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CARDIOVASCULAR SYSTEM › AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM › ACE INHIBITORS, PLAIN › ACE inhibitors, plain
enalapril
C09AA02
Forms & Strengths
- Oral Tablets: 2.5 mg, 5 mg, 10 mg, 20 mg
- Intravenous Solution: 1.25 mg/mL (enalaprilat)
Adult Dosing
- Hypertension: Initial 5 mg PO once daily; titrate from 10 to 40 mg daily in 1 or 2 divided doses
- Heart Failure: Initial 2.5 mg PO twice daily; titrate up to target 10-20 mg PO twice daily
- Asymptomatic Left Ventricular Dysfunction: Initial 2.5 mg PO twice daily; titrate to target 20 mg daily in divided doses
- Intravenous (Enalaprilat): 1.25 mg every 6 hours over 5 minutes
Pediatric Dosing
- Hypertension (Neonates to 16 years): Initial 0.08 mg/kg PO once daily (up to 5 mg total); titrate based on response up to 0.58 mg/kg/day
Indications
- Hypertension
- Heart Failure
- Reduction of incidence of heart failure in patients with asymptomatic left ventricular dysfunction
Mechanism of Action
- Competitive inhibition of angiotensin-converting enzyme (ACE), preventing the conversion of angiotensin I to angiotensin II
- Decreases systemic vascular resistance, blood pressure, and aldosterone secretion while increasing plasma renin activity
Contraindications
- History of hypersensitivity or angioedema related to previous ACE inhibitor treatment
- Hereditary or idiopathic angioedema
- Co-administration with aliskiren in patients with diabetes
- Concomitant use with or within 36 hours of sacubitril/valsartan
Adverse Reactions
- Hypotension and dizziness
- Hyperkalemia
- Renal impairment and elevated serum creatinine
- Persistent dry, hacking cough
- Angioedema (face, lips, tongue, glottis)
- Headache and fatigue
Drug Interactions
- Potassium-sparing diuretics and potassium supplements: Increased risk of severe hyperkalemia
- Lithium: Decreased lithium clearance leading to potential toxicity
- NSAIDs: Reduced antihypertensive efficacy and increased risk of renal deterioration
- Dual blockade of the renin-angiotensin system (ARBs, aliskiren): Increased risk of hypotension, hyperkalemia, and renal dysfunction
Curated Content: Needs Vetting Before Put to Clinical Use