Captopril

Oral health effects

• Dysgeusia (loss/alteration of taste)

  Captopril is classically associated with taste disturbance, attributed to its sulfhydryl group.

  Clinical management: Often reversible on dose reduction; coordinate with prescriber.

• Angioedema

  Class effect: orofacial/airway swelling.

  Mechanism: Bradykinin accumulation.

  Clinical management: Emergency management if airway involved.

• 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 reported in 0.5 to 2% of captopril-treated patients in clinical 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.