Enalapril

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ENAHEXAL (enalapril maleate) lowers blood pressure in patients with hypertension and improves the signs and symptoms associated with chronic heart failure.  Belongs to a class of drugs called ACE inhibitors.

You should not use this medicine if you are pregnant or have had an allergic reaction to ACE-inhibitors such as CapotenŽ, MonoprilŽ, LotensinŽ, AccuprilŽ, or PrinivilŽ.

How to use and store this medicine

Tablets:

• Take this medicine exactly as your doctor ordered. Even if you feel fine your blood pressure can still be high.
• May be taken with or without food.
• Store at room temperature, away from heat, moisture, and direct light.
• Keep all medicine out of the reach of children.

If you miss a dose:

• Take the missed dose as soon as possible.
• Skip the missed dose if it is almost time for your next regular dose.
• You should not use two doses at the same time.

Warnings

• Check with your doctor before taking if you have diabetes, heart, kidney, or liver disease, or lupus.
• Talk with your doctor before use if you are pregnant or breastfeeding.
• Enalapril may make you dizzy or drowsy. Be careful if you drive a car or use machinery.
• Tell your doctor or dentist that you are taking enalapril before having any kind of surgery.

Side effects

Call your doctor right away if you have any of these side effects:

• Irregular heartbeat
• Chest pain
• Swelling of face, mouth, or tongue
• Trouble breathing or swallowing
• Hoarseness
• Skin rash, severe itching or hives
• Fever, chills, or sore throat
• Yellowing of skin or eyes

If you have problems with these less serious side effects, talk with your doctor.

• Dry cough or changes in the sense of taste
• Headache
• Dizziness, lightheadedness, fainting, or fatigue
• Nausea or vomiting
• Diarrhea or constipation

Since absorption of ENAHEXAL tablets is not affected by food, the tablets may be administered before, during, or after meals.

Essential Hypertension:

The initial dose is 5mg and is given once daily. The usual maintenance dose is 20mg taken daily. The dosage should be adjusted according to the needs of the patient to a maximum of 40mg daily.

Renovascular Hypertension:

Since blood pressure and renal function in such patients may be particularly sensitive to ACE inhibition, therapy should be initiated with a lower starting dose (2.5-5mg). The dosage should then be adjusted according to the needs of the patient. Most patients may be expected to respond to one 20mg tablet taken once daily. For patients with hypertension who have been treated recently with diuretics, caution is recommended (see next paragraph).

Concomitant Diuretic Therapy in Hypertension:

Symptomatic hypotension may occur following the initial dose of ENAHEXAL; this is more likely in patients who are being treated currently with diuretics. Caution is recommended, therefore, since these patients may be volume or salt-depleted. The diuretic therapy should be discontinued for 2-3 days prior to initiation of therapy with ENAHEXAL. If this is not possible, the initial dose of ENAHEXAL should be low (2.5mg) to determine the initial effect on the blood pressure. Dosage should then be adjusted according to the needs of the patient.

Dosage in Renal Insufficiency:

Generally, the intervals between the administration of enalapril should be prolonged and/or the dosage reduced.

Limited data are available for overdosage in humans. The most prominent feature of overdosage reported to date is marked hypotension, beginning some six hours after ingestion f tablets, concomitant with blockade of the renin-angiotensin system, and stupor. Serum enalaprilat levels 100 times and 200 times higher than usually seen after therapeutic doses have been reported after ingestion of 300mg of 400mg of enalapril, respectively.

The recommended treatment of overdosage is intravenous infusion of normal saline solution. If ingestion is recent, induce emesis. Enalaprilat may be removed from the general circulation by haemodialysis.

If you have other side effects that you think are caused by this medicine, tell your doctor.

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