Enalapril maleate

CLINICAL USE

Angiotensin converting enzyme inhibitor:Hypertension Heart failure

DOSE IN NORMAL RENAL FUNCTION

2.5–40 mg daily

PHARMACOKINETICS

Molecular weight :492.5

%Protein binding :50–60

%Excreted unchanged in urine : 20

Volume of distribution (L/kg) :0.171

half-life – normal/ESRD (hrs) :11/34–60

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Start with 2.5 mg per day and increase according to response

<10 : Start with 2.5 mg per day and increase according to response

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Dialysed. Dose as in GFR

<10 : mL/min

HD :Dialysed. Dose as in GFR

<10 : mL/min

HDF/high flux :Dialysed. Dose as in GFR

<10 : mL/min

CAV/VVHD :Dialysed. Dose as in GFR=10–20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anaesthetics: enhanced hypotensive effect

Analgesics: antagonism of hypotensive effect and increased risk of renal impairment with NSAIDs; hyperkalaemia with ketorolac and other NSAIDs

Ciclosporin: increased risk of hyperkalaemia and nephrotoxicity

Diuretics: enhanced hypotensive effect; hyperkalaemia with potassium-sparing diuretics

Epoetin: increased risk of hyperkalaemia; antagonism of hypotensive effect

Lithium: reduced excretion, possibility of enhanced lithium toxicity

Potassium salts: increased risk of hyperkalaemia

Tacrolimus: increased risk of hyperkalaemia and nephrotoxicity

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

Side effects (e.g. hyperkalaemia, metabolic acidosis) are more common in patients with impaired renal functionClose monitoring of renal function during therapy is necessary in those with renal insufficiencyRenal failure has been reported in association with ACE inhibitors in patients with renal artery stenosis, post renal transplant, and in those with severe congestive heart failureHigh incidence of anaphylactoid reactions has been reported in patients dialysed with high-flux polyacrylonitrile membranes and treated concomitantly with an ACE inhibitor – this combination should therefore be avoidedACE inhibitor cough may be helped by sodium cromoglycate inhalersEnalapril maleate is a prodrug that requires hepatic conversion to enalaprilatEnalaprilat injection available on a named patient basis

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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