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Related to Vasotec: enalapril, Lasix, ACE inhibitors

enalapril maleate

Apo-Enalapril (CA), CO Enalapril (CA), Gen-Enalapril (CA), Innovace (UK), Novo-Enalapril (CA), PMS-Enalapril (CA), Ratio-Enalapril (CA), Riva-Enalapril (CA), Sandoz-Enalapril (CA), Taro-Enalapril (CA), Vasotec


Vasotec IV

Pharmacologic class: Angiotensin-converting enzyme (ACE) inhibitor

Therapeutic class: Antihypertensive

Pregnancy risk category C (first trimester), D (second and third trimesters)

FDA Box Warning

• When used during second or third trimester of pregnancy, drug can cause fetal injury and even death. Discontinue as soon as pregnancy is detected.


Inhibits conversion of angiotensin I to angiotensin II, a potent vasoconstrictor; inactivates bradykinin and prostaglandins. Also increases plasma renin and potassium levels and reduces aldosterone levels, resulting in systemic vasodilation.


Injection: 1.25 mg/ml

Tablets: 2.5 mg, 5 mg, 10 mg, 20 mg

Indications and dosages


Adults: For patients not taking concomitant diuretics-initially, 5 mg P.O. once daily, increased after 1 to 2 weeks as needed to a maintenance dosage of 10 to 40 mg P.O. daily given as a single dose or in two divided doses; or 1.25 mg I.V. q 6 hours. For patients taking diuretics-initially, 2.5 mg P.O. or 0.625 mg I.V.

Children: 0.08 mg/kg P.O. once daily; may be increased based on blood pressure response up to 5 mg daily. Maximum dosage is 0.58 mg/kg/dose.

Heart failure

Adults: Initially, 2.5 mg P.O. once or twice daily, increased after 1 to 2 weeks as needed to maintenance dosage of 5 to 40 mg P.O. daily given as a single dose or in two divided doses

Asymptomatic left ventricular dysfunction

Adults: Initially, 2.5 mg P.O. once or twice daily, increased after 1 to 2 weeks as needed to a maximum of 20 mg/day in divided doses

Dosage adjustment

• Renal impairment

Off-label uses

• Diabetic nephropathy

• Hypertensive emergency


• Hypersensitivity to drug or other ACE inhibitors

• Angioedema

• Pregnancy


Use cautiously in:

• renal or hepatic impairment, hypovolemia, hyponatremia, aortic stenosis, hypertrophic cardiomyopathy, cerebrovascular or cardiac insufficiency

• concurrent diuretic use

• elderly patients

• breastfeeding patients

• children.


• Give oral doses with food or beverage.

• Discontinue diuretics for 2 to 3 days before starting drug, if possible.

• Know that I.V. administration is usually reserved for patients who cannot take P.O. form.

• Be aware that I.V. administration isn't recommended for pediatric patients.

• Administer I.V. dose either undiluted or diluted in 50 ml of dextrose 5% in water, normal saline solution, dextrose 5% in normal saline solution, or dextrose 5% in lactated Ringer's solution.

• Give single I.V. dose by push or piggyback over 5 minutes. If patient is at risk for hypotension, infusion may be given over 1 hour.

• Be aware that black patients have a higher risk of angioedema.

Adverse reactions

CNS: dizziness, fatigue, headache, insomnia, drowsiness, vertigo, asthenia, paresthesia, ataxia, confusion, depression, nervousness,cerebrovascular accident

CV: orthostatic hypotension, palpitations, angina pectoris, tachycardia, peripheral edema,arrhythmias, cardiac arrest

EENT: sinusitis

GI: nausea, vomiting, constipation, dyspepsia, abdominal pain, dry mouth, pancreatitis

GU: proteinuria, urinary tract infection, erectile dysfunction, decreased libido,oliguria

Hematologic: agranulocytosis, bone marrow depression

Hepatic: hepatitis

Metabolic: hyponatremia,hyperkalemia Respiratory: cough, upper respiratory tract infection, asthma, bronchitis, dyspnea,eosinophilic pneumonitis

Skin: rash, alopecia, photosensitivity, diaphoresis, exfoliative dermatitis, angioedema,erythema multiforme

Other: altered taste, fever, increased appetite, anaphylactoid reactions


Drug-drug. Allopurinol: increased risk of hypersensitivity reaction

Antacids: decreased enalapril absorption Cyclosporine, indomethacin, potassiumsparing diuretics, potassium supplements: hyperkalemia

