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Enalapril, Oral Tablet

Highlights for enalapril

  1. Enalapril is available as both a generic and brand-name drug. Brand names: Vasotec and Epaned.
  2. It is available as an oral tablet and an oral solution.
  3. Enalapril is used to treat high blood pressure, heart failure, and asymptomatic left ventricular dysfunction.
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Important warnings

Important warnings

FDA warning: Use during pregnancy
  • This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to effects that may be dangerous.
  • You shouldn’t take this drug if you’re pregnant or plan to become pregnant. Enalapril can harm or be fatal to your unborn child. You should stop taking this drug right away if you get pregnant.
  • Swelling warning: Enalapril can cause sudden swelling of your face, arms, legs, lips, tongue, throat, and intestines (angioedema). This is serious and can sometimes be fatal. It may occur at any time during treatment. Tell your doctor right away if you have swelling or stomach pain. Your doctor will have you stop taking this drug, and you may be given medication to reduce the swelling. Your risk of swelling may be higher if you’ve had this problem before while taking an angiotensin-converting enzyme (ACE) inhibitor.
  • Low blood pressure warning: Enalapril can cause low blood pressure. Tell your doctor if you feel lightheaded or have any fainting spells. You may have a higher risk of low blood pressure if you:
    • aren’t drinking enough fluids
    • sweat heavily
    • have diarrhea or are vomiting
    • have heart failure
    • are on dialysis
    • take diuretics
  • Dry cough warning: Enalapril may cause a dry cough. This will go away once you stop taking the medication.

About

What is enalapril?

Enalapril oral tablet is a prescription drug that’s available as the brand-name drug Vasotec. it’s also available as a generic drug. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand. Talk to your healthcare provider to see if the generic will work for you.

Enalopril is also available as a prescription oral solution that only comes as the brand name drug Epaned.

Why it's used

Enalapril is used to treat high blood pressure, heart failure, and asymptomatic left ventricular dysfunction.

Enalapril may be used as part of a combination therapy. That means you need to take it with other drugs.

How it works

Enalapril belongs to a class of drugs called angiotensin-converting enzyme (ACE) inhibitors. A class of drugs refers to medications that work similarly. They have a similar chemical structure and are often used to treat similar conditions.

Enalapril helps your blood vessels relax and widen. This lowers your blood pressure.

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Side effects

Enalapril side effects

Enalapril oral tablet does not cause drowsiness. However, it can cause other side effects.

Most common side effects

The most common side effects that occur with enalapril include:

  • dizziness
  • weakness
  • skin rash
  • cough

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

If you experience any of these serious side effects, call your doctor right away. If your symptoms are potentially life-threatening or if you think you’re experiencing a medical emergency, call 911.

  • breathing problems. Symptoms include:
    • trouble breathing or swallowing
    • hoarseness
    • tightness in your chest
  • liver problems. Symptoms include:
    • yellowing of your skin or the whites of your eyes
  • central nervous system problems, such as:
    • lightheadedness
    • fainting
  • kidney problems. Symptoms include:
    • inability to pass urine
    • change in the amount of urine you pass
    • blood in your urine
    • weight gain
  • high potassium levels. Symptoms include:
    • weakness
    • lightheadedness or dizziness
    • numbness or tingling
    • shortness of breath
    • irregular heartbeat
  • swelling(angioedema) of your face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
  • infection.Symptoms include:
    • fever
    • sore throat
    • chills

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Interactions

Enalapril may interact with other medications

Enalapril oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with enalapril are listed below.

Pain drugs

These drugs can increase your risk of kidney problems when taken with enalapril.

Examples of these drugs include:

  • non-steroidal anti-inflammatory drugs (NSAIDs), such as:
    • aspirin
    • diclofenac
    • etodolac
    • ibuprofen
    • indomethacin
    • ketoprofen
    • ketorolac
    • meloxicam
    • nabumetone
    • naproxen
    • piroxicam
    • sulindac
  • COX-2 inhibitors, such as:
    • celecoxib

Heart and blood pressure drugs

Taking these medications with enalapril can increase your risk of kidney problems, low blood pressure, and/or high blood potassium.

