Home Drug Guide Enalaprilat

Drug Guide

Generic Name

Enalaprilat

Brand Names Vasotec (IV formulation)

Classification

Therapeutic: Antihypertensive, Organic Thiazepinone

Pharmacological: ACE (Angiotensin-Converting Enzyme) Inhibitor

FDA Approved Indications

  • Hypertension
  • Heart Failure with reduced ejection fraction
  • Impaired Left Ventricular Systolic Function

Mechanism of Action

Enalaprilat inhibits angiotensin-converting enzyme (ACE), preventing the conversion of angiotensin I to angiotensin II, leading to vasodilation, decreased blood pressure, and reduced aldosterone secretion.

Dosage and Administration

Adult: Initial IV dose: 1.25 mg over 5 minutes, may repeat every 6 hours as needed. Dosage titration depends on clinical response and renal function.

Pediatric: Not typically used in pediatric patients.

Geriatric: Start at lower doses due to increased sensitivity and risk of hypotension.

Renal Impairment: Adjust dose based on severity of renal impairment; use with caution.

Hepatic Impairment: No specific adjustment required.

Pharmacokinetics

Absorption: Not applicable (IV administration).

Distribution: Widely distributed; crosses placental barrier.

Metabolism: Not significantly metabolized.

Excretion: Primarily renal excretion.

Half Life: Approximately 2 hours.

Contraindications

  • History of angioedema related to previous ACE inhibitor therapy.
  • Bilateral renal artery stenosis.
  • Hypersensitivity to enalapril or other ACE inhibitors.

Precautions

  • Monitor blood pressure closely during initiation.
  • Use with caution in patients with renal impairment, volume depletion, or hyperkalemia.
  • Pregnancy category D; avoid during pregnancy, especially in the second and third trimesters.

Adverse Reactions - Common

  • Hypotension (Rare)
  • Cough (Common)
  • Hyperkalemia (Uncommon)

Adverse Reactions - Serious

  • Angioedema (Rare)
  • Renal impairment (Uncommon)
  • Anaphylactoid reactions (Rare)

Drug-Drug Interactions

  • Potassium-sparing diuretics, potassium supplements (risk of hyperkalemia)
  • Diuretics, especially those causing volume depletion
  • Other antihypertensives (additive effect)
  • NSAIDs (risk of reduced antihypertensive effect and renal impairment)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, renal function, serum potassium, and signs of angioedema.

Diagnoses:

  • Risk for decreased cardiac output
  • Risk for hyperkalemia
  • Risk for hypotension

Implementation: Administer IV enalaprilat slowly over at least 5 minutes. Ensure volume status is adequate before administration.

Evaluation: Assess blood pressure response, renal parameters, and signs of adverse reactions.

Patient/Family Teaching

  • Instruct patient to report signs of angioedema (swelling of face, lips, tongue, difficulty breathing).
  • Advise about risk of hyperkalemia and importance of regular blood tests.
  • Warn against sudden dizziness or lightheadedness when standing.

Special Considerations

Black Box Warnings:

  • Pregnancy — can cause injury and death to the developing fetus; contraindicated during pregnancy.
  • Angioedema — risk increased in black patients and patients with a history of angioedema.

Genetic Factors: African Americans may have a reduced blood pressure response.

Lab Test Interference: Can cause falsely elevated serum potassium and creatinine levels.

Overdose Management

Signs/Symptoms: Severe hypotension, hyperkalemia, shock.

Treatment: Discontinue enalaprilat, provide supportive care, administer IV fluids for hypotension, and use vasopressors if necessary. Consider dialysis in severe cases.

Storage and Handling

Storage: Store at room temperature between 20°C to 25°C (68°F to 77°F).

Stability: Stable under recommended conditions; use within the expiration date.

🛡️ 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.