A range of ACE inhibitors and angiotensin II receptor antagonists are suitable for adults with swallowing difficulties.

ACE inhibitors: licensed options

Ramipril 5mg/5ml oral solution

Available as a licensed product. It requires fridge storage and has one month expiry once opened.

Captopril 5mg/5ml and 25mg/5ml oral solutions

Available as licensed products. They have a shelf-life of 21 or 28 days after opening (depending on manufacturer) and do not require fridge storage.
Note: captopril is not usually suitable for once daily administration.

ACE inhibitors: licensed options used in unlicensed manner

Enalapril, lisinopril and ramipril tablets

Can be crushed and/or dispersed in water or crushed and given with soft food.

Perindopril erbumine (perindopril tert-butylamine) tablets

Can be crushed and mixed with water or given with soft food. Absorption might be reduced by food but this might not be clinically relevant; give the medicine the same way each day, monitor for effect and adjust the dose if necessary.

Ramipril capsules

Can be opened and the contents placed directly in the mouth, on a piece of bread or given with soft food. The capsule contents taste unpleasant.

Captopril tablets

Can be crushed and/or dispersed in water or crushed and given with soft food.
Note: captopril is not usually suitable for once daily administration.

Special-order ACE inhibitors

The following are listed in Part VIIIB of the Drug Tariff:

Lisinopril

Available in 20mg/5ml oral solution and 20mg/5ml oral suspension

Perindopril erbumine

Available in 4mg/5ml oral solution and 4mg/5ml oral suspension

Angiotensin II receptor antagonists: licensed options

Valsartan 3mg/ml oral solution

Available as a licensed preparation. It has a three-month expiry once opened and does not require fridge storage. When converting from tablets to oral solution, halve the tablet dose.
Note: The oral solution is only licensed for children and young people aged 1 to less than 18 years of age, not for adults.

Angiotensin II receptor antagonists: licensed products used in unlicensed manner

Candesartan, eprosartan and losartan tablets

Can be crushed and mixed with water or given with soft food.

Irbesartan and telmisartan tablets

Can be crushed and/or dispersed in water or crushed and given with food.

Valsartan capsules

Can be opened and dispersed in water or given with food.

Special-order angiotensin II receptor antagonists

The following is listed in Part VIIIB of the Drug Tariff:

Losartan

Available in 50mg/5ml oral suspension