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enalapril (Oral route)

Pronunciation

en-AL-a-pril MAL-ee-ate

Oral route(Tablet;Solution)

Discontinue enalapril maleate as soon as possible when pregnancy is detected, since fetal toxicity, including injury and death to the developing fetus, can be caused by drugs that act directly on the renin-angiotensin system .

Commonly used brand name(s)

In the U.S.

  • Epaned
  • Vasotec

Available Dosage Forms:

  • Powder for Solution
  • Tablet

Therapeutic Class: Antihypertensive

Pharmacologic Class: Enalapril

Uses For enalapril

Enalapril is used alone or together with other medicines to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. Lowering blood pressure can reduce the risk of strokes and heart attacks.

Slideshow: View Frightful (But Dead Serious) Drug Side Effects

Enalapril is an angiotensin converting enzyme (ACE) inhibitor. It works by blocking a substance in the body that causes the blood vessels to tighten. As a result, enalapril relaxes the blood vessels. This lowers blood pressure and increases the supply of blood and oxygen to the heart.

Enalapril is also used in combination with other medicines to treat congestive heart failure and cut down on the number of hospital visits for heart problems.

enalapril is available only with your doctor's prescription. .

Before Using enalapril

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For enalapril, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to enalapril or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of enalapril to treat hypertension in children 1 month to 16 years of age. However, use is not recommended in children younger than 1 month of age and in children with severe kidney disease.

Geriatric

No information is available on the relationship of age to the effects of enalapril in geriatric patients. However, elderly patients are more likely to have age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving enalapril.

Pregnancy

Pregnancy Category Explanation
All Trimesters D Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Breast Feeding

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking enalapril, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using enalapril with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Aliskiren

Using enalapril with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Allopurinol
  • Alteplase, Recombinant
  • Amiloride
  • Azathioprine
  • Azilsartan
  • Candesartan Cilexetil
  • Canrenoate
  • Eplerenone
  • Eprosartan
  • Interferon Alfa-2a
  • Irbesartan
  • Losartan
  • Olmesartan Medoxomil
  • Potassium
  • Spironolactone
  • Telmisartan
  • Triamterene
  • Valsartan

Using enalapril with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Aceclofenac
  • Acemetacin
  • Amtolmetin Guacil
  • Aspirin
  • Azosemide
  • Bemetizide
  • Bendroflumethiazide
  • Benzthiazide
  • Bromfenac
  • Bufexamac
  • Bumetanide
  • Bupivacaine
  • Bupivacaine Liposome
  • Buthiazide
  • Capsaicin
  • Celecoxib
  • Chlorothiazide
  • Chlorthalidone
  • Choline Salicylate
  • Clomipramine
  • Clonixin
  • Clopamide
  • Cyclopenthiazide
  • Cyclothiazide
  • Dexibuprofen
  • Dexketoprofen
  • Diclofenac
  • Diflunisal
  • Dipyrone
  • Ethacrynic Acid
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Felbinac
  • Fenoprofen
  • Fepradinol
  • Feprazone
  • Floctafenine
  • Flufenamic Acid
  • Flurbiprofen
  • Furosemide
  • Gold Sodium Thiomalate
  • Hydrochlorothiazide
  • Hydroflumethiazide
  • Ibuprofen
  • Ibuprofen Lysine
  • Indapamide
  • Indomethacin
  • Ketoprofen
  • Ketorolac
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Metformin
  • Methyclothiazide
  • Metolazone
  • Morniflumate
  • Nabumetone
  • Naproxen
  • Nepafenac
  • Nesiritide
  • Niflumic Acid
  • Nimesulide
  • Oxaprozin
  • Oxyphenbutazone
  • Parecoxib
  • Phenylbutazone
  • Piketoprofen
  • Piretanide
  • Piroxicam
  • Polythiazide
  • Pranoprofen
  • Proglumetacin
  • Propyphenazone
  • Proquazone
  • Quinethazone
  • Rifampin
  • Rofecoxib
  • Salicylic Acid
  • Salsalate
  • Sodium Salicylate
  • Sulindac
  • Tenoxicam
  • Tiaprofenic Acid
  • Tolfenamic Acid
  • Tolmetin
  • Torsemide
  • Trichlormethiazide
  • Trimethoprim
  • Valdecoxib
  • Xipamide

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of enalapril. Make sure you tell your doctor if you have any other medical problems, especially:

  • Angioedema (swelling of the face, lips, tongue, throat, arms, or legs), history of—May increase risk of this condition occurring again.
  • Collagen vascular disease (an autoimmune disease) together with kidney disease—Increased risk of blood problems.
  • Diabetes or
  • Kidney problems—Increased risk of potassium levels in the body becoming too high.
  • Diabetic patients who are also taking aliskiren (Tekturna®) or
  • Hereditary or idiopathic angioedema—Should not be used in patients with these conditions.
  • Electrolyte imbalance (eg, low sodium in the blood) or
  • Fluid imbalances (caused by dehydration, vomiting, or diarrhea) or
  • Heart or blood vessel problems (eg, aortic stenosis, hypertrophic cardiomyopathy) or
  • Kidney disease or
  • Liver disease—Use with caution. May make these conditions worse.

