Adult Dosing
Hypertension
- Initial dose: 2.5-5 mg PO daily
- Maintenance dose: 10-40 mg/day PO divided daily-bid
CHF
- Initial dose: 2.5 mg PO daily
- Maintenance dose: 2.5-20 mg PO bid
- Max: 40 mg/day PO divided daily-bid
Asymptomatic left ventricular dysfunction
- Initial dose: 2.5 mg PO bid
- Maintenance dose: 10 mg PO bid
Pediatric Dosing
Hypertension
Child >1 month
- Initial dose: 0.08 mg/kg (up to 5 mg) PO daily
- Maintenance dose: 0.1-0.5 mg/kg/day PO divided qd-bid. [Max: 0.58 mg/kg/day or 40 mg/day]
- Note: Adjust dose according to blood pressure response
[Outline]
Renal Dose Adjustment (Based on CrCl)
- <30 mL/min: 2.5 mg PO daily
- Hemodialysis: No supplement
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined
- ACE inhibitors can cause fetal/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
- CAD
- Aortic stenosis
- Cerebrovascular disease
- Collagen vascular disease
- Hypotension
- Volume depletion
- Severe CHF
- Hypertrophic cardiomyopathy
- Elderly patients
- Black patients
- Surgery/anesthesia (hypotension may be exaggerated)
- Dialysis with high-flux membranes
- Insect venom allergy, hymenoptera venom immunotherapy
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 15 July 2010)
US Trade Name(s)
US Availability
enalapril (generic)
Vasotec
Epaned
Canadian Trade Name(s)
Canadian Availability
enalapril maleate (generic)
enalapril sodium (generic)
Vasotec (Based on enalapril maletae content)
UK Trade Name(s)
UK Availability
enalapril (generic)
Innovace
Australian Trade Name(s)
- Alphapril
- Amprace
- Auspril
- Enahexal
- Enalabell
- Renitec
- Renitec M
Australian Availability
enalapril (generic)
Alphapril, Auspril, Enahexal, Enalabell
Amprace, Renitec
Renitec M
[Outline]