Examples of these drugs include:

  • angiotensin-converting enzyme (ACE) inhibitors, such as:
    • benazepril
    • captopril
    • enalaprilat
    • fosniopril
    • moexipril
    • perindopril
    • quinapril
    • ramipril
    • trandolapril
  • angiotensin receptor blockers (ARBs), such as:
    • azilsartan
    • candesartan
    • irbesartan
    • losartan
    • olmesartan
    • telmisatan
    • valsartan
  • renin inhibitor:
    • aliskiren
  • beta blockers, such as:
    • acebutolol
    • arotinolol
    • atenolol
    • betaxolol
    • bisoprolol
    • esmolol
    • metoprolol
    • nadolol
    • nebivolol
    • penbutolol
    • pindolol
    • propranolol
    • timolol(systemic)
  • calcium channel blockers, such as:
    • amlodipine
    • felodipine
    • nicardipine
    • nifedipine
  • loop diuretics, such as:
    • bumetanide
    • furosemide
    • indapamide
    • torsemide
  • potassium-sparing diuretics, such as:
    • eplerenone
    • spironolactone
    • triamterene
    • amiloride
  • thiazide diuretics, such as:
    • chlorthiazide
    • chlorthalidone
    • hydrochlorothiazide
    • methylclothiazide
    • metolazone

Potassium-sparing diuretics, potassium supplements, and potassium-containing salt substitutes

These medications increase your risk of high potassium levels in your blood when taken with enalapril. Examples of these drugs include:

  • spironolactone
  • triamterene
  • amiloride
  • eplerenone

Lithium

Enalapril may increase the lithium levels in your body. This may make you have more side effects.

Gold

Using injectable gold with enalapril may increase your risk of a nitritoid reaction. Nitritoid reactions affect the constriction or dilation of your blood vessels. Symptoms include:

  • warmth and reddening of your face and cheeks (flushing)
  • nausea
  • vomiting
  • low blood pressure

Drugs used to prevent rejection of an organ transplant

These medications increase your risk of sudden swelling of your face, arms, legs, lips, tongue, throat, and intestines (angioedema) when taken with enalapril.

Examples of these drugs include:

  • temsirolimus
  • sirolimus
  • everolimus

Drugs called neprilysin inhibitors

These drugs are used to treat heart failure. They should not be used with enalapril. Do not use enalapril within 36 hours of switching to or from a neprilysin inhibitor. Using these drugs together raises your risk of sudden swelling of your face, arms, legs, lips, tongue, throat, and intestines (angioedema).

An example of this drug class includes:

  • sacubitril

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

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Other warnings

Enalapril warnings

Enalapril oral tablet comes with several warnings.

Allergy warning

Enalapril can cause a severe allergic reaction. Symptoms include:

  • trouble breathing
  • wheezing
  • swelling of your face, lips, tongue, or throat
  • hives

Call 911 or go to the nearest emergency room if you develop these symptoms.

Don’t take this drug again if you’ve ever had an allergic reaction to it before. Taking it again could be fatal (cause death).

Food interactions

You shouldn’t use salt substitutes containing potassium. This can increase your risk of high potassium levels in your body.

Warnings for people with certain health conditions

For people with swelling (angioedema): If you have swelling throughout your body, this drug can make it worse. If you have a history of swelling throughout your body, you shouldn’t take enalapril.

For people with low blood pressure: Enalapril can make your blood pressure lower. Tell your doctor if you already have low blood pressure. They may change your dose, especially if you have heart or kidney problems, or diabetes.

For people with heart problems: Use this drug with caution if you have ischemic heart disease. Enalapril may increase your risk of low blood pressure.

For people with moderate to severe kidney damage: Your doctor may lower your dosage of enalapril.

