Enalapril and Hydrochlorothiazide (Oral)


Enalapril and hydrochlorothiazide are used together to treat high blood pressure. Enalapril is in a class of medicines called angiotensin converting enzyme (ACE) inhibitors, chemicals that narrow the blood vessels that allow the blood to pass through the heart and arteries. Hydrochlorothiazide belongs to a class called diuretics, prompting the kidneys to eliminate excess salt and water from the body through urination. As such, if you have trouble with urinating, your doctor may not prescribe this medication for you.

Enalapril and hydrochlorothiazide may induce side effects, lowering the blood pressure below normal levels. Your doctor will check your blood pressure to make sure you are safe during treatment. Sometimes dehydration can cause problems, so be sure to drink enough fluids, unless your doctor advises against it. Talk with your doctor before starting treatment about the intake measure of liquid you need. You may need to avoid dehydration by limiting your daily activities and exercise or avoiding hot weather.

There's a US public health warning against using enalapril if you are pregnant. It may cause an injury or death to the fetus during the second or third trimester. If you become pregnant during treatment, tell your doctor at once.

Be sure your doctor knows about the medications you are taking before any lab tests are done. Hydrochlorothiazide will interfere with thyroid testing. Both medicines have known interactions with other medicines causing unwanted side effects.

Conditions Treated

Type Of Medicine

  • Angiotensin converting enzyme (ACE) inhibitor
  • Diuretic

Side Effects

All medicines have some level of side effects that vary from person to person, depending on the individuals' health, age and the severity of the treated condition. The side effects associated with this medicine range from mild to serious without proper medical attention. If you have existing disorders treated with other medicines, the effects or the condition itself could worsen.

Here's a list of the most common, least common, rare and allergic side effects that have occurred. You may experience none of these, but if you experience discomfort, talk with your doctor. If the effects worsen or persist beyond a week, contact your doctor immediately.

Some side effects appear at the start of treatment and fade away as your body adjusts to the medication. In some cases, you may have unidentified family genetics causing side effects to new medicines. This is why it's important to share all of your health, medical and family history with your doctor. The information will help in predicting how you may react to this medicine. Your doctor will have solutions of prevention or relief for you.

There are other side effects not listed that may occur. The effects are dependent on your current health and lifestyle routines. If you recognize other effects, check with your doctor.

Most common

Your doctor will tell you what side effects are most prevalent for your condition. Most individuals experience some of the effects listed, but not all. The severity of each effect varies from person to person, depending on your health, the current phase of your disorder and what age you are.

In most situations, medical attention is not needed, but your doctor needs to know how you are responding to the medicine. Do not stop taking the medicine or change the dose without your doctor's approval.

Least common

  • Bruising
  • Changes in urination
  • Chest pain
  • Chills
  • Drowsiness
  • Dry mouth
  • Fainting
  • Irritability
  • Loss of appetite
  • Numbness
  • Sweating
  • Thirst
  • Vision problems

If any of these effects occur and cause stress for you, seek medical attention for your own comfort. Some effects are rare, but they can be caused by the introduction of new medications. From time to time, adjustments made to existing medicines or an underlying health condition can instigate the side effect.

Talk with your doctor about the effects 'what your doctor knows about how your body is responding to the medicine can make a difference in maintaining your health.


  • Coma
  • Confusion
  • Seizures
  • Weak pulse
  • Irregular heartbeat

If you have known allergies before starting this treatment, tell your doctor. Medical decisions are based on your past and current health events.

Allergic reactions

  • Difficulty breathing
  • Rash
  • Severe stomach pain
  • Swelling of your face

Existing health conditions

If you suffer from any of these disorders and take prescription medicines for treatment, let your doctor know. Learn to recognize the side effects or changes with these conditions before they trigger serious consequences for your health. Your doctor will make sure enalapril and hydrochlorothiazide are harmless to you. Sometimes, when two different medicines are taken together, the doses and the scheduled times for taking them need to be adjusted to treat both conditions and avoid side effects.

