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Why it's used

Enalapril is used to treat high blood pressure. It is a prescription medicine. This medicine works by blocking the action of angiotensin-converting enzyme (ACE), which is responsible for the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II, that results in increased blood pressure. This medicine helps by reducing the increased blood pressure. Enalapril is also used to treat symptomatic heart failure. It is also used to prevent heart failure in patients with asymptomatic left ventricular dysfunction in the left part of the heart.
Enalapril may also be taken in combination with other medicines to treat certain conditions as recommended by the doctor. Enalapril is used together with diuretics to treat high blood pressure and heart failure. Enalapril is also used with digitalis to treat heart failure and patients with asymptomatic left ventricular dysfunction in the left part of the heart. Enalapril is also used with beta-blockers for the management of heart failure and patients with asymptomatic left ventricular dysfunction in the left part of the heart.
Angiotensin Converting Enzyme Inhibitor
Enalapril belongs to a class of medicines called Angiotensin Converting Enzyme Inhibitor. Angiotensin-converting enzyme (ACE) inhibitors treat a variety of conditions, such as high blood pressure, migraines, and scleroderma. It helps in relaxing the blood vessels.

How to use

Read the medicine guide provided by your pharmacist, your doctor, or the medicine company. If you have any questions related to Enalapril, ask your doctor or pharmacist. Use Enalapril as per the instructions provided by your doctor.
Enalapril is used with or without food. The absorption of Enalapril is not interfered by the presence of food. Tap the Enalapril powder bottle for an oral solution on a hard surface for five times. Add about one-half (75 ml) of the diluent to the 150 ml Enalapril powder for Oral Solution. Shake properly for about 30 sec and then reopen. Add the remaining of the diluent to the Enalapril powder for oral solution, and shake well for extra 30 seconds. Calculate 60 days from the date of its preparation. Add "Do Not Use After” or a “Discard After” tag with the calculated date added to the reconstituted Enalapril bottle.
The typical dose of Enalapril for adults is 40 mg daily. The usual dose for children is 5 mg once a day. The maximum dose for adult patients of Enalapril is 40 mg per day. Enalapril is commonly used at the same time every day. It takes 1 hour for this medicine to start its action.
This medicine should be used on an as-needed basis. Typically used for long-term in case of high blood pressure. Enalapril should be used as directed by the doctor even if you feel well, or even if you think that there is no need for you to use your medicine.
Discuss with your doctor if you develop new symptoms. Discuss with your doctor if dizziness, lightheadedness, difficulty in breathing, swelling of the face, swelling of the lips, tongue or throat, swelling of the hands, feet or ankles, rash, peeling skin, sore throat or fever, ringing in the ears, reduction in blood cell count, yellowing of the skin, lower hemoglobin, lowering of blood platelets, temporary loss of consciousness, vomiting, diarrhea, excessive sweating, and dehydration. If you have any kidney disease, For patients with kidney damage, the treatment with Enalapril should be started at a low dose. Also, the dosage interval between taking the next dose of Enalapril should be extended and dosage should be reduced. If you have issues with the health of your liver, The patients who are on treatment with Enalapril and develop yellow discoloration of skin or an increase in liver enzymes should discontinue the use of Enalapril and begin appropriate treatment. Consult with your doctor before stopping the use of Enalapril.
Your doctor may prescribe a lower starting dose of this medicine to understand the impact on the body. Please follow your doctor's recommendations. A lower dose of this medicine may be recommended to reduce the risk of side-effects. Older patients may see an increase in the incidence of side-effects. As a result, a lower dose may be recommended for older patients.
If you are giving Enalapril to a child, be sure to use a product that is for use in children. Use the child's weight or age to find the right dose from the product package or medicine label. You can also read the dosage section of this page to know the correct dose for your child. Else, consult with your doctor and follow their recommendation.
Limit drinking alcohol with Enalapril.
Your doctor may request that specific lab tests be performed before you start using Enalapril. Your doctor may ask you to undergo Blood Pressure test. Blood pressure should be monitored both before and after the treatment with Enalapril since cases of low blood pressure have been reported. Your doctor may request Kidney Function Panel test. Test for the functioning of kidneys should be performed both before and after the treatment with Enalapril since cases of kidney failure have been reported.
Medicines may be recommended for uses other than those listed in the medicine guide. You should not use Enalapril for conditions or symptoms for which it was not prescribed. Do not give Enalapril to other people, even if they have the same conditions or symptoms that you have. The use of this medicine without the advice of a doctor may cause harm.
Follow storage instructions on the product package if available. Store Enalapril 15°C-30°C (59°F-86°F), and away from moisture. Store this medicine away from children and pets.

