems with your white blood cells.
Other medicines containing the same active ingredient
There are currently no other medicines available in the UK that contain cilazapril as the active ingredient.