Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 1.25mg/mL
tablet
- 2.5mg
- 5mg
- 10mg
- 20mg
powder for oral solution (Epaned)
- 150 mg bottle (1mg/mL after reconstitution)
Hypertension
Oral
- Initial: 2.5-5 mg PO qDay
- Maintenance: 10-40 mg/day PO qDay or divided q12hr
IV
- 1.25 mg/dose IV over 5 minutes q6hr; doses up to 5 mg/dose IV q6hr have been administered
Left Ventricular Dysfunction
Initial: 2.5 mg PO q12hr
May titrate up to 20 mg/day
Congestive Heart Failure
Initial: 2.5 mg PO qDay or q12hr
Maintenance: 5-40 mg/Day PO divided q12hr; titrate slowly q2Weeks
IV: 1.25-5 mg q6hr; avoid IV administration in unstable heart failure or acute myocardial infarction
Conversion from IV to oral dosage form
If not concurrently receiving diuretics, initiate enalapril 5 mg PO qDay; if concurrently receiving diuretics and responding to 0.625 mg IV q6hr, initiate at 2.5 mg PO qDay; titrate upwards as necessary
Dosage Modifications
Hepatic impairment: No dosage adjustment required
Renal impairment
- CrCl <30 mL/min: (PO) Initiate 2.5 mg; titrate to response; not to exceed 40 mg
- Dialysis: 2.5 mg PO on day of dialysis; adjust dose on nondialysis days according to BP
- CrCl <30 mL/min: (IV) Initiate 0.625 mg q6hr; titrate based on response
- CrCl ≥30 mL/min: (PO) Initiate 5 mg/day; titrate to maximum of 40 mg
- CrCl ≥30 mL/min: (IV) 1.25 mg q6hr; titrate based on response
Dosing Considerations
Beneficial for many patients at risk for heart disease
Reduces risk of MI, stroke, diabetic nephropathy, microalbuminuria, new-onset DM
Consider starting an ACE inhibitor in high-risk patients, even if no HTN or CHF
May prolong survival in CHF
May preserve renal function in DM
May help to prevent migraine headache
Good choice in hyperlipidemia patients
Requires weeks for full effect; to start, use low dose and titrate q1-2Weeks
Abrupt discontinuation not associated with rapid increase in BP
Dosage Forms & Strengths
injectable solution
- 1.25mg/mL
tablet
- 2.5mg
- 5mg
- 10mg
- 20mg
powder for oral solution (Epaned)
- 150 mg bottle (1mg/mL after reconstitution)
Hypertension
1 month to 16 years (oral)
- Initial: 0.08 mg/kg/day PO or divided q12hr; not to exceed 5 mg/day
- May increase PRN q2Weeks according to blood pressure not to exceed 0.58 mg/kg/day (or 40 mg/day)
1 month to 16 years (IV)
- 0.01-0.02 mg/kg/day divided q12hr by IV infusion
Hypertensive Crisis
0.05-0.1 mg/kg by direct IV injection
Renal Impairment
GFR <30 mL/min/1.73 m²: Not recommended
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (3)
- aliskiren
enalapril, aliskiren. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Contraindicated. Aliskiren use contraindicated with ACEIs in patients with diabetes; avoid coadministration with ACEIs if GFR <60 mL/min; dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.
enalapril decreases effects of aliskiren by Other (see comment). Contraindicated. Comment: Aliskiren use contraindicated with ACE-inhibitors in patients with diabetes; avoid coadministration with ACE-inhibitors if GFR. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of ACE-inhibitors with drugs that affect RAAS may increase the risk of renal impairment (including acute renal failure) and cause loss of antihypertensive effect. Monitor renal function periodically. - protein a column
enalapril, protein a column. Other (see comment). Contraindicated. Comment: Risk of anaphylactic reaction. Mechanism: buildup of bradykinin d/t deactivation of kininase by ACE inhibitors. D/C ACE inhibitor 72h prior to use of protein A column.
- sacubitril/valsartan
sacubitril/valsartan, enalapril. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan.
Serious - Use Alternative (40)
- allopurinol
enalapril, allopurinol. Mechanism: unknown. Avoid or Use Alternate Drug. Risk of anaphylaxis, Stevens Johnson syndrome.