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How to take Enalapril

Your dose and how often you take Enalapril will depend on the following factors:
  • age
  • weight
  • patient's health
  • the health of the patient's liver
  • the health of the patient's kidneys
  • response to the medicine

Enalapril Dosage

Dosage for high blood pressure

Adult
  • Recommended: 20mg in a day
  • Initial: 5 mg once per day
  • Maximum: 40 mg once per day or in two divided doses
Children (children more than 1 month of age)
  • Initial: 0.08 mg/kg (0.036 mg/lb) once in a day
  • Maximum: 5 mg in a day

Dosage for symptomatic heart failure

Adult
  • Initial: 2.5 mg twice a day
  • Maximum: 20 mg twice a day

Dosage for heart failure in patients with asymptomatic left ventricular dysfunction in the left part of the heart

Adult
  • Initial: 2.5 mg twice a day
  • Maximum: 10 mg twice a day

Minimum Age

infants more than 1 month

Dosage calculation for children

To calculate the dosage for children please use the weight based dose calculator to calculate the appropriate dosage as per the weight of your child.

Forms

Tablet
Strength: 2 mg, 2.5 mg, 4 mg, 5 mg, 8 mg, 10 mg, 16 mg, and 20 mg
Solution
Strength: 1 mg/1mL

Special Instructions

Use with diuretics
Enalapril may use with a low dose of diuretic if further lowering of blood pressure is required and suggested dose in a patient taking diuretics is 2.5 mg daily.
Patients with a low sodium level in the blood
The recommended initial dose is 2.5 mg once daily in the patients with sodium levels in the blood less than 130 mEq/L or blood creatinine greater than 1.6 mg/dL.

Missed Dose

A missed dose should be taken as early as you remember it. However, if the time for the next dose is almost there, then the missed dose should be skipped, and the regular dosing schedule should be continued. Avoid taking a repeated dose to make up for a missed dose.

Overdose

What to do if you overdose on Enalapril?
The suggested treatment of overdosage is in the veins infusion of normal saline solution. Enalapril may be withdrawn from general circulation by hemodialysis.
Symptoms of an overdose of Enalapril
If you use too much of this medicine, it could lead to dangerous levels of the medicine in your body. In such cases, symptoms of an overdose may include:
If you think you have overdosed on Enalapril, call a poison control center immediately. You can look up the poison control center information from the Poison Center Finder at TabletWise.com.

