Captopril overdose resulting in hypotension
W. L. Augenstein, K. W. Kulig and B. H. Rumack
Rocky Mountain Poison and Drug Center, Denver, CO 80204.
We present a case in which a patient took an overdose of captopril
(Capoten) and alprazolam (Xanax) in a suicide attempt. The patient
presented with hypotension (systolic blood pressure of 80 mm Hg) and
drowsiness. The hypotension initially responded to administration of
intravenous fluids and dopamine; however, it recurred twice at 18.5 and
24.5 hours after ingestion. These episodes again responded to
administration of fluids and dopamine. A plasma captopril level of 27,391.1
nmol/L (5982 ng/mL) was documented, as well as a depressed level of
angiotensin converting enzyme. Captopril is an angiotensin converting
enzyme inhibitor used in the management of hypertension and ventricular
failure; to our knowledge, this is the first case of an acute captopril
overdose reported in the English-language literature. The role of captopril
in inducing hypotension is discussed herein.