- aspirin
aspirin, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- aspirin rectal
aspirin rectal, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- azilsartan
azilsartan, enalapril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.
- candesartan
candesartan, enalapril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.
- celecoxib
celecoxib, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- choline magnesium trisalicylate
choline magnesium trisalicylate, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- diclofenac
diclofenac, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- diflunisal
diflunisal, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- eprosartan
eprosartan, enalapril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.
- etodolac
etodolac, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- fenoprofen
fenoprofen, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- flurbiprofen
flurbiprofen, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- ibuprofen
ibuprofen, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- ibuprofen IV
ibuprofen IV, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- indomethacin
indomethacin, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- irbesartan
irbesartan, enalapril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.
- ketoprofen
ketoprofen, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- ketorolac
ketorolac, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- ketorolac intranasal
ketorolac intranasal, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- leniolisib
leniolisib will increase the level or effect of enalapril by Other (see comment). Avoid or Use Alternate Drug. Leniolisib, an OATP1B1 and OATP1B3 inhibitor, may increase systemic exposure of these substrates
- lofexidine
lofexidine, enalapril. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.
- losartan
losartan, enalapril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.
- meclofenamate
meclofenamate, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- mefenamic acid
mefenamic acid, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- meloxicam
meloxicam, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- nabumetone
nabumetone, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- naproxen
naproxen, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- olmesartan
olmesartan, enalapril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.
- oxaprozin
oxaprozin, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- piroxicam
piroxicam, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- potassium phosphates, IV
enalapril and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- pregabalin
enalapril, pregabalin. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration results in additive risk of developing angioedema of face, mouth, and neck. Angioedema may result in respiratory compromise.
- sacubitril/valsartan
sacubitril/valsartan, enalapril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.
- salsalate
salsalate, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- sulindac
sulindac, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- telmisartan
telmisartan, enalapril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.
- tolmetin
tolmetin, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- trofinetide
trofinetide will increase the level or effect of enalapril by Other (see comment). Avoid or Use Alternate Drug. Trofinetide (an OATP131 and OATP13B inhibitor) may increase plasma levels of OATP131 or OATP13B substrates. Avoid coadministration with sensitive substrates.
- valsartan
valsartan, enalapril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.
Monitor Closely (121)
- albiglutide
enalapril increases effects of albiglutide by unknown mechanism. Use Caution/Monitor. ACE inhibitors may increase hypoglycemic effect. Monitor glycemic control especially during the first month of treatment with an ACE inhibitor. .
- aldesleukin
aldesleukin increases effects of enalapril by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- alfuzosin
enalapril, alfuzosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.
- aluminum hydroxide
aluminum hydroxide decreases effects of enalapril by unspecified interaction mechanism. Use Caution/Monitor.
- amifostine
amifostine, enalapril. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.
- amiloride
enalapril, amiloride. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
- apalutamide
apalutamide will decrease the level or effect of enalapril by increasing elimination. Use Caution/Monitor. Apalutamide weakly induces OATP1B1 and may decrease systemic exposure of drugs that are OATP1B1 substrates.
- asenapine
enalapril, asenapine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.
- aspirin
enalapril, aspirin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly with high dose aspirin, in elderly or volume depleted individuals.
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate decreases effects of enalapril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
enalapril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - avanafil
avanafil increases effects of enalapril by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- azathioprine
enalapril, azathioprine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of neutropenia.
- bretylium
enalapril, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.
- bumetanide
enalapril, bumetanide. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypotension, renal insufficiency.
- calcium carbonate
calcium carbonate decreases effects of enalapril by unspecified interaction mechanism. Use Caution/Monitor.
- canagliflozin
enalapril and canagliflozin both increase serum potassium. Use Caution/Monitor.
- carbamazepine
enalapril increases levels of carbamazepine by decreasing metabolism. Use Caution/Monitor.
- carbidopa
carbidopa increases effects of enalapril by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.
- celecoxib
enalapril, celecoxib. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- chlorpropamide
enalapril increases effects of chlorpropamide by pharmacodynamic synergism. Use Caution/Monitor.
- choline magnesium trisalicylate
enalapril, choline magnesium trisalicylate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- dalteparin
dalteparin increases toxicity of enalapril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.
