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Pronunciation

e-NAL-a-pril, e-NAL-a-pril-at

Classifications

Therapeutic Classification: antihypertensives

Pharmacologic Classification: ace inhibitors

Indications

REMS


Unlabeled Use:

Action

  • Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of bradykinin and other vasodilatory prostaglandins. ACE inhibitors also plasma renin levels and aldosterone levels. Net result is systemic vasodilation.
Therapeutic effects:
  • Lowering of BP in patients with hypertension.
  • Increased survival and reduction of symptoms in patients with symptomatic heart failure.
  • Decreased development of overt heart failure.

Pharmacokinetics

Absorption: Enalapril: 55–75% absorbed following oral administration. Enalaprilat: IV administration results in complete bioavailability.

Distribution: Crosses the placenta; small amounts enter breast milk.

Metabolism/Excretion: Converted by the liver to enalaprilat, the active metabolite; primarily eliminated by kidneys.

Half-Life: Enalapril: Adults: 2 hr; Adults with HF: 3.4–5.8 hr; Children and infants with HF: 2.7 hr; Neonates with HF: 10.3 hr; Enalaprilat:Adults: 35–38 hr; Children and infants with HF: 11.1 hr; Infants 6 wks–8 mo: 6–10 hr; Neonates with HF: 11.9 hr.

Time/Action Profile

(effect on BP—single dose)
ROUTEONSETPEAKDURATION
Enalapril PO1 hr4–8 hr12–24 hr
Enalaprilat IV15 min1–4 hr4–6 hr



Full effects may not be noted for several weeks.



Contraind./Precautions

Contraindicated in:

Use Cautiously in:

Adv. Reactions/Side Effects

CV: hypotension, chest pain

Derm: rash

F and E: hyperkalemia

GI: abdominal pain, diarrhea, nausea, vomiting

GU: proteinuria, impaired renal function

Neuro: dizziness, fatigue, headache, vertigo, weakness

Resp: cough, dyspnea

Misc: ANGIOEDEMA

Interactions

Drug-drug:

Drug-Natural Products:

Route/Dosage

Hypertension

Renal Impairment

Renal Impairment

Heart Failure

Asymptomatic Left Ventricular Dysfunction

Availability

(Generic available)

Enalapril

Enalaprilat

Assessment

Lab Test Considerations:

Implementation

IV Administration:

Patient/Family Teaching

Evaluation/Desired Outcomes

US Brand Names

Epaned, Vasotec

Canadian Brand Names

Vasotec IV

Pill Image

enalapril-maleate_195-8725.jpg