ALTACE is an angiotensin converting enzyme (ACE) inhibitor indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. It may be used alone or in combination with thiazide diuretics (1.1).

In patients 55 years or older at high risk of developing a major cardiovascular event, ALTACE is indicated to reduce the risk of myocardial infarction, stroke, or death from cardiovascular causes (1.2).

ALTACE is indicated in stable patients who have demonstrated clinical signs of congestive heart failure post-myocardial infarction (1.3).

Hypertension: Initial dose is 2.5 mg to 20 mg once daily. Adjust dosage according to blood pressure response after 2–4 weeks of treatment. The usual maintenance dose following titration is 2.5 mg to 20 mg daily as a single dose or equally divided doses (2.1).

Reduction in the risk of myocardial infarction, stroke, or death from cardiovascular causes: 2.5 mg once daily for 1 week, 5 mg once daily for 3 weeks, and increased as tolerated to a maintenance dose of 10 mg once daily (2.2).

Heart failure post-myocardial infarction: Starting dose of 2.5 mg twice daily. If patient becomes hypotensive at this dose, decrease dosage to 1.25 mg twice daily. Increase dose as tolerated toward a target dose of 5 mg twice daily, with dosage increases about 3 weeks apart (2.3).

Dosage adjustment: See respective sections pertaining to dosage adjustment in special situations (2.5).

Capsule: 1.25 mg, 2.5 mg, 5 mg, 10 mg (3)

Angioedema related to previous treatment with an ACE inhibitor, or a history of hereditary or idiopathic angioedema (4).

ALTACE is contraindicated in combination with a neprilysin inhibitor (e.g., sacubitril). Do not administer ALTACE within 36 hours of switching to or from sacubitril/valsartan, a neprilysin inhibitor (4).

Do not co-administer aliskiren with ALTACE in patients with diabetes (4).

Angioedema, increased risk in patients with a prior history (5.1)

Hypotension and hyperkalemia (5.5, 5.8)

Renal impairment: monitor renal function during therapy (5.3)

Avoid concomitant use of an ACE inhibitor and angiotensin blocker (5.7)

Rare cholestatic jaundice and hepatic failure (5.2)

Rare neutropenia and agranulocytosis (5.4)

The most common adverse reactions in patients with hypertension included headache, dizziness, fatigue, and cough (6.1).

To report SUSPECTED ADVERSE REACTIONS, contact Pfizer at 1-800-438-1985 or the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Diuretics: Possibility of excessive hypotension (7.1).

Lithium: Use with caution (7.4).

Gold: Nitritoid reactions have been reported (7.5).

NSAIDS use may lead to increased risk of renal impairment and loss of antihypertensive effect (7.6).

mTOR inhibitor or neprilysin inhibitor use may increase angioedema risk (7.7).

Pregnancy: Discontinue drug if pregnancy is detected (5.6, 8.1).

Nursing mothers: ALTACE use is not recommended in nursing mothers (8.3).