Precautions while using Enalapril

Before you use Enalapril, tell your doctor if you are allergic to it or its ingredients. Your doctor may prescribe an alternative medicine and update your medical records to record this information. Discuss with your doctor if you are allergic to previous treatment with an angiotensin-converting enzyme (ACE) inhibitor.
Before you use Enalapril, tell your doctor of your medical history including heart disease, kidney disease, hardening of connective tissue (scleroderma), high blood sugar, airway surgery, swelling under the lower layer of the skin, damage in the major blood vessels of the heart, high blood pressure, or low levels of sodium in the blood. Patients who have a history of swelling below lower layer of the skin may be are at an increased risk of some fatal reactions such as swelling of the face, lips, and tongue while receiving treatment with ACE inhibitors. Patients in whom there is an involvement of the tongue, space between vocal folds (glottis) or larynx are likely to experience obstruction of the airways, especially those who have a history of airway surgery. Before having any surgery, discuss with your doctor and dentist about medicines you use including prescription medicines, non-prescription medicines, and herbal supplements.
The use of Enalapril may change red blood cells level. Abnormal deficiency of healthy red blood cells has been reported in patients who are on treatment with ACE inhibitors. The use of Enalapril should be done very cautiously in patients with blood disorders, immunosuppressant therapy, and in patients who are on treatment with other medicines such as allopurinol or procainamide, or if there is existing kidney dysfunction. Patients undergoing treatment with Enalapril should undergo frequent monitoring of blood cells count.
The use of this medicine may change white blood cells (agranulocytes and thrombocytes). Abnormal low levels of agranulocytes have been reported in patients who are on treatment with ACE inhibitors. The use of Enalapril should be done very cautiously in patients with blood disorders, immunosuppressant therapy, and in patients who are on treatment with other medicines such as allopurinol or procainamide, or if there is existing kidney dysfunction. Patients undergoing treatment with Enalapril should undergo frequent monitoring of white blood cells count.
The use of Enalapril may change potassium levels. The levels of potassium should be monitored carefully in patients on treatment with Enalapril. Drugs that block the renin-angiotensin system can cause an abnormal increase in potassium levels.
Enalapril is not safe for use in women who are pregnant. If you are pregnant or planning to become pregnant, you should discuss the impact on the fetus with your doctor before you start using this medicine. Enalapril causes harm to an unborn baby when it is given to a pregnant woman. Using drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces the functioning of kidneys of the fetus and increases the risk of fatalities associated with childbirth. Enalapril is not safe for use in women who are breastfeeding. If you are breastfeeding, discuss with your doctor if you should either discontinue breastfeeding, or stop using this medicine during this period. Enalapril and its breakdown product have been found to be present in human breast milk. Because of the risk of serious side effects in the breastfed child including low blood pressure, abnormally increased levels of potassium in the blood and kidney dysfunction, women should be advised not to breastfeed during treatment with Enalapril. Enalapril may impact fertility in women. If you are trying to conceive, discuss with your doctor on the use of this medicine. In case you become pregnant during treatment with Enalapril, consult the doctor immediately.
Limit drinking alcohol with Enalapril. Consumption of alcohol may cause the enhanced lowering blood pressure effect of ACE inhibitors.
Enalapril can make you feel sleepy. Be careful, especially while driving, while using heavy machinery, or when doing any activity that needs you to be completely alert. The consumption of alcohol with Enalapril can worsen the sleepiness.
This medicine may increase your sensitivity to sunlight and make you prone to sunburn. If this happens, limit your time outdoors to prevent sunburn. Use a sunscreen and cover your skin when you are outdoors. If you get sunburns on your body, consult with your doctor.
Older patients may have a higher incidence of side-effects when using Enalapril.

What precautions should be taken during Pregnancy and Nursing, and administering Enalapril to Children or the Older Adults?

Pregnant Women

Contraindication
Warning: Enalapril causes harm to an unborn baby when it is given to a pregnant woman. Using drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces the functioning of kidneys of the fetus and increases the risk of fatalities associated with childbirth.

Breastfeeding

Contraindication
Warning: Enalapril and its breakdown product have been found to be present in human breast milk. Because of the risk of serious side effects in the breastfed child including low blood pressure, abnormally increased levels of potassium in the blood, and kidney dysfunction, women should be advised not to breastfeed during treatment with Enalapril.

Younger Adults Population

Possibly safe
Warning: Enalapril is not recommended for children of 1 month or less.

Older Adults Population

Precaution
Warning: Elderly patients undergoing treatment with Enalapril are at an increased risk to experience decreased functioning of kidneys. Care should be taken while selecting a dose.

