Enalapril

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Especially tell your doctor if you take:

• diuretics, or "water pills"
• spironolactone (Aldactone)
• non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin (Ecotrin) and ibuprofen (Advil)
• methyldopa
• nitrates, such as nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate
• calcium channel blocking drugs, such as amlodipine (Norvasc) and verapamil (Calan)
• hydralazine
• prazosin (Minipress)
• digoxin (Lanoxin)
• lithium
• potassium supplements
• injectable gold (sodium aurothiomalate)

This is not a complete list of enalapril drug interactions. Ask your doctor or pharmacist for more information.

Tell your doctor if you are breastfeeding or plan to breastfeed.

You should not take enalapril if you are breastfeeding. It may be excreted in your breast milk and may harm your nursing child.
 

Take enalapril exactly as prescribed.

This medication comes in tablet form and is taken 1 to 2 times a day, with or without food.

If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of enalapril at the same time.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For enalapril, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to enalapril or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of enalapril to treat hypertension in children 1 month to 16 years of age. However, use is not recommended in children younger than 1 month of age and in children with severe kidney disease.

Geriatric

No information is available on the relationship of age to the effects of enalapril in geriatric patients. However, elderly patients are more likely to have age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving enalapril.

Pregnancy

Breast Feeding

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking enalapril, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using enalapril with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Aliskiren
• Sacubitril

Using enalapril with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Allopurinol
• Alteplase, Recombinant
• Amiloride
• Azathioprine
• Azilsartan
• Azilsartan Medoxomil
• Candesartan Cilexetil
• Canrenoate
• Eplerenone
• Eprosartan
• Everolimus
• Interferon Alfa-2a
• Irbesartan
• Lithium
• Losartan
• Mercaptopurine
• Olmesartan Medoxomil
• Oxypurinol
• Potassium
• Sirolimus
• Spironolactone
• Telmisartan
• Triamterene
• Trimethoprim
• Valsartan

Using enalapril with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Aceclofenac
• Acemetacin
• Amtolmetin Guacil
• Aspirin
• Azosemide
• Bromfenac
• Bufexamac
• Bumetanide
• Bupivacaine
• Bupivacaine Liposome
• Capsaicin
• Celecoxib
• Choline Salicylate
• Clomipramine
• Clonixin
• Dexibuprofen
• Dexketoprofen
• Diclofenac
• Diflunisal
• Dipyrone
• Droxicam
• Ethacrynic Acid
• Etodolac
• Etofenamate
• Etoricoxib
• Felbinac
• Fenoprofen
• Fepradinol
• Feprazone
• Floctafenine
• Flufenamic Acid
• Flurbiprofen
• Furosemide
• Gold Sodium Thiomalate
• Ibuprofen
• Indomethacin
• Ketoprofen
• Ketorolac
• Lornoxicam
• Loxoprofen
• Lumiracoxib
• Meclofenamate
• Mefenamic Acid
• Meloxicam
• Morniflumate
• Nabumetone
• Naproxen
• Nepafenac
• Nesiritide
• Niflumic Acid
• Nimesulide
• Nimesulide Beta Cyclodextrin
• Oxaprozin
• Oxyphenbutazone
• Parecoxib
• Phenylbutazone
• Piketoprofen
• Piretanide
• Piroxicam
• Proglumetacin
• Propionic Acid
• Propyphenazone
• Proquazone
• Rifampin
• Rofecoxib
• Salicylic Acid
• Salsalate
• Sodium Salicylate
• Sulindac
• Tenoxicam
• Tiaprofenic Acid
• Tolfenamic Acid
• Tolmetin
• Torsemide
• Valdecoxib

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of enalapril. Make sure you tell your doctor if you have any other medical problems, especially:

• Angioedema (swelling of the face, lips, tongue, throat, arms, or legs), history of—May increase risk of this condition occurring again.

• Collagen vascular disease (an autoimmune disease) together with kidney disease—Increased risk of blood problems.

