Enalapril Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Diabetic Nephropathy

Initial dose (oral tablets or solution): 5 mg orally once a day
Maintenance dose (oral tablets or solution): 10 to 40 mg orally per day in 1 to 2 divided doses
Intravenous: 1.25 to 5 mg IV every 6 hours over a 5 minute period

Approved indication: Hypertension

Off-label uses: Diabetic neuropathy

Usual Adult Dose for Hypertension

Initial dose (oral tablets or solution): 5 mg orally once a day
Maintenance dose (oral tablets or solution): 10 to 40 mg orally per day in 1 to 2 divided doses
Intravenous: 1.25 to 5 mg IV every 6 hours over a 5 minute period

Approved indication: Hypertension

Off-label uses: Diabetic neuropathy

Usual Adult Dose for Congestive Heart Failure

Initial dose (oral): 2.5 mg orally once a day
Maintenance dose (oral): 2.5 to 20 mg orally twice a day
Doses should be titrated upward, as tolerated, over a period of a few days or weeks.
The maximum daily dose is 40 mg in divided doses.
Intravenous: 1.25 to 5 mg every 6 hours

Usual Adult Dose for Left Ventricular Dysfunction

Initial dose (oral): 2.5 mg orally twice a day
Maintenance dose (oral): 20 mg orally in divided doses
If possible, the dose of any concomitant diuretic should be reduced which may diminish the likelihood of hypotension.
Intravenous: 1.25 to 5 mg every 6 hours

Usual Pediatric Dose for Hypertension

Hypertension:
Oral tablets or solution:
Children 1 month to 17 years: Initial: 0.08 mg/kg/day (up to 5 mg) in 1 to 2 divided doses. Adjust dosage based on patient response.
Doses greater than 0.58 mg/kg (40 mg) have not been evaluated in pediatric patients.

Renal Dose Adjustments

CrCl 30 mL/min or less:
Oral tablets or solution: 2.5 mg once a day, titrated upward until blood pressure is controlled
Intravenous: 0.625 mg every 6 hours and increase dose based on response

Liver Dose Adjustments

Data not available

Dose Adjustments

In some patients treated with once daily dosing, the antihypertensive effect may diminish toward the end of the dosing interval. If trough response is inadequate, increasing dosage or dividing the daily dose should be considered. If blood pressure is not adequately controlled with enalapril alone, a diuretic may be added.

Precautions

Consult WARNINGS section for dosing related precautions.

Dialysis

Enalapril is removed by hemodialysis (20% to 50%).

Hemodialysis: 2.5 mg on dialysis days. The dosage on non-dialysis days should be adjusted according to blood pressure response.

Other Comments

Generally the use of IV enalapril is not recommended for more than 7 days.

Compared with Caucasian patients, Black patients have a reduced blood pressure response to monotherapy with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers; however, the reduced response is largely eliminated if combination therapy that includes an adequate dose of a diuretic is instituted.

Following first time MI, all ACE inhibitors, at comparable appropriate dosages, appear to be equally effective for reducing mortality and recurrent MI rates.

In patients who are currently being treated with a diuretic, symptomatic hypotension occasionally can occur following the initial dose of enalapril. To reduce the likelihood of hypotension, the diuretic should, if possible, be discontinued 2 to 3 days prior to beginning therapy with enalapril. Then, if blood pressure is not controlled with enalapril alone, diuretic therapy should be resumed. If diuretic therapy cannot be discontinued, an initial dose of 2.5 mg (oral) or 0.625 mg (IV) should be used with careful medical supervision for several hours and until blood pressure has stabilized.

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