Enalapril Side-effects

The following side-effects may commonly occur when using Enalapril. If any of these side-effects worsen or last for a long time, you should consult with your doctor:
The following side-effects may commonly occur in older patients on the use of Enalapril. Discuss with your doctor if any of these side-effects last for a long time or are severe:
  • kidney dysfunction
Rarely, the use of Enalapril may cause the following side-effects:
  • abnormal skin sensation (dysesthesia)
  • accumulation of eosinophils in the lungs (eosinophilic pneumonitis)
  • anemia
  • black tarry stools (melena)
  • blockage of arteries in the heart due to a blood clot (pulmonary embolism)
  • change in voice (hoarseness)
  • confusion
  • constipation
  • decrease in blood pressure while standing
  • development of the breasts in males (gynecomastia)
  • dream abnormality
  • dry eyes
  • dry mouth
  • excessive sleepiness
  • excessive sweating (diaphoresis)
  • fever
  • flushing
  • heart attack (cerebrovascular accident)
  • hives
  • inability of a man to achieve an erection during sexual intercourse (impotence)
  • inability of the intestine to contract and move the waste out of the body (ileus)
  • increased number of eosinophils (eosinophilia)
  • indigestion (dyspepsia)
  • inflammation and soreness of the mouth
  • inflammation of blood vessels (vasculitis)
  • inflammation of joints (arthritis)
  • inflammation of muscles (myositis)
  • inflammation of the pancreas (pancreatitis)
  • inflammation of tissues lining chest and stomach (serositis)
  • inflammation of tongue (glossitis)
  • insomnia
  • intense itching
  • kidney dysfunction
  • loss of hair
  • low blood sugar level (hypoglycemia)
  • muscle cramps
  • nervousness
  • numbness in some body parts (Raynaud's phenomenon)
  • pain in joints (arthralgia)
  • pain in muscles
  • pain in the upper part of the stomach, back and sides (Flank pain)
  • presence of excessive proteins in urine
  • rapid or abnormal heartbeat
  • redness and shedding of the skin (exfoliative dermatitis)
  • ringing in the ears (tinnitus)
  • runny nose (rhinorrhea)
  • serious eating disorder (anorexia)
  • sore throat
  • sticky substance within the lungs (pulmonary infiltrates)
  • test for antibodies (positive ANA)
  • test that measures how long red blood cells take to settle down (an increased erythrocyte sedimentation rate)
  • tingling sensation in the skin
  • vertigo
  • vomiting
  • weakness and pain due to nerve damage in hands and feet (peripheral neuropathy)
The following severe side-effects may also occur when using Enalapril:
  • heart and blood disorders
    Symptoms: loss of heart function (cardiac arrest), high blood potassium levels (hyperkalemia), reduced heartbeat (bradycardia), irregular and rapid heart rate (atrial fibrillation), abnormally decreased count of neutrophils (rare cases of neutropenia), abnormally decreased count of thrombocytes, decreased production of cells (bone marrow depression), increased number of white blood cells (leukocytosis) heart attack
  • liver disorders (The use of Enalapril should be discontinued if patients develop such symptoms.)
    Symptoms: liver failure, inflammation of the liver (hepatitis) yellow discoloration of the skin (jaundice)
  • lung disorders
    Symptoms: fluid accumulation in the lungs, lung infection (upper respiratory infection) tightening of muscles of airways of lungs (bronchospasm)
  • allergic reactions
    Symptoms: serious and life-threatening skin disorder (Stevens-Johnson syndrome), a skin disease characterized by blisters (pemphigus), allergic reactions due to infections (erythema multiforme), sensitivity to the sun (photosensitivity), inflammation of the eye (conjunctivitis), tearing reactivation of the chickenpox virus in the body which causes painful rashes (herpes zoster)
Your doctor has prescribed this medicine because they judge that the benefit is greater than the risk posed by side-effects. Many people using this medicine do not have serious cases of side-effects. This page does not contain a complete list of all possible side-effects.
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at TabletWise.com.

