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Enalapril

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Enalapril, Vasotec, Enaprilat

  • See Also
  1. ACE Inhibitor
  • Indications
  1. See ACE Inhibitor
  • Mechanism
  1. See ACE Inhibitor
  2. Dicarbocyl-containing peptide
  3. Angiotensin-converting enzyme (ACE) inhibitor
  4. Enalapril is a prodrug, converted to its active form Enalaprilat in the liver via de-esterification
    1. Lisinopril is a synthetic Lysine derivative of Enalaprilat
  • Dosing
  • Adults
  1. Hypertension
    1. Start Enalapril 5 mg orally daily
      1. Start 2.5 mg/day if GFR <30 ml/min
    2. Target 10 to 40 mg/day divided once to twice daily
    3. Maximum 40 mg/day
  2. Congestive Heart Failure
    1. Start Enalapril 2.5 mg orally twice daily
    2. Target 10 to 20 mg orally twice daily
    3. Maximum 40 mg/day
  3. Hypertensive Emergency (or unable to take oral medications)
    1. Start Enaprilat 1.25 mg to 5 mg IV every 6 hours
  4. Diabetic Nephropathy (not FDA approved)
    1. Enalapril 10 to 20 mg orally daily
  • Dosing
  • Children (age >1 month old)
  1. Hypertension
    1. Start 0.1 mg/kg/day divided once to twice daily and titrate
    2. Maximum: 0.5 mg/kg/day
  2. Hypertensive Emergency (or unable to take oral medications, Not FDA approved)
    1. Enalaprilat 0.005 to 0.01 mg/kg/dose IV every 8 to 24 hours
  • Supplied
  1. Available as scored tablets: 2.5, 5, 10 and 20 mg
  2. Enaprilat is available IV
  3. To make Enalapril oral suspension (0.2 mg/ml)
    1. Dissolve 2.5 mg tablet in 12.5 ml sterile water
    2. Use immediately
  • Metabolism
  1. Excretion both renal and hepatic
  • Adverse Effects
  1. See ACE Inhibitor
  • Safety
  1. See ACE Inhibitor
  2. Pregnancy Category X
  3. Enalapril is among only two ACE Inhibitors labeled by AAP as compatible with Breast Feeding
    1. However, Enalapril is excreted in Breast Milk and may be associated with newborn adverse effects
  • Resources
  1. Enalapril (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=39631f1f-5d19-43c1-b504-bf56d991ed97
  • References
  1. (2016) Presc Lett, Resource #321151, ACE Inhibitor Antihypertensive Dose Comparison
  2. (2020) Med Lett Drugs Ther 62(1598): 73-80
  3. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 68-9
  4. Hamilton (2020) Tarascon Pocket Pharmacopoeia