Medications and Drugs

Salt Shockers: High Sodium Surprises Slideshow Lowering Blood Pressure Slideshow: Tips for Getting Started Healthy Eating: Portion Control

Pharmacy Editor: Jay W. Marks, MD

GENERIC NAME: enalapril

BRAND NAME: Vasotec

DRUG CLASS AND MECHANISM: Enalapril is a drug that is used for treating high blood pressure. It is in a class of drugs called angiotensin converting enzyme (ACE) inhibitors. ACE is an enzyme in the body that causes the formation of angiotensin II. Angiotensin II causes the arteries in the body to narrow, thereby elevating blood pressure. ACE inhibitors, such as enalapril, lower blood pressure by preventing the formation of angiotensin II thereby relaxing the arteries. ACE inhibitors also improve the effectiveness of the heart in patients with heart failure by reducing the blood pressure that the heart must maintain. Enalapril was approved by the FDA in December, 1985.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: Tablets: 2.5, 5, 10, and 20 mg. Injection: 1.25 mg/mL STORAGE: Store below 30°C (86°F).

PRESCRIBED FOR: Enalapril is used alone or in combination with other drugs to treat high blood pressure or congestive heart failure. After a heart attack, enalapril has been found to be effective in improving function of the damaged heart and in reducing symptoms and hospitalizations related to heart failure.

DOSING: The usual oral dose for treating high blood pressure is 2.5-40 mg once daily. It may also be administered twice daily. The dose for treating heart failure is 2.5-20 mg given twice daily. The usual intravenous dose is 1.25 mg every 6 hours.

DRUG INTERACTIONS: Enalapril may increase potassium levels (hyperkalemia) in blood. Therefore, there is an increased risk of hyperkalemia when enalapril is given with potassium supplements or drugs that increase potassium levels (e.g., spironolactone).

Nitritoid reactions (symptoms includie facial flushing, nausea, vomiting and hypotension) may occur when injectable gold (sodium aurothiomalate), used in the treatment of rheumatoid arthritis, is combined with ACE inhibitors, including enalapril.

PREGNANCY: ACE inhibitors, including enalapril, can be harmful to the fetus and should not be taken by pregnant women.

NURSING MOTHERS: ACE inhibitors, including enalapril, should be avoided in nursing mothers.

SIDE EFFECTS: Enalapril is generally well tolerated, and side effects usually are mild and transient. A dry, persistent cough has been reported with the use of ACE inhibitors. Coughing resolves after discontinuing the medication. Other side effects include abdominal pain, diarrhea, dizziness, fatigue, headache, loss of appetite, nausea and vomiting, chest pain, dizziness or fainting, numbness or tingling in the hands or feet, rash, and a sore or swollen throat. In rare instances, liver dysfunction and skin yellowing (jaundice) have been reported with ACE inhibitors. In susceptible individuals ACE inhibitors may reduce kidney function.

Reference: FDA Prescribing Information