Anapril

Indications

Enalapril maleate is used to treat high blood pressure (hypertension) and heart failure, and to prevent heart failure symptoms in people whose heart pumps weakly but who do not yet have symptoms (left ventricular dysfunction).

How It Works

Enalapril is an ACE inhibitor. It is changed in the liver into its active form, enalaprilat, which blocks angiotensin-converting enzyme. This reduces angiotensin II, a hormone that narrows blood vessels and makes the body hold salt and water. As a result, blood vessels relax, blood pressure falls and the heart does not have to work as hard.

Dosage and Administration

Take exactly as prescribed, at the same time each day, with or without food. For high blood pressure adults usually start at 5 mg once daily (lower if on diuretics, older or with kidney problems); the usual maintenance dose is 10 mg to 20 mg daily, up to a maximum of 40 mg daily, given once or split into two doses. For heart failure treatment starts at 2.5 mg daily and is increased slowly under medical supervision. Do not stop suddenly without advice.

Interactions

• Potassium supplements, salt substitutes containing potassium, Spironolactone, Amiloride, Trimethoprim and Heparin can raise blood potassium too much.
• Diuretics and other blood pressure medicines can cause low blood pressure, especially at the start.
• NSAIDs (such as Ibuprofen, Diclofenac) reduce its effect and can harm the kidneys.
• It can raise Lithium levels.
• Do not combine with Aliskiren in diabetes or kidney disease, or with Sacubitril/Valsartan (allow 36 hours between them).

Contraindications

• Allergy to Enalapril or other ACE inhibitors.
• History of angioedema (swelling of the face, lips, tongue or throat), including inherited or unexplained angioedema.
• Pregnancy, especially the second and third trimesters.
• Use with Aliskiren in people with diabetes or kidney impairment.

Side Effects

Common side effects include a dry, tickly cough, dizziness, headache, tiredness, low blood pressure on standing, nausea and changes in taste. Blood potassium may rise and kidney function may change.

Get urgent medical help if you have swelling of the face, lips, tongue or throat or difficulty breathing or swallowing (angioedema), fainting, severe stomach pain, yellow skin or eyes, very little urine, or signs of infection such as fever and sore throat.

Pregnancy and Lactation

Enalapril must not be used in pregnancy because it can seriously harm the unborn baby, particularly after the first trimester. If you become pregnant, contact your doctor straight away to change treatment. It is generally not recommended while breastfeeding a newborn or premature baby; discuss with your doctor.

Precautions and Warnings

• Blood tests for kidney function and potassium are needed, especially at the start and after dose changes.
• The first dose can cause a marked drop in blood pressure, especially if you are dehydrated or on diuretics; take the first dose at bedtime if advised.
• Tell your doctor if you have vomiting or diarrhoea, as dehydration increases the risk of low blood pressure and kidney problems.
• Tell the surgeon or anaesthetist that you take it before any operation.

Overdose

Overdose mainly causes very low blood pressure, dizziness, fainting and kidney problems. Lie down with your legs raised and seek emergency medical help.

Therapeutic Class

Antihypertensive, angiotensin-converting enzyme (ACE) inhibitor.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.