What to Know About Enalapril

Enalapril (brand name Vasotec) is a prescription anti-hypertensive drug to lower high blood pressure. The primary action of enalapril is to lower the blood pressure, making it easier for the heart to circulate sufficiently around the body.

Enalapril is in a class of drugs called angiotensin-converting enzyme (ACE) inhibitors. These medications help lower blood pressure by working on the kidneys. They target an enzyme called angiotensin-converting enzyme (ACE). ACE is a chemical that makes the blood vessels contract (narrow) to retain fluid.

ACE inhibitors work to relax the blood vessels, thereby lowering blood pressure. In addition to treating high blood pressure, enalapril is also used to treat heart failure. For those with hypertension (high blood pressure) enalapril may be given to help prevent a stroke or heart attack.

Uses

ACE inhibitors are commonly the first line treatment for those with diabetes and high blood pressure because they can help protect the kidneys from damage that can occur from high blood sugar. 

Enalapril is considered safe and effective for adults and children. The medication is FDA approved for the treatment of high blood pressure (hypertension) and heart failure. It can be used alone for hypertension, or in combination with other antihypertensive (blood pressure lowering) medications.

Sometimes enalapril is combined with hydrochlorothiazide (another anti-hypertensive drug). The two drugs taken together (enalapril and hydrochlorothiazide) helps to potentiate (cause the other to be more effective) each other.

For congestive heart failure, enalapril is usually given in combination with other medications, such as those that help rid the body of excess fluids (called diuretics) as well as a drug that strengthens the cardiac (heart) output, called digitalis. Digitalis helps to slow the heart rate and make it more effective at circulating the blood.

According to the FDA, enalapril improves symptoms, increases the survival rate, and reduces hospitalization for those with congestive heart failure and high blood pressure.

Before Taking

ACE inhibitors are usually considered first-line treatment for those who are initially diagnosed with high blood pressure. But there are some circumstances in which another type of antihypertensive may be considered instead.

Before taking enalapril, the prescribing healthcare provider will ask you if you are pregnant or if you plan to become pregnant (and if you are using birth control). This is because enalapril can cause damage to an unborn fetus if taken during pregnancy.

The healthcare provider will screen for any other conditions (such as kidney problems) which could potentially cause problems if enalapril is taken.

In addition, it’s important to provide the physician (or other provider) with a list of current medications and over-the-counter drugs or supplements. This should include any vitamins and/or natural herbs or other supplements as well as patches or topical (on the skin) medications like medicated lotions.

Precautions and Contraindications

A contraindication is a particular situation in which a medication, treatment, or a specific type of surgery should not be ordered, because it has a risk of causing harm. Some contraindications apply to specific types of drugs (or procedures) that should not be given together. Contraindications for enalapril include:

• Pregnancy: ACE inhibitors can injure the developing fetus, they may even cause death to the fetus.
• Hypersensitivity from taking an ACE inhibitor in the past or from any other underlying cause (such as an idiopathic angioedema episode): An idiopathic angioedema episode is one that occurs suddenly and is severe, with no known cause.
• Taking a direct renin inhibitor (such as aliskiren, which is another type of medication that works differently than ACE inhibitors to lower the blood pressure)
• Renal artery stenosis (the narrowing of arteries that carry blood to the kidneys)
• Previous allergy to ACE inhibitors  

To be sure that your healthcare provider is fully informed about any conditions or scenarios that could pose an increased risk when you are given enalapril, be sure to disclose if you:

• Have ever had an allergic reaction to any medications in the past (including enalapril)
• Are pregnant or plan to get pregnant
• Are breastfeeding
• Receive dialysis
• Have a heart condition or liver or kidney problems
• Have diabetes
• Have low blood pressure (or unstable blood pressure)
• Are scheduled for any type of surgery
• Have had a recent bout of vomiting or diarrhea
• Are on a low sodium (salt) diet
• Plan to have a desensitization treatment for allergies (specifically if the treatment is for insect bites or other venomous bites; ACE inhibitors may increase the risk of complications from desensitization treatment)
• Have a low white blood cell count

Other ACE Inhibitors

Other ACE Inhibitors with a similar action to enalapril include:

• Prinivil, Zestril (lisinopril)
• Lotensin (benazepril)

So, what is the difference between enalapril and these other ACE inhibitors? The primary difference between the different types of ACE inhibitors is their duration (the amount of time that the drugs are effective after being taken).

For example, benazepril, and enalapril have a duration of approximately two hours, whereas, lisinopril lasts longer. The frequency that you take the medication will depend partially on which type of ACE inhibitor you are taking.

Other differences between brand names of ACE inhibitors are the types of conditions they treat. The FDA has approved specific uses for each type of ACE inhibitor, based on study outcomes.

For example, lisinopril is given to those who have had a heart attack or for the treatment of heart failure. Whereas, enalapril is given to treat heart failure, but not heart attacks. Benazepril is only given for high blood pressure.

