Enalaprilat Dosage

Medically reviewed by Drugs.com. Last updated on Jun 28, 2023.

Usual Adult Dose for Hypertension

ORAL TABLETS OR SOLUTION:
Initial dose: 5 mg orally once a day

• In combination with diuretics: 2.5 mg orally once a day

Maintenance dose: 10 to 40 mg orally once a day as a single dose or in 2 divided doses
Maximum dose: 40 mg orally once a day as a single dose or in 2 divided doses

PARENTERAL:
Initial dose: 1.25 mg to 5 mg slow IV infusion over a 5 minute period every 6 hours

• In combination with diuretics: 0.625 mg slow IV infusion over 5 minutes; dose may be repeated after one hour

TRANSITIONING BETWEEN FORMULATIONS:

• IV to oral form: 5 mg orally once a day, with adjustments as needed
• Oral to IV form: 1.25 mg slow IV infusion over a 5 minute period every 6 hours, with adjustments as needed

Comments:

• Use of the IV formulation should be considered when oral therapy is not practical.
• Clinical response is usually seen within 15 minutes of IV infusion.
• Peak effects may take up to four hours after the first dose, and with subsequent doses it may exceed those of the first.
• If feasible, diuretics should be discontinued 2 to 3 days before initiating this drug.
• If required, diuretic therapy may be gradually resumed.

Use: For the treatment of hypertension

Usual Adult Dose for Congestive Heart Failure

ORAL TABLETS AND SOLUTION:
Initial dose: 2.5 mg orally twice a day
Maintenance dose: 2.5 mg to 20 mg orally twice a day, as tolerated
Maximum dose: 20 mg orally twice a day

Comments:

• Closely monitor the patient after the initial dose.
• In heart failure patients with hyponatremia or serum creatinine greater than 1.6 mg/dL, therapy should start at 2.5 mg daily under close medical supervision.
• The dose can be titrated upward, as tolerated, over a period of a few days or weeks.
• Treatment is usually combined with diuretics and digitalis. The diuretic dose may need to be adjusted to minimize hypovolemia and hypotension.

Use: For the treatment of symptomatic congestive heart failure

Usual Adult Dose for Left Ventricular Dysfunction

ORAL TABLETS AND SOLUTION:
Initial dose: 2.5 mg orally twice a day
Maintenance dose: Titrate up to a maximum of 10 mg orally twice a day, as tolerated
Maximum dose: 10 mg orally twice a day

Comments:

• After the initial dose, the patient should be monitored for at least 2 hours until blood pressure stabilizes.
• If possible, the dose of diuretic should be reduced to lower the risk of hypotension.

Use: In patients with left ventricular dysfunction (ejection fraction 35% or lower) to reduce the rate of development of overt heart failure and reduce hospitalizations due to heart failure

Usual Pediatric Dose for Hypertension

ORAL TABLETS OR SOLUTION:
1 month to less than 18 years:

• Initial dose: 0.08 mg/kg (up to 5 mg) orally once a day
• Doses above 0.58 mg/kg (40 mg) have not been studied.

Comment:

• Adjust dosage based on blood pressure response.
• Use of the IV formulation is not recommended in pediatric patients.

Use: For the treatment of hypertension and to lower blood pressure

Renal Dose Adjustments

Adults:
CrCl greater than 30 mL/min (or serum creatinine up to 3 mg/dL): Oral and IV: No adjustment recommended

CrCl 30 mL/min or less (or serum creatinine 3 mg/dL or greater):

• Oral tablet: 2.5 mg once a day; may titrate upward until blood pressure is controlled up to a maximum of 40 mg orally daily in a single dose or 2 divided doses
• Oral solution: Use a lower initial dose.
• IV: Initial dose: 0.625 mg slow IV infusion over a 5 minute period or longer (up to 1 hour) every 6 hours
• Dose can be increased based on response.

Pediatric:

• This drug is not recommended in neonates and in pediatric patients with glomerular filtration rate less than 30 mL/min/1.73 m2.

Comments:

• No dose adjustment is required in patients with CrCl above 30 mL/min.

Liver Dose Adjustments

Data not available

Dose Adjustments

Dosage Adjustment in Patients with Heart Failure and Renal Impairment or Hyponatremia:
Oral tablet:

• In patients with heart failure and renal impairment or hyponatremia, therapy should be initiated at 2.5 mg daily under close medical supervision. The dose may be increased to 2.5 mg twice a day, then 5 mg twice a day and higher as needed, usually at intervals of four days or more, with adjustments made if hypotension or renal function deterioration is not excessive. The maximum daily dose is 40 mg.