• Diabetes or
• Kidney problems—Increased risk of potassium levels in the body becoming too high.

• Diabetic patients who are also taking aliskiren (Tekturna®) or
• Hereditary or idiopathic angioedema—Should not be used in patients with these conditions.

• Electrolyte imbalance (eg, low sodium in the blood) or
• Fluid imbalances (caused by dehydration, vomiting, or diarrhea) or
• Heart or blood vessel problems (eg, aortic stenosis, hypertrophic cardiomyopathy) or
• Kidney disease or
• Liver disease—Use with caution. May make these conditions worse.

It is very important that your doctor check your progress at regular visits to make sure enalapril is working properly. Blood tests may be needed to check for unwanted effects.

Using enalapril while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.

enalapril may cause serious allergic reactions, including anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, mouth, or throat while you are using enalapril.

Call your doctor right away if you have severe stomach pain (with or without nausea or vomiting). This could be a symptom of intestinal angioedema.

Dizziness, lightheadedness, or fainting may also occur, especially when you get up from a lying or sitting position or if you have been taking a diuretic (water pill). Make sure you know how you react to the medicine before you drive, use machines, or do other things that could be dangerous if you are dizzy or not alert. If you feel dizzy, lie down so you do not faint. Then sit for a few moments before standing to prevent the dizziness from returning.

Check with your doctor right away if you become sick while taking enalapril, especially with severe or continuing nausea, vomiting, or diarrhea. These conditions may cause you to lose too much water or salt and may lead to low blood pressure. You can also lose water by sweating, so drink plenty of water during exercise or in hot weather.

Check with your doctor if you have a fever, chills, or sore throat. These could be symptoms of an infection resulting from low white blood cells.

Check with your doctor right away if you have upper stomach pain, pale stools, dark urine, loss of appetite, nausea, unusual tiredness or weakness, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Hyperkalemia (high potassium in the blood) may occur while you are using enalapril. Check with your doctor right away if you have the following symptoms: abdominal or stomach pain, confusion, difficulty with breathing, irregular heartbeat, nausea or vomiting, nervousness, numbness or tingling in the hands, feet, or lips, shortness of breath, or weakness or heaviness of the legs. Do not use supplements or salt substitutes containing potassium without first checking with your doctor.

Make sure any doctor or dentist who treats you knows that you are using enalapril. You may need to stop using enalapril several days before having surgery.

Do not take other medicines unless they have been discussed with your doctor. This includes over-the-counter (nonprescription) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since they may tend to increase your blood pressure.

~1 hour; Peak effect: 4 to 6 hours

Time to Peak

Serum: Oral: Enalapril: 0.5 to 1.5 hours; Enalaprilat (active metabolite): 3 to 4.5 hours

In those with glomerular filtration rate (GFR) 30 mL/minute or less, the peak and trough enalaprilat levels increase, Tmax increases, and time to steady state may be delayed.

Powder for oral solution kit (for 150 mL, enalapril solution 1 mg/mL): Kit contains 1 bottle of enalapril powder and 1 bottle of Ora-Sweet SF dilution to be added to the enalapril powder prior to dispensing. Firmly tap the enalapril powder for oral solution bottle on a hard surface 5 times. Add approximately one-half (75 mL) of the Ora-Sweet SF diluent to the enalapril 150 mL oral solution bottle and shake well for 30 seconds. Add the remainder of the Ora-Sweet SF diluent and shake well for an additional 30 seconds. May be used for 60 days after reconstitution.

You should not use enalapril if you are allergic to it, or if you have:

• you have a history of angioedema;

• you also take medicine that contains sacubatril (such as Entresto); or

• if you are allergic to any other ACE inhibitor, such as benazepril, captopril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, or trandolapril.

If you have diabetes, do not use enalapril together with any medication that contains aliskiren (Amturnide, Tekturna, Tekamlo).

You may also need to avoid taking enalapril with aliskiren if you have kidney disease.