Combination Drugs

Enalapril is commonly combined with other types of antihypertensive drugs, including:

• Innozide (enalapril combined with hydrochlorothiazide)
• Lexxel (enalapril combined with felodipine)
• Teczem (enalapril combined with diltiazem)

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Dosage

Enalapril is available in 2.5 milligrams (mg), 5 mg, 10 mg, and 20 mg tablets for oral (by mouth) administration.

The usual dosage of enalapril is between 2.5 mg to 20 mg once per day (depending on what type of illness it is being taken for and other factors, such as age). For high blood pressure, a dosage of 20 mg one time per day is average. For heart failure, 20 mg once per day is the average dosage.

The initial dosage is increased gradually over several weeks. The maximum dosage is 20 mg two times per day.  For children or those with kidney problems, lower dosages are usually given.  

Your healthcare provider will keep a close eye on your blood pressure and monitor you for any side effects once you begin taking the medication. A blood test may also be taken to evaluate the effects on your kidneys. 

These dosages represent general guidelines, it’s important to consult with your healthcare provider to find out which specific dosage is right for you.

Modifications

Enalapril comes as tablets to take orally (by mouth), but it is also available in a liquid form for those who are unable to swallow pills safely (such as children and elderly adults).

The pharmacist will have to special order the liquid form of enalpril. Be sure to use a syringe with specific dosing measurements (such as the syringe that is issued with the medication by the pharmacist). 

How to Take and Store

Enalapril should be taken exactly as prescribed by your healthcare provider, usually, that involves taking it once or twice each day. Often, the first dose is ordered to be taken at bedtime because it may cause dizziness.

Those who do not experience dizziness—after the initial dose—can usually take the medication any time during the day. But, it’s advisable to take enalapril at the same time every day, in the morning and in the evening (spreading the dosage out by 10 to 12 hours if possible).

You can swallow the enalapril tablets with water or other types of liquid beverages; you can take it with or without food. If you take the liquid form of the medication be sure to use a syringe with the precise measuring dosage.

It’s important not to skip a dose of enalapril without first getting the OK from the prescribing healthcare provider. If you accidentally miss a dose of enalapril do not take a double dose to make up for it; simply omit the missed dose and take your next dose at the usual time. If you unintentionally take too much enalapril, you should seek emergency medical care right away.

Keep the medication in its original (labeled) container, out of the reach of children. You should store it in a place that is kept at room temperature, away from moisture and heat; do not store it in the bathroom. 

Side Effects

Common Side Effects

Common side effects of enalapril may include:

• Dizziness, feeling faint or lightheaded, particularly when rising from a sitting or lying position
• Dry cough (which occurred in approximately 5% to 35% of those taking ACE inhibitors)
• Skin rash
• Weakness or fatigue

Severe Side Effects

Symptoms that may indicate severe side effects of enalapril include:

• Blurred vision
• Sweating
• Chest pain
• Trouble breathing (such as shortness of breath)
• Productive cough (coughing up mucus)
• Nausea
• Vomiting
• Confusion
• Fainting (or severe dizziness or lightheadedness)
• Fever or chills
• Sore throat
• Jaundice (yellowish tinged skin caused by liver problems)
• The inability to urinate, changes in the amount of urine passed or blood in the urine (may indicate kidney problems)
• Numbness or tingling
• Irregular heartbeat
• Angioedema (swelling in the face, throat, lips, eyes, feet, hands, ankles, or calves).

It’s important to consult with the healthcare provider if you experience any side effects, even those that are more common.

Warnings and Interactions

There are several things to keep in mind when it comes to your health and taking enalapril. Common warnings include:

• Some people develop a persistent, dry cough when they begin taking enalapril. If the cough does not subside, it’s important to consult with the prescribing physician or other healthcare provider.
• Dizziness is a common side effect, particularly after taking the initial dose; it’s advisable to take the first dose at bedtime. If you continue to experience dizziness when you take enalapril, be sure to consult with your healthcare provider.
• For elderly people, side effects of medications (such as dizziness) are a major cause of falls. Be sure to implement falls precautions if you feel dizzy.
• Drinking alcohol while taking enalapril can increase dizziness and/or lightheadedness; therefore, it’s important to abstain from drinking alcohol while taking ACE inhibitors.
• Enalapril can cause blood sugar levels to decrease. If you are taking enalapril and you have diabetes, it’s important to pay close attention to monitoring your blood sugar and be on the lookout for signs of hypoglycemia.
• Enalapril has an impact on your potassium level. If you are using a type of potassium enriched salt substitute, it's important to inform your healthcare provider.
• Diarrhea, vomiting, not drinking enough fluids, and excessive sweating can cause a drop in blood pressure, which may cause lightheadedness and fainting. If you develop diarrhea or vomiting (from a virus or other illness) be sure to talk to your healthcare provider, you may be advised to stop taking enalapril until your symptoms subside.

Black Box Warning

A black box warning is an FDA warning to alert consumers about serious or life-threatening side effects that a drug may have. Enalapril can cause a serious and potentially fatal condition called angioedema.

Angioedema causes swelling in the face, arms, legs, throat, lips, tongue, and intestines. It may occur at any time, from the first dosage of enalapril you take, or anytime thereafter. Studies have shown that people of African ancestry may be more likely to develop angioedema from taking enalapril.