Enalapril

💊 What is Enalapril used for?

• •High blood pressure (hypertension). The label says it can be used alone or with other blood pressure medicines, especially thiazide-type diuretics.
• •Symptomatic congestive heart failure, usually used together with diuretics and digitalis. The label says it improves symptoms, increases survival, and decreases how often people are hospitalized.
• •Asymptomatic left ventricular dysfunction (ejection fraction 35 percent or less) in clinically stable patients. The label says it decreases the rate at which overt heart failure develops and decreases hospitalization for heart failure.

How it works

The label describes enalapril as a prodrug. After it is swallowed, the body changes it (by hydrolysis) into enalaprilat, the active form. The label classifies it as an angiotensin-converting enzyme inhibitor.

How it is usually taken

• •The label says it can be taken as a single dose once a day or split into two doses a day.
• •The label says the dose is adjusted according to blood pressure response.
• •The label says that if you take a water pill (diuretic), it may be advisable to stop the diuretic for two to three days before starting enalapril, if possible. Your prescriber decides this.
• •Follow the instructions from your prescriber or pharmacist.

Comes as

• •Tablets, 10 mg (white, round, scored, engraved with a T above the score and 10 below it)

⚠️ Enalapril side effects

🛑 Who should not take Enalapril, and who should be careful

The label says not to take it if

• 🚨You are allergic (hypersensitive) to enalapril maleate or the product.
• 🚨You have a history of angioedema related to earlier treatment with an ACE inhibitor.
• 🚨You have hereditary or idiopathic angioedema.
• 🚨You have diabetes and are taking aliskiren. The label says not to use these together in patients with diabetes.
• 🚨You are taking a neprilysin inhibitor such as sacubitril. The label says enalapril is contraindicated with these medicines.
• 🚨You are switching to or from sacubitril/valsartan. The label says not to give enalapril within 36 hours of switching.

Tell your doctor before taking it if

• •The label says patients should be cautioned that heavy sweating and dehydration may cause a large drop in blood pressure. Vomiting or diarrhea may also cause this.
• •The label says not to use potassium-containing salt substitutes without first talking with your prescriber.
• •The label says that people with heart failure, low sodium, high-dose diuretic use, kidney dialysis, or severe fluid or salt loss are at risk for excessive drops in blood pressure.
• •Tell your prescriber if you have a history of angioedema, kidney problems, or collagen vascular disease. The label mentions these conditions in discussing other ACE inhibitors and in the dosing and warning sections.
• •The label says female patients of childbearing age should discuss the consequences of exposure during pregnancy, and women planning pregnancy should discuss treatment options with their prescriber.

🔀 Enalapril with other medicines, food and alcohol

The label says to discuss these with your doctor or pharmacist

• •Neprilysin inhibitors (for example sacubitril): may increase the risk of angioedema.
• •Other drugs that act on the renin-angiotensin system, such as angiotensin receptor blockers, other ACE inhibitors, or aliskiren: the label says this combination increases the risk of low blood pressure, high potassium, and kidney changes, and that patients usually get no added benefit. The label says to generally avoid combined use and closely monitor blood pressure, kidney function, and electrolytes.
• •Aliskiren: the label says to avoid use with enalapril in patients with kidney impairment (GFR less than 60 mL/min).
• •Diuretics: the label says the blood pressure lowering effect can be increased, and that excessive blood pressure drops can occur when starting enalapril in patients already on diuretics.
• •Potassium supplements, potassium salt substitutes, and potassium-sparing diuretics: may raise potassium levels in the blood.
• •Nonsteroidal anti-inflammatory drugs (NSAIDs), including COX-2 inhibitors: in elderly patients, patients who are fluid depleted, or those with reduced kidney function, the label says these may worsen kidney function. The label says to monitor kidney function periodically.
• •mTOR inhibitors (for example temsirolimus, sirolimus, everolimus): may increase the risk of angioedema.

Alcohol and food

The label does not say.

🤰 Enalapril in pregnancy and breastfeeding

Pregnancy

The boxed warning says that when pregnancy is detected, enalapril should be stopped as soon as possible, because drugs acting on the renin-angiotensin system can cause injury and death to the developing fetus. The label says women of childbearing age should be told about the consequences of exposure during pregnancy and should report pregnancies to their physician as soon as possible.

Breastfeeding

The label says enalapril and enalaprilat have been found in human breast milk. Because of the potential for serious reactions in nursing infants, the label says a decision should be made whether to stop nursing or stop enalapril, taking into account how important the drug is to the mother.

🗓️ Storage, missed doses and taking too much

Storage

The label says to store at 20 to 25 degrees C (68 to 77 degrees F). Keep the container tightly closed and protect the tablets from moisture. The label says the product comes with a desiccant in the bottle.

If a dose is missed

The label does not say.

If too much is taken

The label says limited human data are available about overdose. The most likely effect of overdose is low blood pressure (hypotension). The label says the usual treatment is intravenous infusion of normal saline. Enalaprilat can be removed from the blood by hemodialysis. If you think someone has taken too much, get medical help right away.

🗒️ Questions to ask about Enalapril

• Why was enalapril chosen for my blood pressure or heart failure instead of another medicine?
• How often should I take enalapril, and how will my dose be adjusted based on my blood pressure?
• What should I do if I feel lightheaded or dizzy, especially in the first few days?
• Should I avoid potassium salt substitutes or potassium supplements while taking enalapril?
• Are my other medicines, including water pills, pain relievers like NSAIDs, or sacubitril, safe to take with enalapril?
• What should I do if I think I might be pregnant, or if I am planning a pregnancy?
• Is it safe for me to breastfeed while taking enalapril?

❓ Enalapril: frequently asked questions