Indications
Enaril is indicated for the treatment of all grades of essential
hypertension, renovascular hypertension and heart failure.
Dosage and Administration
Essential and renovascular hypertension : Treatment should be initiated with 5
mg once a day. Where concomitant therapy is a diuretic, the
recommended initial dose of Enaril is 2.5 mg. The dose should be titrated
to give optimum control of blood pressure. The usual maintenance dose
is 10-20 mg given once daily. In severe hypertension, the dosage may be
increased incrementally to a maximum of 40 mg once daily.
Heart failure : Enaril can be used as an adjunctive therapy with nonpotassium-sparing
diuretics and/or digitalis. The recommended starting
dose of Enaril is 2.5 mg once daily. The dose of Enaril should be
gradually increased depending upon tolerability to the recommended
maintenance dose (10-20 mg) given as a single or twice daily dose.
The absorption of Enaril is not affected by food. The maximum daily
dose is 40 mg.
Use in the elderly (over 65 years) : The starting dose should be 2.5 mg. Enaril
is effective in the treatment of hypertension in the elderly. The dose
should be titrated according to need for the control of blood pressure.
Contraindications
Pregnancy : Enalapril is contraindicated in pregnancy and treatment should
be stopped if pregnancy is suspected, because it has been found to be
foetotoxic in rabbits.
Hypersensitivity : Enaril is also contraindicated in patients who are
hypersensitive to any component of this product and in patients with a
history of angioneurotic oedema relating to previous treatment with an
ACE inhibitor.
Precautions
Hypotension : Symptomatic hypotension has been reported mainly in
patients with severe heart failure. In these patients, by discontinuing
diuretic therapy or significantly reducing the diuretic dose for two to three
days prior to initiating Enalapril, the possibility of this occurrence is
reduced. By initiating therapy with a small dose (2.5 mg), the duration of
any hypotensive effect may be lessened.
If hypotension develops, the patient should be placed in a supine
position. Volume repletion with oral fluids or intravenous normal saline
may be required.
Impaired renal function :Â Enalapril should be used with caution in patients
with renal insufficiency as they may require reduced or less frequent
doses. Renal failure has been reported in association with Enalapril and
has been mainly in patients with severe congestive heart failure or
underlying renal disease, including renal artery stenosis. If recognized
promptly and treated appropriately, renal failure is usually reversible.
Angioneurotic oedema : Angioneurotic oedema has been reported with ACE
inhibitors including Enalapril. In such cases, Enaril should be
discontinued immediately and appropriate monitoring should be
instituted to ensure complete resolution of symptoms prior to dismissing
the patient. Where swelling is confined to the face, lips and mouth, the
condition will usually resolve without further treatment, although
antihistamines may be useful in relieving symptoms. However, where
there is involvement of the tongue, glottis or larynx, likely to cause
airways obstruction, appropriate therapy such as subcutaneous adrenaline
1 : 1000 (0.5 ml) should be administered promptly.
Cough : Cough has been reported with the use of ACE inhibitors.
Surgery/Anaesthesia : In patients undergoing major surgery or during
anaesthesia with agents that produce hypotension, Enalapril blocks
angiotensin II formation secondary to compensatory renin release. This
may lead to hypotension which can be corrected by volume expansion.
Drug Interactions
Combination with other antihypertensive agents such as b blockers,
Methyldopa, calcium antagonists and diuretics may increase the
antihypertensive efficacy. Adrenergic blocking drugs should only be
combined with Enalapril under careful supervision. Concomitant
Propranolol may reduce the bioavailability of Enalapril, but this does not
appear to be of any clinical significance. Concomitant therapy with
Lithium may increase the serum Lithium concentration.
Side Effects
The commonly reported side effects are dizziness and headache. Other
side effects occurring less frequently include orthostatic hypotension,
nausea, rash, cough etc.
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