Enalaprilum, Enalaprilatum
Medicine
Related diseases
Description
Enalapril is an ACE inhibitor and a prodrug. Conversely, Enalaprilat is the active metabolite of Enalapril.
Indications
- Arterial hypertension
- Congestive heart failure
- Prevention of symptomatic congestive heart failure and coronary circulation disorders in cases of asymptomatic left ventricular dysfunction
Contraindications
- Increased sensitivity to ACE inhibitors
- History of angioedema during previous treatment with ACE inhibitors
- Hereditary or idiopathic angioedema
- Second and third trimesters of pregnancy
Dosage
For Adults:
Enalapril:
- Oral administration.
- Arterial hypertension: Initially 5-10 mg once daily. If the patient was taking a high dose of diuretics before starting treatment, start with a 5 mg dose. If possible, discontinue diuretic use 2-3 days before starting Enalapril. The usual maintenance dose is 20 mg once daily. The maximum daily dose is 40 mg (in 1-2 doses).
- Heart failure or asymptomatic left ventricular dysfunction: Initially 2.5 mg per day, with a usual maintenance dose of 20 mg per day (in 1-2 doses).
Enalaprilat:
- Intravenous (IV) administration should be done slowly, specifically not faster than over 5 minutes.
- Arterial hypertension, when oral administration is not possible: 1.25 mg every 6 hours. When taken with a diuretic, start with 0.625 mg (if the effect is inadequate after 1 hour, repeat), then 1.25 mg every 6 hours.
For Elderly Patients:
Enalapril:
- Oral administration. Adjust the dose according to the patient’s kidney function.
Enalaprilat:
- Intravenous (IV) administration (not faster than over 5 minutes). Initially 0.625 mg (if the effect is inadequate after 1 hour, repeat), then 1.25 mg every 6 hours.
For Patients with Renal Impairment (IFN):
Enalapril:
- Oral administration. Initially, 2.5 mg once daily. Usually, extend intervals between doses and/or reduce the dose.
Enalaprilat:
- Intravenous (IV) administration (not faster than over 5 minutes). For creatinine clearance (CC) < 30 ml/min, initially 0.625 mg (if the effect is inadequate after 1 hour, repeat), then 1.25 mg every 6 hours.
Adverse Reactions
Most Common:
- Hypotension
- Impaired kidney function
- Persistent dry cough
- Fever
- Joint pain
- Hyperkalemia
Others:
- Palpitations
- Arrhythmia
- Chest pain
- Facial flushing
- Syncope
- Cerebral circulation disorder
- Myocardial infarction
- Sinusitis
- Rhinitis
- Throat irritation
- Nausea
- Vomiting
- Dyspepsia
- Diarrhea
- Constipation
- Altered taste
- Stomatitis
- Anorexia
- Pancreatitis
- Abnormal liver function tests
- Hepatitis
- Acute renal failure
- Cholestasis-induced jaundice
- Intestinal obstruction
- Thrombocytopenia
- Leukopenia
- Neutropenia
- Agranulocytosis
- Hemolytic anemia
- Headache
- Dizziness
- Fatigue
- General malaise
- Confusion
- Depression
- Nervousness
- Asthenia
- Drowsiness
- Insomnia
- Blurred vision
- Ear noise
- Paresthesia
- Angioedema
- Bronchospasm
- Sweating
- Alopecia
- Polymorphic erythema
- Stevens-Johnson syndrome
- Toxic epidermal necrolysis
- Exfoliative dermatitis
- Pemphigus
- Impotence
- Lung infiltrates
- Pulmonary edema
Pregnancy
- Risk category: CM (DM – II and III trimester)
- Not recommended in the first trimester
- Contraindicated in the second and third trimesters
Breastfeeding
- Use with caution.
Warnings
- Use with caution in cases of left ventricular valve or outflow obstruction.
- Not recommended in cases of cardiogenic shock or significant hemodynamic obstruction.
- Exercise caution in patients with peripheral vascular disease, generalized atherosclerosis, or idiopathic angioedema.
- The first dose may cause acute severe hypotension, especially when taken with diuretics, in cases of dehydration, heart failure, restricted sodium intake, or dialysis. If possible, discontinue diuretic use in the last few days before initiating this medication; it can be resumed after a few weeks. If discontinuing diuretic use is not feasible, monitor the patient for at least 2 hours after the first dose until blood pressure stabilizes.
- When initiating treatment for heart failure, closely monitor the patient (severe heart failure should be treated in a hospital).
Source | Drug Guide | Lithuanian University of Health Sciences | Institute of Physiology and Pharmacology | Doctor of Medical Sciences Rimas Jankūnas, Doctor of Medical Sciences Arvydas Milašius | Clinic of Internal Diseases | Doctor of Medical Sciences Palmira Leišytė