Enalapril

May be taken with or without food.

History of angioedema related to previous ACE inhibitor treatment, idiopathic or hereditary angioedema. Pregnancy. Concomitant use with aliskiren in patients with diabetes mellitus or renal impairment (GFR <60 mL/min/1.73m²). Concomitant use with or within 36 hours of switching to or from a neprilysin inhibitor (e.g. sacubitril).

Patient with Na or volume depletion, diabetes, ascites due to cirrhosis or refractory ascites; cerebrovascular disease, ischaemic heart disease, collagen vascular disease, hypertrophic cardiomyopathy and left ventricular outflow tract obstruction, severe aortic stenosis, bilateral renal artery stenosis or stenosis of the artery to a single functioning kidney; history of angioedema unrelated to ACE inhibitor treatment. Patient undergoing major surgery, desensitisation treatment with hymenoptera venom, LDL apheresis with dextran sulfate or haemodialysis with high-flux dialysis membranes. Black race. Renal and hepatic impairment. Neonates, children and elderly. Lactation. Patient Counselling This drug may cause occasional dizziness or weariness, if affected, do not drive or operate machinery. Monitoring Parameters Monitor blood pressure and renal function before and after treatment. Obtain CBC, BUN, serum creatinine and electrolytes. Evaluate for signs of angioedema.

Significant: Symptomatic hypotension, syncope, haematologic effects (e.g. neutropenia, agranulocytosis, thrombocytopenia, anaemia), cough, hyperkalaemia. Cardiac disorders: Tachycardia, rhythm disturbances, chest pain, angina pectoris. Eye disorders: Blurred vision. Gastrointestinal disorders: Nausea, abdominal pain, diarrhoea, taste alteration. General disorders and administration site conditions: Asthenia, fatigue. Investigations: Increased serum creatinine. Nervous system disorders: Headache, dizziness. Psychiatric disorders: Depression. Respiratory, thoracic and mediastinal disorders: Dyspnoea. Skin and subcutaneous tissue disorders: Rash.
Potentially Fatal: Angioneurotic oedema of the face, extremities, lips, tongue, glottis and/or larynx. Rarely, cholestatic jaundice or hepatitis that may progress to fulminant hepatic necrosis.

Increased risk of angioedema with racecadotril, mTOR inhibitors (e.g. everolimus, sirolimus, temsirolimus), vildagliptin. Increased risk of hyperkalaemia with K-sparing diuretics (e.g. spironolactone, triamterene, amiloride), K supplements, K-containing salt substitutes, and other drugs associated with increases in serum K (e.g. trimethoprim/sulfamethoxazole, heparin, ciclosporin). Increased risk of volume depletion and hypotension with diuretics. Increased hypotensive effect with other antihypertensive drugs, vasodilators (e.g. nitrates), TCAs, antipsychotics. May increase serum lithium concentration and enhance risk of lithium toxicity. Coadministration with NSAIDs (including COX-2 inhibitors) may result in deterioration of renal function. Increased risk of hypoglycaemia with insulin and oral antidiabetic drugs. Nitritoid reactions (e.g. facial flushing, nausea, vomiting, hypotension) may occur when used concurrently with injectable gold (Na aurothiomalate). Decreased antihypertensive effects with sympathomimetics.

ACE Inhibitors/Direct Renin Inhibitors

C09AA02 - enalapril ; Belongs to the class of ACE inhibitors. Used in the treatment of cardiovascular disease.