Enalapril (Oral)

Overview

Enalapril is used to treat hypertension (high blood pressure). Managing hypertension helps prevent heart attacks, strokes and kidney failure. This medication is also used to treat heart failure, as well as preventing patients with left ventricular dysfunction from developing heart failure. The drug can be used alone or in combination with other medications when treating hypertension.

Hypertension increases the workload of the heart and arteries. This may result in failure of the heart and arteries if left untreated. Over time, the patient may suffer from damage to blood vessels in the vital organs, like the heart, brain and kidneys, resulting in heart failure, stroke and even kidney malfunction.

How enalapril works

An angiotensin that converts enzyme (ACE) inhibitor, enalapril works by blocking the secretion of the substance that causes the tightening of the blood vessels. This results in the relaxation of the blood vessels, which, in turn, lowers blood pressure, while increasing the supply of blood and oxygen to the heart and other vital organs of the body.

This medication is only available with the doctor's prescription and it is used in combination with other drugs to manage congestive heart failure and reduce the number of hospital visits for heart conditions.

Enalapril is available in the following forms:

  • Tablet
  • Powder for solution
  • Solution

Conditions Treated

Type Of Medication

  • ACE inhibitor

Side Effects

Along with the intended effects, enalapril may cause some undesired side effects. Some of these side effects are mild and will go away as your body adapts to the medicine. However, other side effects are severe and may require your doctor's attention.

Contact your doctor immediately if you experience the following side effects:

  • Confusion
  • Blurred vision
  • Profuse sweating
  • Faintness, dizziness or lightheadedness when rising up from a resting position
  • Unusual fatigue and body weakness
  • Rashes in the body
  • Tightness of the chest
  • Chest pains
  • Breathing problems
  • Sore throat
  • Diarrhea
  • Severe chest pain

Call your healthcare provider for direction concerning these side effects. You may also report the side effects to the FDA at 1-800-FDA-1088.

Dosage

The dosage, form and frequency with which you should take enalapril depend on a number of factors, such as:

  • Your age
  • The condition for which you are taking the medicine
  • The severity of the condition
  • Any other underlying medical condition
  • Your reaction to the first dose

Enalapril dosage for hypertension

Adult dosage (18 years and older)

The starting dose should be 5 mg, taken orally once per day. Your healthcare provider may recommend an increase in dosage based on your response and blood pressure goals.

They should decide if you are going to take the medication once or twice per day, with the maximum dosage being 40 mg per day. If you are combining enalapril with a diuretic, your starting dose should be 2.5 mg, taken orally once per day.

Child dosage (1 month to 17 years)

The starting dose should be 0.08mg/kg of body weight, administered orally once per day. This dosage may be increased based on the patient's response and blood pressure goals to a maximum dose of 0.58 mg/kg of body weight, administered orally once per day.

Senior dosage (65 years and older)

There is no specific dosage recommendation for seniors. Older adults tend to process the drug slowly and a normal adult dose may result in higher than normal levels of enalapril in the body. Seniors should use this medication under close supervision from their healthcare providers.

Direction of use for people with kidney problems

  • Mild or normal kidney problems 5 mg, taken orally once per day
  • Moderate to severe kidney problems' 2.5 mg, taken orally once per day. Children with moderate to severe kidney problems should not be given this medication
  • Patients on dialysis '2.5 mg on dialysis days. On the days that the patient does not have dialysis, the doctor should recommend dosage based on their blood pressure levels and goals.

Dosage for congestive heart failures

Adult dosage (18 years and older)

The starting dose should be 2.5 mg, taken orally twice per day. Your healthcare provider may adjust this dosage to a maximum dose of 40 mg per day.

Child dosage (1 month old to 17 years)

The use of enalapril is yet to be established in children with congestive heart disease. Thus, enalapril should not be administered to children under the age of 18 for purposes of treating this condition.

Special considerations

  • Kidney conditions: Patients whose blood creatinine levels are greater than 1.6 mg/DL should use a starting dose of 2.5 mg of enalapril per day. This dosage may be adjusted every four days, to 2.5 mg, taken twice per day. This may be adjusted again to a maximum of 40 mg per day.
  • Low sodium: Patients whose blood creatinine levels are greater than 130 mEq/L should have a starting dose of 2.5 mg of enalapril per day. This dosage may be adjusted every four days, to 2.5 mg, taken twice per day. This may be adjusted again to a maximum of 40 mg per day.

