Enalapril Drug Profile

What is Enalapril?

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

Uses

• Hypertension: Reduces elevated blood pressure by relaxing blood vessels, helping prevent stroke, heart attack, and kidney problems
• Heart failure: Improves the heart’s ability to pump blood effectively and reduces symptoms like shortness of breath and swelling
• Left ventricular dysfunction: Helps prevent progression to symptomatic heart failure in patients with reduced heart function after heart attack
• Diabetic nephropathy: Protects kidney function in diabetic patients by reducing protein loss in urine
• Post-myocardial infarction: Improves survival and reduces complications when started after a heart attack

How it works

Enalapril blocks the action of angiotensin-converting enzyme (ACE), which normally converts angiotensin I to angiotensin II, a powerful substance that narrows blood vessels and increases blood pressure. By inhibiting this enzyme, enalapril allows blood vessels to remain relaxed and dilated, reducing the workload on the heart. The medication also helps prevent the breakdown of bradykinin, a substance that further promotes blood vessel dilation.

Side effects

Common side effects:

• Dry cough (persistent, non-productive)
• Dizziness or lightheadedness
• Fatigue or weakness
• Headache
• Nausea
• Low blood pressure (hypotension)
• Elevated potassium levels
• Skin rash

Serious side effects requiring immediate medical attention:

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• Angioedema (swelling of face, lips, tongue, or throat)
• Severe kidney dysfunction or failure
• Dangerously high potassium levels (hyperkalemia)
• Severe hypotension with fainting
• Liver dysfunction or hepatitis

Warnings and precautions

• Pregnancy: Contraindicated during pregnancy as it can cause serious harm or death to the developing fetus, particularly in the second and third trimesters
• Kidney disease: Use with caution in patients with kidney impairment; regular monitoring of kidney function and electrolytes is essential
• Angioedema history: Should not be used in patients with a history of angioedema related to previous ACE inhibitor use
• Bilateral renal artery stenosis: Can cause severe kidney dysfunction in patients with narrowing of both kidney arteries
• Dehydration: Risk of severe blood pressure drop in patients who are volume-depleted or taking diuretics

Interactions

• Potassium supplements and salt substitutes: Increase risk of dangerous high potassium levels when combined with enalapril
• Diuretics: May cause excessive blood pressure reduction, especially when starting treatment
• NSAIDs (ibuprofen, naproxen): Can reduce enalapril’s effectiveness and increase kidney damage risk
• Lithium: Enalapril can increase lithium levels, potentially causing toxicity
• Diabetic medications: May enhance blood sugar-lowering effects, requiring dose adjustments
• Aliskiren: Combination increases risk of kidney problems, high potassium, and low blood pressure
• Gold therapy: May increase risk of severe allergic reactions
• Trimethoprim-sulfamethoxazole: Increases risk of high potassium levels

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Dosage

Typical adult dosages vary based on the condition being treated and individual patient response. For hypertension, the usual starting dose is 5-10 mg once or twice daily, with maintenance doses typically ranging from 10-40 mg daily. For heart failure, treatment usually begins with 2.5 mg twice daily, gradually increasing as tolerated up to 10-20 mg twice daily. Dosages must be individualized and adjusted based on blood pressure response, kidney function, and tolerance. Patients with kidney impairment or those taking diuretics may require lower starting doses. Always follow your healthcare provider’s specific dosing instructions and attend regular follow-up appointments for monitoring.

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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