enalapril, Vasotec (cont.)

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DOSING: The usual oral dose for treating high blood pressure is 2.5-40 mg once daily. It may also be administered twice daily in two divided doses. The dose for treating heart failure is 2.5-20 mg given twice daily. The usual starting intravenous dose is 1.25 mg administered over a 5 minute period every 6 hours. If a patient is receiving diuretic therapy the initial intravenous dose is 0.625 mg every 6 hours.

DRUG INTERACTIONS: Patients receiving diuretics may experience excessive reduction in blood pressure when enalapril is started. Stopping the diuretic or increasing salt intake prior to taking enalapril may prevent excessive blood pressure reduction. Close supervision for at least 2 hours after the start of enalapril and until blood pressure is stable is recommended if the diuretic cannot be stopped.

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 (for example, spironolactone [Aldactone]).

There have been reports of increased lithium (Eskalith, Lithobid) levels when lithium is used in combination with ACE inhibitors. The reason for this interaction is not known, but the increased levels may lead to toxicity from lithium. There have been reports that aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, etc.), indomethacin (Indocin, Indocin-SR), and naproxen (Anaprox, Naprelan, Naprosyn, Aleve) may reduce the effects of ACE inhibitors.

Nitritoid reactions (symptoms include facial flushing, nausea, vomiting and low blood pressure) may occur when injectable gold (sodium aurothiomalate [Myochrysine]), used in the treatment of rheumatoid arthritis, is combined with ACE inhibitors, including enalapril.



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