- diclofenac
enalapril, diclofenac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- diflunisal
enalapril, diflunisal. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- digoxin
enalapril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.
- doxazosin
enalapril, doxazosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.
- drospirenone
enalapril, drospirenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
- encorafenib
encorafenib will increase the level or effect of enalapril by Other (see comment). Modify Therapy/Monitor Closely. Encorafenib (a OATP1B3 inhibitor) may increase the concentration and toxicities of OATP1B3 substrates. Closely monitor for signs and symptoms of increased exposure and consider adjusting the dose of these substrates.
- enoxaparin
enoxaparin increases toxicity of enalapril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.
- eplerenone
enalapril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
- ethacrynic acid
enalapril, ethacrynic acid. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypotension, renal insufficiency.
- etodolac
enalapril, etodolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- everolimus
enalapril, everolimus. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration increases risk of angioedema.
- exenatide injectable solution
enalapril increases effects of exenatide injectable solution by Other (see comment). Use Caution/Monitor. Comment: ACE inhibitors may increase hypoglycemic effect. Monitor glycemic control especially during the first month of treatment with an ACE inhibitor. .
- exenatide injectable suspension
enalapril increases effects of exenatide injectable suspension by Other (see comment). Use Caution/Monitor. Comment: ACE inhibitors may increase hypoglycemic effect. Monitor glycemic control especially during the first month of treatment with an ACE inhibitor.
- fenoprofen
enalapril, fenoprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- ferric maltol
enalapril, ferric maltol. Mechanism: unknown. Use Caution/Monitor. Risk of GI symptoms, hypotension.
- ferrous gluconate
enalapril, ferrous gluconate. Mechanism: unknown. Use Caution/Monitor. Risk of GI symptoms, hypotension.
- finerenone
enalapril and finerenone both increase serum potassium. Modify Therapy/Monitor Closely. Finerenone dose adjustment based on current serum potassium concentration. Monitor serum potassium and adjust finerenone dose as described in the prescribing information as necessary.
- flurbiprofen
enalapril, flurbiprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- fostemsavir
fostemsavir will increase the level or effect of enalapril by Other (see comment). Modify Therapy/Monitor Closely. Fostemsavir inhibits OATP1B1/3 transporter. If possible, avoid coadministration or modify dose of OATP1B1/3 substrates coadministered with fostemsavir.
- furosemide
enalapril, furosemide. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypotension, renal insufficiency.
- glecaprevir/pibrentasvir
glecaprevir/pibrentasvir will increase the level or effect of enalapril by Other (see comment). Use Caution/Monitor. Coadministration with glecaprevir/pibrentasvir may increase plasma concentration of drugs that are substrates of OATP1B1 or OATP1B3
- glimepiride
enalapril increases effects of glimepiride by pharmacodynamic synergism. Use Caution/Monitor.
- glipizide
enalapril increases effects of glipizide by pharmacodynamic synergism. Use Caution/Monitor.
- glyburide
enalapril increases effects of glyburide by pharmacodynamic synergism. Use Caution/Monitor.
- gold sodium thiomalate
enalapril, gold sodium thiomalate. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Combo of ACE inhibitors and injectable gold has caused rare cases of nitritoid reaction (flushing, N/V, hypot'n).
- heparin
heparin increases toxicity of enalapril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.
- ibuprofen
enalapril, ibuprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- ibuprofen IV
enalapril, ibuprofen IV. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- icatibant
icatibant decreases effects of enalapril by pharmacodynamic antagonism. Use Caution/Monitor. Icatibant has potential to have a pharmacodynamic interaction with ACE inhibitors where it may attenuate the antihypertensive effect of ACE inhibitors.
- indomethacin
enalapril, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- insulin aspart
enalapril increases effects of insulin aspart by pharmacodynamic synergism. Use Caution/Monitor.
- insulin degludec
enalapril, insulin degludec. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.
- insulin degludec/insulin aspart
enalapril, insulin degludec/insulin aspart. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.
- insulin detemir
enalapril increases effects of insulin detemir by pharmacodynamic synergism. Use Caution/Monitor.
- insulin glargine
enalapril increases effects of insulin glargine by pharmacodynamic synergism. Use Caution/Monitor.
- insulin glulisine
enalapril increases effects of insulin glulisine by pharmacodynamic synergism. Use Caution/Monitor.
