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enalapril (Vasotec)

Tradename: Vasotec. (enalapril maleate) Indications: - hypertension - improved survival in patients with mild to severe heart failure - diminished incidence of heart failure in patients with asymptomatic left ventricular systolic dysfunction - diabetic nephropathy - nondiabetic proteinuric nephropathy - scleroderma & sclerdermal renal crisis [6] Contradindications: - pregnancy: - teratogenic in 1st trimester [8] - fetal or neonatal renal failure in 2nd or 3rd trimester - scleroderma renal crisis is exception [8] - safe in lactation [8] - increases mortality when give in 1st 24 hours after acute myocardial infarction [4] Dosage: 1) HTN: - 1.25 mg IV every 6 hours. - Start 5 mg PO QD, max 40 mg/day. 2) CHF: Start 2.5 mg PO QD/BID, max 40 mg/day. Tabs: 2.5, 5, 10, 20 mg. Pharmacokinetics: - Enalapril is hepatically hydrolyzed to the active ACE inhibitor enalaprilat. Adverse effects: 1) infrequent (1-10%) - chest pain, palpitations, tachycardia, syncope, insomnia, headache, dizziness, fatigue, malaise, rash, abnormal taste, abdominal pain, nausea/vomiting, anorexia, constipation, paresthesia, weakness, bronchitis, cough dyspnea 2) uncommon (< 1%) agranulocytosis - incidence may be less than for captopril, angina pectoris, flushing, alopecia, erythema multiforme, pruritus, Stevens-Johnson syndrome, urticaria, angioedema, hypoglycemia, hyperkalemia, impotence, anemia, myalgia, blurred vision, tinnitus, oliguria, asthma, bronchospasm, diaphoresis Drug interactions: 1) non-steroidal anti-inflammatory agents (NSAIDs) decrease effect of enalapril 2) Li+ increases serum levels & toxicity of enalapril Test interactions: 1) positive direct antiglubin (Coomb's) test (DAT) 2) may cause false positive urine acetone with sodium nitroprusside reagent

Interactions

drug interactions drug adverse effects (more general classes) monitor with ACE inhibitors

Related

ACE inhibitors vs angiotensin receptor blockers (ARB) enalaprilat (Vasotec IV)

General

amide amine angiotensin-converting enzyme (ACE) inhibitor carboxylic acid ester pyrrolidine; tetrahydropyrrole

Properties

INHIBITS: angiotensin converting enzyme MISC-INFO: elimination route LIVER KIDNEY 1/2life 12-24 HOURS 35-38 HOURS pregnancy-category D safety in lactation ?

Database Correlations

PUBCHEM correlations

References

  1. Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1990. pg 760-1
  2. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996.
  3. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 117
  4. contribution from Paul Goebel, M.D., UCSF Fresno
  5. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  6. Deprecated Reference
  7. Department of Veterans Affairs, VA National Formulary
  8. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015

Component-of

enalapril/diltiazem (Teczem) enalapril/felodipine (Lexxel) enalapril/hydrochlorothiazide; enalapril/HCTZ (Vaseretic)