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What is enalapril, and how does it work (mechanism of action)?
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.
What brand names are available for enalapril?
Is enalapril available as a generic drug?
Do I need a prescription for enalapril?
What are the side effects of enalapril?
Enalapril is generally well tolerated, and side effects usually are mild and transient. A dry, persistent cough has been reported commonly with the use of ACE inhibitors. Coughing resolves after discontinuing the medication.
Other important side effects include:
- abdominal pain,
- loss of appetite,
- nausea and vomiting,
- chest pain,
- 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. Enalapril may cause hypersensitivity (allergic) reactions and angioedema (swelling of face, lips, tongue, throat).
What is the dosage for enalapril?
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.
Which drugs or supplements interact with enalapril?
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.
Is enalapril safe to take if I'm pregnant or breastfeeding?
ACE inhibitors, including enalapril, can be harmful to the fetus and should not be taken by pregnant women.
ACE inhibitors, including enalapril, should be avoided in nursing mothers.
What else should I know about enalapril?
What preparations of enalapril are available?
- Tablets: 2.5, 5, 10, and 20 mg.
- Injection: 1.25 mg/mL
- STORAGE: Tablets should be stored at room temperature between 15 C - 30 C (59 F - 86 F). The injectable formulation should be stored at 20 C to 25 C (68 F to 77 F).
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Related Disease Conditions
Kidney (Renal) Failure
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, or medication. Some of the renal causes of kidney failure include sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones.Treatment options included diet, medications, or dialysis.
High Blood Pressure (Hypertension)
High blood pressure (hypertension) is a disease in which pressure within the arteries of the body is elevated. About 75 million people in the US have hypertension (1 in 3 adults), and only half of them are able to manage it. Many people do not know that they have high blood pressure because it often has no has no warning signs or symptoms. Systolic and diastolic are the two readings in which blood pressure is measured. The American College of Cardiology released new guidelines for high blood pressure in 2017. The guidelines now state that blood normal blood pressure is 120/80 mmHg. If either one of those numbers is higher, you have high blood pressure. The American Academy of Cardiology defines high blood pressure slightly differently. The AAC considers 130/80 mm Hg. or greater (either number) stage 1 hypertension. Stage 2 hypertension is considered 140/90 mm Hg. or greater. If you have high blood pressure you are at risk of developing life threatening diseases like stroke and heart attack.REFERENCE: CDC. High Blood Pressure. Updated: Nov 13, 2017.
Congestive Heart Failure (CHF)
Congestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease, high blood pressure, diabetes, myocarditis, and cardiomyopathies are just a few potential causes of congestive heart failure. Signs and symptoms of congestive heart failure may include fatigue, breathlessness, palpitations, angina, and edema. Physical examination, patient history, blood tests, and imaging tests are used to diagnose congestive heart failure. Treatment of heart failure consists of lifestyle modification and taking medications to decrease fluid in the body and ease the strain on the heart. The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual.
Diabetes (Type 1 and Type 2)
Diabetes is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Chronic cough treatment is based on the cause, but may be soothed natural and home remedies.
Pulmonary edema (swelling or fluid in the lungs) can either be caused by cardiogenic causes (congestive heart failure, heart attacks, abnormal heart valves) or noncardiogenic causes such as ARDS, kidney failure, high altitude, pneumothorax, pleural effusion, aspirin overdose, pulmonary embolism, and infections. The treatment of pulmonary edema depends on the cause of the condition.
Heart Attack (Myocardial Infarction)
A heart attack happens when a blood clot completely obstructs a coronary artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical instability of the heart.
High Blood Pressure Treatment (Natural Home Remedies, Diet, Medications)
High blood pressure (hypertension) means high pressure (tension) in the arteries. Treatment for high blood pressure include lifestyle modifications (alcohol, smoking, coffee, salt, diet, exercise), drugs and medications such as ACE inhibitors, angiotensin receptor blockers, beta blockers, diuretics, calcium channel blockers (CCBs), alpha blockers, clonidine, minoxidil, and Exforge.
Diabetes Treatment: Medication, Diet, and Insulin
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Type 1 diabetes is treated with: insulin, exercise, and a diabetic diet. Type 2 diabetes is first treated with: weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
Heart Attack Treatment
A heart attack involves damage or death of part of the heart muscle due to a blood clot. The aim of heart attack treatment is to prevent or stop this damage to the heart muscle. Heart attack treatments included medications, procedures, and surgeries to protect the heart muscle against injury.
Hypertensive Kidney Disease
High blood pressure can damage the kidneys and is one of the leading causes of kidney failure (end-stage renal kidney disease). Kidney damage, like hypertension, can be unnoticeable and detected only through medical tests. If you have kidney disease, you should control your blood pressure. Other treatment options include prescription medications.
Heart Attack Prevention
Heart disease and heart attacks can be prevented by leading a healthy lifestyle with diet, exercise, and stress management. Symptoms of heart attack in men and women include chest discomfort and pain in the shoulder, neck, jaw, stomach, or back.
Pregnancy and Drugs (Prescription and OTC)
Taking prescription medications or over-the-counter drugs or supplements should be discussed with your doctor. There are some medications that have been found to cause no problems in pregnancy, however, medications such as Accutane for acne, should never be taken during pregnancy.
Febrile seizures, or convulsions caused by fever, can be frightening in small children or infants. However, in general, febrile seizures are harmless. Febrile seizure is not epilepsy. It is estimated that one in every 25 children will have at least one febrile seizure. It is important to know what to do to help your child if he/she has a febrile seizure. Some of the features of a febrile seizure include losing consciousness, shaking, moving limbs on both sides of the body, and lasts 1-2 minutes. Less commonly, a febrile seizure may only affect one side of the body.
Treatment & Diagnosis
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- Congestive Heart Failure Medications
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- benazepril (Lotensin HTC)
- trandolapril (Mavik)
- quinapril (Accupril)
- lisinopril and hydrochlorothiazide (Zestoretic, Prinzide)
- fosinopril sodium, Monopril
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Prevention & Wellness
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- Heart Failure Drugs Put to the Test
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You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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