Hypertension:

• If this drug is added to a diuretic, the dose of diuretic should be reduced or discontinued for 2 to 3 days before initiating this drug to reduce the risk of hypotension.
• 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.

Precautions

US BOXED WARNING:

• FETAL TOXICITY: Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus. If pregnancy is detected, this drug should be discontinued immediately.

CONTRAINDICATIONS:
IV and Oral Formulations:

• Hypersensitivity to this product
• In patients with a history of angioedema with previous ACE inhibitor use or hereditary/idiopathic angioedema

Oral Formulations:

• Coadministration with aliskiren in diabetic patients
• Concomitant treatment with a neprilysin inhibitor (e.g., sacubitril)
• Do not administer this drug within 36 hours of switching to or from sacubitril/valsartan or a product containing neprilysin inhibitor

IV solution: Safety and efficacy have not been established in patients younger than 18 years.
Oral solution: This drug is not recommended for use in neonates (1 month or younger), preterm infants less than 44 weeks (corrected post-conceptual age), or pediatric patients with CrCl less than 30 mL/min. Safety and efficacy have not been established in pediatric patients with heart failure or asymptomatic left ventricular dysfunction.
Oral tablet: This drug is not recommended for use in neonates or pediatric patients with CrCl less than 30 mL/min.

Consult WARNINGS section for additional precautions.

Dialysis

Oral tablets: 2.5 mg orally on dialysis days
Oral solution: Use a lower initial dose.

Comments:

• This drug should be taken after hemodialysis on dialysis days.
• The dosage on non-dialysis days should be adjusted according to blood pressure response.
• Enalapril is removed by hemodialysis (20% to 50%).

Other Comments

Administration Advice:

• When administered with a diuretic or in patients with heart failure, ensure medical supervision for at least 2 hours, and until blood pressure has stabilized for at least an additional hour.
• The antihypertensive effect may diminish in some patients with once daily dosing before the next dose. Consider increasing the dose or switching to twice-daily administration in these cases.
• If blood pressure is not adequately controlled with enalapril alone, a diuretic may be added.

Storage requirements:
Tablets:

• Store at 25C (77F) with excursions permitted to 15C to 30C (59F to 86F)
• Keep the container tightly closed. Protect from moisture.

Oral Solution:

• Store in a refrigerator at 2C to 8C (36F to 46F) in a tightly closed container or at room temperature 20C to 25C (68F to 77F).
• If stored at room temperature, discard after 60 days.
• Avoid freezing and excessive heat.

IV injection:

• Vial: Store at 20C to 25C (68F to 77F)
• Diluted solution for infusion: Product maintains full activity for 24 hours at room temperature when mixed with compatible diluents.

IV compatibility:

• This drug is compatible with the following diluents for up to 24 hours at room temperature: 5% dextrose injection, 0.9% sodium chloride injection, 0.9% sodium chloride in 5% dextrose, 5% dextrose in Lactated Ringer's, and Isolyte(E).

Preparation techniques:

• IV solution: May be administered as packaged, or diluted with up to 50 mL of a compatible diluent.
• The manufacturer product information should be consulted.

General:

• Compared with Caucasian patients, Black patients have a reduced blood pressure response to monotherapy with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers.

Monitoring:

• Cardiovascular: Blood pressure
• Hepatic: Liver function, jaundice, hepatic enzymes
• Hematologic: White blood cell counts, electrolytes, serum potassium
• Hypersensitivity: Angioedema
• Renal: Renal function

Patient advice:

• Read the US FDA-approved patient labeling (Patient Information).
• IV solution may be administered as packaged or diluted with up to 50 mL of a compatible diluent.
• Advise patients to immediately report any signs or symptoms suggestive of angioedema (swelling of face, eyes, lips, tongue, larynx, or extremities, or difficulty swallowing or breathing).
• Advise patients to report any lightheadedness, especially in the first few days of treatment.
• Patients should discontinue the drug immediately if they experience syncope and should consult their prescribing physician before restarting.
• Inform patients that excessive sweating and dehydration, along with vomiting or diarrhea, can cause excessive fall in blood pressure. Patients should consult their physician if these issues arise.
• Advise patients to avoid salt substitutes with potassium unless they have consulted their physician.
• Patients should promptly report any signs of infection, like a sore throat or fever, as they may indicate neutropenia.
• Advise female patients of childbearing age to report pregnancies to their physician promptly.

Further information

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