Enalapril
Mechanism :
Enalapril is a specific competitive inhibitor of angiotensin I-converting enzyme (ACE), the enzyme responsible for the conversion of angiotensin I to angiotensin II.
Indication :
- Hypertension
- Hypertensive crisis
- Congestive cardiac failure
- Proteinuria
Contraindications :
Enalapril is contraindicated in patients who are hypersensitive to this product or any other angiotensin-converting enzyme inhibitor. Avoid in neonates, in volume depletion and renovascular disease. Not recommended in neonates and in pediatric patients with glomerular filtration rate <30 mL/min/1.73 m2.
Dosing :
Hypertension:
Use in children above 1 month of age.
Oral:
0.1-0.5 mg/kg/day PO OD or in 2 divided doses. Max: 40 mg/day. Adjust according to blood pressure.
IV:
0.01-0.02 mg/kg/day in two divided doses.
Hypertensive crisis:
0.05-0.1 mg/kg given as an intravenous injection.
Adverse Effect :
Neutropenia, agranulocytosis, anemia, thrombocytopenia, pancytopenia, rash, pruritus, arthralgia, fever, eosinophilia, hypotension, angioedema, cough.
Interaction :
Diuretics: A precipitous reduction of blood pressure usually within the first hour of receiving the initial dose of enalapril.
Potassium-sparing diuretics such as spironolactone, triamterene, or amiloride: Since enalapril decreases aldosterone production, elevation of serum potassium may occur.
Nonsteroidal anti-inflammatory agents: Reduces the antihypertensive effect of enalapril.
Lithium: Increased serum lithium levels and symptoms of lithium toxicity.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Start with 2.5 mg per day and increase according to response |
| <10 | Start with 2.5 mg per day and increase according to response |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Dialysed. Dose as in GFR<10 mL/ min |
| HD | Dialysed. Dose as in GFR<10 mL/ min |
| HDF/High flux | Dialysed. Dose as in GFR<10 mL/ min |
| CAV/VVHD | Dialysed. Dose as in GFR=10– 20 mL/min |
Hepatic Dose :
No dosage adjustments are recommended.