Benazepril

Oral health effects

• Angioedema / dysgeusia

  Class effects: orofacial swelling and altered taste.

  Mechanism: Bradykinin accumulation from ACE inhibition.

  Clinical management: Emergency care for airway angioedema; otherwise symptomatic.

• Persistent dry cough (ACE inhibitor cough)

  A dry, tickly, non-productive cough is a class effect of ACE inhibitors caused by bradykinin accumulation; it can start weeks to months after starting and resolves within days to weeks of stopping. Label: cough was one of the most common reasons for discontinuation (0.5%) in U.S. trials.

  Clinical management: Ask about chronic cough at medical history review. Cough can be triggered by water spray, prophy paste or supine positioning: use high-volume suction, a more upright chair position and short breaks. Persistent cough is a reason for the patient to discuss alternatives (e.g. an ARB) with their prescriber; do not advise stopping the medication.

• Dizziness on standing (orthostatic hypotension)

  Postural dizziness was reported in 2% of benazepril-treated patients vs 0% on placebo in U.S. trials.

  Clinical management: Raise the chair back slowly at the end of the appointment, let the patient sit upright for 1–2 minutes before standing, and steady them as they get up. Take extra care in older patients, after long supine procedures and when other blood-pressure-lowering drugs are taken.