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
- Note: If converting to oral therapy, 1.25 mg IV q6 hrs to start 5 mg PO daily and subsequently adjust for desired response
Hypertensive Emergency [Non-FDA approved]
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
Renal Dose Adjustment (Based on CrCl)
- 10-50 mL/min: Decrease dose 25%
- <10 mL/min: Decrease dose 50%
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined
- ACE inhibitors can cause fetal and neonatal morbidity and death when administered to pregnant women[US Black Box Warning]
- Enalaprilat 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 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: Due to the potential for serious adverse reactions in nursing infants, manufacturer recommends discontinuation of nursing or discontinuation of drug, taking into account the importance of the drug to the mother.