- insulin inhaled
enalapril, insulin inhaled. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.
- insulin lispro
enalapril increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor.
- insulin NPH
enalapril increases effects of insulin NPH by pharmacodynamic synergism. Use Caution/Monitor.
- insulin regular human
enalapril increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor.
- ketoprofen
enalapril, ketoprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- ketorolac
enalapril, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- ketorolac intranasal
enalapril, ketorolac intranasal. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- lanthanum carbonate
lanthanum carbonate decreases levels of enalapril by cation binding in GI tract. Use Caution/Monitor. Administer ACE inhibitor at least 2 hr before or after lanthanum.
- letermovir
letermovir increases levels of enalapril by Other (see comment). Use Caution/Monitor. Comment: Letermovir, an OATP1B1/3 inhibitor may increase plasma concentrations of coadministered OATP1B1/3 substrates.
- levodopa
levodopa increases effects of enalapril by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.
- levoketoconazole
levoketoconazole increases levels of enalapril by decreasing metabolism. Use Caution/Monitor.
- liraglutide
enalapril increases effects of liraglutide by unknown mechanism. Use Caution/Monitor. ACE inhibitors may increase hypoglycemic effect. Monitor glycemic control especially during the first month of treatment with an ACE inhibitor. .
- lithium
enalapril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule.
- lurasidone
lurasidone increases effects of enalapril by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.
- maraviroc
maraviroc, enalapril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.
- meclofenamate
enalapril, meclofenamate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- mefenamic acid
enalapril, mefenamic acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- meloxicam
enalapril, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- metformin
enalapril increases toxicity of metformin by unspecified interaction mechanism. Use Caution/Monitor. Increases risk for hypoglycemia and lactic acidosis.
- methylphenidate
methylphenidate will decrease the level or effect of enalapril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.
- methylphenidate transdermal
methylphenidate transdermal decreases effects of enalapril by anti-hypertensive channel blocking. Use Caution/Monitor.
- mipomersen
mipomersen, enalapril. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.
- moxisylyte
enalapril, moxisylyte. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.
- nabumetone
enalapril, nabumetone. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- naproxen
enalapril, naproxen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- nesiritide
nesiritide, enalapril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.
- nitroglycerin rectal
nitroglycerin rectal, enalapril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Observe for possible additive hypotensive effects during concomitant use. .
- oxaprozin
enalapril, oxaprozin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- phenoxybenzamine
enalapril, phenoxybenzamine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.
- phentolamine
enalapril, phentolamine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.
- piroxicam
enalapril, piroxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- potassium acid phosphate
enalapril increases levels of potassium acid phosphate by decreasing elimination. Use Caution/Monitor. Risk of hyperkalemia.
- potassium chloride
enalapril increases levels of potassium chloride by decreasing elimination. Use Caution/Monitor. Risk of hyperkalemia.
- potassium citrate
enalapril increases levels of potassium citrate by decreasing elimination. Use Caution/Monitor. Risk of hyperkalemia.
- potassium citrate/citric acid
enalapril and potassium citrate/citric acid both increase serum potassium. Use Caution/Monitor.
- potassium iodide
potassium iodide and enalapril both increase serum potassium. Use Caution/Monitor. Potassium salts may increase the hyperkalemic effects of ACE inhibitors; the effect may be the result of aldosterone suppression in patients receiving ACE inhibitors.
- prazosin
enalapril, prazosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.
- rose hips
enalapril, rose hips. Mechanism: unknown. Use Caution/Monitor. Risk of GI symptoms, hypotension.
- salsalate
enalapril, salsalate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- silodosin
enalapril, silodosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.
- sirolimus
enalapril, sirolimus. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration increases risk of angioedema.
- sodium bicarbonate
sodium bicarbonate decreases effects of enalapril by unspecified interaction mechanism. Use Caution/Monitor.
- sodium citrate/citric acid
sodium citrate/citric acid decreases effects of enalapril by unspecified interaction mechanism. Use Caution/Monitor.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of enalapril by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.
- sodium sulfate/potassium sulfate/magnesium sulfate
sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of enalapril by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.
