Proposal to fund medicines for people with high blood pressure and bacterial infections
Captopril liquid for high blood pressure in patients with autonomic dysreflexia following spinal cord injury
What would the effect be?
From 1 November captopril oral liquid would be funded for patients experiencing episodes of high blood pressure during autonomic dysreflexia as a result of spinal cord injury.
We estimate that an additional 12 people per year over the next 5 years would receive captopril oral liquid as a result of this proposal.
About autonomic dysreflexia and captopril liquid
Autonomic dysreflexia is a potentially life-threatening condition that can occur in people with spinal cord injuries. It causes a sudden and severe rise in blood pressure, usually in response to a trigger such as a full bladder, bowel problems, skin irritation, or another stimulus below the level of the spinal cord injury. If not treated promptly, autonomic dysreflexia can lead to serious complications such as stroke, seizures, heart problems, or death.
Captopril is a type of medicine (ACE inhibitor) that lowers blood pressure by relaxing blood vessels and reducing the workload on the heart. The oral liquid form allows flexible dosing and may be used where rapid treatment of high blood pressure is needed. .
Why we’re proposing this
Pharmac received a funding application in 2023 seeking funded access to captopril oral liquid for the treatment of autonomic dysreflexia in people with spinal cord injury. Currently, funded access to captopril oral liquid is restricted to children under 12 years of age.
Glyceryl trinitrate (GTN) is commonly used to manage autonomic dysreflexia but is not suitable for people who have recently taken medicines such as sildenafil and other phosphodiesterase-5 (PDE5) inhibitors. Clinical advice provided to Pharmac supported captopril oral liquid as an alternative treatment option when GTN is not appropriate.
Access to funded captopril oral liquid could allow some people to manage autonomic dysreflexia at home and reduce the need for urgent hospital treatment. A summary of the clinical advice received is available on the funding application webpage.
Details about our proposal
From 1 November 2026, captopril oral liquid (5 mg per ml) will be listed in Section B of the Pharmaceutical Schedule subject to the following amended listing note:
“Oral liquid restricted to children under 12 years of age.”
“Restricted to use for children under 12 years of age (any condition) or for treatment of acute autonomic dysreflexia in any person with spinal cord injury where glyceryl nitrate is contraindicated.”