Dosage for asymptomatic left ventricular dysfunction

Adult dosage (18 years and older)

The starting dose should be 2.5 mg, taken orally twice per day. This may be adjusted to a maximum dose of 10 mg taken orally twice per day.

Child dosage (1 month to 17 years old)

Enalapril has not been studied for treatment of children with asymptomatic left ventricular dysfunction and should not, therefore, be administered to children under the age of 18 years for purposes of treating this condition.

Missed doses

Take any missed dose as soon as possible. However, if it is almost time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not make up for missed doses by double dosing.

Overdose

Report any sign of enalapril overdose your healthcare provider immediately. Symptoms of enalapril overdose include fainting and severe dizziness.

Interactions

While certain medications should not be used in combination, in most cases two different medications can be used together, even if there is an interaction. In such cases, your healthcare provider may recommend a change in dosage or suggest other precautions.

Enalapril may interact with other medications, herbal remedies and vitamins supplements. Therefore, be sure to inform your healthcare provider about the medications and supplements you are currently taking before starting this medication.

Never take enalapril if you have recently taken a heart medication called sacubatril. Do not use enalapril within 36 hours before or after taking a drug that contains sacubatril, such as Entresto.

If you are diabetic, do not take this medication in combination with medicines that contain aliskiren (such as Tekamlo, Tekturna or Amturnide). You should also avoid combining enalapril with aliskiren if you have a kidney condition.

Following are some of the medications that may interact with enalapril:

Pain medications

These medications can increase the patient's risk of developing kidney problems when taken in combination with enalapril. They include:

  • Non-steroidal anti-inflammatory drugs, such as ibuprofen, aspirin, etodolac, ketoprofen, diclofenac, naproxen and meloxicam.
  • COX-2 inhibitors, like celecoxib

Heart and blood pressure medications

Combining enalapril with blood pressure medications can increase the risk of low blood pressure and kidney problems, as well as high levels of potassium in the patient's blood. Examples of these medications include:

  • Angiotensin-converting enzyme (ACE) inhibitors, like captopril, benazepril, quinapril, moexipril, trandolapril and perindopril.
  • Angiotensin receptor blockers (ARBs), like candesartan, azilsartan, losartan, valsartan and Irbesartan.
  • Renin inhibitors, like aliskiren
  • Beta blockers, such as betaxolol, pindolol, nadolol, acebutolol, bisoprolol, penbutolol and atenolol
  • Calcium channel blockers, such as felodipine, amlodipine, nifedipine and nicardipine
  • Loop diuretics, such as furosemide, bumetanide, torsemide and indapamide
  • Potassium-sparing diuretics, such as amiloride, eplerenone, triamterene and spironolactone
  • Thiazide diuretics, such as chlorthalidone, metolazone, chlorthiazide and hydrochlorothiazide.

Lithium

Enalapril may increase the lithium levels in the patient's body, resulting in various side effects

Gold

Using injectable gold in combination with enalapril may increase the patient's risk of nitritiod reaction. Nitritoid reactions affect the dilation or constriction of the blood vessels. This is symptomized by nausea, low blood pressure, vomiting and flushing.

Medications used to prevent the body from rejecting transplanted organs

Using enalapril alongside medications like sirolimus, temsirolimus and everolimus may trigger sudden swelling on the patient's face, limbs, tongue, intestines and throat.

Enalapril and food interactions

Do not use salt substitutes containing potassium with enalapril as this can increase the risk of high potassium levels in the body. In addition, discuss with your healthcare provider whether you can use alcohol and tobacco while on this medication. Alcohol consumption can cause a further decline in your blood pressure and trigger certain side effects of enalapril. Avoid alcohol and tobacco products all together while using this medication.

Warnings

It is important that your healthcare provider monitors your progress to be sure that enalapril is working as intended. Blood tests may be necessary to look out for undesired effects.

Laboratory tests (especially on potassium levels and kidney function) should be performed regularly to check for side effects, as well as monitoring your recovery progress. Blood pressure levels should also be checked regularly during the treatment period. It is important that you learn how to monitor your blood pressure from home and share your results with the healthcare provider.

Using enalapril during pregnancy may harm your unborn baby, especially if taken during the second and third trimesters. Thus, it is important that you use an effective birth control method to avoid conceiving while on this medication. Contact your healthcare provider right away should you conceive while on enalapril treatment. You should also avoid enalapril if you are breastfeeding, as the medication can be passed on and harm your baby.