Digoxin, lithium: increased blood levels of these drugs, possible toxicity

Diuretics, nitrates, other antihypertensives, phenothiazines: additive hypotension

Nonsteroidal anti-inflammatory drugs: decreased antihypertensive response

Rifampin: decreased enalapril efficacy

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen (BUN), creatinine, potassium: increased levels Antinuclear antibodies: positive titer Sodium: decreased level

Drug-food. Salt substitutes containing potassium: hyperkalemia

Drug-herbs. Capsaicin: increased incidence of cough

Drug-behaviors. Acute alcohol ingestion: additive hypotension

Sun exposure: photosensitivity reaction

Patient monitoring

Assess for rapid blood pressure drop leading to cardiovascular collapse, especially when giving with diuretics.

In patient with renal insufficiency or renal artery stenosis, monitor for worsening renal function.

• After initial dose, observe patient closely for at least 2 hours until blood pressure has stabilized. Then continue to observe for additional hour.

• Monitor vital signs, fluid intake and output, and daily weight.

• Supervise patient during ambulation until effects of drug are known.

• Monitor liver function tests, BUN, and creatinine and electrolyte levels.

Patient teaching

• Inform patient that drug's full effect may not occur for several weeks.

• Advise patient to report persistent dry cough with nasal congestion.

Tell patient to immediately report swelling of face, eye area, tongue, lips, hands, or feet; rash, hives, or severe itching; unexplained fever; unusual tiredness; yellowing of skin or eyes; abdominal pain; or easy bruising.

• Instruct patient to move slowly when sitting up or standing, to avoid dizziness or light-headedness from sudden blood pressure decrease.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.


A trademark for the drug enalapril maleate.


Enalapril maleate, see there.
References in periodicals archive ?
10 The first Merck product was Vasotec, see Merck World 7 (Mar.
Apotex claims it started work on Apo-Enalapril, its version of Vasotec, in 1987, before Merck received its Canadian patent in 1990.
ACE (angiotensin-converting enzyme) inhibitors, including Capoten, Vasotec, Prinivil, and Zestril, cause blood vessels to dilate.
Nerve Blockers Generic Name Trade Name rauwolfia derivatives Reserpine guanethidine Ismelin guanadrel Hylorel alpha methyldopa Aldomlet clonidine Catapres guanabenz Wytensin prazosin Minipress terazosin Hytrin Beta Blockers propranolol Inderal metoprolol Lopressor nadolol Corgard atenolol Tenormin timolol Blocadren pindolol Visken acebutolol Sectral labetolol Normodyne or Trandate Blood Vessel Dilators hydralazine, Apresoline minoxidil Loniten(**) Hormone inhibitors captopril Capoten enalapril Vasotec lisinopril Prinivel or Zestril Calcium Channel Blockers nifedipine Procardia verapamil Isoptin or Calan diltiazem Cardizem nicardipine Cardene (*) Many combinations of these drugs are available--usually with a diuretic.
Angiotensin converting enzyme inhibitors (ACEIs) such as captopril (Capoten) and enalapril (Vasotec) may be used to prevent urinary protein losses that are associated with diabetes damage to the kidney.
Much of Merck's rapid growth was due to Vasotec, a heart drug introduced in 1986 that now commands over US $ 1 billion a year in sales, and an assortment of other medications for heart disease.
Medications that can relieve your symptoms and help your heart pump more effectively include beta blockers (Lopressor, Inderal) and ACE inhibitors (Lotensin, Vasotec).
Commonly prescribed antihypertensive medications include diuretics (HydroDiuril); angiotensin-converting enzyme (ACE) inhibitors (Vasotec); angiotensin receptor blockers (Avapro); beta blockers (Lopressor); calcium channel blockers (Verapamil); and a new class of drugs called renin inhibitors (Aliskiren).
I am not suggesting that the success of alternative techniques in lowering BP should preclude the use of calcium channel blockers such as amlodipine (Norvasc), angiotensin II receptor blockers such as candesartan cilexetil (Atacand), or ACE inhibitors such as enalapril (Vasotec) in hypertensive patients.
Patients on active treatment with enalapril (Vasotec) 20 mg were randomized to also receive eplerenone 50 mg or 100 mg, or placebo.
* Merck & Co.'s major products include Vasotec and Prinivil (angiotensin-converting enzyme inhibitors for high blood pressure and angina), Mevacor and Zocor (cholesterol-lowering agents), Fosamax (osteoporosis), Vioxx (an antiarthritic), Crixivan (HIV/AIDS), Singulair (asthma), and Prilosec (gastro-intestinal disorders).