enalapril (Vasotec)
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Introduction
Tradename: Vasotec. (enalapril maleate)
Indications
- hypertension
- improved survival in patients with mild to severe heart failure
- diminished incidence of heart failure in patients with asymptomatic left ventricular systolic dysfunction
- diabetic nephropathy
- nondiabetic proteinuric nephropathy
- scleroderma & sclerdermal renal crisis[6] Contradindications:
- pregnancy:
- teratogenic in 1st trimester[8]
- fetal or neonatal renal failure in 2nd or 3rd trimester
- scleroderma renal crisis is exception[8]
- safe in lactation[8]
- increases mortality when give in 1st 24 hours after acute myocardial infarction[4]
Dosage
Tabs: 2.5, 5, 10, 20 mg.
Pharmacokinetics
- Enalapril is hepatically hydrolyzed to the active ACE inhibitor enalaprilat.
elimination via liver
elimination via kidney
1/2life = 12-24 hours
1/2life = 35-38 hours
Adverse effects
- infrequent (1-10%)
- chest pain, palpitations, tachycardia, syncope, insomnia, headache, dizziness, fatigue, malaise, rash, abnormal taste, abdominal pain, nausea/vomiting, anorexia, constipation, paresthesia, weakness, bronchitis, cough dyspnea
- uncommon (< 1%) agranulocytosis - incidence may be less than for captopril, angina pectoris, flushing, alopecia, erythema multiforme, pruritus, Stevens-Johnson syndrome, urticaria, angioedema, hypoglycemia, hyperkalemia, impotence, anemia, myalgia, blurred vision, tinnitus, oliguria, asthma, bronchospasm, diaphoresis
- drug adverse effects of renin-angiotensin-aldosterone system inhibitors (RAAS inhibitors)
- drug adverse effects of ACE inhibitors
- drug adverse effects of antihypertensive agents
Drug interactions
- non-steroidal anti-inflammatory agents (NSAIDs) decrease effect of enalapril
- Li+ increases serum levels & toxicity of enalapril
- drug interaction(s) of fluticasone with HIV1 protease inhibitors
- drug interaction(s) of calcineurin inhibitors with ACE inhibitors
- drug interaction(s) of calcium channel blockers with ACE inhibitors
- drug interaction(s) of renin-angiotensin-aldosterone inhibitors with trimethoprim-sulfamethoxazole
- drug interaction(s) of lithium carbonate with ACE inhibitors
- drug interaction(s) of ACE inhibitor with trimethoprim
- drug interaction(s) of ACE inhibitors with potassium-sparing diuretics
- drug interaction(s) of ACE inhibitors with aliskiren
- drug interaction(s) of ACE inhibitors with angiotensin II receptor antagonists
- drug interaction(s) of potassium chloride with ACE inhibitors
- drug interaction(s) of spironolactone with ACE inhibitors
- drug interaction(s) of diuretics with ACE inhibitors
- drug interaction(s) of beta blockers with ACE inhibitors
- drug interaction(s) of NSAIDs, diuretics & ACE inhibitors
- drug interaction(s) of NSAIDs with ACE inhibitors
- drug interaction(s) of NSAIDs & antihypertensives
Test interactions
- positive direct antiglubin (Coomb's) test (DAT)
- may cause false positive urine acetone with sodium nitroprusside reagent
More general terms
- pyrrolidine; tetrahydropyrrole
- amide
- amine
- carboxylic acid
- ester
- angiotensin-converting enzyme (ACE) inhibitor
Additional terms
Component of
- enalapril/felodipine (Lexxel)
- enalapril/hydrochlorothiazide; enalapril/HCTZ (Vaseretic)
- enalapril/diltiazem (Teczem)
References
- ↑ Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1990. pg 760-1
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996.
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 117
- ↑ 4.0 4.1 contribution from Paul Goebel, M.D., UCSF Fresno
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ 6.0 6.1 Deprecated Reference
- ↑ Department of Veterans Affairs, VA National Formulary
- ↑ 8.0 8.1 8.2 8.3 Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015