- INDICATIONS AND DOSE
Hypertension
▶BY MOUTH
▶Adult: Initially 5 mg once daily, lower initial doses may be required when used in addition to diuretic or in renal impairment; maintenance 20 mg once daily; maximum 40 mg per day
Heart failure▶BY MOUTH
▶Adult (under close medical supervision): Initially 2.5 mg once daily, increased if tolerated to 10–20 mg twice daily, dose to be increased gradually over 2–4 weeks
Prevention of symptomatic heart failure in patients with asymptomatic left ventricular dysfunction▶BY MOUTH
▶Adult (under close medical supervision): Initially 2.5 mg once daily, increased if tolerated to 10–20 mg twice daily, dose to be increased gradually over 2–4 weeks
- INTERACTIONS → Appendix 1: ACE inhibitors
- SIDE-EFFECTS
▶Common or very common
Depression . hypersensitivity . postural hypotension . vision blurred
▶UncommonAnaemia . appetite decreased . asthma . bone marrow disorders . epigastric discomfort. flushing . gastrointestinal disorders . hoarseness . hypoglycaemia . malaise . muscle cramps . nervousness . proteinuria . rhinorrhoea .throat pain
▶ Rare or very rare Autoimmune disorder. gynaecomastia . lymphadenopathy . oliguria . oral disorders . Raynaud’s phenomenon .toxic epidermal necrolysis
Arthritis . leucocytosis . myositis . serositis . SIADH . vasculitis - BREAST FEEDING Avoid in first few weeks after delivery, particularly in preterm infants—risk of profound neonatal hypotension; can be used in mothers breast-feeding older infants if essential but monitor infant’s blood pressure.
- HEPATIC IMPAIRMENT Monitoring Enalapril is a prodrug and requires close monitoring in patients with hepatic impairment.
- RENAL IMPAIRMENT
Dose adjustmentsMax. initial dose 2.5 mg daily if eGFR less than 30 mL/minute/1.73 m2 .
- DIRECTIONS FOR ADMINISTRATION Tablets may be crushed and suspended in water immediately before use. 168 Blood pressure conditions BNF 76 Cardiovascular system 2
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