For people who plan to have surgery or an anesthetic: You may experience low blood pressure while having major surgery or during anesthesia.

Warnings for other groups

For pregnant women: Enalapril is a category D pregnancy drug. That means two things:

  1. Research in humans has shown adverse effects to the fetus when the mother takes the drug.
  2. This drug should only be used during pregnancy in serious cases where it's needed to treat a dangerous condition in the mother.

Talk to your doctor if you’re pregnant or planning to become pregnant. Ask your doctor to tell you about the specific harm that may be done to the fetus. This drug should only be used if the potential risk to the fetus is acceptable given the drug’s potential benefit.

For women who are breastfeeding: Enalapril may pass into breast milk and may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your baby. You may need to decide whether to stop breast-feeding or stop taking this medication.

For seniors: Older adults may process drugs more slowly. A normal adult dose may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dose or a different schedule.

For children: Enalapril shouldn’t be used to treat high blood pressure in infants and children with severe kidney disease. The use of this medicine to treat heart failure hasn’t been studied in children and shouldn’t be used in people younger than 18 years. Additionally, the use of this medicine to treat asymptomatic left ventricular dysfunction hasn’t been studied in children and shouldn’t be used in people younger than 18 years.

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Dosage

How to take enalapril

This dosage information is for enalapril oral tablet. All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Forms and strengths

Brand: Vasotec

  • Form: Oral tablet
  • Strengths: 2.5 mg, 5 mg, 10 mg, and 20 mg

Brand: Epaned

  • Form: Oral solution
  • Strengths: 1 mg/mL

Generic: enalapril

  • Form: Oral tablet
  • Strengths: 2.5 mg, 5 mg, 10 mg, and 20 mg

Dosage for high blood pressure

Adult dosage (ages 18 years and older)

The starting dose is 5 mg taken by mouth once per day. Your doctor may increase your dose depending on your blood pressure goals. They’ll decide if you take the drug once or twice per day. The maximum dose is 40 mg per day. If you’re using enalapril with a diuretic, your starting dose should be 2.5 mg taken by mouth once per day.

Child dosage (ages 1 month–17 years)

The starting dose is 0.08 mg/kg of body weight taken by mouth once per day (up to 5 mg once per day). Your doctor may increase your dose depending on your blood pressure goals. The maximum dose is 0.58 mg/kg taken by mouth once per day (40 mg once per day).

Senior dosage (ages 65 years and older)

There are no specific recommendations for senior dosing. Older adults may process drugs more slowly. A normal adult dose may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dose or a different schedule.

Special considerations

Kidney problems:

  • Normal or mild kidney problems: 5 mg taken once per day
  • Moderate to severe kidney problems: 2.5 mg taken once per day. Children with moderate to severe kidney problems should not take enalapril.
  • People on dialysis: 2.5 mg taken once per day on dialysis days. On the days that you don’t have dialysis, your doctor will change your dose based on your blood pressure.

Dosage for heart failure

Adult dosage (ages 18 years and older)

The starting dose is 2.5 mg taken by mouth twice per day. The usual dose is 2.5–20 mg taken twice per day. Your doctor may increase your dose over a period of a few days or weeks. The maximum dose is 40 mg per day taken in divided doses.

Child dosage (ages 0–17 years)

This medicine hasn’t been studied in children for heart failure and shouldn’t be used in children younger than 18 years.

Senior dosage (ages 65 years and older)

There are no specific recommendations for senior dosing. Older adults may process drugs more slowly. A normal adult dose may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dose or a different schedule.

Special considerations

Kidney problems: If your blood serum creatinine level is greater than 1.6 mg/dL, the starting dose is 2.5 mg, taken once per day. Your doctor may increase your dose every 4 days to 2.5 mg, taken twice per day. They may increase it again to 5 mg, taken twice per day. The maximum dose is 40 mg per day.

