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.
Indication
Hypertension, Heart failure
Contra Indication
Hypersensitivity. History of angioedema due to previous treatment with ACE inhibitors; bilateral renal artery stenosis. Pregnancy.
Dose
N/A
Side Effect
1-10%
Dizziness (4-8%),Hypotension (0.9-6.7%),Headache (2-5%),Chest pain (2%),Cough (1-2%),Rash (1.5%)
Frequency Not Defined
Asthenia,Nausea,Vomiting,Hyperkalemia
Potentially Fatal: Angioedema.
Pregnancy Category
Name :
Not Classified
Description
FDA has not yet classified the drug into a specified pregnancy category.
Mode of Action
Enalapril, a prodrug of enalaprilat, competitively inhibits ACE from converting angiotensin I to angiotensin II (a potent vasoconstrictor) resulting in increased plasma renin activity and reduced aldosterone (a hormone that causes water and Na retention) secretion. This promotes vasodilation and BP reduction.
Interaction
May potentiate hypotensive action w/ diuretics, other antihypertensives, TCAs, nitrates or anaesth. Concomitant admin w/ lithium carbonate may cause lithium toxicity. Increased risk of renal impairment w/ NSAIDs. May increase hyperkalaemic effect w/ K-sparing diuretics and supplements.
Pregnancy Category Note
Pregnancy
May cause fetal harm when administered to a pregnant woman; use of drugs that act on renin-angiotensin system during second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death; when pregnancy is detected, discontinue therapy as soon as possible
Hypertension in pregnancy increases maternal risk for pre-eclampsia, gestational diabetes, premature delivery, and delivery complications (e.g., need for cesarean section, and post-partum hemorrhage); hypertension increases fetal risk for intrauterine growth restriction and intrauterine death; pregnant women with hypertension should be carefully monitored and managed accordingly
Lactation
Enalapril and enalaprilat have been detected in human breast milk; because of potential for serious adverse reactions in breastfed infant, including hypotension, hyperkalemia, and renal impairment, advise women not to breastfeed during therapy
Adult Dose
Hypertension
Oral
Initial: 2.5-5 mg PO qDay
Maintenance: 10-40 mg/day PO qDay or divided q12hr
Left Ventricular Dysfunction
Initial: 2.5 mg PO q12hr
May titrate up to 20 mg/day
Congestive Heart Failure
Initial: 2.5 mg PO qDay or q12hr
Maintenance: 5-40 mg/Day PO divided q12hr; titrate slowly q2Weeks
Hepatic impairment: No dosage adjustment required
Child Dose
Hypertension
1 month to 16 years (oral)
Initial: 0.08 mg/kg/day PO or divided q12hr; not to exceed 5 mg/day
May increase PRN q2Weeks according to blood pressure not to exceed 0.58 mg/kg/day (or 40 mg/day)
Renal Dose
Renal impairment
CrCl <30 mL/min: (PO) Initiate 2.5 mg; titrate to response; not to exceed 40 mg
Dialysis: 2.5 mg PO on day of dialysis; adjust dose on nondialysis days according to BP
CrCl <30 mL/min: (IV) Initiate 0.625 mg q6hr; titrate based on response
CrCl ?30 mL/min: (PO) Initiate 5 mg/day; titrate to maximum of 40 mg
CrCl ?30 mL/min: (IV) 1.25 mg q6hr; titrate based on response
Administration
May be taken with or without food.
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