To make sure enalapril is safe for you, tell your doctor if you have:

• kidney disease (or if you are on dialysis);

• liver disease;

• a history of blood clot or stroke (including "mini-stroke");

• an electrolyte imbalance (such as high levels of potassium in your blood); or

• heart disease or congestive heart failure (unless you are taking enalapril for this condition).

Do not use if you are pregnant. If you become pregnant, stop taking this medicine and tell your doctor right away. Enalapril can cause injury or death to the unborn baby if you take the medicine during your second or third trimester.

Enalapril can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using this medicine.

Get emergency medical help if you have signs of an allergic reaction to enalapril: hives; severe stomach pain; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• a light-headed feeling, like you might pass out;

• slow heartbeats;

• pounding heartbeats or fluttering in your chest;

• little or no urination;

• jaundice (yellowing of the skin or eyes);

• numbness, tingling, or burning pain in your hands or feet;

• fever, chills, cold or flu symptoms;

• easy bruising, unusual bleeding; or

• high potassium - nausea, slow or unusual heart rate, weakness, loss of movement; or

Common enalapril side effects may include:

• dizziness, feeling tired;

• cough; or

• feeling light-headed.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Usual Adult Dose for Hypertension:

Initial dose (oral tablets or solution): 5 mg orally once a day
Maintenance dose (oral tablets or solution): 10 to 40 mg orally per day as a single dose or in 2 divided doses
Maximum dose: 40 mg orally daily as a single dose or in 2 divided doses

In combination with diuretics:
Initial dose: 2.5 mg orally once a day
If feasible, the diuretic should be discontinued 2 to 3 days prior to initiation of therapy with enalapril. If required, diuretic therapy may be gradually resumed.

Parenteral: 1.25 to 5 mg IV over a 5 minute period every 6 hours

Comments:
-Clinical response is usually seen within 15 minutes after IV administration.
-If required, diuretic therapy may be gradually resumed.

Usual Adult Dose for Congestive Heart Failure:

Initial dose: 2.5 mg orally once a day
Maintenance dose: 2.5 to 20 mg daily in 2 divided doses
Maximum dose: 40 mg orally per day in 2 divided doses

Comments:
-Treatment is usually combined with diuretics and digitalis.
-Doses should be titrated upward, as tolerated, over a period of a few days or weeks.

Usual Adult Dose for Left Ventricular Dysfunction:

Initial dose: 2.5 mg orally twice a day
Maintenance dose: 20 mg orally per day in 2 divided doses

Comments:
-After the initial dose, the patient should be observed for at least 2 hours and until blood pressure has stabilized for at least an additional hour.
-If possible, the dose of any concomitant diuretic should be reduced which may diminish the likelihood of hypotension.

Usual Pediatric Dose for Hypertension:

Oral tablets or solution:
Children 1 month to 17 years:
Initial dose: 0.08 mg/kg/day (up to 5 mg) in 1 to 2 divided doses. Adjust dosage based on patient response.
Maximum dose: Doses greater than 0.58 mg/kg (40 mg) have not been evaluated in pediatric patients.

Comment:
-Not recommended in neonates and in pediatric patients with glomerular filtration rate less than 30 mL/min, as no data are available.

Oral tablets or solution:
Children 1 month to 17 years:
Initial dose: 0.08 mg/kg/day (up to 5 mg) in 1 to 2 divided doses. Adjust dosage based on patient response.
Maximum dose: Doses greater than 0.58 mg/kg (40 mg) have not been evaluated in pediatric patients.

Comment:
-Not recommended in neonates and in pediatric patients with glomerular filtration rate less than 30 mL/min, as no data are available.

US BOXED WARNING:
-FETAL TOXICITY: If pregnancy is detected, this drug should be discontinued as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.

IV solution: Safety and efficacy have not been established in patients younger than 18 years.
Oral solution: This drug is not recommended for use in neonates (1 month or younger), preterm infants less than 44 weeks (corrected post-conceptual age), or pediatric patients with CrCl less than 30 mL/min. Safety and efficacy have not been established in pediatric patients with heart failure or asymptomatic left ventricular dysfunction.
Oral tablet: This drug is not recommended for use in neonates or pediatric patients with CrCl less than 30 mL/min.

