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 (1st trimester), category D (2nd and 3rd 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

    

 
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