Kidney injury is a common issue among cats and dogs and a common treatment option for proteinuria is an angiotensin-converting enzyme inhibitor (ACEI) treatment. ACEI treatments relieve pressure on the glomerulus and slow the detrimental effects in your patients’ glomerular filtration rate. ACEI also delays the progression to end-stage renal disease and prolongs your patients’ survival time.
Let’s look at the pros and cons of the medicines you can use in your ACEI treatments to help you better decide how to treat your patients.
Enalapril is a slow onset drug (4-6 hours), but that is offset by its longer duration of action (12-14 hours). The daily dose of enalapril for dogs is 0.25 – 1 mg/kg by mouth q 12 -24h when creatinine clearance is >0.4 mL/kg/min.
For cats, the dosage is 0.25-0.5 mg/kg by mouth q 12-24 hours when creatinine clearance is > 0.4 mL/kg/min. The goal of the treatment is to decrease urine protein and the creatinine ratio by at least half.
Be sure to measure serum creatinine before and 1-2 weeks after initiating the therapy. This will help you keep track of progress and monitor your patients’ progress.
There is stronger evidence of enalapril’s efficacy in dogs with protein-losing nephropathy, as opposed to animals with chronic kidney disease without severe protein-losing nephropathy.
Benazepril is a quicker onset drug—it hits peak levels at 75 minutes after dosing— but it has a shorter duration of action in dogs (half-life of 3.5 hours). However, the inhibition of ACE is longer lasting in cats (half-life of 16-23 hours).
The daily dose of benazepril for dogs is 0.25-0.5 mg/kg by mouth q 12-24 h. For cats, the dose is 0.5-1 mg/kg by mouth once daily.
With benazepril, mild to moderate renal dysfunction does not significantly alter elimination. Biliary clearance may compensate for the decrease in renal clearance though.
Which Is the Better Option: Enalapril or Benazepril?
Both benazepril and enalapril are not recommended for critically ill patients with acute kidney injury. The potential negative effects on the patient’s glomerular filtration rate and a worsening of azotemia outweigh the benefits of using these drugs.
Enalapril is 95% cleared by the kidneys and reduced renal function can impact your patients’ elimination rates. This often requires a reduced dose in patients with renal insufficiency (50% of usual daily dose).
Benazepril is cleared by the renal (45%) and hepatic (55%) routes. Because benazepril is cleared via both renal and hepatic routes in contrast to enalapril (primarily renal), it may be more safely dosed in patients with decreased renal function.
ACEI therapy is the first-line of treatment for proteinuria in cats and dogs. Picking the right medication for your patient is critical to not worsen their kidney function.
Benazepril exhibits dual metabolism, therefore, it is a better option for patients with decreased renal function.
Benazepril is a much safer and more effective medication for the treatment of proteinuria. EPC can help you formulate a compliant formulation to promote long-term compliance in a tasty, low-volume suspension.
To prescribe benazepril, or to talk to one of our experienced veterinary compounding pharmacists, call 888-733-0300 FREE ext 3.
With best regards,
Drew Olson, DVM
National Director – Veterinary Division