Other Brands/Names

Renacardon, Tenaten, Tenace, Co-Renitec, Enalapril Maleate, Inoprilat 10, Meipril.

How It Works

Enalapril is an antihypertensive medicine to lower blood pressure from the angiotensin-converting enzyme (ACE) inhibitor class. It works by inhibiting the ACE enzyme, which is essential in regulating blood pressure and body fluid balance.

In patients with hypertension, the system that regulate blood pressure is disrupted, leading to elevated blood pressure. ACE inhibitors, including enalapril, will widen blood vessels and reduce renal water reabsorption. The result is smoother blood flow, less fluid retention, and a gradual fall in blood pressure.

Indications

Hypertension

This drug is used to treat high blood pressure. A person is considered to have high blood pressure if, after two measurements on different days, systolic blood pressure is ≥130 mmHg and/or diastolic blood pressure is ≥80 mmHg. The diagnosis of hypertension has to be established by a physician before starting this therapy.

Heart Failure

ACE inhibitors are effective in treating heart failure and post-myocardial infarction patients. Enalapril is usually combined with other cardiovascular medicines. Use caution in using enalapril for people with kidney disorders or those currently taking diuretics (medicines that increase urine output).

Contraindication

• History of angioedema (rapid swelling under the skin) related to ACE inhibitor use.

• Allergy or hypersensitivity to ACE inhibitors.

• Hereditary or idiopathic angioedema.

• Pregnancy in the second and third trimesters.

Side Effects

Common effects include cough, nausea, blurred vision, and dizziness. Other possible effects:

• Blood disorders such as anemia.

• Headache.

• Shortness of breath.

• Depression.

• Low blood pressure.

• Chest pain.

• Skin rash.

Enalapril can also increase potassium levels (hyperkalemia), more often in people with chronic kidney failure and diabetes.

Seek urgent care if severe allergic reactions occur:

• Swelling of the face, throat, feet, or hands.

• Generalized skin rash.

• Shortness of breath.

• Loss of consciousness.

Types

Available in Indonesia as:

• 5 mg tablets.

• 10 mg tablets.

• Combination tablets with HCT 25/10 mg.

Dosage

The dose of enalapril treatment depends on patient's clinical status and will be adjusted to the patient’s profile, treatment response, and their current condition.

Oral treatment for hypertension

• Adults

  • Initial dose: 5 mg once daily.

  • Maintenance dose: 10–20 mg per day, which may be divided into two doses.

  • Maximum dose: 40 mg per day.

• Children

  • 20–49 kg: Initial dose is 2.5 mg once daily; may be increased to 20 mg once daily if needed.

  • ≥50 kg: Initial dose is 5 mg once daily; may be increased to 40 mg once daily.

• Elderly
  • Initial dose is 2.5 mg once daily.

Heart Diseases

Asymptomatic heart failure and left ventricular dysfunction

• Adults

  • Initial dose: 2.5 mg once daily; may increase to 20 mg once daily.

  • Maximum dose: 40 mg per day in two divided doses.

• Elderly:
  • initial dose is 2.5 mg once daily.

Safety

Pregnancy category D: there is evidence of fetal risk in human studies. Enalapril is not recommended to be prescribed to breastfeeding mothers.

Drug Interactions

• May increase the risk of elevated potassium levels (hyperkalemia) if enalapril is combined with diuretics.

• The blood pressure–lowering effect may be increased, causing hypotension, when it is prescribed with ARBs such as candesartan or valsartan.

• May increase the risk of low blood sugar when enalapril is used with antidiabetic medicines or insulin.

• May increase the risk of kidney damage when enalapril is combined with NSAIDs, such as aspirin or ibuprofen.

• May raise the risk of severe allergic reactions and infections when it is used with allopurinol (a uric acid–lowering agent).

• Alcohol can augment the antihypertensive effect.

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