Prescription medicines or over the counter (OTC) treatments, health supplements and herbal remedies can cause side effects. Lifestyle choices about alcohol, tobacco, exercise routines and specific foods also affect your body's response to medications. Your doctor will watch how these medicines work for you. In most cases, controlling and managing hypertension involves medications with a few lifestyle changes.

If you have been taking a single drug for a long time, whether it's a prescription or non-prescription, let your doctor know. It could change how you response to these medications. If you notice changes, talk to your doctor, as tests may be needed to monitor the changes and determine the cause.


The dose and forms of this medicine are different for each person. Some prescriptions are individual tablets taken at the same time during the day. There are also single tablets containing both medicines. In most cases, the medication is taken in the morning, depending on the dose and the severity of your condition. It's important to follow your doctor's instructions and read the product label about precautions. If this is a new medicine for you, your pharmacist can explain how it should be taken and answer any questions.

The following information includes only the average doses of this medicine. 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. Your doctor will prescribe the number of doses you should take each day and the time allowed between doses.

You may need to schedule lab tests or take your blood pressure as a daily routine to make sure the medicine is working. Your doctor will monitor your condition. If you recognize unusual changes or reactions to the medication, tell your doctor.

For high blood pressure:

Be sure to take each dose with a full glass of water.

Individual tablets

  • Enalapril '10 to 40 milligrams (mg) per day 'administered in one or two doses daily.
  • Hydrochlorothiazide '12.5 mg to 50 mg daily ' administered in one or two doses daily.

Single tablet - each tablet contains 10 mg enalapril and 25 mg hydrochlorothiazide

  • Adults 'one or two tablets taken once or twice a day as directed by your doctor.
  • Maximum daily dose 20 mg enalapril and 50 mg hydrochlorothiazide


  • Safety and effectiveness guidelines are not established.
  • Your doctor will decide the dosage.

If you are scheduled for surgery or dental work, your doctors need to know what medicines you're taking 'sometimes, you doctor may order a change in dosage or select another medicine.

Missed dose

If you miss a dose, take it as soon as possible. The only exception is that, if it is almost time to take the next dose, skip the missed dose and continue with your normal schedule. Do not double the dose, as you could trigger a serious side effect. Keep your doctor advised about missing a dose of this medication.


In any situation where there is an accidental or unintended overdose, contact emergency immediately. If a child is involved in this overdose, contact the pediatric poison information center in your area for instructions.

Overdose reactions include, nausea, dizziness, dry mouth, muscle pain and fainting.


Medicines like enalapril and hydrochlorothiazide work well together to manage the condition. There are other situations where different medicines interact with each other and cause other disorders or prompt serious effects to existing health conditions. Your doctor may change the frequency or the administering time to reduce or prevent the reactions. The doctor may adjust the doses of the different drugs to maintain treatment of the conditions.

There are health situations where using multiple medications is necessary and doctors monitor the interactions for any change in effects, results and increased health risks. All medicines go through a development process and, in many instances, they share the same chemical compounds. If you are taking multiple prescriptions, they may change the outcome of treatment due to the chemical quantities.

Based on a full examination of your health and the condition treated with this medicine, your doctor will decide if any of the medicines you are taking now could cause you harm. It may be necessary to change some medicines or adjust the doses for better health results.

If you are taking any of these medicines listed or you believe you are taking medicines that may share similar ingredients, tell your doctor. There are medications not listed that interact with this condition. Your doctor will check your medications to be sure this medicine is risk-free for you.

