Suspected Cross-Reactivity of Enalapril- and Captopril-Induced Hepatotoxicity

Abstract

OBJECTIVE: To present evidence that enalapril and captopril may produce hepatotoxicity by a common mechanism. DATA SOURCES: A case report and review of pertinent literature. DATA SYNTHESIS: A patient developed hepatotoxicity once while taking enalapril and again while taking captopril. Hepatotoxicity resolved with cessation of therapy. Hepatotoxicity has been reported with use of captopril, enalapril, and lisinopril. Apparent cross-reactivity has been reported on just one other occasion. CONCLUSIONS: Because hepatotoxicity is uncommon with angiotensin-converting enzyme (ACE) inhibitors, our observations suggest the possibility that these agents produce hepatotoxicity by a common mechanism. In patients who develop hepatotoxicity while taking one ACE inhibitor, other agents in this class probably should be avoided.