What is enalapril, and how does it work (mechanism of action)?
Enalapril is a drug that is used for
treating high blood pressure. It is in a class of drugs called angiotensin
converting enzyme (ACE) inhibitors. ACE is an enzyme in the body that causes the
formation of angiotensin II. Angiotensin II causes the arteries in the body to
narrow, thereby elevating blood pressure. ACE inhibitors, such as enalapril,
lower blood pressure by preventing the formation of angiotensin II thereby
relaxing the arteries. ACE inhibitors also improve the effectiveness of the
heart in patients with heart failure by reducing the blood pressure that the
heart must maintain. Enalapril was approved by the FDA in December 1985.
What brand names are available for enalapril?
Vasotec, Epaned
Is enalapril available as a generic drug?
Yes
Do I need a prescription for enalapril?
Yes
What are the side effects of enalapril?
Enalapril is generally well tolerated, and side effects
usually are mild and transient. A dry,
persistent cough has been reported
commonly with the use of ACE inhibitors. Coughing resolves after discontinuing
the medication.
Other important side effects include:
- abdominal pain,
- diarrhea,
- dizziness,
- fatigue,
- headache,
- loss of appetite,
- nausea and vomiting,
- chest pain,
- fainting,
- numbness or tingling in the hands or feet,
- rash, and a
- sore or swollen throat.
In rare instances,
liver dysfunction and skin yellowing
(jaundice) have been reported with ACE inhibitors. In susceptible individuals
ACE inhibitors may reduce kidney function. Enalapril may cause hypersensitivity
(allergic) reactions and angioedema (swelling of face, lips, tongue, throat).
What is the dosage for enalapril?
The usual oral dose for treating high blood pressure is 2.5-40
mg once daily. It may also be administered twice daily in two divided doses. The
dose for treating heart failure is 2.5-20 mg given twice daily. The usual
starting intravenous dose is 1.25 mg administered over a 5 minute period every 6
hours. If a patient is receiving diuretic therapy the initial intravenous dose
is 0.625 mg every 6 hours.
QUESTION
Salt and sodium are the same.
See Answer
Which drugs or supplements interact with enalapril?
Patients receiving diuretics may experience
excessive reduction in blood pressure when enalapril is started. Stopping the
diuretic or increasing salt intake prior to taking enalapril may prevent
excessive blood pressure reduction. Close supervision for at least 2 hours after
the start of enalapril and until blood pressure is stable is recommended if the
diuretic cannot be stopped.
Enalapril may increase potassium levels (hyperkalemia) in blood. Therefore,
there is an increased risk of hyperkalemia when enalapril is given with
potassium supplements or drugs that increase potassium levels (for example,
spironolactone [Aldactone]).
There have been reports of increased lithium (Eskalith, Lithobid) levels when
lithium is used in combination with ACE inhibitors. The reason for this
interaction is not known, but the increased levels may lead to toxicity from
lithium. There have been reports that
aspirin and other
nonsteroidal
anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Children's
Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, etc.), indomethacin (Indocin,
Indocin-SR), and naproxen (Anaprox, Naprelan, Naprosyn, Aleve) may reduce the
effects of ACE inhibitors.
Nitritoid reactions (symptoms include facial flushing, nausea, vomiting and
low blood pressure) may occur when injectable gold (sodium aurothiomalate
[Myochrysine]), used
in the treatment of rheumatoid arthritis, is combined with ACE inhibitors,
including enalapril.
Is enalapril safe to take if I’m pregnant or breastfeeding?
ACE inhibitors, including enalapril, can be harmful to the
fetus and should not be taken by pregnant women.
ACE inhibitors, including enalapril, should be
avoided in nursing mothers.
What else should I know about enalapril?
What preparations of enalapril are available?
- Tablets: 2.5, 5, 10, and 20 mg.
- Injection: 1.25 mg/mL
- STORAGE: Tablets should be stored at room temperature between 15 C – 30 C (59 F – 86 F).
The injectable formulation should be stored at 20 C to 25 C (68 F to 77 F).