Benazepril and lisinopril are both ACE Inhibitors that are commonly used in practice. Lisinopril is the most frequently used ACE inhibitor. In this article, we will compare benazepril versus lisinopril and highlight some of the differences that may help guide the selection of one versus the other.
Angiotensin-converting enzyme (ACE) inhibitors are a specific medication class utilized in patients with hypertension to minimize risks associated with high blood pressure which include heart disease, heart failure, stroke, and other cardiovascular conditions. Other ACE inhibitors include captopril, enalapril, quinapril, and ramipril. There are many more similarities between ACE inhibitors beyond their drug classifications and mechanisms of action. In the benazepril versus lisinopril comparison table below, similarities will be shown between the two drugs and how they contrast.
Angiotensin-converting enzyme (ACE) inhibitors are a specific medication class utilized in patients with hypertension to minimize risks associated with high blood pressure which include heart disease, heart failure, stroke, and other cardiovascular conditions. When speaking about the similarity between Lisinopril and Benazepril, the easiest comparison to make is the acknowledgment that they are both ACE inhibitors. Other ACE inhibitors include captopril, enalapril, quinapril, and ramipril. There are many more similarities between ACE inhibitors beyond their drug classifications and mechanisms of action. In the table below, similarities will be shown between the two drugs, as well as how they contrast.
| Lisinopril | Benazepril | |
| MOA | ACE inhibitor | |
| Onset of Action | 1-2 hours | <1 hour |
| Duration of Action | Long-acting (>24 hours) | Shorter-acting (~19 hours) |
| Pharmacokinetics: Absorption | Tmax: <7 hours Bioavailability: 25-28% | Tmax: 1-2 hours Bioavailability: >37% |
| Effect of Food | None | Increase Tmax to 2-4 hours |
| Pharmacokinetics: Distribution | Protein binding: none VD: 124 L | Protein binding: 95.3-96.7% |
| Pharmacokinetics: Metabolism | N/A | Prodrug: Hepatic cleavage, Active drug: glucuronide conjugates |
| Pharmacokinetics: Excretion | Renal: 100% unchanged | Prodrug: Renal 4%, Active Drug: Hepatic 11-12% and Renal 8% |
| Elimination ½ Life | 12 hours (increased with renal dysfunction) | 10-11 hours |
| FDA Uses | Acute myocardial infarction, Heart failure adjunct, Hypertension | Hypertension |
| Non-FDA Uses | Diabetic nephropathy, Erythrocytosis, Non-diabetic kidney disease, Migraine prophylaxis | Diabetic nephropathy, Heart failure, Non-diabetic kidney disease, Left ventricular hypertrophy |
| Administration | Oral | |
| Contraindications | Concomitant Aliskiren or Sacubitril use, Angioedema, Hypersensitivity history | |
| Black Box Warning | Pregnancy | |
| REMS | None | |
| Pregnancy | Pregnancy: teratogenic | |
| Monitoring Recommendations | Indications of efficacy include a reduction in mortality, a reduction in the signs and symptoms of heart failure, and decreased blood pressure readings. Monitor for adherence, blood pressure response, kidney function, and potassium. | |
| How Supplied | Oral tablets: 2.5mg, 5mg, 10mg, 20mg, 30mg, 40mg Oral solution: 1mg/1mL | Oral tablets: 5mg, 10mg, 20mg, and 40mg |
| Storage/Stability | Store at a controlled room temperature, protect from freezing, excessive heat and from moisture. | |
As shown in the table, there are some differences noted when comparing benazepril versus lisinopril. Lisinopril has a longer duration of action than benazepril. This can reduce the likelihood of blood pressure fluctuations. In addition, lisinopril tends to have more evidence to support its use in various disease states which is demonstrated by an increased number of indications that are FDA-approved. Lisinopril can be supplied as both an oral tablet and a solution, making it a good choice for patients who have difficulty swallowing pills. Lisinopril is also not affected by food; therefore, it may help improve the consistency of drug levels. The high level of protein binding with benazepril is interesting. There is not much evidence on whether this has clinical significance but theoretically could lead to some variability if the medication is being used in patients with lower blood protein levels or in patients taking other highly protein-bound medications. Benazepril does not have any unique upsides that lisinopril also does not have, which is why it is not prescribed more than it’s counterpart. Benazepril’s efficacy for lowering blood pressure is similar to that of Lisinopril, but due to the many upsides of prescribing lisinopril, it will most likely continue to be prescribed less frequently than lisinopril.
Looking for more on ACE Inhibitors? Check out this comparison table.
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This article was written by Dean Dubay, PharmD, Candidate in collaboration with Eric Christianson, PharmD, BCPS, BCGP.
References:
- Lisinopril: https://www.micromedexsolutions.com/micromedex2/librarian/PFDefaultActionId/evidencexpert.DoIntegratedSearch?navitem=topHome&isToolPage=true#
- Benazepril: https://www.micromedexsolutions.com/micromedex2/librarian/PFDefaultActionId/evidencexpert.DoIntegratedSearch?navitem=topHome&isToolPage=true#
- ACEi: https://www.ncbi.nlm.nih.gov/books/NBK430896/
- ACEi: https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/ace-inhibitors/art-20047480
- https://www.goodrx.com/classes/ace-inhibitors/list
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