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.