Vasotec (Enalapril) - Oral

What Is Vasotec?

Vasotec (enalapril) is a prescription medication used alone or in combination with other medications to treat high blood pressure, also known as hypertension. It belongs to the angiotensin-converting enzyme (ACE) inhibitor drug class.

Vasotec contains the active drug enalapril. It works on the renin-angiotensin-aldosterone system to lower blood pressure. Enalapril decreases the chemicals that tighten blood vessels, causing the blood vessels to relax. This action improves the blood flow and makes it easier for the heart to circulate blood efficiently.

Enalapril is available under the brand names Vasotec (in tablet form) and Epaned (as an oral solution). It is also available as a generic drug.

What Is Vasotec Used For?

Vasotec is indicated to treat high blood pressure as monotherapy (by itself) or in combination with other blood pressure lowering drugs. Lowering high blood pressure helps prevent:

• Heart attacks
• Kidney problems
• Loss of vision
• Strokes

This medication is sometimes combined with drugs such as diuretics (also known as water pills) and digitalis (another medication used for heart conditions) to treat congestive heart failure. Vasotec also helps prevent heart failure due to a heart problem called left ventricular dysfunction. In this type of heart failure, the left side of the heart must work harder to pump the same amount of blood to the rest of the body.

How to Take Vasotec

Before taking enalapril, read your prescription label and talk to your healthcare provider if you have any questions or concerns.

Vasotec is available as an immediate and extended-release (long-acting) oral tablet.  Take one tablet once or twice a day, with or without food, exactly as your healthcare provider prescribes. Do not take more, less, or more often than prescribed.

If taking the solution form (Epaned), shake the bottle well each time before use. Accurately measure the dose with a measuring device or spoon provided. Do not use a household spoon, which can result in incorrect dose measurement. The dosing schedule for the solution is usually once daily for high blood pressure and twice daily for heart failure.

Children may start at a lower dose than adults. Talk to the child's healthcare provider about the correct dosage if you are a parent or caregiver.

Take the medication around the same time(s) every day to help you adhere to your regimen. Your healthcare provider may start you on a low dose and gradually increase it. Continue to take it even if you feel better; do not stop the medication without asking your healthcare provider.

Storage

Keep the tablets in a well-closed container. Store at room temperature (around 68 degrees F) away from light, heat, and moisture. Do not store it in the bathroom. Keep all medications locked out of the sight and reach of children.

Store the solution in its container with a tightly closed lid, away from moisture, at 77 degrees F. Do not store it in the bathroom or freeze it.

Do not keep unwanted or expired medications with you. Never throw medicines in a waste bin or flush down the toilet unless instructed. Instead, the most suitable way to dispose of unwanted medication is through a medicine take-back program. Contact your pharmacist or local waste disposal company in your community.

Off-Label Uses

A healthcare provider may prescribe off-label treatments when the decision is supported by scientific evidence or expert clinical experience.

Enalapril may be prescribed for some off-label uses, such as:

• Heart failure in adolescents, children, and infants
• Post-transplant erythrocytosis (increased number of red blood cells)
• Proteinuric chronic kidney disease (loss of excessive protein when you urinate)
• Stable coronary artery disease
• To control abnormal heart rhythms after a heart attack
• Migraine prevention
• Raynaud’s phenomenon (a disease in which areas such as fingers and toes feel numb and cold in cold temperatures or when under stress)

What Are the Side Effects of Vasotec?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or healthcare provider. You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Vasotec may cause some side effects, such as:

• Cough
• Dizziness
• Fatigue
• Headache
• Rash
• Weakness

These side effects are not severe and do not need medical attention. However, contact your healthcare provider or pharmacist if the symptoms are severe or do not go away.

Severe Side Effects

Vasotec may cause some severe side effects. Call your healthcare provider right away if you have:

• Lightheadedness
• Chest pain
• Change in amount of or no urination
• Flu-like symptoms, such as fever, chills, or sore throat
• High potassium (hyperkalemia): Symptoms can include nausea, weakness, tingly feeling, and irregular heartbeat.
• Jaundice (yellowing of the skin and whites of the eyes)

Get emergency medical help if you have signs of an allergic reaction to enalapril, which can include swelling of the face, throat, tongue, or lips and difficulty breathing or swallowing.

Modifications

Dose modifications (changes) may be necessary for people older than 65 or those with kidney impairment.