Side-effects and Allergic Reactions of Enalapril by Severity and Frequency

Common Side-effects

Following are the common side-effects of this medicine:

Infrequent and Rare Side-effects

Following are the infrequent and rare side-effects of this medicine:

Severe Side-effects

Following are the severe side-effects of this medicine:
  • abnormally decreased count of neutrophils (rare cases of neutropenia)
  • abnormally decreased count of thrombocytes (thrombocytopenia)
  • allergic reactions due to infections (erythema multiforme)
  • bronchospasm or asthma
  • decreased production of cells (bone marrow depression)
  • fluid accumulation in the lungs
  • herpes zoster
  • high blood potassium levels (hyperkalemia)
  • increased number of white blood cells (leukocytosis)
  • inflammation of the eye (conjunctivitis)
  • irregular and rapid heart rate (atrial fibrillation)
  • liver failure (hepatic failure)
  • loss of heart function (cardiac arrest)
  • lung infection (upper respiratory infection)
  • reduced heartbeat (bradycardia)
  • sensitivity to the sun (photosensitivity)
  • serious and life-threatening skin disorder (Stevens-Johnson syndrome)
  • skin disease characterized by blisters (pemphigus)
  • tearing

Side-effects in Older Adults

Following are the side-effects of this medicine in elderly patients:
  • kidney dysfunction

Mild Allergic Reactions

Following are the symptoms of mild allergic reactions to this medicine:

Serious Allergic Reactions

Following are the symptoms of serious allergic reactions to this medicine:
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at TabletWise.com.

Warnings

Patients with low blood sugar

Patients who are on treatment with blood sugar lowering agents and Enalapril such as Enalapril are at an increased risk to develop low blood sugar during the first month of the treatment with this combination. Such patients should be informed to closely monitor for reduced levels of sugar in the blood.

Decreased white blood cells (neutrophils, thrombocytes, or agranulocytes)

Patients who are undergoing treatment with Enalapril, who have blood disorders, undergoing immunosuppressant therapy, patients who are on treatment with other drugs such as allopurinol or procainamide, in addition to existing kidney failure are at an increased risk when using this medicine. These patients have experienced a decrease in the number of white blood cells in the blood. Enalapril should be used under careful supervision in such patients and frequent monitoring of white blood cells is advised to patients. They should also be informed to report any sign of infection.

Abnormal thickening of heart muscles

Patients with problems in blood flow from the heart (left ventricular valvular and outflow tract obstruction) are at an increased risk when using this medicine. Such patients who have left ventricular valvular and outflow tract obstruction should take Enalapril with caution. It should be avoided in patients with cardiogenic shock in which heart cannot pump enough blood to meet the needs of the body and who have significant obstruction of blood.

Anaphylactoid reactions (during desensitization and dialysis)

Patients experiencing low-density lipoprotein apheresis with dextran sulfate absorption, desensitizing therapy with Hymenoptera venom while receiving Enalapril, and patients dialyzed with high-flux membranes and treated in combination with Enalapril are at an increased risk for life-threatening allergic reaction. Dialysis must be stopped instantly, and aggressive therapy for allergic reactions must be started in such patients. A different kind of dialysis membrane or a distinct class of antihypertensive agent should be considered in such patients.

Swelling in the lower layer of the skin

Patients with a history of swelling of the lower layer of the skin unrelated to ACE inhibitor therapy, combined use of Enalapril and mTOR inhibitor (e.g., temsirolimus, everolimus, and sirolimus) therapy may be at an increased risk. Swelling of the face, lips, extremities, tongue, glottis or larynx, including fatal reactions, have occurred in patients treated with Enalapril. These patients are likely to experience airway obstruction, especially those with a history of airway surgery. Intestinal swelling has been seen in patients treated with Enalapril. These patients were shown to have stomach pain with or without vomiting or nausea; in some cases, there was no history of facial swelling and level of C-1 esterase were normal. Enalapril should be immediately discontinued and proper therapy or monitoring should be given until full and continued purpose of signs and symptoms of swelling of the lower layer of the skin has appeared. Swelling of the lower layer of the skin should be diagnosed by procedures including ultrasound or abdominal CT scan, or at surgery, and symptoms solved after stopping Enalapril.

