Enalapril: Complete Drug Profile

What is Enalapril?

Enalapril is an oral medication belonging to a class of drugs called ACE inhibitors (angiotensin-converting enzyme inhibitors). It is primarily prescribed to treat high blood pressure and heart failure by helping blood vessels relax and widen. This medication has been widely used since the 1980s and is considered an essential medicine by the World Health Organization.

Uses

Enalapril is approved for several cardiovascular conditions:

• Hypertension (High Blood Pressure): Helps lower blood pressure in adults and children, reducing the risk of heart attack, stroke, and kidney problems
• Heart Failure: Improves symptoms and survival in patients with reduced heart function by decreasing the heart’s workload
• Left Ventricular Dysfunction: Used in patients following heart attack to prevent progression to heart failure
• Diabetic Kidney Disease: Helps protect kidney function in diabetic patients by reducing protein loss in urine
• Prevention of Cardiovascular Events: May be prescribed to reduce risk of heart attack and stroke in high-risk patients

How it works

Enalapril blocks the action of angiotensin-converting enzyme (ACE), which normally converts angiotensin I to angiotensin II, a powerful substance that causes blood vessels to narrow and triggers salt and water retention. By inhibiting this enzyme, enalapril allows blood vessels to relax and widen, reducing blood pressure and making it easier for the heart to pump blood. The medication also helps prevent the breakdown of bradykinin, a substance that further promotes blood vessel relaxation.

Side effects

Common side effects:

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• Dry, persistent cough
• Dizziness or lightheadedness
• Fatigue or weakness
• Headache
• Nausea
• Low blood pressure
• Elevated potassium levels
• Skin rash

Serious side effects requiring immediate medical attention:

• Angioedema (swelling of face, lips, tongue, or throat)
• Severe kidney problems or kidney failure
• Dangerously high potassium levels (hyperkalemia)
• Severe allergic reactions
• Liver damage or dysfunction

Warnings and precautions

• Pregnancy: Enalapril can cause serious harm or death to developing babies, especially during the second and third trimesters. Women should not become pregnant while taking this medication.
• Kidney Disease: Patients with kidney problems require careful monitoring and possible dose adjustments, as the medication can worsen kidney function in some cases.
• Heart Conditions: Patients with severe heart valve problems or certain types of heart disease may not be suitable candidates for enalapril therapy.
• Dehydration: Risk of excessive blood pressure drop is increased in patients who are dehydrated, on dialysis, or taking diuretics.
• Surgery: Patients should inform their surgeon about enalapril use before any procedures, as it may affect blood pressure during anesthesia.

Interactions

Enalapril can interact with numerous medications and supplements:

• Potassium supplements and salt substitutes: May cause dangerously high potassium levels when combined with enalapril
• Diuretics (water pills): Can cause excessive blood pressure reduction, especially when starting treatment
• NSAIDs (ibuprofen, naproxen): May reduce enalapril’s effectiveness and increase risk of kidney problems
• Lithium: Enalapril can increase lithium levels in the blood, potentially causing toxicity
• Diabetes medications: May enhance blood sugar-lowering effects, requiring dose adjustments
• Other blood pressure medications: Combined use may cause excessive blood pressure reduction
• Allopurinol: Increases risk of serious allergic reactions when used with enalapril
• Gold injections: May cause facial flushing and low blood pressure when combined with ACE inhibitors

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Dosage

Typical adult dosages vary depending on the condition being treated:

• Hypertension: Initial dose is usually 5-10 mg once daily, with maintenance doses ranging from 10-40 mg daily, taken as a single dose or divided into two doses
• Heart Failure: Starting dose is typically 2.5 mg twice daily, gradually increased to a target dose of 10-20 mg twice daily as tolerated
• Left Ventricular Dysfunction: Initial dose of 2.5 mg twice daily, increased gradually to 20 mg daily in divided doses

Dosages must be individualized based on patient response, kidney function, and other medical conditions. Your healthcare provider will determine the appropriate starting dose and make adjustments as needed. Never change your dose without consulting your doctor.

Sources: FDA DailyMed drug labels (public domain), BNF, WHO Essential Medicines List. This article is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider before starting or stopping any medication.

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