Class: ACE-I, Antihypertensive
Dosage Forms. Tablet: 2.5 mg, 5 mg, 10 mg, 20 mg
Common FDA Label Indication, Dosing, and Titration.
1. CHF: Children 4 d and older, 0.1-0.5 mg/kg po daily, max 0.94 mg/kg po daily; Adults, 2.5 mg po daily or bid, max 40 mg po daily in divided doses
2. Hypertension: Children 6-16 y, 0.08 mg/kg up to 5 mg po daily, max 0.58 mg/kg or 40 mg po daily; Adults, 5 mg po daily, max 40 mg po daily in divided doses
3. Kidney disease, nondiabetic: Children 7-18 y, 0.1-0.5 mg/kg po daily, max 20 mg po daily; Adults, 5 mg po daily, max 20 mg po daily
1. Diabetic nephropathy: 5-20 mg po daily
2. MI: 2.5 mg po daily, may titrate to 20 mg po daily
MOA. Enalapril is a prodrug that is rapidly converted to its active metabolite, enalaprilat, a competitive ACE inhibitor. It reduces serum aldosterone, leading to decreased sodium retention, potentiates the vasodilator kallikrein–kinin system, inhibits the sympathetic nervous system, and inhibits the tissue renin–angiotensin system. The net effect is reduction in total peripheral resistance and blood pressure in hypertensive patients, and reduction of elevated afterload in patients with CHF.
Drug Characteristics: Enalapril
Medication Safety Issues: Enalapril
Drug Interactions: Enalapril
Adverse Reactions: Enalapril
Efficacy Monitoring Parameters. Decreased BP, signs of CHF.
Toxicity Monitoring Parameters. Signs of angioedema (swelling of the face, eyes, lips, tongue, or throat), severe persistent cough, hypotension; monitor baseline and periodic electrolytes, SCr, BUN, and urine protein.
Key Patient Counseling Points. Use potassium supplements or salt substitutes only under medical supervision.
Clinical Pearls. Progressive renal impairment including acute renal failure may occur on enalapril therapy. Injectable formulation, enalaprilat, also available. Injectable and oral dosing not interchangeable.