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.

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.

Epaned, Vasotec

• 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.

• 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.

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.

Vasotec IV

(effect on BP—single dose†)

†Full effects may not be noted for several weeks.

• Emphasize the importance of continuing to take medication as directed at the same time each day, even if feeling well. Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses. Warn patient not to discontinue enalapril unless directed by health care professional.
  • Caution patient to avoid salt substitutes containing potassium or foods containing high levels of potassium or sodium unless directed by health care professional. See Appendix M.
  • Caution patient to change positions slowly to minimize orthostatic hypotension. Use of alcohol, standing for long periods, exercising, and hot weather may increase orthostatic hypotension.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially NSAIDs and cough, cold, or allergy remedies.
  • May cause dizziness, especially during first few days of therapy. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
  • Advise patient to inform health care professional of medication regimen before treatment or surgery.
  • Instruct patient to notify health care professional immediately if rash; mouth sores; sore throat; fever; swelling of hands or feet; irregular heart beat; chest pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue; or if difficulty swallowing or breathing occurs. Persistent dry cough may occur and may not subside until medication is discontinued. Consult health care professional if cough becomes bothersome. Also notify health care professional if nausea, vomiting, or diarrhea occurs and continues.
  • Advise diabetic patients to monitor blood glucose closely, especially during first mo of therapy; may cause hypoglycemia.
  • Rep: Advise females of reproductive potential to use effective contraception and notify health care professional of pregnancy is planned or suspected and to avoid breastfeeding during therapy. If pregnancy is detected, discontinue medication as soon as possible.
  • Emphasize the importance of follow-up examinations to evaluate effectiveness of medication.
• Hypertension: Encourage patient to comply with additional interventions for hypertension (weight reduction, low sodium diet, discontinuation of smoking, moderation of alcohol consumption, regular exercise, and stress management). Medication controls but does not cure hypertension.
  • Instruct patient and family on correct technique for monitoring BP. Advise them to check BP at least weekly and to report significant changes to health care professional.

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