  • Aceclofenac
  • Acemetacin
  • Acetyldigoxin
  • Aliskiren
  • Allopurinol
  • Alteplase
  • Amiloride
  • Amphetamine
  • Amtolmetin
  • Arsenic
  • Aspirin
  • Azathioprine
  • Azilsartan
  • Azosemide
  • Bepridil
  • Bromfenac
  • Bumetanide
  • Bupivacaine
  • Canrenoate
  • Capsaicin
  • Carbamazepine
  • Celecoxib
  • Choline Salicylate
  • Clomipramine
  • Clonixin
  • Cyclophosphamide
  • Deslanoside
  • Dexibuprofen
  • Diclofenac
  • Diflunisal
  • Digitalis
  • Digitoxin
  • Dipyrone
  • Dofetilide
  • Droperidol
  • Droxicam
  • Eplerenone
  • Eprosartan
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Everolimus
  • Felbinac
  • Fenoprofen
  • Fepradinol
  • Feprazone
  • Flecainide
  • Floctafenine
  • Flurbiprofen
  • Furosemide
  • Ginkgo
  • Gossypol
  • Ibuprofen
  • Indomethacin
  • Ketanserin
  • Ketoprofen
  • Ketorolac
  • Levomethadyl
  • Licorice
  • Lithium
  • Lornoxicam
  • Losartan
  • Loxoprofen
  • Lumiracoxib
  • Meclofenamate
  • Meloxicam
  • Mercaptopurine
  • Methotrexate
  • Metildigoxin
  • Morniflumate
  • Nabumetone
  • Naproxen
  • Nepafenac
  • Nesiritide
  • Nimesulide
  • Ouabain
  • Oxaprozin
  • Oxyphenbutazone
  • Oxypurinol
  • Parecoxib
  • Phenylbutazone
  • Piketoprofen
  • Piretanide
  • Piroxicam
  • Potassium
  • Proglumetacin
  • Propyphenazone
  • Proquazone
  • Proscillaridin
  • Rifampin
  • Rofecoxib
  • Sacubitril
  • Salsalate
  • Sirolimus
  • Sotalol
  • Spironolactone
  • Sulindac
  • Telmisartan
  • Tenoxicam
  • Tolmetin
  • Topiramate
  • Torsemide
  • Triamterene
  • Trimethoprim
  • Valdecoxib
  • Valsartan

Medicines should improve our health, and most work well together, yet there are certain medications when used together serious or unpleasant interactions happen. Your doctor may change the dose to alleviate the discomfort.

It's not always the medicine that causes the interactions; in some cases, dietary items, health supplements, herbs and over the counter medicine can trigger a reaction. Your own lifestyle choices, such as alcohol or tobacco, can affect the interaction of a drug. There are medical treatments and drugs that interact with enalapril and hydrochlorothiazide 'the severity of the reaction depends on your health condition and the dose of medication. If you experience any reaction, talk with your doctor.

Keep in mind that medications are blended mixtures of chemical compounds with ingredients reacting to other drugs when used together. It's the major reason medication listings post the levels of interactions. Over 4,000 brand name and generic medications interact with enalapril and hydrochlorothiazide.

  • 109 major interactions
  • 706 moderate interactions
  • 116 minor interactions

Other interactions

Besides medicine, alcohol consumption and foods interact with these medicines. Talk with your doctor so you understand the effects to your health; more importantly, you need to know about the changes you can make to improve your health and life. Here are three interactions that will affect your response to this treatment.


Enalapril and alcohol have moderate drug reactions. The combination can lower your blood pressure, causing a reduced heart rate, fainting and headaches. This is not a hangover ' it's life threatening. Do not stop taking your medicines' you may need to discontinue the consumption of alcohol to manage this condition.

Hydrochlorothiazide and alcohol have a moderate reaction. You may notice changes as you begin a new treatment or restart treatments. Interactions also occur when doses are increased. Precautions are necessary when you feel these side effects 'do not drink and drive, and do not operate machinery or equipment.


Enalapril and foods can cause higher than normal potassium levels in your blood (hyperkalemia). You need to talk with your doctor about your dietary routines to avoid increased levels potassium (salt substitutes) intakes.

