What should I do if I accidentally take an extra dose of an angiotensin-converting enzyme (ACE) inhibitor? (2024)

Last Updated 3/3/2023

Treatment

Most people who take an extra dose of an angiotensin-converting enzyme (ACE) inhibitor will be fine.



If you take two doses of your ACE inhibitor at once, there is a slight chance your blood pressure may drop too low. Watch for symptoms of low blood pressure like nausea, dizziness, rapid heart rate, or weakness.

Call your doctor right away if you don't feel well or have other concerns. Your doctor may have you check your blood pressure at home and have you watch for symptoms for a day. They may ask you to come into their office. In most cases you won’t need to.

To avoid taking an extra dose of your ACE inhibitor, try to take your medicine at the same time every day. Use a pillbox or other system to help keep track of your pills. This can help keep you from missing or taking an extra dose.

If you don't feel ok, call your doctor right away!

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Authors

What should I do if I accidentally take an extra dose of an angiotensin-converting enzyme (ACE) inhibitor? (1)

Lisa Souza, M.L.I.S.

  • Weill Cornell Medicine

What should I do if I accidentally take an extra dose of an angiotensin-converting enzyme (ACE) inhibitor? (2)

Amanda S. Carmel, M.D.

  • Weill Cornell Medicine

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What should you do if you accidentally take an extra dose of an angiotensin-converting enzyme (ACE) inhibitor?

This is incorrect. If you accidentally take an extra dose of an ACE inhibitor, watch for symptoms of low blood pressure like nausea, dizziness, weakness, or a rapid heart rate. Call your doctor right away if you don't feel well.

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This is incorrect. If you accidentally take an extra dose of an ACE inhibitor, you'll most likely be fine. Watch for symptoms of low blood pressure like nausea, dizziness, weakness, or a rapid heart rate. Call your doctor right away if you don't feel well.

If you accidentally take an extra dose of an ACE inhibitor, watch for symptoms of low blood pressure like nausea, dizziness, weakness, or a rapid heart rate. Call your doctor right away if you don't feel well.

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See the Science

There have not been enough studies addressing the course of action for a patient who accidentally took an extra dose of an angiotensin-converting enzyme (ACE) inhibitor. The recommendation found in this article was developed by doctors at Weill Cornell Medicine in consultation with experts in the field.

A 2006 retrospective case review of 33 patients with ACE inhibitor overdose found the ingested quantity of ACE inhibitor was 20 (7-42) times the defined daily dose.1 The lowest blood pressure recorded for each patient occurred within 4.5 hours (3.8-5.5). Although in cases of serious overdose, severe hypotension has occurred,2-7 most cases are mild, and most patients do not require any specific treatment.8-10

Manufacturers state limited data are available in regard to overdosage in humans, but the most likely manifestation of overdose would be hypotension.11-24

References

  1. Lucas C, Christie GA, Waring WS. Rapid onset of haemodynamic effects after angiotensin converting enzyme-inhibitor overdose: implications for initial patient triage. Emerg Med J 2006; 23 (11): 854-857.
  2. Augenstein WL, Kulig KW, Rumack BH. Captopril overdose resulting in hypotension. JAMA 1988; 259 (22): 3302-3305.
  3. Park H, Purnell GV, Mirchandani HG. Suicide by captopril overdose. J Toxicol Clin Toxicol 1990; 28 (3): 379-382.
  4. Barr CS, Payne R, Newton RW. Profound prolonged hypotension following captopril overdose. Postgrad Med J 1991; 67 (792): 953-954.
  5. Newby DE, Lee MR, Gray AJ, Boon NA. Enalapril overdose and the corrective effect of intravenous angiotensin II. Br J Clin Pharmacol 1995; 40 (1): 103-104.
  6. Dawson AH, Harvey D, Smith AJ, et al. Lisinopril overdose. Lancet 1990; 335 (8687): 487-488.
  7. Trilli LE, Johnson KA. Lisinopril overdose and management with intravenous angiotensin II. Ann Pharmacother 1994; 28 (10): 1165-1168.
  8. Varughese A, Taylor AA, Nelson EB. Consequences of angiotensin-converting enzyme inhibitor overdose. Am J Hypertens 1989; 2 (5 Pt 1): 355-357.
  9. Lip GY, Ferner RE. Poisoning with anti-hypertensive drugs: angiotensin converting enzyme inhibitors. J Hum Hypertens 1995; 9 (9): 711-715.
  10. Christie GA, Lucas C, Bateman DN, Waring WS. Redefining the ACE-inhibitor dose-response relationship: substantial blood pressure lowering after massive doses. Eur J Clin Pharmacol 2006; 62 (12): 989-993.
  11. Lotensin [package insert]. Parsippany, NJ: Validus Pharmaceuticals LLC; 2019.
  12. Capoten [package insert]. Chestnut Ridge, NY: Par Pharmaceutical; 2017.
  13. Epaned [package insert]. Wilmington, MA: Azurity Pharmaceuticals, Inc.; 2020.
  14. Vasotec [package insert]. Bridgewater, NJ: Bausch Health US LLC; 2018.
  15. Enalaprilat [package insert]. Lake Forest, IL: Hospira, Inc.; 2021.
  16. Monopril [package insert]. Princeton, NJ: Bristol-Myers Squibb Company; 2003.
  17. Qbrelis [package insert]. Wilmington, MA: Azurity Pharmaceuticals, Inc.; 2020.
  18. Prinivil [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp.; 2021.
  19. Zestril [package insert]. Morristown, NJ: Almatica Pharma LLC; 2020.
  20. Univasc [package insert]. Smyrna, GA: USB, Inc; 2012.
  21. Aceon [package insert]. Cincinnati, OH: Patheon Pharmaceuticals, Inc.; 2017.
  22. Accupril [package insert]. New York, NY: Parke Davis, Pfizer; 2021.
  23. Altace [package insert]. New York, NY: Pfizer Laboratories; 2022.
  24. Mavik [package insert]. Whippany, NJ: Halo Pharmaceutical Inc.; 2017.

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What should I do if I accidentally take an extra dose of an angiotensin-converting enzyme (ACE) inhibitor? (2024)

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