Enalapril/Enalaprilat (Vasotec)

Category:

Antihypertensive

Description:

ACE inhibitor

Indications:

Hypertension
Heart failure
Left ventricular dysfunction (clinically stable asymptomatic patients, decreases rate of overt heart failure)

Precautions:

Pregnancy category C (1^st trimester), category D (2^nd and 3^rd trimesters); ACE inhibitors can cause fetal and neonatal morbidity and death when administered to pregnant women
Impaired renal function, dialysis patients, hypovolemia, diuretic therapy
Collagen-vascular diseases, CHF, elderly, bilateral renal artery stenosis

Adverse Reactions (Side Effects):

CNS: anxiety, dizziness, fatigue, headache, insomnia, paresthesia
CV: angina, hypotension, palpitations, postural hypotension, syncope
GI: abdominal pain, constipation, melena, nausea, vomiting
GU: decreased libido, impotence, increased BUN/creatinine, UTI
METAB: hyperkalemia, hyponatremia
MS: arthralgia, arthritis, myalgia
RESP: asthma, bronchitis, cough, dyspnea, sinusitis
SKIN: angioedema, flushing, rash, sweating

Dosage:

Administered orally, intravenously

Adult: PO 2.5-5mg daily, increase as needed, usually 10-40mg daily divided 1-2 times; IV (enalaprilat) 0.625-1.25 mg/dose given over 5 minutes every 6 hours; dosing adjustment in renal impairment: CrCl 10-50 ml/min, 75%-100% of normal dose; CrCl <10 ml/min, 50% of normal dose
Child: PO 0.1 mg/kg/day initially, increase as needed over 2 weeks to max of 0.5 mg/kg/day; IV (enalaprilat) 5-10 mcg/kg/dose every 8-24 hours

Drug interactions:

Allopurinal: predisposition to hypersensitivity reactions to ACE inhibitors
Aspirin, NSAIDS: inhibition of the antihypertensive response to Ace inhibitors
Prazosin, terazosin, doxazosin: exaggerated first-dose hypotensive response to a-blockers

Source: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300