Enalapril
Related Subjects:
|Hypertension
|Acute Heart Failure
|Chronic Heart Failure
⚠️ First-dose hypotension is a recognised risk.
💡 Always start at the lowest dose, ideally at night with the patient in bed.
More frequent when used in heart failure than in hypertension.
If hypotension occurs → lie patient flat, raise legs, and give IV fluids if BP remains low.
- 🔹 Competitively inhibits angiotensin-converting enzyme (ACE).
- 🛑 Prevents formation of angiotensin II, a potent vasoconstrictor.
- ⬆️ Increases bradykinin, leading to cough and angioedema.
- 📉 Lowers blood pressure without reflex tachycardia.
🎯 Indications / Dose
- ❤️ Hypertension – often part of combination therapy.
- 💔 Heart failure due to systolic dysfunction.
- 🧪 Diabetic nephropathy and reduction of post-MI cardiac remodelling.
- ⚠️ In heart failure: start with the lowest dose, but aim for the highest tolerated dose.
📊 Dose Range (check U+Es, BP, and target BP; always refer to BNF)
- ➡️ Starting dose: 2.5–5 mg PO OD or BD (depending on BP and renal function).
- ➡️ Maintenance/long-term dose: 10–20 mg PO BD (adjust according to renal function and BP response).
⚠️ Cautions
- Less effective as monotherapy in African-Caribbean patients (consider thiazides or CCBs as first-line per NICE guidance).
⛔ Contraindications
- 🚫 Pregnancy and breastfeeding – teratogenic (risk of birth defects).
- ⚠️ Severe aortic stenosis or hypertrophic cardiomyopathy.
- 🚫 Bilateral renal artery stenosis.
- ⚠️ Pre-existing hyperkalaemia.
🔄 Interactions
- ⚠️ With alteplase (tPA) → risk of angioedema in acute stroke thrombolysis.
- ❌ Avoid NSAIDs (reduce efficacy and worsen renal function).
- ⬆️ Hyperkalaemia risk with potassium-sparing diuretics, ARBs, or supplements.
⚠️ Side Effects
- 📉 Postural hypotension (especially after the first dose).
- 💨 Cough (bradykinin-mediated).
- 😮 Angioedema (rare, but potentially life-threatening).
- 💧 Reduced renal perfusion in bilateral renal artery stenosis.
- 🧪 Hyperkalaemia.
- 🌸 Urticaria, taste disturbance.
📋 Monitoring
- 🔍 Check renal function and electrolytes at 4 days and 2 weeks after initiation.
- 📈 Recheck 1 week after any dose increase.
- ⚠️ Stop or reduce if creatinine ↑ >30% or K⁺ >6.0 mmol/L.
