Enalapril

Note: for the active metabolite available in IV, see Enalaprilat

General

• Type: ACE inhibitor
• Dosage Forms: 2.5, 5, 10, 20
• Common Trade Names: Vasotec, Epaned

General information:

• Doses > 40mg/day rarely more effective
• Decreased efficacy as monotherapy in Black patients
• Obtain Chem 10 if starting in ED to assess renal function

Adult Dosing

• hypertension: 10 - 40mg PO Qday, max 40mg/day

Pediatric Dosing

• 1 month -16 year old: 0.1 - 0.5mg/kg/day PO divided q12 - 24h, max 40mg/day

Special Populations

• Pregnancy Rating: D
• Lactation: Probably Safe
• Renal Dosing
  • Adult: CrCl < 30, start 2.5mg qday, max 40mg q/day
  • Pediatric creatinine Cl 10-50: decrease dose 25%, CrCl < 10: decrease dose 50%
• Hepatic Dosing
  • Adult: Not defined
  • Pediatric: Not defined

Contraindications

• Allergy to class/drug
• history of angioedema
• pregnancy
• caution if renal artery stenosis
• caution if severe CHF
• caution if renal impairment

Adverse Reactions

Serious

• angioedema
• hypotension
• hyperkalemia
• renal impairment
• hepatotoxicity
• neutropenia
• pancreatitis
• steven johnson syndrome
• fetal/neonatal harm
• congenital malformations

Common

• dizziness
• elevated Cr
• headache
• diarrhea
• hypotension
• abdominal pain
• hyperkalemia

Pharmacology

• Half-life: 12 hours
• Metabolism: Liver
• Excretion: urine, feces
• Mechanism of Action: inhibits angiotensin converting enzyme, interferes with conversion of angiotensin 1 to angiotensin 2

References

Authors

Babak Missaghi, Ross Donaldson, Claire, Neil Young, Daniel Ostermayer