Enalapril
Uses of Enalapril
Enalapril is commonly used to treat diabetic kidney disease and heart attack. It is also used to prevent the occurrence of heart attack and stroke.
How Enalapril Works
Enalapril is an angiotensin-converting enzyme (ACE) inhibitor which prevents ACE from converting angiotensin I to angiotensin II. As a result, there is an increase in plasma renin activity and reduce the secretion of aldosterone. All these actions combined will encourage vasodilation and reduce blood pressure.
Side Effects of Enalapril
Headache, Hypotension, Dizziness, Peripheral neuropathy, Insomnia, Vertigo, Persistent dry cough, Nausea, Vomiting, Diarrhea, Rash, Muscle cramps
Warnings
Kidney Use With Care
In patients with renal impairment, the dosage of Enalapril needs to be adjusted depending on the renal function, particularly the patient's creatinine clearance. It is also important to do routine monitoring of the renal function during the treatment for such patients. There are also cases of renal failure reported in regards to Enalapril and most occur in patients with severe heart failure or underlying renal disease. When treated early, renal failure caused by Enalapril is reversible.
Alcohol Not Advisable
It is not advisable to consume Enalapril with alcohol because they can have an additive hypotensive effect.
Pregnancy Not Safe
There is evidence of human studies in which Enalapril possesses risks to the fetus even though potential benefits may warrant the usage during pregnancy. Any ACE inhibitor should not be started during pregnancy and unless continuous therapy with ACE inhibitor is indicated, it is inevitable that antihypertensive need to be changed to other alternatives with known safety profile in pregnancy. Specifically, during the second and third trimester of pregnancy, Enalapril can cause human fetotoxicity and neonatal toxicity, thus it should be avoided at all cost.
Driving Generally Safe
Enalapril usually does not affect the ability to drive. Do not drive unless you are feeling well.
Liver Limited Data
ACE inhibitor could be associated with cholestatic jaundice or hepatitis which then progresses to fulminant hepatic necrosis or death. If the patient develops jaundice or a significant increase of liver enzymes following usage of Enalapril, it is best to discontinue Enalapril and advice the patient to seek appropriate medical attention.
Lactation Limited Data
There is limited data on the safety profile of Enalapril in breastfeeding. However, few studies have shown that Enalapril is excreted in very low concentrations in breast milk. Although this could be deemed as insignificant, the usage of Enalapril during breastfeeding is not advisable for preterm infants and early delivery period because of the potential risk of cardiovascular and renal effects.
Frequently Asked Questions
Written by Dr Sri Viknarajan, MD (Universiti Hasanuddin, Indonesia)
Reviewed by Dr Nur Syuhada binti Zulkifli, MD, Universiti Kebangsaan Malaysia (UKM).