Consult WARNINGS section for dosing related precautions.

• May be used for the treatment of high blood pressure or heart failure.
• Enalapril may also be given to people with evidence of dysfunction of the left ventricle of their heart, but currently without symptoms of heart failure (a condition called left ventricular dysfunction). Trials have shown enalapril reduces the development of heart failure in people with this condition and reduces the incidence of hospitalization.
• In high blood pressure, enalapril reduces both lying down and standing blood pressure without a significant orthostatic effect (this is the drop sometimes seen when going from sitting to standing). However, dehydrated patients may be at higher risk of an orthostatic effect.
• In people with heart failure, enalapril decreases heart size and increases how much blood the heart can pump out. It also increases exercise tolerance, without having much of an effect on heart rate. Enalapril use can decrease the severity of heart failure, rates of hospitalization and symptoms such as shortness of breath and tiredness. Beneficial effects remain apparent with continued dosing.
• Effective alone or in combination with other treatments for high blood pressure.
• Available as oral tablets, a suspension, and in an injectable form.
• Generic enalapril is available.

• May be taken with or without food.
• Treatments that lower blood pressure, such as enalapril, should always be part of a comprehensive cardiovascular risk reduction plan that also targets, if appropriate, cholesterol lowering, diabetes risk reduction, exercise, weight loss, and smoking cessation.
• Ensure adequate hydration before starting enalapril.
• If you are prescribed enalapril suspension, shake it well before measuring the dose with the dosing syringe provided or a properly calibrated measuring cup. Do not use a kitchen teaspoon. Store the suspension in the refrigerator, do not freeze. Throw away any unused suspension after 60 days.
• Enalapril may make you feel dizzy, especially in the first few weeks of therapy and when going from a sitting or lying down position to standing. Always take your time when standing up. Talk with your doctor if this feeling persists.
• Call emergency services if your throat, face or lips show signs of swelling.
• Report any signs of fever or a sore throat to your doctor who may carry out further tests to ensure it is not neutropenia (a decrease in white blood cells).
• Also call your doctor if you develop chest pain, a change in your heartbeat or muscle contraction or weakness.
• Your doctor should monitor your blood pressure, kidney function and potassium levels regularly.
• For high blood pressure, continue this medication even if you feel well. High blood pressure does not usually have symptoms.
• Do not use salt substitutes or potassium supplements while taking lisinopril, unless recommended by your doctor.
• If you also have diabetes, you may need to monitor your blood sugar levels more closely during the first few weeks of lisinopril therapy.
• Do not use enalapril if you are pregnant or trying to become pregnant or if you are breastfeeding.
• Limit your alcohol intake while taking enalapril because enalapril can further lower your blood pressure and increase the risk of side effects.

• Peak concentrations of enalapril occur within an hour of oral administration, 15 minutes after IV administration. Enalapril is hydrolyzed to enalaprilat once inside the body; enalaprilat is a more potent inhibitor of angiotensin converting enzyme than enalapril. Peak concentrations of enalaprilat occur within three to four hours after administration of enalapril.
• Blood pressure lowering effects are seen within an hour of oral administration with peak effects achieved by four to six hours. Blood pressure lowering effects are maintained for at least 24 hours, although in some patients these effects may diminish towards the end of the 24 hour period. It may take several weeks before optimal blood pressure lowering effects are achieved. Abrupt withdrawal of enalapril has not resulted in an abrupt increase in blood pressure; however, as with most antihypertensive drugs, it is best to discontinue enalapril slowly.

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Substance Name

Enalapril

CAS Registry Number

75847-73-3

Drug Class

Antihypertensive Agents

Angiotensin-Converting Enzyme Inhibitors

LactMed Record Number

102

Last Revision Date

20161110

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Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.