Enaril 5

Indications

Hypertension: All grades of essential hypertension and renovascular hypertension.

Heart failure: In heart failure, Enaril should be used as an adjunctive therapy with non-potassium-sparing diuretics and, where appropriate, digitalis.

Severe heart failure: Treatment with Enaril should always be initiated in hospital under close medical supervision. When used as an adjunct to conventional therapy in these patients, Enaril improves symptoms, and reduces mortality and hospitalization.

Mild to moderate heart failure: Treatment with Enaril should always be initiated under close medical supervision. When used as an adjunct to conventional therapy in these patients, Enaril improves symptoms, and reduces mortality and hospitalization.

Pharmacology

Enalapril, after hydrolysis to enalaprilate, inhibits Angiotensin Converting Enzyme (ACE). ACE is a peptidyl dipeptidase that catalyses the conversion of angiotensin I to the vasoconstrictor substance angiotensin II. Angiotensin II also stimulates aldosterone secretion by the adrenal cortex. The beneficial effects of enalapril in hypertension and heart failure appear to result primarily from suppression of the renin-angiotensin aldosterone system.

Dosage & Administration

The maximum daily dose is 40 mg. The absorption of Enalapril is not affected by food. Essential and renovascular hypertension: Treatment should be initiated with 5 mg once a day. Where concomitant therapy is a diuretic, the recommended initial dose of Enalapril 2.5 mg. The dose should be titrated to give optimum control of blood pressure. The usual maintenance dose is 10-20 mg given once daily. In severe hypertension, the dosage may be increased incrementally to a maximum of 40 mg once daily. The dosage of other antihypertensive agents being used together with Enalapril may need to be adjusted.

With concomitant diuretic therapy: The recommended initial dose of Enalapril is 2.5 mg. Symptomatic hypotension can occur following the initial dose of Enalapril; this is more likely when Enalapril is added to previous diuretic therapy. If possible, the diuretic therapy should be discontinued for 2-3 days prior to initiation of therapy with Enalapril.

Use in the elderly (over 65 years): The starting dose should be 2.5 mg. Enalapril is effective in the treatment of hypertension in the elderly. The dose should be titrated according to need for the control of blood pressure.

Heart failure: Enalapril can be used as an adjunctive therapy with non-potassium-sparing diuretics and/or digitalis. Therapy with Enalapril should be initiated under close medical supervision with a recommended starting dose of 2.5 mg once daily. The dose of Enalapril should be gradually increased depending upon tolerability to the recommended maintenance dose (10-20 mg) given as a single or twice daily dose.

Use in impaired renal function: Enaril should be used with caution in patients with renal insufficiency as they may require reduced or less frequent doses. Angioneurotic oedema has been reported with angiotensin-converting enzyme inhibitors, including Enaril. In such cases, Enaril should be discontinued immediately.

Cough: Cough has been reported with the use of ACE inhibitors. Characteristically, the cough is non-productive, persistent and resolves after discontinuation of therapy.

Surgery/Anaesthesia: In patients undergoing major surgery or during anaesthesia with agents that produce hypotension, Enaril blocks angiotensin II formation secondary to compensatory renin release. This may lead to hypotension which can be corrected by volume expansion.

Contraindications

Hypersensitivity to the product or any of its components, and in patients with a history of angioneurotic oedema relating to previous treatment with an ACE inhibitor.

Pregnancy & Lactation

Enalapril has been shown to be fetotoxic in rabbits during middle and late pregnancy. Because of these findings Enalapril is contra-indicated in pregnancy. Enalapril and enalaprilat are excreted in human milk; caution should be exercised if Enalapril is given to lactating mothers.

Storage Conditions

Do not store above 25°C. Keep away from light and wet place. Keep out of reach of children.

Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your physician or pharmacist before starting any medication.