e-NAL-a-pril, e-NAL-a-pril-at
Therapeutic Classification: antihypertensives
Pharmacologic Classification: ace inhibitors
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.
Contraindicated in:
- Hypersensitivity;
- History of angioedema (either idiopathic or with previous use of ACE inhibitors);
- Concurrent use with aliskiren in patients with diabetes or moderate-to-severe renal impairment (CCr <60 mL/min)
- Concurrent use with sacubitril/valsartan; must be a 36–hr washout period after switching to/from sacubitril/valsartan;
- OB: Pregnancy (may cause fetal harm).;
- Lactation: Lactation.
Use Cautiously in:
- Patients with renal impairment, hypovolemia, hyponatremia, and concurrent diuretic therapy;
- Black patients (monotherapy of hypertension less effective, may require additional therapy; higher risk of angioedema);
- Surgery/anesthesia (hypotension may be exaggerated);
- Rep: Women of reproductive potential;
- Pedi: Injectable product contains benzyl alcohol which is associated with gasping syndrome in neonates; oral solution not recommended in pediatric patients with GFR <30 mL/min/1.73 m2;
- Geri: Initial dose ↓ recommended.
Exercise Extreme Caution in:
- Family history of angioedema.
Hypertension
- PO (Adults ): 2.5–5 mg once daily, ↑ as required up to 40 mg/day in 1–2 divided doses (initiate therapy at 2.5 mg once daily in patients receiving diuretics).
- PO (Children >1 mo): 0.08 mg/kg once daily; may be slowly titrated up to a maximum of 0.58 mg/kg/day.
- IV (Adults ): 0.625–1.25 mg (0.625 mg if receiving diuretics) every 6 hr; can be titrated up to 5 mg every 6 hr.
- IV (Children >1 mo): 5–10 mcg/kg/dose given every 8–24 hr.
Renal Impairment
- PO IV (Adults ): CCr 10–50 mL/min: 75% of dose; CCr <10 mL/min: 50% of dose.
Renal Impairment
- PO IV (Children >1 mo): CCr <30 mL/min: Contraindicated.
Heart Failure
- PO (Adults ): 2.5 mg 1–2 times daily, titrated up to target dose of 10 mg twice daily; initiate therapy at 2.5 mg once daily in patients with hyponatremia (serum sodium <130 mEq/L).
Asymptomatic Left Ventricular Dysfunction
- PO (Adults ): 2.5 mg twice daily, titrated upward to a target dose of 10 mg twice daily.
