Enalapril

• Type of Drug: Angiotensin-converting-enzyme (ACE) inhibitor.
• Prescribed for: Hypertension and congestive heart failure. Enalapril may also be prescribed for diabetic kidney disease, childhood high blood pressure and high blood pressure related to scleroderma disease, and post-heart attack treatment when the function of the left ventricle is affected.

General Information

Enalapril belongs to the class of drugs known as angiotensin-converting-enzyme (ACE) inhibitors. ACE inhibitors work by preventing the conversion of a hormone called angiotensin I to another hormone called angiotensin II, a potent blood-vessel constrictor. Preventing this conversion relaxes blood vessels and helps to reduce blood pressure and relieve the symptoms of heart failure by making it easier for a failing heart to pump blood through the body. The production of other hormones and enzymes that participate in the regulation of blood-vessel dilation is also affected by Enalapril and probably plays a role in the effectiveness of this medicine. Enalapril begins working about 1 hour after you take it and continues to work for 24 hours.

Some people who, start taking Enalapril after they are already on a diuretic (water pill) experience a rapid blood-pressure drop after their first dose or when their dose is increased. To prevent this from happening, your doctor may tell you to stop taking your diuretic 2 or 3 days before starting Enalapril or increase your salt intake during that time. The diuretic may then be restarted gradually. Heart-failure patients generally have been on Digoxin and a diuretic before beginning Enalapril treatment.

Cautions and Warnings

Do not take Enalapril if you have had an allergic reaction to it. It can (rarely) cause very low blood pressure. It may also affect your kidneys, especially if you have congestive heart failure. Your doctor should check your urine for protein content during the first few months of treatment.

Enalapril may cause a decline in kidney function. Dosage adjustment of Enalapril is necessary if you have reduced kidney function because this drug is generally eliminated from the body via the kidneys.

Enalapril can affect white-blood-cell counts, possibly increasing your susceptibility to infection. Your doctor should monitor your blood counts periodically.

Possible Side Effects

• Most common: dizziness, fatigue, headache, nausea, and chronic cough. The cough usually goes away a few days after you stop taking the medicine.
• Less common: angina (chest tightness/pain), dizziness when rising from a sitting or lying position, fainting, abdominal pain, nausea, vomiting, diarrhea, bronchitis, urinary tract infection, breathing difficulty, weakness, and skin rash.
• Other: itching; fever; heart attack; stroke; abdominal pain; abnormal heart rhythms; heart palpitations; sleeping difficulty; tingling in the hands or feet; appetite loss; odd taste perception; hepatitis and jaundice; blood in the stool; hair loss; unusual skin sensitivity to the sun; flushing; anxiety; nervousness; reduced sex drive; impotence; muscle cramps or weakness; muscle aches; arthritis; asthma; respiratory infections; sinus irritation; depression; feelings of ill health; sweating; kidney problems; anemia; blurred vision; swelling of the arms, legs; lips, tongue, face, and throat; upset stomach; and inflammation of the pancreas.

Drug Interactions

• The blood-pressure-lowering effect of Enalapril is additive with diuretic drugs and beta blockers. Any other drug that causes a rapid blood-pressure drop should be used with caution if you are taking Enalapril’.
• Enalapril may increase blood-potassium levels, especially when taken with Dyazide or other potassium-sparing diuretics.
• Enalapril may increase the effects of Lithium; this combination should be used with caution.
• Antacids may reduce the amount of Enalapril absorbed into the blood. Separate doses of these by at least 2 hours.
• Capsaicin may cause or aggravate the cough associated with Enalapril therapy.
• Indomethacin may reduce the blood-pressure-lowering effects of Enalapril.
• Phenothiazine tranquilizers and antiemetics may increase the effects of Enalapril.
• Rifampin may reduce the effects of Enalapril.
• The combination of Allopurinol and Enalapril increases the chance of an adverse drug reaction. Avoid this combination.
• Enalapril increases blood levels of Digoxin, which possibly increases the chance of Digoxin-related side effects.

Food Interactions

Enalapril’s action is not affected by food. You may take it with food if it upsets your stomach.

Usual Dose

2.5 to 40 mg, once per day. Some people may take their total daily dosage in 2 divided doses. People with poor kidney function need less medicine to achieve reduced blood pressure.

Overdosage

The principal effect of Enalapril overdose is a rapid drop in blood pressure, as evidenced by dizziness or fainting. Take the overdose victim to a hospital emergency room immediately. ALWAYS bring the medicine bottle.

Special Information

Enalapril can cause swelling of the face, lips, hands, or feet. This swelling can also affect the larynx (throat) or tongue and interfere with breathing. If this happens, go to a hospital emergency room at once. Call your doctor if you develop a sore throat, mouth sores, abnormal heartbeat, chest pain, a persistent rash, or loss of taste perception.

You may get dizzy if you rise to your feet too quickly from a sitting or lying position. Avoid strenuous exercise and/or very hot weather because heavy sweating or dehydration can cause a rapid blood-pressure drop.

Avoid nonprescription diet pills, decongestants, and stimulants that can raise blood pressure while taking Enalapril.

If you take Enalapril once a day and forget to take a dose, take it a soon as you remember. If it is within 8 hours of your next dose, skip the one you forgot and continue with your regular schedule.

If you take Enalapril twice a day and miss a dose, take it right away. If it is within 4 hours of your next dose, take 1 dose and then another in 5 or 6 hours, then go back to your regular schedule. Do not take a double dose.

Special Populations

Pregnancy/Breast-feeding
ACE inhibitors have caused low blood pressure, kidney failure, slow skull formation, and death in developing fetuses when taken during the last 6 months of pregnancy. Women who are or who may become pregnant should not take any ACE inhibitors. Sexually active women of childbearing age who must taka Enalapril must use an effective contraceptive method to prevent pregnancy or use a different medicine. If you become pregnant, stop taking the medicine and call your doctor immediately.
Relatively small amounts of Enalapril pass into breast milk, and the effect on a nursing infant is likely to be minimal. However, nursing mothers who must take this drug should consider an alternative feeding method because infants, especially newborns, are more susceptible to this medicine’s effects than adults.

Seniors
Older adults may be more sensitive to the effect of this drug because of normal age-related declines in kidney or liver function. Dosage must be individualized to your needs.