about Enalapril class, uses, side effects contraindications
Enalapril
Short Description
Enalapril belongs to a group of medicines that widen the blood vessels called angiotensin converting enzyme inhibitors (ACEIs) that are given to treat?high blood pressure??and congestive heart failure. In many cases, enalapril is given with another medicine in order to increase its effect.
Taking the first dose of enalapril can cause a sudden drop in blood pressure, so it is recommended that the patient lie down when receiving the first dose for a period of two to three hours.
The most common side effects are dizziness and headache, but they quickly disappear with the continuation of treatment. A rash may appear, but it also quickly disappears with stopping the medication, and in some cases the rash disappears automatically even with the continued use of the medication.
Category
Chemical class: Dicarbocyl-containing ACE inhibitor
Therapeutic class: Antihypertensive
Pregnancy category: C
(first trimester), D (later trimesters)
Indications
To control hypertension
Adults.Initial: 5 mg daily, increased after 1 to 2 wk, as needed. Maintenance: 10 to 40 mg once daily or in divided doses b.i.d. Children.0.08 mg/kg daily, titrated according to blood pressure response up to 5 mg daily. Maximum: 0.58 mg/kg/dose or 40 mg/dose.
I.V.INJECTION
Adults.1.25 mg every 6 hr.
DOSAGE ADJUSTMENT Initial dose 2.5 mg P.O. or 0.625 mg I.V. for patients who have sodium and water depletion from diuretic therapy, are receiving diuretics, or have a creatinine clearance below 30 ml/min/ 1.73 m2. If response to I.V. dose is inadequate after 1 hr, I.V. dose of 0.625 mg is repeated and therapy continued at 1.25 mg every 6 hr. To treat heart failure
Adults. Initial: 2.5 mg once or twice daily, increased after 1 to 2 wk, as needed. Maintenance: 5 to 40 mg once daily or in divided doses b.i.d. To treat asymptomatic left ventricular dysfunction
Adults. Initial: 2.5 mg b.i.d., increased to 20 mg daily in divided doses.
DOSAGE ADJUSTMENT Initial dosage reduced to 2.5 mg daily and, if possible, diuretic dosage reduced in patients who have a serum sodium level below 130 mEq/L or a serum creatinine level above 1.6 mg/dl. Route Onset Peak Duration P.O. 1 hr 4–6 hr About 24 hr I.V. 15 min 1–4 hr About 6 hr
Mechanism of Action
May reduce blood pressure by affecting the renin-angiotensin-aldosterone system. By inhibiting angiotensin-convering enzyme (ACE), enalapril:
prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor that also stimulates the adrenal cortex to enalapril maleate 367 E F secrete aldosterone may inhibit renal and vascular production of angiotensin II decreases the serum angiotensin II level and increases serum renin activity, which decreases aldosterone secretion and slightly increases serum potassium level and fluid loss decreases vascular tone and blood pressure inhibits aldosterone release, which reduces sodium and water reabsorption and increases their excretion, further reducing blood pressure. Contraindications
History of angioedema from previous ACE inhibitor; hypersensitivity to enalapril, enalaprilat, or their components Interactions
allopurinol, bone marrow depressants (such as amphotericin B and methotrexate), procainamide, systemic corticosteroids: Possibly increased risk of fatal neutropenia or agranulocytosis cyclosporine, potassium-sparing diuretics, potassium supplements: Increased risk of hyperkalemia diuretics, other antihypertensives: Additive hypotensive effects lithium: Increased blood lithium level and lithium toxicity
NSAIDs: Possibly reduced antihypertensive effects of enalapril and enalaprilat sodium aurothiomalate: Increased risk of nitritoid reactions, such as facial flushing, nausea, vomiting, and hypotension sympathomimetics: Possibly reduced therapeutic effects of enalapril and enalaprilat potassium-containing salt substitutes: Increased risk of hyperkalemia
alcohol use: Possibly additive hypotensive effect Side Efect
CNS: Ataxia, confusion, depression, dizziness, dream disturbances, fatigue, headache, insomnia, nervousness, peripheral neuropathy, somnolence, stroke, syncope, vertigo, weakness
CV: Angina, arrhythmias, cardiac arrest, hypotension, MI, orthostatic hypotension, palpitations, pulmonary embolism and infarction, Raynaud’s phenomenon
EENT: Blurred vision, conjunctivitis, dry eyes and mouth, glossitis, hoarseness, lacrimation, loss of smell, pharyngitis, rhinorrhea, stomatitis, taste perversion, tinnitus
ENDO: Gynecomastia
GI: Abdominal pain, anorexia, constipation, diarrhea, hepatic failure, hepatitis, ileus, indigestion, melena, nausea, pancreatitis, vomiting
GU: Flank pain, impotence, oliguria, renal failure, UTI
MS: Muscle spasms
RESP: Asthma, bronchitis, bronchospasm, cough, dyspnea, pneumonia, pulmonary edema, pulmonary infiltrates, upper respiratory tract infection
SKIN: Alopecia, diaphoresis, erythema multiforme, exfoliative dermatitis, flushing, pemphigus, photosensitivity, pruritus, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria
Other: Anaphylaxis, angioedema, herpes zoster, hyperkalemia Cautions
Use enalapril and enalaprilat cautiously in patients with impaired renal function. Avoid giving drug to children with a GFR less than 30 ml/min/1.73 m2. For children who can’t swallow tablets, consult with prescriber and pharmacist about preparing an oral suspension from tablets as directed by manufacturer. Administer each I.V. dose over at least 5 minutes. Measure patient’s blood pressure immediately after first dose and frequently for at least 2 hours thereafter. If hypotension requires a dosage reduction, monitor blood pressure frequently for 2 hours after reduced dosage is administered and for another hour after blood pressure has stabilized. Monitor blood pressure regularly during therapy. If hypotension develops, place patient in a supine position and expect to give I.V. normal saline solution or other volume expander as prescribed. Monitor patient’s heart rate and rhythm. Expect to obtain repeated 12-lead ECG tracings. Monitor laboratory test results to check hepatic and renal function, leukocyte count, and serum potassium level. enalapril maleate 368 Monitor patient closely for angioedema of the face, lips, tongue, glottis, larynx, and limbs. For angioedema of the face and lips, stop drug and give an antihistamine, as prescribed. If tongue, glottis, or larynx is involved, assess patient for airway obstruction and prepare to give epinephrine 1:1,000 (0.3 to 0.5 ml) subcutaneously and maintain a patent airway. PATIENT SAFTY
Advise patient to take enalapril or enalaprilat at the same time each day. Instruct patient not to split, crush, or chew tablets. Inform patient that light-headedness and fainting may occur, especially during first few days of therapy. Advise him to change position slowly and avoid hazardous activities until drug’s CNS effects are known. Inform patient that diarrhea, excessive sweating, vomiting, and other conditions may cause dehydration, which can lead to dizziness, fainting, and very low blood pressure during therapy. Urge sufficient fluid intake to prevent dehydration and related Side Efect
. If diarrhea or vomiting is severe or prolonged, instruct patient to notify prescriber. Urge patient to immediately notify prescriber if angioedema and other adverse reactions, including persistent dry cough, occur. Advise patient to consult prescriber before using salt substitutes, potassium supplements, or other (including OTC ) while taking drug.
WARNING Caution women of childbearing age that they should use a reliable form of contraception and should notify prescriber immediately if pregnancy is suspected because enalapril may cause fetal harm and should be discontinued.
Trade Name & Company Name
effect of Enalapril in Pregnancy, Fetal Health
and Breast feeding
Pregnancy
. There are no adequate reports or well-controlled studies of enalapril in pregnant women. It is generally well tolerated, and Pregnancy
does not alter dosing. However, enalapril should be discontinued immediately when discovered during Pregnancy
and replaced with another suitable hypotensive agent to prevent or minimize the fetal risks. Fetal Health
There are no adequate reports or well-controlled studies in human fetuses. Enalapril crosses the human placenta, but does not equilibrate, even after 6h, at least in the isolated perfused model. Relative to laboratory-tested species, the human fetus has higher vulnerability to enalapril and other ACEIs, exhibiting a syndrome not seen in experimental animals because humans develop these systems prior to calvarial ossification at the end of 1st trimester. Exposure to agents that interfere with angiotensin actions are associated with cranial hypoplasia, anuria, reversible or irreversible renal failure, death, oligohydramnios, prematurity, IUGR, and patent ductus arteriosus, even in the 1st trimester. Longterm renal disease is reported in survivors. Enalapril produces fetal hypotension in rhesus macaques. 344 Breastfeeding
There are no adequate reports or well-controlled studies in nursing women. Trace amounts of enalapril are detected in breast milk, though the kinetics remain to be elucidated. Until further study, the infant should be monitored for possible adverse effects, the drug given at the lowest effective dose, and Breastfeeding avoided at times of peak drug levels if
the follwing drugs will increse Enalapril by inhepiting cyp450
the follwing drugs will decrease Enalapril by inhancing cyp450
trad drugs based on Enalapril
| Gen name | Trade name | Catagory name |
| enalapril / hydrochlorothiazide | Vaseretic | ACE inhibitors with thiazides |
| enalapril/felodipine | Lexxel | ACE inhibitors with calcium channel blocking agents |
| Enalapril | ANGIOTEC 10MG TAB | |
| Enalapril | ANGIOTEC 20MG TAB | |
| Enalapril | ANGIOTEC 5MG TAB | |
| Enalapril | CO-RENITEC | |
| Enalapril | ENAPRIL 10 MG TAB | |
| Enalapril | NARAPRIL 10MG TABLET | |
| Enalapril | NARAPRIL 20MG TABLET | |
| Enalapril | NARAPRIL 5MG TABLET | |
| Enalapril | RENITEC | |
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