enalapril and hydrochlorothiazide, Vaseretic
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
GENERIC NAME: enalapril and hydrochlorothiazide
BRAND NAME: Vaseretic
DRUG CLASS AND MECHANISM: Vaseretic is a combination of enalapril and hydrochlorothiazide (HCTZ) and is used for treating high blood pressure (hypertension). 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 muscles surrounding the arteries in the body to contract, thereby narrowing the arteries and elevating the blood pressure. ACE inhibitors such as enalapril (Vasotec) lower blood pressure by preventing the formation of angiotensin II thereby relaxing the arteries.
HCTZ is a diuretic (water pill) used for treating high blood pressure and accumulation of fluid. It works by blocking salt and water reabsorption in the kidneys, thus causing increased urine output (diuresis). The mechanism of its action in lowering high blood pressure is not well understood. The combination of enalapril and HCTZ reduces blood pressure better than either drug alone. The FDA approved Vaseretic in October 1986.
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets (mg enalapril/mg HCTZ): 5/12.5 and 10/25
STORAGE: Vaseretic should be stored at 15C to 30 C (59 F to 86 F) and protected from excessive light and humidity.
PRESCRIBED FOR: Vaseretic is used for treating high blood pressure.
DOSING: Patients who have not adequately responded to enalapril or HCTZ alone may be started on 10/25 mg/mg of Vaseretic. The dose may be increased after 2-3 weeks if adequate. The maximum dose is 2 tablets of 10/25 mg/mg once daily.
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, for example, spironolactone (Aldactone).
There have been reports of increased lithium levels (Eskalith, Lithobid) 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 effectiveness of ACE inhibitors in lowering blood pressure.
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.
Blood sugar levels can be elevated by HCTZ necessitating adjustment in the doses of medications that are used for treating diabetes.
Combining HCTZ with corticosteroids may increase the risk for low levels of blood potassium (hypokalemia) and other electrolytes. Low blood potassium can increase the toxicity of digoxin (Lanoxin). Cholestyramine (Questran, Questran Light) and colestipol (Colestid) bind to hydrochlorothiazide and reduce its absorption from the gastrointestinal tract by 43% to 85%.
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