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enalaprilat
Innovace§, Vasotec I.V.

enalapril maleate
Amprace‡, Renitec‡, Vasotec

Pregnancy Risk Category C (D in second and third trimesters)

How supplied
enalaprilat

Injection:
1.25 mg/ml
enalapril maleate

Tablets:
2.5 mg, 5 mg, 10 mg, 20 mg

Action
Unknown. Inhibits ACE, preventing conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Reduced formation of angiotensin II decreases peripheral arterial resistance, thus decreasing aldosterone secretion.

Indications & dosage
Hypertension
--
Adults:
in patients not receiving diuretics, initially 5 mg P.O. once daily; then adjusted based on response. Usual dosage range is 10 to 40 mg daily as a single dose or two divided doses. Or, 1.25 mg I.V. infusion over 5 minutes q 6 hours.
Adjust-a-dose:
For patients on diuretics, initially 2.5 mg P.O. once daily. Or, 0.625 mg I.V. over 5 minutes, repeated in 1 hour if needed; then 1.25 mg I.V. q 6 hours.
To convert from I.V. therapy to oral
therapy--

Adults:
initially, 2.5 mg P.O. once daily; if patient was receiving 0.625 mg I.V. q 6 hours, then 2.5 mg P.O once daily. Dosage is adjusted based on response.
To convert from oral therapy to I.V.
therapy
--
Adults:
1.25 mg I.V. over 5 minutes q 6 hours. Higher dosages haven't shown greater efficacy.
Adjust-a-dose:
For patients with renal impairment or hyponatremia, if serum creatinine level is over 1.6 mg/dl or serum sodium level is below 130 mEq/L, dosage is initiated at 2.5 mg P.O. daily and adjusted slowly.
Management of symptomatic heart failure
--
Adults:
initially, 2.5 mg P.O. daily or b.i.d. increased gradually over several weeks. Maintenance is 5 to 20 mg daily, given in two divided doses. Maximum daily dose is 40 mg given in two divided doses.

Adverse reactions
CNS:
headache, dizziness, fatigue, vertigo, asthenia, syncope.
CV:
hypotension, chest pain, angina.
GI:
diarrhea, nausea, abdominal pain, vomiting.
GU:
decreased renal function in patients with bilateral renal artery stenosis or heart failure, increased BUN and creatinine levels.
Hematologic:
decreased hemoglobin level and hematocrit, bone marrow depression.
Hepatic:
increased liver function test results, decreased bilirubin level.
Respiratory:
dyspnea; dry, persistent, tickling, nonproductive cough.
Skin:
rash.
Other:
angioedema.

Interactions
Drug-drug.
Diuretics: excessive reduction of blood pressure. Use together cautiously.
Insulin, oral antidiabetics:
risk of hypoglycemia, especially at initiation of enalapril therapy. Monitor closely.
Lithium:
lithium toxicity can occur. Monitor lithium levels.
NSAIDs:
may reduce antihypertensive effect. Monitor blood pressure.
Potassium-sparing diuretics, potassium supplements:
increased risk of hyperkalemia. Avoid these drugs unless hypokalemic blood levels are confirmed.
Drug-food.
Salt substitutes containing potassium: risk of hyperkalemia. Monitor closely.

Effects on diagnostic tests
None reported.

Contraindications
Contraindicated in patients with hypersensitivity to drug or history of angioedema related to previous treatment with an ACE inhibitor.

Nursing considerations

I.V. administration

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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