Increased potassium level

Patients with high blood sugar (diabetes mellitus), poor function of the kidneys, and the combined use of potassium-sparing diuretics, potassium-containing salt substitutes or potassium supplements are at an increased risk of a rise of high potassium level. Drugs that block the renin-angiotensin system can cause high potassium level. Potassium levels in the blood should be monitored in patients receiving Enalapril.

Abnormal functioning of kidneys

Patients with narrowing of arteries carrying blood to one or both of the kidneys (kidney artery stenosis), severe congestive heart failure, long-term kidney disease, and post-heart attack or volume depletion may be at an increased risk of acquiring acute kidney failure when using this medicine. Changes in the functioning of kidneys including acute kidney failure can be induced by Enalapril. Also, such patients are at an increased risk to experience a change in blood levels of creatinine. Monitoring of the functioning of kidneys is required in patients treated with Enalapril. Discontinuation of the therapy is recommended in patients with a decrease in the functioning of the kidney.

Liver failure

ACE inhibitors including Enalapril have been related to a syndrome that starts with reduced bile flow from the liver (cholestatic jaundice) and progresses to a severe abnormality of liver function (hepatic necrosis) and sometimes fatal. Patients taking ACE inhibitors who develop yellowing of the eyes and skin (jaundice) or raised liver enzymes should discontinue ACE inhibitor and seek proper medical follow-up.

Low blood pressure

Patients with severe narrowing of the valve of aorta (aortic stenosis) or thickening of heart muscle (hypertrophic cardiomyopathy), heart failure with systolic blood pressure below 100 mmHg, ischemic heart disease, brain disease, low sodium level, high dose diuretic therapy, kidney dialysis, and salt depletion or severe volume of any cause are at an increased risk when using this medicine. Enalapril can cause symptomatic low blood pressure, sometimes complicated by decreased production of urine, abnormally high levels of nitrogen-containing compounds, acute kidney failure or fatality. In patients undergoing extreme surgery or while using anesthesia with agents that produce low blood pressure, Enalapril may block angiotensin II production secondary to renin release. Also, such patients are at an increased risk to experience a change in blood levels of creatinine. In patients with low blood pressure, Enalapril should be started under close medical supervision, and such patients should be followed nearly for the first two weeks of therapy and whenever Enalapril dose or diuretic dose is raised. In patients undergoing surgery or anesthesia, if low blood pressure occurs and is considered to be through angiotensin II production mechanism, it can be improved by volume expansion.

Fetal damage

Pregnant women and newborns are at an increased risk when using this medicine. Use of Enalapril during pregnancy (second and third trimesters) reduces fetal functioning of kidneys, increases fetal and newborn diseased state and fatality rate. It can result in a deficiency of amniotic fluid which can be related to fetal lung incomplete development (hypoplasia) and skeletal abnormalities. Possible neonatal side effects include an underdeveloped skull, non-passage of urine, low blood pressure, kidney failure, and fatality. Discontinue Enalapril as soon as pregnancy is suspected.

Cough

The patients who are on treatment with Enalapril are at an increased risk to develop cough which disappears after the drug is discontinued.

Patients undergoing surgery or temporary loss of consciousness (anesthesia)

Patients undergoing major surgery or anesthesia along with drugs that result in reduced blood pressure, Enalapril blocks the formation of angiotensin II, a substance which is responsible for the constriction of vessels. If a reduction in blood pressure occurs due to this mechanism, volume expansion can be used as a correcting measure.

Patients taking lithium

Treatment with lithium and Enalapril is generally not recommended.

Blockage of the renin-angiotensin-aldosterone system (RASS)

The patients who are on treatment with Enalapril, angiotensin II receptor blockers and aliskiren are at an increased risk. Such patients may develop low blood pressure, increased levels of potassium in the blood, and decreased functioning of kidneys. Dual blockage of RASS due to the use of Enalapril, angiotensin II receptor blockers and aliskiren in combination is not recommended.

