ENALAPRIL

Angiotensin converting enzyme inhibitor antihypertensive

Dosage forms

Tablet

5 mg

Uses

  • Moderate and severe hypertension (stage 2)
  • Heart failure

Dose and duration

Hypertension stage 2 (with another antihypertensive)
Adult: 5 mg once daily. Usual maintenance dose 20 mg once daily (max 40 mg once daily)
Child 12–18 years: 2.5 mg once daily. Usual maintenance dose 10–20 mg daily in 1–2 divided doses (max 40 mg daily in 1–2 divided doses if body-weight over 50 kg)
Child 1 month–12 years: 0.1 mg/kg once daily, increased as needed to max 1 mg/kg daily in 1–2 divided doses
Neonate: 0.01 mg/kg once daily increased as necessary up to 0.5 mg/kg daily in 1–3 divided doses
Renal failure: 2.5 mg once daily if eGFR is <30 ml/minute/1.73 m²
Heart failure
Adult: 2.5 mg once daily under close medical supervision increased gradually over 2–4 weeks to 10–20 mg, once or twice daily if tolerated (max 40 mg)

Preparation

  • For use in children, the tablet may be crushed and suspended in water immediately before use

Contra-indications

  • Hypersensitivity to enalapril and other ACEIs
  • Angioedema
  • Renovascular disease

Side effects

  • Dizziness, headache, blurred vision
  • Depression
  • Hypotension, orthostatic hypotension, syncope, chest pain, rhythm disturbances, angina pectoris, tachycardia
  • Persistent dry cough, dyspnoea
  • Hypersensitivity: angioneurotic oedema of face, extremities, lips, tongue, glottis and larynx
  • Nausea, abdominal pain, taste alteration, diarrhoea
  • Rash, Stevens-Johnson syndrome
  • Weakness, fatigue
  • Hyperkalaemia, increase in serum creatinine
  • Raynaud’s syndrome

Interactions

  • Acetazolamide (enhanced hypotensive effect)
  • Amiloride (enhance hypotensive effect)
  • Ciclosporin (increased risk of hyperkalaemia)
  • Furosemide (enhanced hypotensive effect)
  • Hydrochlorothiazide (enhanced hypotensive effect)
  • Lithium (increased plasma concentration of lithium)
  • Potassium salts (increased risk of severe hyperkalaemia)
  • Spironolactone (enhanced hypotensive effect, increased risk of severe hyperkalaemia)

Pregnancy

  • Do not use

Breast-feeding

  • Can be used

⚠️ Caution

  • Monitor liver function in hepatic impairment
  • Use with caution in renal impairment
  • Avoid use in breast-feeding during the first few weeks after delivery to avoid risk of neonatal hypotension
  • Concomitant use with diuretics may lead to very rapid fall in blood pressure in volume depleted patients. Discontinue high dose diuretics (furosemide ≥80 mg) 24 hours before initiation of enalapril
  • Avoid enalapril during dialysis with high-flux polyacrilonitrile membranes and during low density lipoprotein aphaeresis with dextran
  • Give with caution in patients with aortic/mitral valve stenosis, peripheral vascular disease or atherosclerosis as there may be clinically silent renovascular disease