1. Overview

Enalapril (Vasotec) is an Antihypertensive agent that belongs to a class of drugs known as angiotensin-converting enzyme inhibitors (ACE-inhibitors). Enalapril is rapidly converted to its active metabolite, Enalaprilat, by hepatic biotransformation.

This agent is a vasodilator that is used to treat high blood pressure and heart failure. Enalapril is sold under the brand name Vasotec, it is available as oral tablets, powder for oral solution and injection solution.

Maleate salt of Enalapril is called Enalapril maleate, it is also available as combinations with diuretics such as:

Enalapril maleate/ hydrochlorothiazide (available as the brand name Vaseretic)

2. Uses of Enalapril

Enalapril (Vasotec) is used in the treatment of:

- Hypertension (high blood pressure)

- Symptomatic heart failure

- Asymptomatic left ventricular disorder

3. Dosage forms & strengths

Enalapril (Vasotec) is available as:

- Tablets: 2.5 mg, 5 mg, 10 mg, 20 mg

- Injection solution: 1.25 mg/mL

- Powder for oral Solution: 1 mg/mL

4. Enalapril dosage and indications

Hypertension

Adults and Elderly:

Oral: Initially 2.5mg/day (if the patient is taking diuretics)

Oral: Initially 5 mg/ day orally (if the patient is not taking diuretics)

Usually, the dosage range is 10 to 40 mg daily as 1 or 2 divided doses.

Parenteral: 0.625-1.25 mg up to 5 mg, intravenously over 5 minutes, every six hours.

Heart failure

Adults and Elderly:

Oral: Initially 2.5 mg once or twice daily. The dose can be increased gradually over 2-4 weeks. The maintenance is 5 to 40 mg daily as two divided doses.

The maximum daily dose is 40 mg in two divided doses.

Left ventricular dysfunction

Adults and Elderly:

Oral: 2.5 mg twice daily. Maintenance dose is 20 mg/day in 2 divided doses

Renal dose adjustment

If CrCl is 30 mL/minute or less:

- Hypertension

Oral: Initially 2.5 mg/day, and then titrated until blood pressure is controlled.

- Heart failure

Oral: Initially 2.5 mg twice daily, then it can be increased by 2.5 mg/dose at greater than 4-day intervals.

The maximum dose is 40 mg/day.

If CrCl is greater than 30 mL/minute:

Usually, no dosage adjustment will be needed.

Hemodialysis:

On dialysis days, initially 2.5 mg; on-dialysis days the dose should be adjusted depending on the blood pressure.

5. Dosage in Hepatic Impairment

No dose adjustment.