Home Drug Guide Enalapril Maleate

Drug Guide

Generic Name

Enalapril Maleate

Brand Names Vasotec, Epaned Kit, Epaned

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/A

Nursing 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.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.