Clearance of Temocapril and Enalapril during Haemodialysis Treatment

The dialysis clearance of active metabolites and the effective doses of temocapril and enalapril were studied in haemodialysis patients. Enalapril reduced blood pressure at dosages of 2.5 or 5 mg/day, and these dosages were lower than in patients with normal renal function (5 to 10 mg/day). In contrast, temocapril showed hypotensive effects at dosages of 2 or 4 mg/day, almost the same as in patients with normal renal function. The reason for this may be attributed to the different major excretory pathways of these drugs, i.e. enalapril via the kidneys and temocapril preferentially via both the liver and kidney. Dialysis clearance was determined after multiple oral doses. Enalaprilat showed a high clearance during dialysis (69.3 ± 24.2 ml/min), and this increased as the plasma drug concentration became high. On the other hand, temocaprilat clearance was rather low (7.7 ± 15.4 ml/min) and not dependent on the plasma drug concentration. These results indicate that temocapril can be used in haemodialysis patients without risk of significant accumulation, but its low haemodialysis clearance may require minimum dose adjustment.