Enalapril

(e nal' a pril)

PCI  : Contraindicated in pregnancy

LCaution when used during lactation : Caution when used during lactation

Molecule Info

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WARNING

FETAL TOXICITY

  • When pregnancy is detected, discontinue Enalapril as soon as possible
  • Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.
Indication(s) & Dosage HYPERTENSION
Adult: Initially, 5 mg at bedtime. Maintenance: 10-20 mg orally once daily increased up to 40 mg in divided doses in severe hypertension. Max: 40 mg/day. 
Child: 80 mcg/kg once daily. Max: 5 mg/day.
Elderly: May initiate at lower doses at 2.5 mg daily. 
Renal impairment: Initial dose should be halved. 
Heart failure
Adult: Initially, 2.5 mg orally daily. Maintenance: 20 mg once daily as a single or in 2 divided doses, up to 40 mg daily in 2 divided doses.
Renal impairment: Initial dose should be halved. 
Intravenous
Hypertension
Adult: 1.25 mg by slow injection over 5 minutes repeated every 6 hr if needed.
Renal impairment: Initial dose should be halved.
Special Populations: Treatment of hypertension in renal impairment (CrCl: <30 mL/min) or in patients on diuretics: initial dose should be halved.
Administration Should be taken on an empty stomach. Take 15-30 min before meals.
Contraindications Hypersensitivity. History of angioedema due to previous treatment with ACE inhibitors; bilateral renal artery stenosis. Pregnancy.
Special Precautions Impaired renal function. Hyperkalaemia, hypovolaemia, collagen vascular disease, valvular stenosis, during or immediately before or after anaesthesia, unilateral renal artery stenosis. Hypotension due to volume depletion, diuretic therapy. Monitor WBC count. Lactation, children.
Adverse Drug Reaction(s) Initial hypotension may be severe and prolonged. Dizziness, headache, fatigue, persistent dry cough, abnormal taste, lassitude, rash, neutropenia, renal impairment or failure.
Potentially Fatal: Angioedema.
Drug Interactions Diuretics potentiate hypotensive action. May increase lithium levels. Other antihypertensives potentiate enalapril action.
Potentially Fatal: Increased risk of bone marrow suppression when used with immunosuppressive drugs. Hyperkalaemia with potassium-sparing diuretics or potassium supplements especially in the presence of renal failure.Probenecid delays excretion. Potentiates analgesia and respiratory depression produced by morphine. NSAIDs may result in further deterioration of renal function.
Click to view more enalapril Drug Interactions
Lab Interference False-positive Coombs' test.
Pregnancy Category (FDA) 

Category D: There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

Storage Store below 30°C.
Pharmacology Enalapril is de-esterified into the active enalaprilat resulting in potent inhibition of ACE thus leading to reduced levels of angiotensin II and aldosterone. Clinically, BP is reduced, salt and water retention is corrected. Ventricular hypertrophy is reversed. Renal blood flow is increased but in patients with renal impairment there may be oliguria or acute renal failure.
Absorption: 60% of dose is absorbed from the GI tract (oral); peak plasma concentrations after 1 hr (enalapril), 3-4 hr (enalaprilat).
Distribution: Protein-binding: 50-60% (enalaprilat).
Metabolism: Hepatic: Hydrolysed to enalaprilat.
Excretion: Via urine (60% as enalaprilat and unchanged drug); via faeces (remaining dose); 11 hr (elimination half-life). Removed by haemodialysis and peritoneal dialysis.
ATC Classification C09AA02 - enalapril; Belongs to the class of ACE inhibitors. Used in the treatment of cardiovascular disease.

Brand/Product Info


Total Products : 6      
Brand Name Manufacturer/Marketer Composition Dosage Form Pack Size & Price
ANAPRIL Eskayef Bangladesh Ltd Enalapril maleate 5mg & 10mg Tablet 100's each, MRP: 151.00 & 270.00
ENARIL 5 Beximco Pharmaceuticals Ltd Enalapril maleate 5mg Tablet 100's: 100.00 MRP
ERIL Orion Pharma Ltd. Enalapril maleate 5mg & 10mg/tablet Tablet 5mg x 50s: 50.00 MRP; 10mg x 50s: 100.00 MRP
MINIPRIL Renata Limited Enalapril maleate 5mg & 10mg Tablet 100's each: 152.00 & 202.00 MRP
VASOPRIL 10 Square Pharmaceuticals Ltd. Enalapril Maleate 10mg Tablet 5x10's: 113.50 MRP
VASOPRIL 5 Square Pharmaceuticals Ltd. Enalapril Maleate 5 mg Tablet 10x10's: 125.00 MRP

Gen. MedInfo

IMPORTANT WARNING:

Do not take enalapril if you are pregnant. If you become pregnant while taking enalapril, call your doctor immediately. Enalapril may harm the fetus.

 

Why Enalapril is prescribed?

Enalapril is used alone or in combination with other medications to treat high blood pressure. It is also used in combination with other medications to treat heart failure. Enalapril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. It works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart can pump blood more efficiently.

How should Enalapril be used?

Enalapril comes as an immediate and extended release tablet to take by mouth. It is usually taken once or twice a day with or without food. To help you remember to take enalapril, take it around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take enalapril exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor will probably start you on a low dose of enalapril and gradually increase your dose.

Enalapril controls high blood pressure and heart failure but does not cure them. Continue to take enalapril even if you feel well. Do not stop taking enalapril without talking to your doctor.

Other uses of Enalapril

Enalapril is also sometimes used to treat kidney disease related to diabetes. Talk to your doctor about the possible risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions to follow?

Before taking enalapril,

  • tell your doctor if you are allergic to enalapril, benazepril, captopril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, trandolapril, or any other medications.
  • tell your doctor what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin; lithium; and potassium supplements. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • tell your doctor if you have or have ever had heart or kidney disease; lupus; scleroderma; diabetes; or angioedema, a condition that causes difficulty swallowing or breathing and painful swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs.
  • tell your doctor if you plan to become pregnant or are breast-feeding.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking enalapril.
  • you should know that diarrhea, vomiting, not drinking enough fluids, and sweating a lot can cause a drop in blood pressure, which may cause lightheadedness and fainting.

What special dietary instructions to follow?

Talk to your doctor before using salt substitutes containing potassium. If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully.

What to do if I forget a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can appear? 

Enalapril may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • cough
  • dizziness
  • rash
  • weakness
  • swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
  • hoarseness
  • difficulty breathing or swallowing
  • yellowing of the skin or eyes
  • fever, sore throat, chills, and other signs of infection
  • lightheadedness
  • fainting

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

Enalapril may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

What storage conditions are needed for this medicine?

Keep this medication in the container it came in and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, consult your Doctor. If the victim has collapsed or is not breathing, admit to Hospital Emergency.

Symptoms of overdose may include:

  • lightheadedness
  • fainting

Ref: U.S. Natl. Library of Medicine

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