- sofosbuvir/velpatasvir
sofosbuvir/velpatasvir increases levels of enalapril by Other (see comment). Use Caution/Monitor. Comment: Velpatasvir inhibits OATP1B1, OATP1B3, and OATP2B1 transporters. .
- spironolactone
enalapril, spironolactone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
- sulfasalazine
sulfasalazine decreases effects of enalapril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
enalapril, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - sulindac
enalapril, sulindac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- synthetic human angiotensin II
enalapril increases effects of synthetic human angiotensin II by unspecified interaction mechanism. Use Caution/Monitor.
- tadalafil
tadalafil increases effects of enalapril by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- temsirolimus
enalapril, temsirolimus. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration increases risk of angioedema.
- tenapanor
tenapanor decreases levels of enalapril by Other (see comment). Modify Therapy/Monitor Closely. Comment: Tenapanor inhibits intestinal uptake transporter, OATP2B1; peak exposure (Cmax) of enalapril and its active metabolite, enalaprilat, decreases significantly when both drugs administered concomitantly; monitor blood pressure and increase dosage of enalapril, if needed, when coadministered with this drug.
- terazosin
enalapril, terazosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.
- tolazamide
enalapril increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor.
- tolbutamide
enalapril increases effects of tolbutamide by pharmacodynamic synergism. Use Caution/Monitor.
- tolmetin
enalapril, tolmetin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- torsemide
enalapril, torsemide. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypotension, renal insufficiency.
- triamterene
enalapril, triamterene. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
- trimethoprim
trimethoprim and enalapril both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- voclosporin
voclosporin and enalapril both increase serum potassium. Use Caution/Monitor.
voclosporin, enalapril. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity. - xipamide
xipamide increases effects of enalapril by pharmacodynamic synergism. Use Caution/Monitor.
- zotepine
enalapril, zotepine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.
Minor (31)
- aceclofenac
aceclofenac decreases effects of enalapril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- acemetacin
acemetacin decreases effects of enalapril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- agrimony
agrimony increases effects of enalapril by pharmacodynamic synergism. Minor/Significance Unknown.
- brimonidine
brimonidine increases effects of enalapril by pharmacodynamic synergism. Minor/Significance Unknown.
- capsicum
capsicum, enalapril. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increase ACE inhibitor induced cough.
- chlorpromazine
chlorpromazine increases effects of enalapril by unspecified interaction mechanism. Minor/Significance Unknown.
- cornsilk
cornsilk increases effects of enalapril by pharmacodynamic synergism. Minor/Significance Unknown.
- creatine
creatine, enalapril. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical interaction) Combination may have additive nephrotoxic effects.
- cyclosporine
cyclosporine will increase the level or effect of enalapril by Other (see comment). Minor/Significance Unknown. may increase plasma concentrations of OATP substrates
- entecavir
enalapril, entecavir. Either increases effects of the other by decreasing renal clearance. Minor/Significance Unknown. Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of either entecavir or the coadministered drug.
- fluphenazine
fluphenazine increases effects of enalapril by unspecified interaction mechanism. Minor/Significance Unknown.
- lornoxicam
lornoxicam decreases effects of enalapril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- maitake
maitake increases effects of enalapril by pharmacodynamic synergism. Minor/Significance Unknown.
- octacosanol
octacosanol increases effects of enalapril by pharmacodynamic synergism. Minor/Significance Unknown.
- parecoxib
parecoxib decreases effects of enalapril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- patiromer
patiromer, enalapril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
- perphenazine
perphenazine increases effects of enalapril by unspecified interaction mechanism. Minor/Significance Unknown.
- probenecid
probenecid increases effects of enalapril by unspecified interaction mechanism. Minor/Significance Unknown.
- prochlorperazine
prochlorperazine increases effects of enalapril by unspecified interaction mechanism. Minor/Significance Unknown.
- promazine
promazine increases effects of enalapril by unspecified interaction mechanism. Minor/Significance Unknown.
- promethazine
promethazine increases effects of enalapril by unspecified interaction mechanism. Minor/Significance Unknown.
- reishi
reishi increases effects of enalapril by pharmacodynamic synergism. Minor/Significance Unknown.
- rifampin
rifampin decreases levels of enalapril by increasing metabolism. Minor/Significance Unknown.
- salicylates (non-asa)
salicylates (non-asa) decreases effects of enalapril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- shepherd's purse
shepherd's purse, enalapril. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.
- thioridazine
thioridazine increases effects of enalapril by unspecified interaction mechanism. Minor/Significance Unknown.
- tizanidine
tizanidine increases effects of enalapril by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.
- tolfenamic acid
tolfenamic acid decreases effects of enalapril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- treprostinil
treprostinil increases effects of enalapril by pharmacodynamic synergism. Minor/Significance Unknown.
- trifluoperazine
trifluoperazine increases effects of enalapril by unspecified interaction mechanism. Minor/Significance Unknown.
- voclosporin
voclosporin will increase the level or effect of enalapril by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.
Adverse Effects
1-10%
Dizziness (4-8%)
Hypotension (0.9-6.7%)
Headache (2-5%)
Chest pain (2%)
Cough (1-2%)
Rash (1.5%)
Frequency Not Defined
Asthenia
Nausea
Vomiting
Hyperkalemia
Warnings
Black Box Warnings
Discontinue as soon as possible when pregnancy is detected; affects renin-angiotensin system, causing oligohydramnios, which may result in fetal injury and/or death
Contraindications
Hypersensitivity to enalapril/other ACE inhibitors
History of ACE inhibitor-induced angioedema, hereditary or idiopathic angioedema
Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan
Do not coadminister with aliskiren in patients with diabetes mellitus or with renal impairment (ie, GFR <60 mL/min/1.73 m²)
Bilateral renal artery stenosis
Cautions
Apheresis (LDL) with dextran sulfate, hypertrophic cardiomyopathy, collagen vascular disease, hemodialysis with high flux membrane, renal or aortic stenosis
For HTN patients on diuretics, if possible discontinue diuretics 2-3 days before starting enalapril
Excessive hypotension if concomitant diuretics, hypovolemia, hyponatremia
Risk of hyperkalemia, especially in patients with renal impairment or DM or in those taking concomitant K+-elevating drugs
Dual blockade of the renin angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for hypotension, hyperkalemia, and renal function changes (including acute renal failure) compared to monotherapy
Injection contains benzyl alcohol preservative (linked to potentially fatal "gasping syndrome" in preemies)
ACE inhibition also causes an increase in bradykinin levels, which putatively mediates angioedema
Angioedema of the face, extremities, lips, tongue, glottis, and larynx has been reported in patients treated with angiotensin-converting enzyme inhibitors
If laryngeal stridor or angioedema of the face, tongue, or glottis occurs discontinue therapy and institute appropriate therapy immediately
Patients receiving coadministration of ACE inhibitor and mTOR (mammalian target of rapamycin) inhibitor (e.g. temsirolimus, sirolimus, everolimus) therapy or a neprilysin inhibitor may be at increased risk for angioedema Intestinal angioedema has been reported in patients treated with ACE inhibitors
Dry hacking nonproductive cough may occur within few months of treatment; consider other causes of cough prior to discontinuation
Agranulocytosis, neutropenia, or leukopenia with myeloid hypoplasia reported with other ACE inhibitor; patients with renal impairment are at high risk; monitor CBC with differential in these patients
Discontinue STAT if patient becomes pregnant
Less effective in blacks
Renal impairment
Pregnancy & Lactation
Pregnancy
May cause fetal harm when administered to a pregnant woman; use of drugs that act on renin-angiotensin system during second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death; when pregnancy is detected, discontinue therapy as soon as possible
Hypertension in pregnancy increases maternal risk for pre-eclampsia, gestational diabetes, premature delivery, and delivery complications (e.g., need for cesarean section, and post-partum hemorrhage); hypertension increases fetal risk for intrauterine growth restriction and intrauterine death; pregnant women with hypertension should be carefully monitored and managed accordingly
Lactation
Enalapril and enalaprilat have been detected in human breast milk; because of potential for serious adverse reactions in breastfed infant, including hypotension, hyperkalemia, and renal impairment, advise women not to breastfeed during therapy
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Angiotensin converting enzyme (ACE) inhibitors dilate arteries and veins by competitively inhibiting the conversion of angiotensin I to angiotensin II (a potent endogenous vasoconstrictor) and by inhibiting bradykinin metabolism; these actions result in preload and afterload reductions on the heart
ACE inhibitors also promote sodium and water excretion by inhibiting angiotensin-II induced aldosterone secretion; elevation in potassium may also be observed
ACE inhibitors also elicit renoprotective effects through vasodilation of renal arterioles
ACE inhibitors reduce cardiac and vascular remodeling associated with chronic hypertension, heart failure, and myocardial infarction
Absorption
Bioavailability: 60%
Onset: 1 hr
Duration: 6 hr (IV), 12-24 hr (PO)
Peak plasma time: 15 min (IV), 1 hr (PO)
Onset of action
- Initial response for HTN: 15 min (IV), 1 hr (PO)
- Peak response for HTN: 1-4 hr (IV), 4-6 hr (PO)
Distribution
Protein bound: 50-60%
Metabolism
Liver (70%); enalapril undergoes hepatic biotransformation to enalaprilat within 4 hr following oral administration
Metabolites: Enalaprilat (active)
Elimination
Half-life elimination: 2 hr (parent drug), 35-38 hr (active metabolite [enalaprilat])
Dialyzable: Yes (hemodialysis)
Excretion: Urine (61%); feces (6% as enalapril, 27% as enalaprilat)
Administration
IV Incompatibilities
Y-site: Ampho B, ampho B chol SO4, cefepime, phenytoin
IV Compatibilities
Solution: D5W, Normosol R
Additive: Dobutamine, dopamine, heparin, meropenem, nitroglycerin, KCl, sodium nitroprusside
Y-site (partial list): Allopurinol, ampicillin, ampicillin-sulbactam, cefazolin, clindamycin, dobutamine, dopamine, esmolol, fentanyl, heparin, labetalol, linezolid, MgSO4, metronidazole, morphine SO4, nicardipine, KCl, propofol, tobramycin, TMP-SMX, vancomycin
IV Administration
Slow IVP over at least 5 minutes if undiluted, OR
Infused in up to 50 mL of compatible IV infusion solution
Storage
Clear, colorless solution
Store below 30°C
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Epaned oral - | 1 mg/mL solution |  | |
| enalapril maleate oral - | 2.5 mg tablet |  | |
| enalapril maleate oral - | 20 mg tablet |  | |
| enalapril maleate oral - | 5 mg tablet |  | |
| enalapril maleate oral - | 20 mg tablet |  | |
| enalapril maleate oral - | 10 mg tablet |  | |
| enalapril maleate oral - | 1 mg/mL solution |  | |
| enalapril maleate oral - | 20 mg tablet |  | |
| enalapril maleate oral - | 5 mg tablet |  | |
| enalapril maleate oral - | 5 mg tablet |  | |
| enalapril maleate oral - | 5 mg tablet |  | |
| enalapril maleate oral - | 10 mg tablet |  | |
| enalapril maleate oral - | 2.5 mg tablet |  | |
| enalapril maleate oral - | 20 mg tablet |  | |
| enalapril maleate oral - | 10 mg tablet |  | |
| enalapril maleate oral - | 2.5 mg tablet |  | |
| enalapril maleate oral - | 2.5 mg tablet |  | |
| enalapril maleate oral - | 10 mg tablet |  | |
| enalapril maleate oral - | 20 mg tablet |  | |
| enalapril maleate oral - | 20 mg tablet |  | |
| enalapril maleate oral - | 5 mg tablet |  | |
| enalapril maleate oral - | 2.5 mg tablet |  | |
| enalapril maleate oral - | 20 mg tablet |  | |
| enalapril maleate oral - | 10 mg tablet |  | |
| enalapril maleate oral - | 20 mg tablet |  | |
| enalapril maleate oral - | 2.5 mg tablet |  | |
| enalapril maleate oral - | 10 mg tablet |  | |
| enalapril maleate oral - | 10 mg tablet |  | |
| enalapril maleate oral - | 10 mg tablet |  | |
| enalapril maleate oral - | 5 mg tablet |  | |
| enalapril maleate oral - | 2.5 mg tablet |  | |
| enalapril maleate oral - | 10 mg tablet |  | |
| enalapril maleate oral - | 20 mg tablet |  | |
| enalapril maleate oral - | 1 mg/mL solution |  | |
| Vasotec oral - | 5 mg tablet | | |
| Vasotec oral - | 2.5 mg tablet | | |
| Vasotec oral - | 10 mg tablet | | |
| Vasotec oral - | 5 mg tablet |  | |
| Vasotec oral - | 20 mg tablet | |
Copyright © 2010 First DataBank, Inc.
Patient Handout
enalapril maleate oral
ENALAPRIL SOLUTION - ORAL
(en-AL-a-pril)
COMMON BRAND NAME(S): Epaned
WARNING: This drug can cause serious (possibly fatal) harm to an unborn baby if used during pregnancy. It is important to prevent pregnancy while taking this medication. Consult your doctor for more details and to discuss the use of reliable forms of birth control while taking this medication. If you are planning pregnancy, become pregnant, or think you may be pregnant, contact your doctor right away.
USES: Enalapril is used to treat high blood pressure. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. It is also used to treat heart failure and to help prevent people with a certain heart problem (left ventricular dysfunction) from developing heart failure.Enalapril belongs to a class of drugs known as ACE inhibitors. It works by relaxing blood vessels so blood can flow more easily.
HOW TO USE: Take this medication by mouth with or without food as directed by your doctor, usually once or twice daily.Carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.The dosage is based on your medical condition and response to treatment. For children, the dosage is also based on weight.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day. Keep taking this medication even if you feel well. Most people with high blood pressure do not feel sick.For the treatment of high blood pressure, it may take several weeks before you get the full benefit of this medication. For the treatment of heart failure, it may take weeks to months before you get the full benefit of this medication.Tell your doctor if your condition worsens (for example, your blood pressure readings increase).
SIDE EFFECTS: Dizziness, lightheadedness, or weakness may occur as your body adjusts to the medication. Dry cough may also occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: fainting, symptoms of a high potassium blood level (such as muscle weakness, slow/irregular heartbeat).Although enalapril may be used to prevent kidney problems or treat people who have kidney problems, it may also rarely cause serious kidney problems or make them worse. Your doctor will check your kidney function while you are taking enalapril. Tell your doctor right away if you have any signs of kidney problems such as a change in the amount of urine.Enalapril may rarely cause serious (possibly fatal) liver disease. Get medical help right away if you have any symptoms of liver damage, including: nausea/vomiting that doesn't stop, loss of appetite, dark urine, stomach/abdominal pain, yellowing eyes/skin.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking enalapril, tell your doctor or pharmacist if you are allergic to it; or to other ACE inhibitors (such as benazepril); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: history of an allergic reaction which included swelling of the face/lips/tongue/throat (angioedema), blood filtering procedures (such as LDL apheresis, dialysis), high level of potassium in the blood.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Too much sweating, diarrhea, or vomiting may cause dehydration and increase your risk of lightheadedness. Report prolonged diarrhea or vomiting to your doctor. Be sure to drink enough fluids to prevent dehydration unless your doctor directs you otherwise.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).This medication may increase your potassium levels. Before using potassium supplements or salt substitutes that contain potassium, consult your doctor or pharmacist.Older adults may be more sensitive to the side effects of this drug, including dizziness and increases in potassium level.Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using enalapril. Enalapril may harm an unborn baby. If you become pregnant, talk to your doctor right away about the risks and benefits of this medication. Consult your doctor for more details. (See also Warning section.)This medication passes into breast milk but is unlikely to harm a nursing infant. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: See also Precautions section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: aliskiren, certain drugs that weaken the immune system/increase the risk of infection (such as everolimus, sirolimus), lithium, drugs that may increase the level of potassium in the blood (such as ARBs including losartan/valsartan, birth control pills containing drospirenone), sacubitril.Some products have ingredients that could raise your blood pressure or worsen your heart failure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).A very serious reaction may occur if you are getting injections for bee/wasp sting allergy (desensitization) and are also taking enalapril. Make sure all your doctors know you use this drug.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe dizziness, fainting.
NOTES: Do not share this medication with others.Lifestyle changes that may help this medication work better include exercising, stopping smoking, and eating a low-cholesterol/low-fat diet. Consult your doctor for more details.Lab and/or medical tests (such as kidney function, potassium levels) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.Have your blood pressure checked regularly while taking this medication. Learn how to monitor your own blood pressure at home, and share the results with your doctor.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Different brands of this medication have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised November 2022. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