Enalapril can cause serious allergic reactions, including the life-threatening anaphylaxis. Do not take it if you are allergic to ACE inhibitors like captopril, benazepril, fosinopril, moexipril, lisinopril, quinapril, perindopril and trandolapril. Contact your healthcare provider immediately if you experience itching, breathing difficulty, hoarseness, swallowing troubles or swelling on the face, mouth, limbs and throat.

Do not take enalapril if you have a history of angioedema and contact your healthcare provider immediately if you experience stomach pain that is accompanied by nausea and vomiting, as this could be a symptom of intestinal angioedema.

Some patients may experience dizziness, fainting and lightheadedness, especially when rising from a resting position or if they have been taking a diuretic. It is important that you know how you react to this medication before operating a dangerous machinery or driving.

Contact your healthcare provider immediately if you fall sick while taking enalapril, especially when you are experiencing severe diarrhea, nausea and vomiting. These conditions can cause dehydration resulting in low blood pressure.

Consult your healthcare provider if you have chills, fever, or sore throat. These could be indicators of an infection as a result of low white blood cells.

Contact your healthcare provider right away if you experience upper stomach pains, pass dark urine or pale stool, experience nausea, loss of appetite, unusual fatigue, or yellowing of eyes. These could be indicators of a severe liver problem.

Hyperkalemia (high blood potassium levels) may occur if you are using enalapril. Check with your healthcare provider right away if you experience the symptoms discussed above. Never use supplements or salt substitutes that contain potassium without your doctor's knowledge or approval.

Be sure to inform your doctors and dentist that you are using enalapril, as you may need to stop using the medication before checking in for surgery.

Do not take other medications, including supplements and non-prescription medications, before informing your healthcare provider.

Warnings for patients with pre-existing medical conditions

  • Patients with angioedema enalapril can worsen the swellings. Patients with a history of swelling throughout the body should not use this medication.
  • Patients with low blood pressure enalapril can lower the patient's blood pressure further. The patient should inform their healthcare provider if they have low blood pressure. This may necessitate change of dose, especially if the patient is diabetic or has kidney or heart problems.

To be sure enalapril is safe for you, inform your healthcare provider is you have any of the following:

  • A liver disease
  • A kidney disease or if you are currently on dialysis
  • A history of stroke or blood clot
  • Heart disease or congestive heart failure 'unless you are taking enalapril to treat this condition
  • An electrolyte imbalance such as abnormally high levels of potassium in your blood.

Storage

The medicine should be kept out of reach of children and pets. Do not keep enalapril longer than needed. Tablets should be stored at room temperature away from moisture, heat and direct sunlight. Unused suspensions should be stored in the refrigerator for no more than 30 days.

Ask your healthcare provider how you should get rid of any medications that you do not use. Do not flush medications into the sink or toilet unless by approval from your pharmacist.

Summary

Enalapril is an ACE-inhibitor medication that is administered orally to treat high blood pressure. Managing blood pressure is key to preventing heart attacks, strokes and kidney problems. The medication can also be used for treatment of heart failures, as well as preventing patients with left ventricular dysfunction from developing heart failure. The medication belongs to a group of drugs referred to as ACE-inhibitors and works by relaxing the blood vessels to ease blood flow.

Enalapril is administered orally with or without food and should be taken as directed by your healthcare provider, usually once or twice per day. If you are using the suspension form of enalapril, be sure to shake the bottle well before use. To get the dosage right, use the special measuring spoon that comes with the drug.

Enalapril dosage is based on the patient's medical condition, as well as response to medication. For children (1 month old to 17 years old), the dosage is determined by the weight of the patient.

It is advisable that you use enalapril regularly in order to benefit from it. To help you remember your daily dose, be sure to take your medication at the same time each day. It is important that you continue taking enalapril even if you are feeling well. Most high blood pressure patients do not feel sick.

When treating hypertension, it may take several weeks before your experience full benefits of enalapril. The same applies when using the medication for treating a heart failure. Inform your healthcare provider if your condition worsens, or fails to improve, after taking this medication for a couple of weeks.

Lifestyle changes like exercises, stress management program, and dietary changes may increase the effectiveness of this medication, especially if you are using it to treat high blood pressure. Discuss with your doctor possible lifestyle changes that might benefit you during this treatment period.