Classes
DEA Class; Rx
Common Brand Names; enalaprilat, Epaned, Vasotec, Vasotec IV
- ACE Inhibitors
Description
IV and oral ACE inhibitor; used for hypertension and CHF; longer-acting than captopril but shorter-acting than other ACE inhibitors; usually dosed twice daily when given orally.
Indications
Indicated for the treatment of hypertension
Contraindications
Hypersensitivity to enalapril/other ACE inhibitors
History of ACE inhibitor-induced angioedema, hereditary or idiopathic angioedema
Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan
Do not coadminister with aliskiren in patients with diabetes mellitus or with renal impairment (ie, GFR <60 mL/min/1.73 m²)
Bilateral renal artery stenosis
Adverse Effects
- Dizziness (4-8%)
- Hypotension (0.9-6.7%)
- Headache (2-5%)
- Chest pain (2%)
- Cough (1-2%)
- Rash (1.5%)
- Asthenia
- Nausea
- Vomiting
- Hyperkalemia
Warnings
Apheresis (LDL) with dextran sulfate, hypertrophic cardiomyopathy, collagen vascular disease, hemodialysis with high flux membrane, renal or aortic stenosis
For HTN patients on diuretics, if possible discontinue diuretics 2-3 days before starting enalapril
Excessive hypotension if concomitant diuretics, hypovolemia, hyponatremia
Risk of hyperkalemia, especially in patients with renal impairment or DM or in those taking concomitant K+-elevating drugs
Dual blockade of the renin angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for hypotension, hyperkalemia, and renal function changes (including acute renal failure) compared to monotherapy
Injection contains benzyl alcohol preservative (linked to potentially fatal “gasping syndrome” in preemies)
ACE inhibition also causes an increase in bradykinin levels, which putatively mediates angioedema
Angioedema of the face, extremities, lips, tongue, glottis, and larynx has been reported in patients treated with angiotensin-converting enzyme inhibitors
If laryngeal stridor or angioedema of the face, tongue, or glottis occurs discontinue therapy and institute appropriate therapy immediately
Patients receiving coadministration of ACE inhibitor and mTOR (mammalian target of rapamycin) inhibitor (e.g. temsirolimus, sirolimus, everolimus) therapy or a neprilysin inhibitor may be at increased risk for angioedema Intestinal angioedema has been reported in patients treated with ACE inhibitors
Dry hacking nonproductive cough may occur within few months of treatment; consider other causes of cough prior to discontinuation
Agranulocytosis, neutropenia, or leukopenia with myeloid hypoplasia reported with other ACE inhibitor; patients with renal impairment are at high risk; monitor CBC with differential in these patients
Discontinue STAT if patient becomes pregnant
Less effective in blacks
Renal impairment
Pregnancy and Lactation
May cause fetal harm when administered to a pregnant woman; use of drugs that act on renin-angiotensin system during second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death
Enalapril and enalaprilat have been detected in human breast milk; because of potential for serious adverse reactions in breastfed infant, including hypotension, hyperkalemia, and renal impairment, advise women not to breastfeed during therapy
Maximum Dosage
40 mg/day PO or 20 mg/day IV.
40 mg/day PO or 20 mg/day IV.
17 years: 40 mg/day PO for hypertension; safety and efficacy of IV enalaprilat has not been established; however, doses up to 10 mcg/kg/dose IV (Max: 1.25 mg/dose IV) have been used off-label.
13 to 16 years: 0.6 mg/kg/day PO (Max: 40 mg/day PO) for hypertension; doses of up to 0.94 mg/kg/day PO have been used off-label for congestive heart failure; safety and efficacy of IV enalaprilat has not been established; however, doses up to 10 mcg/kg/dose IV (Max: 1.25 mg/dose IV) have been used off-label.
0.6 mg/kg/day PO (Max: 40 mg/day PO) for hypertension; doses of up to 0.94 mg/kg/day PO have been used off-label for congestive heart failure; safety and efficacy of IV enalaprilat has not been established; however, doses up to 10 mcg/kg/dose IV (Max: 1.25 mg/dose IV) have been used off-label.
0.6 mg/kg/day PO for hypertension; however, doses as high as 0.94 mg/kg/day PO have been used off-label for congestive heart failure; safety and efficacy of IV enalaprilat has not been established; however, doses up to 10 mcg/kg/dose IV have been used off-label.
Safety and efficacy have not been established; however, doses up to 0.27 mg/kg/day PO and 10 mcg/kg/dose IV have been used off-label.
How supplied
Enalapril maleate
injectable solution
- 1.25mg/mL
tablet
- 2.5mg
- 5mg
- 10mg
- 20mg
powder for oral solution (Epaned)
- 150 mg bottle (1mg/mL after reconstitution)
