Enalapril

Indications
 Oral
Hypertension
Adult: Initially, 5 mg at bedtime. Maintenance: 10-20 mg 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.
Oral
Heart failure
Adult: Initially, 2.5 mg 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 inj 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.
Contraindications
 Hypersensitivity. History of angioedema due to previous treatment with ACE inhibitors; bilateral renal artery stenosis. Pregnancy.
Warnings / 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 Reactions
 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.
See Below for More enalapril Drug Interactions
Lab Interactions
 False-positive Coombs' test.
Mechanism of Actions
 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.
Administration
 May be taken with or without food.
Storage Conditions
 Intravenous: Store below 30°C. Oral: Store below 30°C.
ATC Classification
 C09AA02 - enalapril ; Belongs to the class of ACE inhibitors. Used in the treatment of cardiovascular disease.
Storage
 Intravenous: Store below 30°C. Oral: Store below 30°C.
Available As
  • Enalapril 1.25 mg
  • Enalapril Maleate 10 mg
  • Enalapril 10 mg
  • Enalapril Maleate 2.5 mg
  • Enalapril 2.5 mg
  • Enalapril Maleate 20 mg
  • Enalapril 20 mg
  • Enalapril Maleate 5 mg
  • Enalapril 5 mg
  • Enalapril Maleate IP 5 mg

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