Low sodium: If your blood serum sodium level is less than 130 mEq/L, the starting dose is 2.5 mg, taken once per day. Your doctor may increase your dose every 4 days to 2.5 mg, taken twice per day. They may increase it again to 5 mg, taken twice per day. The maximum dose is 40 mg per day.

Dosage for asymptomatic left ventricular dysfunction

Adult dosage (ages 18 years and older)

The starting dose is 2.5 mg taken by mouth twice per day. Your doctor may increase your dose up to a maximum of 10 mg taken twice per day.

Child dosage (ages 0–17 years)

This medicine hasn’t been studied in children for asymptomatic left ventricular dysfunction and shouldn’t be used in children younger than 18 years.

Senior dosage (ages 65 years and older)

There are no specific recommendations for senior dosing. Older adults may process drugs more slowly. A normal adult dose may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dose or a different schedule.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.

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Take as directed

Take as directed

Enalapril oral tablet is used for long-term treatment. It comes with serious risks if you don’t take it as prescribed.

If you don’t take it at all

  • For high blood pressure: Your blood pressure may get worse. This increases your risk for heart attack and stroke.
  • For heart failure: Your heart failure may get worse. This condition can be fatal.
  • For asymptomatic left ventricular dysfunction: Your condition can worsen and progress to heart failure.

If you stop taking it suddenly

Don’t stop taking this drug without talking to your doctor first.

  • For high blood pressure: Your blood pressure may suddenly increase. This can cause anxiety, sweating, and a fast heart rate.
  • For heart failure: You may have chest pain, shortness of breath, and swelling of your limbs.
  • For asymptomatic left ventricular dysfunction: You may not feel any different, but your condition may get worse and can lead to heart failure.

If you don’t take it on schedule

  • For high blood pressure: Your blood pressure may get worse. This increases your risk for heart attack and stroke.
  • For heart failure: Your heart failure may get worse. This condition can be fatal.
  • For asymptomatic left ventricular dysfunction: Your condition can worsen and progress to heart failure.

What to do if you miss a dose

If you forget to take your dose, take it as soon as you remember. If it’s just a few hours until the time for your next dose, then wait and only take one dose at that time. Never try to catch up by taking two doses at once. This could cause toxic side effects.

If you take too much

You may have more side effects caused by this medication. You may have the following symptoms:

  • low blood pressure
  • loss of consciousness
  • kidney failure

If you think you’ve taken too much of the drug, act right away. Call your doctor or local Poison Control Center, or go to the nearest emergency room.

How to tell this drug is working

  • For high blood pressure: You may be able to tell if this drug is working if your blood pressure goes down.
  • For heart failure: You may be able to tell if this drug is working if your symptoms of heart failure, such as shortness of breath, get better.
  • For asymptomatic left ventricular dysfunction: If this drug is working, you should have fewer episodes of chest pain.

Important considerations

Important considerations for taking enalapril

Keep these considerations in mind if your doctor prescribes enalapril oral tablet for you.

Travel

When traveling with your medication:

  • Always carry it with you or in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt this medication.
  • You may need to show airport staff your pharmacy’s preprinted label to clearly identifying the medication. Keep the original prescription label with you when traveling.
  • Don’t leave this medicine in the car, especially when the temperature is hot or freezing.

Self-management

You may need to check your blood pressure and heart rate at home. You should keep a log with the date, time of day, and your blood pressure readings. Bring this diary with you to your doctor appointments.

Clinical monitoring

Before starting and during your treatment with this drug, your doctor will check your:

  • kidney function
  • electrolyte levels
  • lithium levels if you’re taking lithium
  • blood pressure
  • swelling

Sun sensitivity

This drug may make your skin more sensitive to sunlight. You may get severe sunburn even if you’re in the sun for a short period of time. You should:

  • Wear sunscreen and protective clothing when you’re out in the sun.
  • Avoid tanning booths.

Avoid being in the sun for long periods of time.

Hidden costs

You may need to purchase a blood pressure monitor to check your blood pressure at home.

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Alternatives

Are there any alternatives?

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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