Enalapril Maleate

ACE Inhibitor · ACE inhibitor

Indications

Congestive heart failure. All grades of essential hypertension and renovascular hypertension where standard therapy is ineffective or inappropriate.

Dosage

Adults: ORAL: Congestive heart failure: Initially 2.5 mg under close hospital supervision in conjunction with diuretics and/or digitalis. Usual maintenance dose 10-20 mg twice daily. Hypertension: Initiate with 5 mg daily; In patients over 65 yr and those with renal impairment, initiate with 2.5 mg daily. Usual maintenance, 10-20 mg once daily; max 40 mg once daily. Adjunctive therapy, discontinue diuretic 2-3 days before initiating with 2.5 mg daily. Adults: INJECTION: Hypertension: 2.5-5 mg/day then increase as required, usual therapeutic dose for hypertension is 10-40 mg/day in 1-2 divided doses. Children: Not recommended.

Administration

Give direct IVP over at least 5 min or dilute up to 50 mL and infuse. Compatibility: Stable in NS, D5W, D5NS. Y-site administration: Drug to Drug IV Compatibility: Acyclovir, amikacin, aztreonam, bumetanide, calcium gluconate, cephazolin, ceftriaxone, cimetidine, cisatracurium, dexamethasone, diltiazem, diphenhydramine, dobutamine, dopamine, epinephrine, esmolol, famotidine, fentanyl, fluconazole, furosemide, gentamicin, heparin, hydrocortisone, hydromorphone, imipenem, insulin regular, labetalol, levofloxacin, linezolid, lorazepam, magnesium sulphate, meropenem, methylprednisolone, metoclopramide, metronidazole, midazolam, milrinone, morphine, nitroglycerin, nitroprusside, norepinephrine, ondansetron, phenylephrine, piperacillin/tazobactam, propofol, ranitidine, tobramycin, vancomycin, vasopressin. Drug to Drug IV Incompatibility: Amphotericin B, amphotericin B cholesteryl sulphate…

Adverse Effects

Hypotension, renal failure angioedema, rash, headache, fatigue, dizziness, GI upset, cough, blurred vision, syncope, chest pain, arrhythmias, angina, tachycardia, dysgeusia, dyspnoea, hyperkalaemia, increased serum creatinine. Very rarely anaphylactoid reactions during desensitization and LDL apheresis. Withdraw promptly if jaundice or angioedema occurs.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Contraindicated in pregnancy. Lactation: Caution advised or effect undetermined. Contraindications: Aortic stenosis, outflow obstruction, cardiogenic shock, angioedema (hereditary, idiopathic or associated with previous ACE inhibitor therapy). Precautions: Haemodialysis (avoid in patients dialysed with high-flux membranes). Monitor serum electrolytes. Fluid or electrolyte imbalance, aortic stenosis, outflow obstruction, renovascular hypertension, ischaemic or cerebrovascular disease. Renal or hepatic impairment. Collagen vascular disease, anaesthesia, apheresis, diabetes.

Interactions

K+ supplement, K+ -sparing diuretics, NSAIDs, antidiabetic agents, lithium, neuroleptics, narcotic drugs, antihypertensives, antacids, sympathomimetics, cyclosporin, immunosuppressants, cytostatic agents, corticosteroids, procainamide, allopurinol, alcohol, trimethoprim, heparin, lithium, sodium aurothiomalate (gold), TCADs, antipsychotics, anaesthetics, vasodilators, hyposensitising agents, alcohol, high-flux dialysis membranes.

Advice to Patient

Take 1 hour before or 2 hours after meals. Do not chew or crush tablets. Take first dose at bedtime. Contact prescriber if there is constant nausea and vomiting; chest pain; palpitations; mouth sores; fever; chills; swelling of ankles, feet, face, mouth or tongue; skin rash; numbness; tingling; muscle pain; difficulty in breathing or unusual dry cough. Do not take potassium supplements or salt substitutes without consulting prescriber. Change position slowly. Take sufficient amount of liquid to prevent dehydration.

Pharmacokinetics

Onset of action: Approx. 1 hr. Peak effect: 4-6 hrs. Duration: 12-24 hrs. Absorption: 55%-75%. Metabolism: Prodrug, undergoes hepatic biotransformation to enalaprilat. Half-life elimination: Enalapril: CHF: Neonates (PNA=10-19 days): 10.3 hrs. CHF: Infants and Children =6.5 yrs: 2.7 hrs. Adults: Healthy: 2 hrs; CHF: 3.4-5.8 hrs. Enalaprilat: CHF: Neonates (PNA=10-19 days): 11.9 hrs. CHF: Infants and Children =6.5 yrs: 11.1 hrs. Infants 6 wks-8 mth: 6-10 hrs. Adults: Approx. 35 hrs. Time to peak, serum: Oral: Enalapril: 0.5-1.5 hrs. Enalaprilat (active metabolite): 3-4.5 hrs.

Brands with this active ingredient

Compiled by Healify Pharmacy from published drug references. How we compile it →

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