Adult Dosing
Hypertension
- 0.625-1.25 mg IV q6 hrs (0.625 mg if receiving diuretics); may titrate up to 5 mg per dose
- Max: 5 mg IV q6 hrs
Heart failure (Non-FDA Approved)
- Note that similar dosing to that used for hypertension is typically used for this indication
Note: If converting to oral therapy, start 5 mg PO qd and subsequently adjust for desired response
Pediatric Dosing
Hypertension (Not FDA approved)
- 0.005-0.01 mg/kg IV q8-24 hrs; use lower dose if on diuretics
- Max: 0.03-0.06 mg/kg/day
[Outline]
Renal Dose Adjustment (Based on CrCl/serum CrCl)
- <30 mL/min OR
3 mg/dL - 0.625 mg x 1; may repeat after 1 hr if inadequate response
- Additional dose of 1.25 mg IV q6 hrs may be given
- Hemodialysis: Not defined
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined
- Enalapril IV is administered by slow IV infusion over a period of at least 5 minutes. The drug should not be administered by other parenteral routes of administration
- ACE inhibitors can cause fetal and neonatal morbidity and death when administered to pregnant women
- ACE inhibitors may cause angioedema of the head and neck, including the tongue, lips, eyes, or throat
- Assess renal and hepatic function prior and periodically throughout therapy. Monitor serum potassium levels
- Assess heart failure patient for evidence of worsening failure (eg, daily weights, evaluation of peripheral edema, shortness of breath)
- Severely salt- or volume-depleted patients or those with heart failure may experience significant decreases in BP especially after first dose. Monitor closely for 2 hrs or more after initial dose and during first 2 wks of therapy
- Rarely, ACE inhibitors have been associated with a syndrome that starts with cholestatic jaundice and progresses to fulminant hepatic necrosis and sometimes death
- Neutropenia and agranulocytosis have occurred. Risk appears to be greater with renal dysfunction, heart failure, or immunosuppression
- Patients with a history of airway surgery may have a higher risk of airway obstruction
- Assess renal and hepatic function prior and periodically throughout therapy; monitor serum potassium levels
- Evaluation of patients with HTN or heart failure should always include assessment of renal function
- Monitor WBC if collagen vascular disease, especially if renal impairment
- Monitor BUN/Cr at baseline, then periodically, or more frequently if CHF, renal artery stenosis
Cautions: Use cautiously in
- Renal impairment
- Renal artery stenosis
- CAD
- Aortic stenosis
- Cerebrovascular disease
- Collagen vascular disease
- Hypotension
- Hyponatremia
- Volume depletion
- Severe CHF
- Hypertrophic cardiomyopathy
- Elderly patients
- Black patients
- Surgery/anesthesia (hypotension may be exaggerated)
- Dialysis with high-flux membranes
- Low density lipoprotein apheresis with dextran sulfate absorption
Pregnancy Category:C (D in second and third trimesters)
Breastfeeding: Enalapril is excreted in breast milk in low levels; hence it would not be expected to cause any adverse effects in breastfed infants. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 20 July 2010)
Note: ACE inhibitors can cause fetal and neonatal morbidity and death when administered to pregnant women
- CNS: Headache, dizziness, fatigue, vertigo, weakness, depression
- RESP: Cough, bronchitis, dyspnea, pneumonia
- CV: Hypotension, chest pain, syncope, orthostatic hypotension, myocardial infarction
- GI: Abdominal pain, diarrhea, nausea, vomiting, constipation, pancreatitis, elevated liver transaminases
- GU: Proteinuria, impaired renal function, UTI, pancreatitis, oliguria
- HEMA: Neutropenia, agranulocytosis
- DERM: Rash, photosensitivity
- METABOLIC: Hyperkalemia
- MUSC: Muscle cramps, myalgia
- LOCAL: Application-site reactions including mild local erythema
- MISC: Angioedema, anaphylactoid reactions
