ENALAPRIL

Indications & Dose:

Hypertension

•   BY MOUTH  

Adult: Initially 5 mg once daily, lower initial doses may be required when used in addition to diuretic or in renal impairment; maintenance 20 mg onc daily; maximum 40 mg per day

Heart failure 

•  BY MOUTH

Adult (under close medical supervision): Initially 2.5 mg once daily, increased if tolerated to 10–20 mg twice daily, dose to be increased gradually over 2–4 weeks

Prevention of symptomatic heart failure in patients with asymptomatic left ventricular dysfunction

• BY MOUTH

Adult (under close medical supervision): Initially 2.5 mg once daily, increased if tolerated to 10–20 mg twice daily, dose to be increased gradually over 2–4 weeks

Children

0.1-0.5 (atleast 0.36mg) mg/kg/day as improvised suspension of crushed tablet. 

Contraindications:

Aortic stenosis, hyper-sensitivity. Pregnancy.

Side Effects:

CNS: Anxiety, dizziness, fatigue, headache, insomnia, paresthesia

CV: Angina, hypotension, palpitations, postural hypotension, syncope (especially with 1st dose)

GI: Abdominal pain, constipation, melena, nausea, vomiting

GU: Decreased libido, impotence, increased BUN/ creatinine, UTI

HEME: Agranulocytosis, neutropenia

METAB: Hyperkalemia, hyponatremia

MS: Arthralgia, arthritis, rnyalgia

RESP: Asthma, bronchitis, cough, dyspnea, sinusitis

SKIN: Angioedema, flushing, rash, sweating

Cautions:

Precautions:

History of anaphylaxis, renal insufficiency (<30 ml/min), hypotension (CHF, elderly, volume depletion-diuretics, dialysis; cirrhosis), aortic stenosis, hyperkalemia (potassium supplements, potassium sparing diuretics, renal disease, diabetes), neutropenia (autoimmune diseases, collagen vascular, febrile illness, immunosuppressant drug therapy), proteinuria, renal artery stenosis, surgery/ anesthesia (excessive hypotension, correctable with fluids).

Breast-feeding: Use with caution.

Old age: May be used.

Interaction:

Drugs 

Allopurinol: Predisposition to hypersensitivity reactions to ACE inhibitors

Aspirin, NSAIDs: Inhibition of the antihypertensive response to ACE inhibitors

Azathioprine: Increased myelosuppression

Insulin: Enhanced insulin sensitivity

Iron: Increased risk of anaphylaxis with administration of parenteral (IV) iron

Lithium: Increased risk of serious lithium toxicity

Loop diuretics: Initiation of ACE inhibitor therapy in the presence of intensive diuretic therapy results in a precipitous fall in blood pressure in some patients; ACE inhibitors may induce renal insufficiency in the presence of diuretic-induced sodium depletion

Potassium: Increased risk for hyperkalemia

Potassium-sparing diuretics: Increased risk for hyperkalemia

Prazosin, terazosin, doxazosin: Exaggerated first-dose hypotensive response to α-blockers

Trimethoprim: Additive risk of hyperkalemia, especially in patient predisposed to renal insufficiency

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: