Enalapril

What is Enalapril?

Enalapril is in a class of drugs known as ACE inhibitors.  It is prescribed primarily to  lower blood pressure, but can also treat heart failure and protect kidney function.

How does Enalapril work?

Enalapril works by interfering with an enzyme known as “angiotensin converting enzyme” (ACE).  This enzyme functions to convert angiotensin from its inactive form, known as angiotensin I, to its active form, angiotensin II.  Angiotensin II then binds to arteries, causing them to constrict, thereby raising blood pressure.  By reducing levels of angiotensin II in the circulation, Enalapril allows blood vessels to relax and widen, leading to lower blood pressure.  

How long does Enalapril take to work?

Enalapril usually begins to work in as little as an hour after ingestion and can remain effective for 24 hours or longer.  Hypertension (high blood pressure) is frequently a condition without symptoms.  Despite a lack of symptoms, an individual with uncontrolled hypertension is at risk of serious complications such as heart attacks or strokes.  You may not feel any different after taking Enalapril or other blood pressure medications, however, this does not mean that the medication is not working, and it is important that you continue taking it as prescribed by your doctor.  
 

How effective is Enalapril?

Enalapril is very effective in lowering blood pressure, although the full effect of the medication may not be felt for several weeks. Enalapril can lower mean blood pressure by an average of 5 to 20 points depending on the dose.  Treatment with Enalapril, and antihypertensive therapy in general, is most effective when used long-term.  For many patients, this will be a life-long commitment, even if blood pressure is well controlled.  Blood pressure is likely to rise again, and complications are more likely to occurr, if the medication is discontinued. 

Enalapril is also available as a single tablet in combination with Hydrochlorthiazide.  When combined with Hydrochlorthiazide which is a diuretic (water pill), Enalapril is more effective in lowering blood pressure.  More information on this combination tablet is available below.

Active ingredients

The active ingredient in Enalapril is enalapril maleate.

Inactive ingredients

The inactive ingredients in Enalapril are lactose, magnesium stearate, sodium bicarbonate, and starch.

Which ingredients can cause an allergic reaction?

It is possible to have a severe allergic reaction to enalapril. The incidence of a severe allergic reaction is not known. If you do notice any symptoms of a severe allergic reaction such as lip/eye swelling, chest tightness, hard to breathe and dizziness, please contact emergency medical services as soon as possible. While enalapril does contain lactose, it is present in very small amounts that will not cause uncomfortable symptoms if you are lactose intolerant. 

How to take Enalapril

Enalapril should be swallowed whole with a glass of water, with or without food. Depending on your doctor’s instructions, you may need to take Enalapril once or twice a day.  Twice daily dosing is usually administered as a morning dose and an evening dose, 10 to 12 hours apart.  Due to possible effects of dizziness, it may be advised that you take your first dose before bedtime. If no such effects are experienced, it is safe to take Enalapril at any time of day; although, it should be taken at the same time daily.   

What should I do if I miss a dose of Enalapril?

If you forget to take a dosage of Enalapril, skip the missed dose altogether and wait until your next scheduled dose. It is important not to take a double dose to make up for a missed one as this can cause undesired side effects.

Side Effects

The most common side effects of Enalapril are:

• Headache (5.5% of people)
• Dizziness (8.6% of people)
• Fatigue (3.9% of people)
• Dry cough (3.5% of people)
• Increase in blood potassium levels (2.0 %)
• Rarely, swelling of the face, lips, tongue, throat, and extremities may occur.  This reaction is known as angioedema. If this occurs, discontinue the medication and seek immediate medical attention.

Drug Interactions

Enalapril can interact with drugs from the following categories:

• Antidiabetic Agents
• Diuretics
• Lithium
• Nitrates
• NSAIDs or NSAIAs

Contraindications

Enalapril should be avoided if any of the following situations apply:

• Hypersensitivity to Enalapril or any component of the formulation
• Angioedema related to previous treatment with an ACE inhibitor
• Pregnancy, as it is toxic to the fetus. If you are pregnant, you should speak to your doctor about alternative high blood pressure treatments. 
• Idiopathic or hereditary angioedema
• Concomitant use with aliskiren in patients with diabetes mellitus
• Sacubitril use or within 36 hours of switching to or from sacubitril

Enalapril vs Enalipril with Hydrochlorothiazide

Medzino offers both Enalapril and Enalapril in combination with Hydrochlorothiazide (known by the brand name Vasoretic).  Hydrochlorothiazide is a diuretic (water pill), and when combined with Enalapril, works better to lower blood pressure than either medication alone.  On average, Hydrochlorothiazide combined with Enalapril can lead to an additional 10 point reduction in mean blood pressure.  The effect is dose dependent.  

Hydrochlorothiazide

Hydrochlorothiazide is a type of thiazide diuretic and works to reduce the amount of water in the body by increasing urination. Reducing the amount of water in the body also reduces the amount of total fluid inside the blood vessels.  This, in turn, reduces the pressure inside the vessels and thereby lowers blood pressure.

Hydrochlorothiazide is used to treat high blood pressure alone or in combination with other medications such as Enalapril.  It is also used to treat edema (fluid retention), which can be caused by different conditions such as heart failure or cirrhosis of the liver.  

While it is commonly prescribed as a first-line agent for high blood pressure, Hydrochlorothiazide may not be appropriate for some patients and should be generally avoided by individuals with the following conditions:

• Anuria (an inability to urinate)
• Sulfa drug allergy
• Asthma 
• Diabetes 
• Electrolyte abnormalities such as low sodium, low potassium, low calcium or low magnesium
• Gout or hyperuricemia (high levels of uric acid in the blood)
• Hypoglycemia (low blood sugar) 
• Use with caution and only after discussion with your doctor if you have kidney disease, liver disease or systemic lupus erythematosis (SLE)

Multiple medications or supplements may interact with Hydrochlorothiazide.  Please consult your doctor or pharmacist if you are taking any medications or herbal supplements before taking Hydrochlorothiazide.