Enalapril maleate

[en-AL-ah-prill] Pregnancy Category: D

Apo-Enalapril M, Vasotec, Vasotec I.V., Vasotec Oral M (Rx) Classification: Angiotensin-convert-ing enzyme inhibitor

See also Angiotensin-Converting Enzyme Inhibitors. Action/Kinetics: Converted in the liver by hydrolysis to the active metabolite, enalaprilat. The parenteral product is enalaprilat injection. Onset, PO: 1 hr; IV, 15 min. Time to peak action, PO: 4-6 hr; IV, 1-4 hr. Duration, PO: 24 hr; IV, About 6 hr. Approximately 50%-60% is protein bound. tv2, enalapril, PO: 1.3 hr; IV, 15 min. tv2, enalaprilat, PO: 11 hr. Excreted through the urine (half unchanged) and feces; over 90% of enalaprilat is excreted through the urine.

Uses: Alone or in combination with a thiazide diuretic for the treatment of hypertension (step I therapy). As adjunct with digitalis and diuretic in acute and chronic CHF. Non-FDA Approved Uses: Hypertension in children, hypertension related to sclero-derma renal crisis, diabetic neph-ropathy, asymptomatic left ventricular dysfunction following MI.

Enalaprilat may be used for hypertensive emergencies (effect is variable). Contraindications: See also An-giotensin-Converting Enzyme Inhibitors.

Special Concerns: Use with caution during lactation. Safety and effectiveness have not been determined in children.

Side Effects: CV: Palpitations, hypotension, chest pain, angina, CVA, MI, orthostatic hypotension, disturbances in rhythm, tachycardia, cardiac arrest, orthostatic effects, atrial fibrillation, bradycardia. Oral: Alterations in taste, dry mouth, glossitis, stomatitis. GI: N&V, diarrhea, abdominal pain, anorexia, constipation, dyspepsia, ileus, melena. CNS: Insomnia, headache, fatigue, dizziness, paresthesias, nervousness, sleepiness, ataxia, confusion, depression, vertigo. Hepatic: Hepatitis, hepatocellular or cholestatic jaundice, pancreatitis, elevated liver enzymes, hepatic failure. Respiratory: Bronchitis, cough, dyspnea, bronchospasm, upper respiratory infection, pneumonia, pulmonary infiltrates, asthma, pulmonary embolism and infarction, pulmonary edema. Renal: Renal dysfunction, ol-iguria, UTI, transient increases in creatinine and BUN. Hematologic: Rarely, neutropenia, thrombocyto-

penia, bone marrow depression, decreased H&H in hypertensive or CHF clients. Hemolytic anemia, including hemolysis, in clients with G6PD deficiency. Dermatologic: Rash, pruritus, alopecia, flushing, erythema multiforme, exfoliative dermatitis, photosensitivity, urticaria, increased sweating, pemphigus, Stevens-Johnson syndrome, herpes zoster, toxic epidermal necrolysis. Other: Angioedema, asthenia, impotence, blurred vision, fever, arthralgia, arthritis, vasculitis, eosinophilia, tinnitus, syncope, myalgia, rhinorrhea, sore throat, hoarseness, conjunctivitis, tearing, dry eyes, loss of sense of smell, hearing loss, peripheral neuropathy, anosmia, myositis, flank pain, gynecomastia.

Drug Interactions: See also An-giotensin-Converting Enzyme Inhibitors.

How Supplied: Tablet: 2.5 mg, 5 mg, 10 mg, 20 mg; Injection: 1.25 mg/mL


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