Enalapril Maleate(e nal’ a pril)
Epaned, Vasotec
Enalaprilat
PREGNANCY CATEGORY D
Drug Classes
ACE inhibitor
Antihypertensive
Therapeutic Actions
Renin, synthesized by the kidneys, is released into the circulation where it acts on a plasma precursor to produce angiotensin I, which is converted by ACE to angiotensin II, a potent vasoconstrictor that also causes release of aldosterone from the adrenals; both of these actions increase BP. Enalapril blocks the conversion of angiotensin I to angiotensin II, decreasing BP, decreasing aldosterone secretion, slightly increasing serum K+ levels, and causing Na+ and fluid loss; increased prostaglandin synthesis also may be involved in the antihypertensive action. In patients with heart failure, peripheral resistance, afterload, preload, and heart size are decreased.
Indications
Oral
Treatment of hypertension alone or in combination with other antihypertensives, especially thiazide-type diuretics in patients 1 mo and older
Treatment of acute and chronic heart failure
Treatment of asymptomatic left ventricular dysfunction (LVD)
Unlabeled uses: Raynaud phenomenon in adults, management of diabetic nephropathy, treatment of pediatric hypertensive emergency (IV)
Parenteral
Treatment of hypertension when oral therapy is not possible
Contraindications and Cautions
Contraindicated with pregnancy, allergy to enalapril, history of hereditary or idiopathic angioedema.
Use cautiously with impaired renal function; salt or volume depletion (hypotension may occur); lactation.
Available Forms
Tablets—2.5, 5, 10, 20 mg; injection—1.25 mg/mL; oral solution—1 mg/mL
Dosages
Adults
Oral
Hypertension: Patients not taking diuretics: Initial dose is 5 mg/day PO. Adjust dosage based on patient response. Usual range is 10–40 mg/day as a single dose or in two divided doses.
Patients taking diuretics: Discontinue diuretic for 2–3 days if possible. If it is not possible to discontinue diuretic, give initial dose of 2.5 mg, and monitor for excessive hypotension for at least 2 hr.
Converting to oral therapy from IV therapy: 5 mg daily with subsequent doses based on patient response.
Heart failure: 2.5 mg PO daily or bid usually given in conjunction with diuretics and digitalis. Maintenance dose is 2.5–20 mg/day given in two divided doses. Maximum daily dose is 40 mg.
Asymptomatic LVD: 2.5 mg PO bid; target maintenance dose 20 mg/day in two divided doses.
Parenteral
Give IV only. 1.25 mg every 6 hr given IV over 5 min. A response is usually seen within 15 min, but peak effects may not occur for 4 hr.
Hypertension: Converting to IV therapy from oral therapy: 1.25 mg every 6 hr; monitor patient response.
Patients taking diuretics: 0.625 mg IV over 5 min. If adequate response is not seen after 1 hr, repeat the 0.625-mg dose. Give additional doses of 1.25 mg every 6 hr.
Pediatric patients 1 mo–16 yr
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
