Enalapril is indicated in- All grades of essential hypertension and renovascular hypertension either alone or in combination with other antihypertensive agents especially thiazide diuretics. Prevention of symptomatic heart failure. Treatment of congestive heart failure (adjunct), usually in combination with diuretics and digitalis. Prevention of coronary ischaemic events in patients with left ventricular dysfunction. Enalapril is also used either alone or as an adjunct in the treatment of angina, diabetic nephropathy and Raynaud's disease.
Angiotensin-converting enzyme (ACE) inhibitors
Enalapril, after hydrolysis to enalaprilate, inhibits Angiotensin Converting Enzyme (ACE). ACE is a peptidyl dipeptidase that catalyses the conversion of angiotensin I to the vasoconstrictor substance angiotensin II. Angiotensin II also stimulates aldosterone secretion by the adrenal cortex. The beneficial effects of enalapril in hypertension and heart failure appear to result primarily from suppression of the renin-angiotensin aldosterone system.
Hypertension: Initially 5 mg once daily if used alone or 2.5 mg daily if used in addition to diuretic, in elderly patients or in patients with renal impairment. Usual maintenance dose is 10-20 mg once daily. However, in severe hypertension it may be increased to a maximum of 40 mg once daily. Heart failure (adjunct) and asymptomatic left ventricular dysfunction: Initially 2.5 mg under close medical supervision. Usual maintenance dose is 20 mg daily in 1-2 divided doses
Combination with other antihypertensive agents such as beta-blockers, methyldopa, calcium antagonists, and diuretics may increase the antihypertensive efficacy. Adrenergic - blocking drugs should only be combined with Enalapril under careful supervision, Concomitant propranolol may reduce the bioavailability of Enalapril, but this does not appear to be of any clinical significance. Plasma potassium usually remains within normal limits, although cases of hyperkalaemia have been reported. If Enalapril is given with potassium losing diuretic, the likelihood of diuretic-induced hypokalaemia may be lessened. Enalapril may elevate plasma potassium levels in patients with renal failure. Potassium supplements, potassium-containing saft substitutes are not recommended, particularly in patients with impaired renal function, since they may lead to significant increases in plasma potassium.
Aortic stenosis or outflow tract obstruction. Renovascular disease. Severe resistant HTN. Peripheral vascular disease or generalized atherosclerosis. Assess renal function; regular WBC counts in patient w/ collagen vascular disease eg SLE & scleroderma. Patient receiving immunosuppressive therapy; those prone to salt or water depletion. Pregnancy.
Dizziness and headache are more commonly reported side effects. Fatigue and asthenia were reported in 2-3% of patients. Other side effects occurred in less than 2% of patients and included hypotension, orthostatic hypotension, syncope, nausea, diarrhoea, muscle cramps, rash and cough. Less frequently renal dysfunction, renal failure and oliguria have been reported. Angioedema, hyperkalemia and hyponatremia have also been reported rarely
Category D: Contraindicated in pregnancy. The drug is excreted in trace amount in human milk and caution should be exercised if given to nursing mothers.
Limited data are available for overdosage in humans. The most prominent features of overdosage reported to date are marked hypotension, beginning some six hours after ingestion of tablets, concomitant with blockage of the renin - angiotensin system, and stupor. The recommended treatment of overdosage is intravenous infusion of normal saline solution. If ingestion is recent, induce emesis. Enalapril can be removed from the general circulation by haemodialysis
Do not store above 25°C. Keep away from light and wet place. Keep out of reach of children.
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