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enalapril

Pronunciation

Generic Name: enalapril (e NAL a pril)
Brand Name: Epaned, Vasotec

What is enalapril?

Enalapril is an ACE inhibitor. ACE stands for angiotensin converting enzyme.

Enalapril is used to treat high blood pressure (hypertension) and congestive heart failure.

Enalapril is also used to treat a disorder of the ventricles (the lower chambers of the heart that allow blood to flow out of the heart). This disorder can decrease the heart's ability to pump blood to the body.

Enalapril may also be used for purposes not listed in this medication guide.

What is the most important information I should know about enalapril?

Do not use if you are pregnant. Stop using and tell your doctor right away if you become pregnant.

You should not use enalapril if you have ever had angioedema.

If you have diabetes or kidney disease, you may not be able to take enalapril if you are taking medication that contains aliskiren. Tell your doctor about all medicines you use.

Enalapril can cause kidney problems. Call your doctor at once if you have swelling, rapid weight gain, little or no urinating, or if you feel short of breath.

Enalapril can affect your heart or your electrolyte levels. Call your doctor if you have chest pain, pounding heartbeats or fluttering in your chest, a slow heart rate or weak pulse, a tingly feeling, muscle weakness, or muscle tightness or contraction.

What should I discuss with my healthcare provider before taking enalapril?

You should not use enalapril if you have ever had angioedema, or if you are allergic to enalapril or to any other ACE inhibitor (benazepril, captopril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, trandolapril).

To make sure enalapril is safe for you, tell your doctor if you have:

  • kidney disease (or if you are on dialysis);

  • liver disease;

  • heart disease or congestive heart failure (unless you are taking enalapril for this condition);

  • diabetes; or

  • a history of blood clot or stroke (including "mini-stroke").

FDA pregnancy category D. Do not use enalapril if you are pregnant. Stop using this medication and tell your doctor right away if you become pregnant. Enalapril can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. Use effective birth control while taking this medication.

Enalapril can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using enalapril.

How should I take enalapril?

Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Your doctor may occasionally change your dose to make sure you get the best results.

Enalapril can be taken with or without food.

Shake the oral suspension (liquid) well just before you measure a dose. Measure the liquid with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

You may have very low blood pressure while taking this medication. Call your doctor if you are sick with vomiting or diarrhea, or if you are sweating more than usual.

Your blood pressure will need to be checked often. Your kidney or liver function may also need to be tested.

If you need surgery, tell the surgeon ahead of time that you are using enalapril. You may need to stop using the medicine for a short time.

If you are being treated for high blood pressure, keep using this medication even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

Store the liquid medicine in the refrigerator, do not freeze. Throw away any unused liquid after 30 days.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking enalapril?

Avoid drinking alcohol. It can further lower your blood pressure and may increase some of the side effects of enalapril.

Do not use salt substitutes or potassium supplements while taking enalapril, unless your doctor has told you to.

Enalapril side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; severe stomach pain; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • a light-headed feeling, like you might pass out;

  • little or no urinating;

  • confusion, loss of appetite, vomiting, pain in your side or lower back;

  • swelling, rapid weight gain;

  • weakness, confusion, increased thirst, loss of appetite, vomiting, pounding heartbeats or fluttering in your chest;

  • fever, chills, body aches, flu symptoms;

  • pale skin, easy bruising or bleeding;

  • fast or uneven heartbeats;

  • high potassium (slow heart rate, weak pulse, muscle weakness, tingly feeling);

  • chest pain; or

  • jaundice (yellowing of the skin or eyes).

Common side effects may include:

  • cough;

  • dry mouth, loss of taste sensation, loss of appetite;

  • dizziness, drowsiness, headache;

  • sleep problems (insomnia);

  • nausea, vomiting, diarrhea; or

  • mild skin itching or rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Enalapril dosing information

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 as a single dose or in 2 divided doses
Maximum dose: 40 mg orally daily as a single dose or in 2 divided doses

In combination with diuretics:
Initial dose: 2.5 mg orally once a day
If feasible, the diuretic should be discontinued 2 to 3 days prior to initiation of therapy with enalapril. If required, diuretic therapy may be gradually resumed.

Parenteral: 1.25 to 5 mg IV over a 5 minute period every 6 hours

Comments:
-Clinical response is usually seen within 15 minutes after IV administration.
-If required, diuretic therapy may be gradually resumed.

Usual Adult Dose for Congestive Heart Failure:

Initial dose: 2.5 mg orally once a day
Maintenance dose: 2.5 to 20 mg daily in 2 divided doses
Maximum dose: 40 mg orally per day in 2 divided doses

Comments:
-Treatment is usually combined with diuretics and digitalis.
-Doses should be titrated upward, as tolerated, over a period of a few days or weeks.

Usual Adult Dose for Left Ventricular Dysfunction:

Initial dose: 2.5 mg orally twice a day
Maintenance dose: 20 mg orally per day in 2 divided doses

Comments:
-After the initial dose, the patient should be observed for at least 2 hours and until blood pressure has stabilized for at least an additional hour.
-If possible, the dose of any concomitant diuretic should be reduced which may diminish the likelihood of hypotension.

Usual Pediatric Dose for Hypertension:

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

Comment:
-Not recommended in neonates and in pediatric patients with glomerular filtration rate less than 30 mL/min, as no data are available.

What other drugs will affect enalapril?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with enalapril, especially:

  • lithium;

  • a diuretic or "water pill";

  • gold injections to treat arthritis;

  • a potassium supplement such as Cytra, Epiklor, K-Lyte, K-Phos, Kaon, Klor-Con, or Polycitra; or

  • aspirin or NSAIDs (non-steroidal anti-inflammatory drugs)--ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.

This list is not complete. Other drugs may interact with enalapril, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about enalapril.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 9.02. Revision Date: 2013-11-19, 9:03:15 AM.

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