Patients with lactose intolerance

Patients with family history problems of inability to digest galactose (galactose intolerance), deficiency of lactase enzyme (Lapp lactase deficiency) or glucose-galactose intolerance are at an increased risk because Enalapril contains lactose which will not be absorbed if taken by such patients. The use of Enalapril in such patients is not recommended.

Interactions with Enalapril

When two or more medicines are taken together, it can change how the medicines work and increase the risk of side-effects. In medical terms, this is called as a Drug Interaction.
Enalapril may interact with Non-Steroidal Anti-Inflammatory Agents (NSAIDs), which are used as pain relievers and in a condition such as arthritis. It may result in deterioration of the functioning of kidneys, including potential acute kidney failure which usually is reversible. NSAIDs may also reduce the antihypertensive effect of Enalapril. Monitor functioning of kidneys regularly in patients taking Enalapril and NSAID therapy.
There may be an interaction of Enalapril with Renin-angiotensin inhibitors, which are used to reduce high blood pressure. Increased risks of low blood pressure, high potassium level, and changes in the functioning of kidneys (including acute kidney failure) are associated with dual blockade of the renin-angiotensin system with Enalapril. Combined usage of RAS inhibitors should be avoided. Close monitoring of blood pressure, the functioning of kidneys, and electrolytes in patients on Enalapril and other agents that affect the renin-angiotensin system. The use of aliskiren with Enalapril in patients with kidney abnormality and diabetes should be avoided.
Enalapril interacts with Agents increasing blood potassium levels such as spironolactone, triamterene, or amiloride, which are used to treat low potassium levels and heart failure. Enalapril reduces potassium loss caused by thiazide-type diuretics. Potassium supplements, or potassium-containing salt substitutes, potassium-sparing diuretics may lead to a notable increase in blood potassium level.
Special instructions need to be followed while taking this medicine along with Lithium which is used to treat mental illnesses, eating disorders, and blood disorders. Lithium poisoning has been notified in patients taking Enalapril and lithium together which was usually reversible. Blood lithium levels should be monitored frequently if Enalapril is taken in combination with lithium.
Your doctor's guidelines may need to be followed while taking this medicine along with Gold (sodium-aurothiomalate) which is used for its anti-inflammatory action in the treatment of rheumatoid arthritis. Symptoms such as nausea, facial flushing, vomiting, and low blood pressure have been notified rarely in patients on treatment with sodium aurothiomalate (injectable gold) and Enalapril therapy together.
Enalapril may interact with mTOR inhibitors, which are used in the treatment of kidney cancer. Patients taking Enalapril and mTOR inhibitor (e.g., sirolimus, temsirolimus, everolimus) treatment may be at an increased risk for swelling of the lower layer of the skin.
There may be an interaction of Enalapril with Alcohol, which is used as an antiseptic, disinfectant, and an antidote. Alcohol enhances the blood pressure lowering effect of Enalapril.
Enalapril interacts with Sympathomimetics, which are used to treat low blood pressure. Sympathomimetics may decrease the blood pressure lowering effects of Enalapril.
Special instructions need to be followed while taking this medicine along with Co-trimoxazole, which is used to treat certain bacterial infections. Patients taking Enalapril and trimethoprim/sulfamethoxazole (co-trimoxazole) together may be at an increased risk for high potassium level.
Your doctor's guidelines may need to be followed while taking this medicine along with Other antihypertensives, which are used to treat high blood pressure. The use of antihypertensive agents and Enalapril together may increase the blood pressure lowering effects of Enalapril. The use of nitroglycerine and other nitrates or vasodilators with Enalapril may further decrease the blood pressure.
Enalapril may interact with Tricyclic antidepressants, which are used to treat depression, anxiety, and certain kinds of pain. The combined use of tricyclic antidepressants with Enalapril may result in further lowering of blood pressure.
There may be an interaction of Enalapril with Diuretics (thiazide or loop diuretics), which are used to treat high blood pressure. History of high dose diuretics use may result in volume depletion and a risk of low blood pressure when starting therapy with Enalapril. The blood pressure lowering effect can be decreased by the discontinuation of the diuretic, by salt intake, or increasing volume or by starting therapy with a low dose of Enalapril.
This page does not contain all the possible interactions of Enalapril. Share a list of all medicines that you use with your doctor and pharmacist. Do not start, stop, or change the dose of any medicines without the approval of your doctor.