Proper Use of enalapril

In addition to the use of enalapril, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium (salt). Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.

Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.

Remember that enalapril will not cure your high blood pressure but it does help control it. Therefore, you must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.

Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.

If your child cannot swallow the tablets, an oral liquid may be given. Ask your doctor or pharmacist about this.

Dosing

The dose of enalapril will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of enalapril. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (oral solution):
    • For high blood pressure:
      • Adults—At first, 5 milligrams (mg) once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 40 mg per day.
      • Children 1 month of age and older—Dose is based on body weight and must be determined by your doctor. The usual starting dose is 0.08 mg per kilogram (kg) of body weight per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 0.58 mg per kg of body weight or 40 mg per day.
      • Children younger than 1 month of age—Use is not recommended.
  • For oral dosage form (tablets):
    • For high blood pressure:
      • Adults—At first, 5 milligrams (mg) once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 40 mg per day.
      • Children 1 month of age and older—Dose is based on body weight and must be determined by your doctor. The usual starting dose is 0.08 mg per kilogram (kg) of body weight per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 0.58 mg per kg of body weight or 40 mg per day.
      • Children younger than 1 month of age—Use is not recommended.
    • For heart failure:
      • Adults—At first, 2.5 milligrams (mg) once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 40 mg per day.
      • Children—Use and dose must be determined by your doctor.
    • For abnormal heart ventricle:
      • Adults—At first, 2.5 milligrams (mg) two times a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 20 mg per day.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of enalapril, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Store the Epaned™ mixed oral liquid at room temperature for up to 60 days. Keep the Vasotec® mixed oral liquid in the refrigerator and store it for up to 30 days. Do not freeze.

Precautions While Using enalapril

It is very important that your doctor check your progress at regular visits to make sure enalapril is working properly. Blood tests may be needed to check for unwanted effects.

Using enalapril while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.

enalapril may cause serious allergic reactions, including anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, mouth, or throat while you are using enalapril.

Call your doctor right away if you have severe stomach pain (with or without nausea or vomiting). This could be a symptom of intestinal angioedema.

Dizziness, lightheadedness, or fainting may also occur, especially when you get up from a lying or sitting position or if you have been taking a diuretic (water pill). Make sure you know how you react to the medicine before you drive, use machines, or do other things that could be dangerous if you are dizzy or not alert. If you feel dizzy, lie down so you do not faint. Then sit for a few moments before standing to prevent the dizziness from returning.

Check with your doctor right away if you become sick while taking enalapril, especially with severe or continuing nausea, vomiting, or diarrhea. These conditions may cause you to lose too much water or salt and may lead to low blood pressure. You can also lose water by sweating, so drink plenty of water during exercise or in hot weather.

Check with your doctor if you have a fever, chills, or sore throat. These could be symptoms of an infection resulting from low white blood cells.

Check with your doctor right away if you have upper stomach pain, pale stools, dark urine, loss of appetite, nausea, unusual tiredness or weakness, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Hyperkalemia (high potassium in the blood) may occur while you are using enalapril. Check with your doctor right away if you have the following symptoms: abdominal or stomach pain, confusion, difficulty with breathing, irregular heartbeat, nausea or vomiting, nervousness, numbness or tingling in the hands, feet, or lips, shortness of breath, or weakness or heaviness of the legs. Do not use supplements or salt substitutes containing potassium without first checking with your doctor.

Make sure any doctor or dentist who treats you knows that you are using enalapril. You may need to stop using enalapril several days before having surgery.

Do not take other medicines unless they have been discussed with your doctor. This includes over-the-counter (nonprescription) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since they may tend to increase your blood pressure.

enalapril Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
  • Blurred vision
  • confusion
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • sweating
  • unusual tiredness or weakness
Less common
  • Chest pain
  • cough producing mucus
  • diarrhea
  • difficult or labored breathing
  • fainting
  • fever or chills
  • nausea
  • sneezing
  • sore throat
  • tightness in the chest
  • vomiting

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Dizziness
Less common
  • Lack or loss of strength
  • rash

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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