This medication also comes in two oral forms: a tablet (Vasotec) and a solution (Epaned). The solution version may be better for children and people who have difficulty swallowing tablets.

Enalapril can also be given intravenously (directly into the vein).

Missed Dose

If you missed a dose, take it as soon as you remember. Leave the missed one if it is nearly the time for your next dose. Take the following doses at the regular time. Don't take two doses at a time to make up for the missed one.

Overdose: What Happens If I Take Too Much Vasotec?

Overdose data on enalapril is limited in humans. However, it is expected that an overdose would cause hypotension (too low blood pressure).

Symptoms of hypotension include:

• Dizziness
• Lightheadedness
• Tiredness
• Weakness
• Blurry vision
• Confusion
• Fainting or feeling faint

Precautions

What Are Reasons I Shouldn’t Take Vasotec?

It is not recommended to use Vasotec:

• With aliskiren-containing products (e.g., certain blood pressure medications, such as Tekturna) in people with diabetes or kidney impairment
• If you are hypersensitive to enalapril or any of the ingredients in the tablet
• If you have a history of angioedema (short-lived swelling in the deeper layers of the skin) associated with previous treatment with ACE inhibitor drugs
• Have idiopathic or hereditary angioedema (swelling of the lower layer of tissue under the skin or mucous membranes)
• During pregnancy or while breastfeeding
• With Entresto (sacubitril and valsartan) therapy: Vasotec must be initiated more than 36 hours after the last dose of sacubitril and valsartan.

What Other Medications Interact With Vasotec?

Tell your healthcare provider about all the medications you take before starting the treatment with Vasotec. Many drugs can interact with enalapril, including:

• Aliskiren
• Angiotensin II receptor blockers such as Edarbi (azilsartan), Cozaar (losartan), and Diovan (valsartan)
• Birth control pills containing drospirenone, like Yaz (drospirenone and ethinyl estradiol) and Slynd (drospirenone)
• A diuretic or any other blood pressure medication
• Gold injections to treat arthritis
• Insulin or oral diabetes medicine
• Lithobid (lithium)
• NSAIDs (nonsteroidal anti-inflammatory drugs), such as Advil (ibuprofen), Celebrex (celecoxib), and Aleve or Naprosyn (naproxen)
• Potassium supplements

This may not be a complete list of drugs or supplements that interact with Vasotec. Consult your healthcare provider for more information on potential interactions.

What Medications Are Similar?

Other ACE inhibitors include:

• Accupril (quinapril)
• Perindopril
• Altace (ramipril)
• Captopril
• Lotensin (benazepril)
• Trandolapril
• Fosinopril
• Zestril (lisinopril)
• Moexipril

The choice of a specific ACE inhibitor drug depends on various factors. Studies have examined the efficacy and safety differences between many of these drugs.

Compared with other ACE inhibitors (e.g., captopril, lisinopril, ramipril, trandolapril, or combinations of these), enalapril appeared to be most effective in treating heart failure. However, it was also associated with the highest incidence of cough, declining kidney function, and gastrointestinal discomfort.

Other findings suggested:

• Lisinopril is associated with a higher rate of all-cause mortality (death from any cause) compared with a placebo or ramipril.
• Lisinopril was the least effective in lowering systolic and diastolic blood pressure.
• Ramipril was associated with the lowest incidence of all-cause mortality.

Your healthcare provider will likely consider many factors when deciding which treatment is the best for you and your health.

How Can I Stay Healthy While Taking Vasotec?

Hypertension is a growing challenge for health care systems. ACE inhibitors are a drug of choice and a mainstay for high blood pressure and heart failure treatment. However, there is a wide array of ACE inhibitor options to choose from. Enalapril is a commonly used ACE inhibitor and a well-tolerated option.

When taking Vasotec, keep the following in mind:

• Dizziness can occur, so try to avoid moving too quickly to a standing position from lying or sitting down.
• Drink adequate fluids and avoid overheating or dehydrating during exercise or in hot temperatures.
• Don't drink alcohol as it can lower your blood pressure and enhance enalapril's side effects.
• Do not use potassium supplements unless advised.
• Keep up with your regular medical appointments and lab tests.

Along with medical treatment, lifestyle changes such as a healthy diet, exercise, quitting smoking, and reducing stress can help lead to a healthy life.