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Enalapril (ACE-inhibitor, antihypertensive agent)

Uses|Precautions & warnings|Side effects|Interactions|Dosage

Enalapril is an antihypertensive agent, specifically an ACE-inhibitor. By blocking the action of angiotensin-converting enzyme (ACE), there is less of the vasoconstrictor angiotensin II produced. This results in the lowering of blood pressure and sodium and water retention.

enalapril

Uses

What is enalapril used for?

Enalapril is mainly indicated to treat the following conditions:

  • Hypertension
  • Heart failure

How should I take enalapril?

Enalapril is available as an oral tablet. The oral tablet should be taken by mouth without chewing or crushing it. The tablets can be taken with or without food. If you have trouble chewing or swallowing tablets, you can crush or divide it and mix it with soft food like yogurt or pudding.

How do I store enalapril?

This product is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store it in the bathroom or the freezer.

There may be different brands of this drug that may have different storage needs. So, it is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush this product down the toilet or pour them into a drain unless instructed to do so. Additionally, it is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using enalapril?

ACE-inhibitors, including enalapril, are associated with an increased risk of hypotension and cough. This risk is further increased in older patients usually over 60 years of age, regular alcohol drinkers, and those with respiratory conditions.

Some groups of people with conditions like asthma may experience an exacerbation of symptoms after using ACE-inhibitors.

Before using this drug, tell your doctor if you are/have:

  • Pregnant or breastfeeding.
  • Taking any other medicines. This includes any prescription, OTC, and herbal remedies.
  • An allergy to any of the ingredients of this product.
  • Any other illnesses, disorders, or medical conditions.

Is it safe during pregnancy or breastfeeding?

There is evidence from human studies that shows it can cause fetal harm when taken during pregnancy. Therefore, always consult with your doctor to weigh the potential benefits and risks before taking this medication. You may need to stop taking this drug if you become pregnant.

This medication is pregnancy risk category D according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk
  • B=No risk in some studies
  • C=There may be some risk
  • D=Positive evidence of risk
  • X=Contraindicated
  • N=Unknown

Side effects

What side effects can occur when using enalapril?

Like all drugs, this product may have side effects. If they occur, side effects are generally mild and resolve once treatment is finished or the dose is lowered. Some reported side effects include:

  • Nausea, vomiting, diarrhea
  • Hypotension
  • Persistent dry cough
  • Dizziness
  • Headache
  • Insomnia
  • Peripheral neuropathy
  • Changes in your sense of taste
  • Muscle cramps
  • Rash

Seek medical attention immediately if you experience any of these serious, potentially fatal drug reactions:

  • Angioedema
    • Laryngeal edema
  • Hepatic necrosis (rare)

However, not everyone experiences these side effects. In addition, some people may experience other side effects. So, if you have any concerns about a side effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with enalapril?

This medication may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects.

To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs, and herbal products) and share it with your doctor and pharmacist.

Drugs with known interactions:

  • Other antihypertensives
    • Enhanced hypotension
  • Diuretics
    • Enhanced hypotension
    • Hyperkalemia (with potassium-sparing diuretics)
  • Tricyclic antidepressants (TCAs)
    • Enhanced hypotension
  • Nitrates
    • Enhanced hypotension
  • Anesthesia
    • Enhanced hypotension
  • Lithium
    • Increased risk of lithium toxicity
  • NSAIDs
    • Increased risk of renal impairment

If you experience an adverse drug interaction, stop taking this drug and continue taking your other medication. Inform your doctor immediately to reevaluate your treatment plan. Approaches include dose adjustment, drug substitution, or ending therapy.

Does food or alcohol interact with enalapril?

This drug may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with enalapril?

This drug may interact with underlying conditions. This interaction may worsen your health condition or alter the way the drug works. Therefore, it is important to always let your doctor and pharmacist know all the health conditions you currently have, especially:

  • Active bronchial asthma
  • History of angioedema
  • Collagen vascular disease
  • Pre-existing renal insufficiency
  • Renal artery stenosis
  • Aortic or mitral valve stenosis

Dosage

The information provided is not a substitute for any medical advice. Therefore, you should always consult with your doctor or pharmacist before using any medication.

What is the dose for an adult?

For hypertension

  • Initial dose: take 5 mg once at bedtime.
    • Dose adjustment for elderly patients: 2.5 mg/day
  • Maintenance dose: take 10-20 mg/day as a single dose.
  • Maximum dose: increase up to 40 mg in 2 divided doses (severe hypertension)

For heart failure

  • Initial dose: take 5 mg once at bedtime.
    • Dose adjustment for elderly patients: 2.5 mg/day
  • Maintenance dose: take 20 mg/day as a single dose or in 2 divided doses.
  • Maximum dose: 40 mg/day in 2 divided doses.

What is the dose for a child?

For hypertension

Bodyweight of 20 to <50 kg

  • Initial dose: 2.5 mg once a day
  • Maximum dose: increase up to 20 mg once a day

Bodyweight of >50 kg

  • Initial dose: 5 mg once a day
  • Maximum dose: increase up to 40 mg once a day

How is enalapril available?

This drug is available in the following brands, dosage forms, and strengths:

  • Hypace tablet 5 mg, 10 mg, 20 mg
  • Hypril tablet 5 mg, 10 mg
  • Naprilate tablet 5 mg, 20 mg
  • Renite XL tablet 5 mg, 10 mg

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to the nearest emergency room.

What should I do if I miss a dose?

If you miss a dose, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Enalapril https://www.mims.com/philippines/drug/info/enalapril?mtype=generic Accessed June 15, 2021

Enalapril (Oral Route) https://www.mayoclinic.org/drugs-supplements/enalapril-oral-route/side-effects/drg-20069221?p=1 Accessed June 15, 2021

Enalapril https://pubchem.ncbi.nlm.nih.gov/compound/Enalapril Accessed June 15, 2021

Enalapril https://www.uofmhealth.org/health-library/d00013a1 Accessed June 15, 2021

Enalapril. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed June 15, 2021. http://online.lexi.com

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Written by Stephanie Nicole Nera, RPh, PharmD Updated Jun 15