Enalapril is an ACE inhibitor. ACE stands for angiotensin converting enzyme.
Enalapril is used to treat high blood pressure (hypertension) in adults and children who are at least 1 month old.
Enalapril is also used to treat congestive heart failure in adults.
Enalapril is also used to treat a disorder of the ventricles (the lower chambers of the heart that allow blood to flow out of the heart). This disorder can decrease the heart"s ability to pump blood to the body.
Important information
Do not use enalapril if you are pregnant. Stop using and tell your doctor right away if you become pregnant.
You should not use enalapril if you have ever had angioedema.
Enalapril can cause kidney problems. Call your doctor at once if you have swelling, rapid weight gain, little or no urinating, or if you feel short of breath.
If you have diabetes, do not use enalapril together with any medication that contains aliskiren (Amturnide, Tekturna, Tekamlo, Valturna).
Enalapril can affect your heart or your electrolyte levels. Call your doctor if you have chest pain, pounding heartbeats or fluttering in your chest, a slow heart rate or weak pulse, a tingly feeling, muscle weakness, or muscle tightness or contraction.
Before taking this medicine
You should not use enalapril if you are allergic to it, or if you have:
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a history of angioedema; or
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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, Valturna).
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:
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kidney disease (or if you are on dialysis);
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liver disease;
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a history of blood clot or stroke (including "mini-stroke";
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an electrolyte imbalance (such as high levels of potassium in your blood); or
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heart disease or congestive heart failure (unless you are taking enalapril for this condition).
FDA pregnancy category D. Do not use enalapril if you are pregnant. Stop using this medicine and tell your doctor right away if you become pregnant. Enalapril can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. Use effective birth control while taking this medication.
See also: Pregnancy and breastfeeding warnings (in more detail)
Enalapril can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using this medicine.
How should I take enalapril?
Take enalapril exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.
You may take enalapril with or without food.
Shake the oral suspension (liquid) well just before you measure a dose. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.
Your blood pressure will need to be checked often. Your kidney or liver function may also need to be tested.
You may have very low blood pressure while taking this medication. Call your doctor if you are sick with vomiting or diarrhea, or if you are sweating more than usual.
If you need surgery, tell the surgeon ahead of time that you are using enalapril. You may need to stop using the medicine for a short time.
If you are being treated for high blood pressure, keep using this medicine even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medicine for the rest of your life.
Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.
Store the liquid medicine in the refrigerator, do not freeze. Throw away any enalapril liquid not used within 60 days.
Enalapril dosing information
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.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while taking enalapril?
Avoid drinking alcohol. It can further lower your blood pressure and may increase some of the side effects of enalapril.
Do not use salt substitutes or potassium supplements while taking enalapril, unless your doctor has told you to.
Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.
Enalapril side effects
Get emergency medical help if you have any of these 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:
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a light-headed feeling, like you might pass out;
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pounding heartbeats or fluttering in your chest;
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high potassium - slow heart rate, weak pulse, muscle weakness, tingly feeling;
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low white blood cell counts - sudden weakness or ill feeling, fever, chills, painful mouth sores, pain when swallowing, skin sores, cold or flu symptoms, cough, trouble breathing; or
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signs of a kidney problem - little or no urinating; painful or difficult urination; swelling in your feet or ankles; feeling tired or short of breath.
Common enalapril side effects may include:
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.
See also: Side effects (in more detail)
What other drugs will affect enalapril?
Tell your doctor about all medicines you use, and those you start or stop using during your treatment with enalapril, especially:
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lithium;
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a diuretic or "water pill";
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gold injections to treat arthritis;
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a potassium supplement such as Cytra, Epiklor, K-Lyte, K-Phos, Kaon, Klor-Con, or Polycitra; or
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aspirin or NSAIDs (non-steroidal anti-inflammatory drugs) - ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.
This list is not complete. Other drugs may interact with enalapril, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.
