Ace inhibitors list
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Comprehensive List of ACE Inhibitors
Angiotensin-converting enzyme (ACE) inhibitors are a class of medications widely used to manage hypertension and various cardiovascular and renal conditions. This article provides a detailed overview of different ACE inhibitors, their classifications, and their specific characteristics.
Commonly Used ACE Inhibitors
Synthetic ACE Inhibitors
Synthetic ACE inhibitors are the most commonly prescribed and include several well-known drugs:
- Captopril: The first orally active ACE inhibitor, discovered in 1977, known for its rapid onset and short duration of action.
- Enalapril: A prodrug converted to enalaprilat in the body, with a longer duration of action compared to captopril.
- Lisinopril: Not a prodrug, it has a long half-life and is often preferred for its consistent 24-hour blood pressure control.
- Ramipril: Another prodrug, known for its potent and long-lasting effects.
- Fosinopril: Unique for its dual route of elimination (renal and hepatic), making it suitable for patients with varying degrees of renal function.
- Quinapril: Known for its early peak time and shorter half-life.
- Benazepril: Similar to enalapril but with a slightly shorter terminal half-life.
- Perindopril: Exhibits a similar peak time and terminal half-life to enalapril.
- Zofenopril: A prodrug with greater potency and longer duration of action than captopril.
Phosphinyloxyacyl Proline Inhibitors
A newer class of ACE inhibitors includes phosphinyloxyacyl proline derivatives:
- SQ 29,852: Demonstrates superior potency and oral activity compared to captopril, with a high level of oral activity.
Natural ACE Inhibitors
Plant-Based ACE Inhibitors
There is growing interest in natural ACE inhibitors due to their minimal side effects and lower toxicity. Several plants and their extracts have shown significant ACE-inhibitory activity:
- Angelica keiskei
- Momordica charantia
- Muntingia calabura
- Prunus domestica
- Peperomia pellucida
These plants contain bioactive metabolites such as peptides, phenolics, flavonoids, terpenoids, and alkaloids, which contribute to their ACE-inhibitory properties.
Pharmacokinetic and Pharmacodynamic Considerations
Pharmacokinetics
The pharmacokinetic properties of ACE inhibitors, such as terminal half-life and route of elimination, play a crucial role in their clinical selection:
- Lisinopril, Enalapril, and Trandolapril: Preferred for their higher trough to peak ratios, ensuring consistent blood pressure control over 24 hours.
- Fosinopril: Notable for its dual elimination route, making it suitable for patients with renal insufficiency.
Pharmacodynamics
The antihypertensive efficacy of ACE inhibitors is generally similar across different agents, with some variations in their trough to peak ratios and impact on left ventricular hypertrophy and insulin resistance.
Conclusion
ACE inhibitors are a diverse group of medications with varying pharmacokinetic and pharmacodynamic profiles. While synthetic ACE inhibitors like captopril, enalapril, and lisinopril are widely used, natural ACE inhibitors from plants offer promising alternatives with fewer side effects. Understanding the specific characteristics of each ACE inhibitor can help in selecting the most appropriate agent for individual patients.
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