enalapril and hydrochlorothiazide (Vaseretic)

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.

What brand names are available for enalapril and hydrochlorothiazide?

Vaseretic

Is enalapril and hydrochlorothiazide available as a generic drug?

Yes

Do I need a prescription for enalapril and hydrochlorothiazide?

Yes

The side effects of the Vaseretic are similar to the side effects of the individual component drugs:

• A dry, persistent cough has been reported commonly with the use of ACE inhibitors. Coughing resolves after discontinuing the medication.

Other side effects include of ACE inhibitors include:

• abdominal pain,
• diarrhea,
• dizziness,
• fatigue,
• headache,
• loss of appetite,
• nausea and vomiting,
• chest pain,
• fainting,
• sexual dysfunction,
• increased potassium levels,
• 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).

Side effects of HCTZ include:

• weakness,
• low blood pressure,
• sunlight sensitivity,
• impotence,
• nausea,
• abdominal pain,
• electrolyte disturbances,
• pancreatitis,
• jaundice,
• anaphylaxis, and
• rashes, both mild and severe.

Patients allergic to sulfa may also be allergic to HCTZ because of the similarity in the chemical structure of the medications.

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.

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

What preparations of enalapril and hydrochlorothiazide are available?

Tablets (mg enalapril/mg HCTZ): 5/12.5 and 10/25

How should I keep enalapril and hydrochlorothiazide stored?

Vaseretic should be stored at 15C to 30 C (59 F to 86 F) and protected from excessive light and humidity.