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Enalapril maleate
Enalapril maleate (Vasotec)
Enalapril maleate
(en-AL-ah-prill)
Pregnancy Category: D Vasotec Vasotec I.V. (Rx)

Classification: Angiotensin-converting enzyme inhibitor

See Also: See also Angiotensin-Converting Enzyme Inhibitors.

Action/Kinetics: Converted in the liver by hydrolysis to the active metabolite, enalaprilat. The parenteral product is enalaprilat injection. Onset, PO: 1 hr; IV, 15 min. Time to peak action, PO: 4-6 hr; IV, 1-4 hr. Duration, PO: 24 hr; IV, About 6 hr. Approximately 50%-60% is protein bound. t1/2, enalapril, PO: 1.3 hr; IV, 15 min. t1/2, enalaprilat, PO: 11 hr. Excreted through the urine (half unchanged) and feces; over 90% of enalaprilat is excreted through the urine.

Uses: Alone or in combination with other antihypertensives (e.g., a thiazide diuretic) for the treatment of hypertension. As adjunct with digitalis and diuretic in acute and chronic CHF. Asymptomatic left ventricular dysfunction in clinically stable asymptomatic clients. IV for treatment of hypertension when PO is not practical. Investigational: Hypertension in children, hypertension related to scleroderma renal crisis. Enalaprilat may be used for hypertensive emergencies (effect is variable).

Special Concerns: Use with caution during lactation. Safety and effectiveness have not been determined in children.

Side Effects: CV: Palpitations, hypotension, chest pain, angina, CVA, MI orthostatic hypotension, disturbances in rhythm, tachycardia, cardiac arrest orthostatic effects, atrial fibrillation, tachycardia, bradycardia, Raynaud's phenomenon. GI: N&V;, diarrhea, abdominal pain, alterations in taste, anorexia, dry mouth, constipation, dyspepsia, glossitis, ileus, melena, stomatitis. CNS: Insomnia, headache, fatigue, dizziness, paresthesias, nervousness, sleepiness, ataxia, confusion, depression, vertigo, abnormal dreams. Hepatic: Hepatitis, hepatocellular or cholestatic jaundice, pancreatitis, elevated liver enzymes, hepatic failure. Respiratory: Bronchitis, cough, dyspnea, bronchospasm, URI, pneumonia, pulmonary infiltrates, asthma, pulmonary embolism and infarction, pulmonary edema. Renal: Renal dysfunction, oliguria, UTI, transient increases in creatinine and BUN. Hematologic: Rarely, neutropenia, thrombocytopenia, bone marrow depression, decreased H&H; in hypertensive or CHF clients. Hemolytic anemia, including hemolysis, in clients with G6PD deficiency. Dermatologic: Rash, pruritus, alopecia, flushing, erythema multiforme, exfoliative dermatitis, photosensitivity, urticaria, increased sweating, pemphigus, Stevens-Johnson syndrome herpes zoster, toxic epidermal necrolysis. Other: Angioedema, asthenia, impotence, blurred vision, fever, arthralgia, arthritis, vasculitis, eosinophilia, tinnitus, syncope, myalgia, muscle cramps, rhinorrhea, sore throat, hoarseness, conjunctivitis, tearing, dry eyes, loss of sense of smell, hearing loss, peripheral neuropathy, anosmia, myositis, flank pain, gynecomastia.

Additional Drug Interactions: Rifampin may the effects of enalapril. Do not discontinue without first reporting to the provider.

How Supplied: Tablet: 2.5 mg, 5 mg, 10 mg, 20 mg; Injection: 1.25 mg/mL (as enalaprilat)

Dosage
•Tablets (Enalapril) Antihypertensive in clients not taking diuretics.
Initial: 5 mg/day; then, adjust dosage according to response (range: 10-40 mg/day in one to two doses).
Antihypertensive in clients taking diuretics.
Initial: 2.5 mg. Since hypotension may occur following the initiation of enalapril, the diuretic should be discontinued, if possible, for 2-3 days before initiating enalapril. If BP is not maintained with enalapril alone, diuretic therapy may be resumed.
Adjunct with diuretics and digitalis in heart failure.
Initial: 2.5 mg 1-2 times/day; then, depending on the response, 2.5-20 mg/day in two divided doses. Dose should not exceed 40 mg/day. Dosage must be adjusted in clients with renal impairment or hyponatremia.
In clients with impaired renal function.
Initial: 5 mg/day if C_CR ranges between 30 and 80 mL/min and serum creatinine is less than 3 mg/dL; 2.5 mg/day if C_CR is less than 30 mL/min and serum creatinine is more than 3 mg/dL and in dialysis clients on dialysis days.
Renal impairment or hyponatremia.
Initial: 2.5 mg/day if serum sodium is less than 130 mEq/L and serum creatinine is more than 1.6 mg/dL. The dose may be increased to 2.5 mg b.i.d. and then 5 mg b.i.d. or higher if required; dose is given at intervals of 4 or more days. Maximum daily dose is 40 mg.
Asymptomatic LV dysfunction following MI.
2.5 mg b.i.d., titrated as tolerated to the daily dose of 20 mg in divided doses.
•IV (Enalaprilat) Hypertension.
1.25 mg over a 5-min period; repeat q 6 hr.
Antihypertensive in clients taking diuretics.
Initial: 0.625 mg over 5 min; if an adequate response is seen after 1 hr, administer another 0.625-mg dose. Thereafter, 1.25 mg q 6 hr. In those taking diuretics, start with 0.625 mg enalaprilat over 5 min; if there is an inadequate effect after 1 hr, repeat the 0.625 mg dose. Give additional doses of 1.25 mg q 6 hr.
Clients with impaired renal function.
Give enalaprit, 1.25 mg q 6 hr for clients with a C_CR more than 30 mL/min and an initial dose of 0.625 mg for clients with a C_CR less than 30 mL/min. If there is an adequate response, an additional 0.625 mg may be given after 1 hr; thereafter, additional 1.25-mg doses can be given q 6 hr. For dialysis clients, the initial dose is 0.625 mg q 6 hr.