Interactions of Enalapril by Severity

Serious

The following medicines may interact when taken together and can cause harmful effects in the body. Please consult with your doctor or pharmacist before taking these medicines together.

Moderate

The following medicines may interact when taken together and can increase your risk of harmful effects. Please consult with your doctor or pharmacist before taking these medicines together.

When should Enalapril be not used?

Swelling of the lower layer of the skin

Enalapril should not be used in patients with a history or a family history of swelling of the lower layer of the skin. It is also not to be used in patients with an unknown cause of swelling of the lower layer of the skin. These patients may have the following symptoms if they use this medicine:
  • swelling of the face, extremities, lips, tongue and glottis
  • swelling of larynx
  • blockage in any part of the airway (airway obstruction)

Use of Aliskiren

Aliskiren should not be used with Enalapril in patients with diabetes or kidney abnormality. These patients may have the following symptoms if they use this medicine:
  • decreased blood pressure
  • increased level of potassium
  • changes in the functioning of kidneys
  • acute kidney failure

Use in pregnancy

Enalapril should not be used in second and third trimesters of pregnancy. Enalapril causes harm to an unborn baby when it is given to a pregnant woman. Using drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces the functioning of kidneys of the fetus and increases the risk of fatalities associated with childbirth.

History of a severe allergic reaction related to previous therapy with Enalapril

Enalapril should not be used in patients with a history of severe allergic reaction. There is a risk of sudden and possibly life-threatening allergic reactions. These patients may have the following symptoms if they use this medicine:
  • redness and peeling of the skin over the body (exfoliative dermatitis)
  • severe skin reaction
  • watery blisters form on the skin (pemphigus)
  • severe painful rash (herpes zoster)
  • infectious skin reaction (erythema multiforme)
  • hives
  • severe itching
  • hair loss
  • flushing
  • excessive abnormal swelling (diaphoresis)
  • sun allergy

Traveling With Medication

  • Ensure that you carry enough doses of each of your prescription medicines to last the entire trip. The best place to store your medicines is in the carry on baggage. However, while flying, if carrying liquid medicines, make sure you do not go over the limits imposed for carry-on liquids.
  • While traveling overseas, make sure that you can carry each of your prescription medicines legally to your destination country. One way to ensure this is by checking with your destination country's embassy or website.
  • Make sure that you carry each of your medicines in their original packaging, which should typically include your name and address, and the details of the prescribing doctor.
  • If your travel involves crossing time zones, and you are required to take your medicine as per a fixed schedule, make sure that you adjust for the change in time.

Expired Medication

Taking a single dose of expired Enalapril is unlikely to cause a side-effect. However, please discuss with your doctor or pharmacist, if you feel unwell or sick. An expired medicine may become ineffective in treating your prescribed conditions. To be on the safe side, it is important not to use an expired drug. You are much safer by always keeping a fresh supply of unexpired medicines.

Safe Disposal of Medication

  • If there are disposal instructions on the package, please follow the instructions.
  • If there are medicine take-back programs in your country, you should contact the respective authority to arrange for the disposal of the medicine. For example, in the USA, the Drug Enforcement Administration regularly hosts National Prescription Drug Take-Back events.
  • If there are no take-back programs, mix the medicine with dirt and place them in a sealed plastic bag. Throw the plastic bag in your household trash. Separately, remove all personal information including the prescription label from the medicine packaging and then dispose off the container.
  • If specifically indicated on the medicine package that it needs to be flushed down the toilet when no longer needed, perform the required step.
This page provides information for Enalapril .
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