BMA Concise Guide to Medicine & Drugs

Enalapril

Brand name Innovace

Used in the following combined preparation Innozide

QUICK REFERENCE

Drug group ACE inhibitor and antihypertensive drug

Overdose danger rating Medium

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Enalapril belongs to the ACE inhibitor group of vasodilator drugs, which are used to treat hypertension (high blood pressure) and heart failure (reduced ability of the heart to pump blood). It is also given to patients following a heart attack. Enalapril may be given with a diuretic to increase its effect.

The first dose of enalapril may cause a sudden drop in blood pressure. For this reason, you should be resting at the time and be able to lie down for 2 to 3 hours afterwards.

The more common adverse effects such as dizziness and headache, usually diminish with long-term treatment. Rashes can also occur but usually disappear when the drug is stopped. In some cases, they clear up on their own despite continued treatment.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets.

Frequency and timing of doses 1–2 x daily.

Adult dosage range 2.5–5mg daily (starting dose), increased to 10–40mg daily (maintenance dose).

Onset of effect 30–60 minutes; full beneficial effect may take several weeks.

Duration of action 24 hours.

Diet advice Your doctor may advise you to reduce your salt intake to help control your blood pressure.

Storage Keep in original container below 25°C and out of the reach of children. Protect from light.

Missed dose Take as soon as you remember. If your next dose is due within 8 hours, take a single dose now and skip the next.

Stopping the drug Do not stop the drug without consulting your doctor; stopping the drug may lead to worsening of the underlying condition.

Exceeding the dose An occasional unintentional extra dose is unlikely to be a cause for concern. Large overdoses may cause dizziness or fainting. Notify your doctor.

POSSIBLE ADVERSE EFFECTS

The more common adverse effects, such as dizziness and headache, often diminish with long-term treatment. Less common side effects, such as a dry cough and mouth ulcers or a sore mouth, may also diminish with time, although it may be necessary to adjust the drug dosage. Rashes may occur but usually disappear when the drug is stopped. If you experience any of these side effects or if you develop a sore throat or fever with the drug, discuss with your doctor. If you develop swelling of the mouth or lips or breathing difficulty, you should stop taking the drug and contact your doctor immediately.

INTERACTIONS

Potassium supplements and potassium-sparing diuretics Enalapril may enhance the effect of these drugs, leading to raised levels of potassium in the blood.

Non-steroidal anti-inflammatory drugs (NSAIDs) Some of these drugs may reduce the effectiveness of enalapril. There is also risk of kidney damage when they are taken with enalapril.

Vasodilators, diuretics, and other antihypertensives These may increase the blood-pressure-lowering effect of enalapril.

Lithium Enalapril increases the levels of lithium in the blood, and serious adverse effects from lithium excess may occur.

Ciclosporin Taken with enalapril, this drug may increase blood levels of potassium.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have kidney or liver problems.

· You have heart problems.

· You have had angioedema or a previous allergic reaction to ACE inhibitors.

· You are taking other medicines.

· You are pregnant or intend to become pregnant.

Pregnancy Not prescribed. There is evidence of harm to the developing fetus.

Breast-feeding Safety not established. Discuss with your doctor.

Infants and children Not recommended.

Over 60 Reduced dose may be necessary.

Driving and hazardous work Avoid such activities until you have learned how enalapril affects you because the drug can cause dizziness and fainting.

Alcohol Avoid. Alcohol may increase the blood-pressure-lowering and adverse effects of the drug.

Surgery and general anaesthetics Enalapril may have to be stopped before you have a general anaesthetic. Discuss with your doctor or dentist before any operation.

PROLONGED USE

No problems expected.

Monitoring Periodic checks on potassium levels, white blood cell count, kidney function, and urine are usually performed.