Drug Name
Generic Name : enalapril maleate
Brand Name: Vasotec , enalaprilat , Vasotec I.V.
Classification: Antihypertensive, ACE inhibitor
Pregnancy Category D
Dosage & Route
Available forms : Tablets—2.5, 5, 10, 20 mg; injection—1.25 mg/mL
ADULTS
Oral
Hypertension:
- Patients not taking diuretics: Initial dose is 5 mg/day PO. Adjust dosage based on patient response. Usual range is 10–40 mg/day as a single dose or in two divided doses.
- Patients taking diuretics: Discontinue diuretic for 2–3 days if possible. If it is not possible to discontinue diuretic, give initial dose of 2.5 mg, and monitor for excessive hypotension.
- Converting to oral therapy from IV therapy: 5 mg daily with subsequent doses based on patient response.
CHF: 2.5 mg PO daily or bid in conjunction with diuretics and digitalis. Maintenance dose is 5–20 mg/day given in two divided doses. Maximum daily dose is 40 mg.
Asymptomatic LVD: 2.5 mg PO bid; target maintenance dose 20 mg/day in two divided doses.
Parenteral
- Give IV only. 1.25 mg q 6 hr given IV over 5 min. A response is usually seen within 15 min, but peak effects may not occur for 4 hr.
Hypertension:
Converting to IV therapy from oral therapy: 1.25 mg q 6 hr; monitor patient response.
Patients taking diuretics: 0.625 mg IV over 5 min. If adequate response is not seen after 1 hr, repeat the 0.625-mg dose. Give additional doses of 1.25 mg q 6 hr.
PEDIATRIC PATIENTS 1 MO–16 YR
Oral
Hypertension: Initial dose is 0.08 mg/kg PO once daily; maximum dose is 5 mg.
GERIATRIC PATIENTS AND PATIENTS WITH RENAL IMPAIRMENT
Oral
- Excretion is reduced in renal failure; use smaller initial dose, and adjust upward to a maximum of 40 mg/day PO. For patients on dialysis, use 2.5 mg on dialysis days.
Therapeutic actions
- Enalapril is de-esterified into the active enalaprilat resulting in potent inhibition of ACE thus leading to reduced levels of angiotensin II and aldosterone. Clinically, BP is reduced, salt and water retention is corrected. Ventricular hypertrophy is reversed. Renal blood flow is increased but in patients with renal impairment there may be oliguria or acute renal failure.
Indications
- Treatment of hypertension alone or in combination with other antihypertensives, especially thiazide-type diuretics
- Treatment of acute and chronic CHF
- Treatment of asymptomatic left ventricular dysfunction (LVD)
- Unlabeled use: Diabetic nephropathy
Adverse effects
- Initial hypotension may be severe and prolonged. Dizziness, headache, fatigue, persistent dry cough, abnormal taste, lassitude, rash, neutropenia, renal impairment or failure.
- Potentially Fatal: Angioedema.
Contraindications
- Hypersensitivity. History of angioedema due to previous treatment with ACE inhibitors; bilateral renal artery stenosis. Pregnancy.
Nursing considerations
Assessment
- History: Allergy to enalapril, impaired renal function, salt or volume depletion, lactation, pregnancy
- Physical: Skin color, lesions, turgor; T; orientation, reflexes, affect, peripheral sensation; P, BP, peripheral perfusion; mucous membranes, bowel sounds, liver evaluation; urinalysis, LFTs, renal function tests, CBC, and differential
Interventions
- WARNING: Alert surgeon, and mark patient’s chart with notice that enalapril is being taken; the angiotensin II formation subsequent to compensatory renin release during surgery will be blocked; hypotension may be reversed with volume expansion.
- Be aware that use of this drug in second and third trimesters can cause serious injury or death to the fetus; advise contraceptive use.
- Monitor patients on diuretic therapy for excessive hypotension after the first few doses of enalapril.
- Monitor patient closely in any situation that may lead to a drop in BP secondary to reduced fluid volume (excessive perspiration and dehydration, vomiting, diarrhea) because excessive hypotension may occur.
- Arrange for reduced dosage in patients with impaired renal function.
- WARNING: Monitor patient carefully because peak effect may not be seen for 4 hr. Do not administer second dose until BP has been checked.
Teaching points
- Do not stop taking the medication without consulting your health care provider.
- Be careful in any situation that may lead to a drop in blood pressure (diarrhea, sweating, vomiting, dehydration).
- Avoid over-the-counter medications, especially cough, cold, and allergy medications that may interact with this drug.
- You may experience these side effects: GI upset, loss of appetite, change in taste perception (will pass with time); mouth sores (frequent mouth care may help); rash; fast heart rate; dizziness, light-headedness (usually passes in a few days; change position slowly, limit activities to those not requiring alertness and precision).
- Use of contraception is advised while taking the drug.
- Report mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular heartbeat, chest pains; swelling of the face, eyes, lips, tongue, difficulty breathing.