Enalapril Maleate

Indications

Enalapril Maleate is used for: Hypertension, Heart failure

Adult Dose

Hypertension Oral Initial: 2.5-5 mg PO qDay Maintenance: 10-40 mg/day PO qDay or divided q12hr Left Ventricular Dysfunction Initial: 2.5 mg PO q12hr May titrate up to 20 mg/day Congestive Heart Failure Initial: 2.5 mg PO qDay or q12hr Maintenance: 5-40 mg/Day PO divided q12hr; titrate slowly q2Weeks Hepatic impairment: No dosage adjustment required

Child Dose

Hypertension 1 month to 16 years (oral) Initial: 0.08 mg/kg/day PO or divided q12hr; not to exceed 5 mg/day May increase PRN q2Weeks according to blood pressure not to exceed 0.58 mg/kg/day (or 40 mg/day)

Renal Dose

Renal impairment CrCl <30 mL/min: (PO) Initiate 2.5 mg; titrate to response; not to exceed 40 mg Dialysis: 2.5 mg PO on day of dialysis; adjust dose on nondialysis days according to BP CrCl <30 mL/min: (IV) Initiate 0.625 mg q6hr; titrate based on response CrCl ?30 mL/min: (PO) Initiate 5 mg/day; titrate to maximum of 40 mg CrCl ?30 mL/min: (IV) 1.25 mg q6hr; titrate based on response

Administration

May be taken with or without food.

Contra Indications

Hypersensitivity. History of angioedema due to previous treatment with ACE inhibitors; bilateral renal artery stenosis. Pregnancy.

Precautions

Impaired renal function. Hyperkalaemia, hypovolaemia, collagen vascular disease, valvular stenosis, during or immediately before or after anaesthesia, unilateral renal artery stenosis. Hypotension due to volume depletion, diuretic therapy. Monitor WBC count. Lactation, children.

Pregnancy-Lactation

Pregnancy 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; when pregnancy is detected, discontinue therapy as soon as possible Hypertension in pregnancy increases maternal risk for pre-eclampsia, gestational diabetes, premature delivery, and delivery complications (e.g., need for cesarean section, and post-partum hemorrhage); hypertension increases fetal risk for intrauterine growth restriction and intrauterine death; pregnant women with hypertension should be carefully monitored and managed accordingly Lactation 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

Interactions

May potentiate hypotensive action w/ diuretics, other antihypertensives, TCAs, nitrates or anaesth. Concomitant admin w/ lithium carbonate may cause lithium toxicity. Increased risk of renal impairment w/ NSAIDs. May increase hyperkalaemic effect w/ K-sparing diuretics and supplements.

Side Effects

Side effects of Enalapril Maleate : 1-10% Dizziness (4-8%), Hypotension (0.9-6.7%), Headache (2-5%), Chest pain (2%), Cough (1-2%), Rash (1.5%) Frequency Not Defined Asthenia, Nausea, Vomiting, Hyperkalemia Potentially Fatal: Angioedema.

Mode of Action

Enalapril, a prodrug of enalaprilat, competitively inhibits ACE from converting angiotensin I to angiotensin II (a potent vasoconstrictor) resulting in increased plasma renin activity and reduced aldosterone (a hormone that causes water and Na retention) secretion. This promotes vasodilation and BP reduction.