Health interactions

There have been reports of adverse reactions occurring when using medicines that share pharmacological similarities. Precautions are recommended, be sure to talk to your doctor. Your doctor will make sure any existing condition along with the current situation is treated.

When two different drugs come in contact, there is a certain amount of risk to the individual and the health disorders. There may be a solution or alternatives to help ease unexpected reactions. The first action in response to the effect is changing the dosage of one or both medicines.

If you suffer with any of these disorders, your doctor needs to know before starting any form of treatment with enalapril and hydrochlorothiazide.

  • Allergies
  • Angioedema ' body swelling
  • Anuria ' urination difficulty
  • Asthma
  • Diabetes
  • Electrolyte losses
  • Glaucoma
  • Gout
  • Heart disease
  • Hypercalcemia high calcium
  • Hypercholesterolemia high cholesterol
  • Hyperkalemia' high potassium
  • Hypotension ' low blood pressure
  • Kidney disease
  • Liver disease
  • Lupus erythematosus
  • Renal dysfunction

The reactions may be minor, but it's important that your doctor checks your progress with regular visits and lab tests to make sure this medicine is working without unwanted effects. For most individuals blood and urine test are necessary to monitor these interactions and maintain your health.


The US Food and Drug Administration (FDA) has posted warnings for enalapril and hydrochlorothiazide. FDA regulations and notices are intended to protect the public health and offer information for consumers and industry professionals when making health decisions involving the use of drugs or medications.

Warnings provide known risk factors associated with an individual's health and the current medical care. The information collected about medication responses affecting medical conditions are all connected with the course of illness and recovery of a doctor's patient.

This information is available to the treated individuals' the purpose is to recognize the early signs for preventing unwanted or emerging health disorders before they develop into serious conditions.

To date, this warning is posted: fetal toxicity.


FDA pregnancy category D' do not use enalapril and hydrochlorothiazide if you are pregnant. It could harm the unborn child. Recommendations include using birth control and talking to your doctor if you become pregnant during treatment.

Hydrochlorothiazide passes through breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breastfeeding.


Few, if any, differences were noted between individuals 65 year of age and older, compared to younger individuals taking this medicine. One difference was the dose determinations between elderly and younger individuals. Precautions are taken for elderly persons, starting at the lowest dose range, due to existing health conditions or an increased susceptibility as a matter of being older.

In this age group, the drug has a higher risk of toxic reactions when impaired renal functions exist. Before administering this medicine, a full assessment of renal functions in this age group is deemed necessary. Elderly adults may be more sensitive to the side effects leading to kidney problems.


Safety and effectiveness in this age group has not been established. Your doctor will make a full assessment of the child's condition and health before prescribing or administering this medicine.

Health precautions

Because symptoms of blood pressure are invisible, the condition can go unnoticed or untreated. Once discovered, you may need to take this medicine for the rest of your life. There are precautions with dehydration 'you need to talk with your doctor and understand how to manage this condition and learn to recognize hidden symptoms. Dehydration can cause a drop in blood pressure, electrolyte disorders and kidney failure these ailments are harmful to your health.


Keep this medicine out of reach of children and pets. Store it in a closed container at room temperature, away from heat, moisture and direct light. Don't freeze this medication.

Dispose of any unused portions or outdated medicines. Do not dispose of it by flushing or in the household trash. Your doctor or pharmacist can help you with disposal to prevent any accidents.


Overall, this medicine has been effective in controlling, but not curing, high blood pressure. Individuals taking this medicine need to follow the doctor's instructions for drug therapy and lifestyle choices. By continuing to manage the condition, you can lower your blood pressure. Some individuals may need to take this medicine for the rest of their life with dose adjustments.

The side effects can instigate a health disorder, but avoiding treatment for high blood pressure has a serious consequence to your life. You need to meet with your doctor and understand the benefits of this medicine compared to the health risk of not receiving treatment.