Nurses Compass
Drug Guide
Enalapril Maleate
Classification
Therapeutic: Antihypertensive, Heart Failure Agent
Pharmacological: ACE (Angiotensin-Converting Enzyme) Inhibitor
FDA Approved Indications
- Hypertension
- Symptomatic heart failure
Mechanism of Action
Enalapril inhibits the angiotensin-converting enzyme, preventing the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This results in vasodilation, decreased blood pressure, and reduced afterload in heart failure.
Dosage and Administration
Adult: Typically 5-10 mg once daily, titrated based on response. For heart failure, start at 2.5 mg twice daily.
Pediatric: Dosing varies; consult specific pediatric guidelines.
Geriatric: Start at lower doses; monitor renal function carefully.
Renal Impairment: Use with caution; dose adjustments required based on severity.
Hepatic Impairment: Adjust dose as needed; monitor closely.
Pharmacokinetics
Absorption: Well absorbed orally, with 60-70% bioavailability.
Distribution: Widely distributed; crosses placental barrier.
Metabolism: Primarily via hepatic hydrolysis to the active metabolite enalaprilat.
Excretion: Renally excreted; dose adjustments needed in renal impairment.
Half Life: Enalapril: approximately 11 hours; Enalaprilat: 11-12 hours.
Contraindications
- History of angioedema related to previous ACE inhibitor therapy
- Bilateral renal artery stenosis
- Hypersensitivity to enalapril or other ACE inhibitors
Precautions
- Pregnancy (category D), Lactation, Renal impairment, Hyperkalemia, Volume depletion
Adverse Reactions - Common
- Cough (Frequent)
- Dizziness (Common)
- Headache (Common)
- Fatigue (Common)
Adverse Reactions - Serious
- Angioedema (Rare)
- Neutropenia / Agranulocytosis (Rare)
- Elevated serum potassium (Uncommon)
- Hypotension (Uncommon)
Drug-Drug Interactions
- Diuretics, other antihypertensives, potassium supplements, lithium, NSAIDs
Drug-Food Interactions
- Salt substitutes containing potassium
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood pressure, renal function, serum potassium levels regularly.
Diagnoses:
- Risk for hypotension,
- Altered renal function
- ,
- Electrolyte imbalance
Implementation: Administer as prescribed, monitor blood pressure and labs, educate patient on signs of adverse effects.
Evaluation: Assess blood pressure response, renal function, and serum potassium levels to determine efficacy and safety.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Do not discontinue abruptly.
- Report signs of angioedema, persistent cough, hyperkalemia.
- Avoid potassium supplements and salt substitutes unless directed.
- Rise slowly to prevent dizziness.
Special Considerations
Black Box Warnings:
- Pregnancy risk—discontinue as soon as pregnancy is detected.
Genetic Factors: Genetic variations may affect response.
Lab Test Interference: May falsely elevate serum potassium and blood urea nitrogen.
Overdose Management
Signs/Symptoms: Severe hypotension, dizziness, electrolyte disturbances.
Treatment: Discontinue medication, provide supportive care, administer IV fluids, vasopressors if necessary, monitor electrolytes and renal function.
Storage and Handling
Storage: Store at room temperature, 20°C to 25°C.
Stability: Stable for the shelf life indicated by manufacturer.