Enalapril is used for

Contents

Enalapril

Generic Name: enalapril (e NAL a pril)
Brand Names: Epaned, Vasotec

Medically reviewed by Sanjai Sinha, MD Last updated on Dec 4, 2018.

  • Overview
  • Side Effects
  • Dosage
  • Professional
  • Tips
  • Interactions
  • More

What is enalapril?

Enalapril is an ACE inhibitor. ACE stands for angiotensin converting enzyme.

Enalapril is used to treat high blood pressure (hypertension) in adults and children who are at least 1 month old.

Enalapril is also used to treat congestive heart failure (CHF). CHF is a disorder of the ventricles (the lower chambers of the heart) which decreases the heart’s ability to pump blood to the body.

Important information

Do not use enalapril if you are pregnant. If you become pregnant, stop taking this medicine and tell your doctor right away.

You should not use enalapril if you have ever had angioedema. Do not take enalapril within 36 hours before or after taking any medicine that contains sacubatril (such as Entresto).

If you have diabetes, do not use enalapril together with any medication that contains aliskiren (such as Tekturna or Tekamlo).

Enalapril can affect your heart or your electrolyte levels. Call your doctor if you have chest pain, pounding heartbeats or fluttering in your chest, a slow heart rate or weak pulse, a tingly feeling, muscle weakness, or muscle tightness or contraction.

Before taking this medicine

You should not use enalapril if you are allergic to it, or if you have:

  • you have a history of angioedema;

  • you recently took a heart medicine called sacubatril; or

  • if you are allergic to any other ACE inhibitor, such as benazepril, captopril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, or trandolapril.

Do not take enalapril within 36 hours before or after taking medicine that contains sacubatril (such as Entresto).

If you have diabetes, do not use enalapril together with any medication that contains aliskiren (Amturnide, Tekturna, Tekamlo).

You may also need to avoid taking enalapril with aliskiren if you have kidney disease.

To make sure enalapril is safe for you, tell your doctor if you have:

  • kidney disease (or if you are on dialysis);

  • liver disease;

  • a history of blood clot or stroke (including TIA or “mini-stroke”);

  • an electrolyte imbalance (such as high levels of potassium in your blood); or

  • heart disease.

Do not use if you are pregnant. If you become pregnant, stop taking this medicine and tell your doctor right away. Enalapril can cause injury or death to the unborn baby if you take the medicine during your second or third trimester.

Enalapril can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using this medicine.

How should I take enalapril?

Take enalapril exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose. Do not take this medicine in larger or smaller amounts or for longer than recommended.

You may take enalapril with or without food.

Shake the oral suspension (liquid) well just before you measure a dose. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Your blood pressure will need to be checked often. Your kidney or liver function may also need to be tested.

Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking enalapril. This can lead to very low blood pressure, electrolyte disorders, or kidney failure.

If you are being treated for high blood pressure, keep using this medicine even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medicine for the rest of your life.

If you need surgery, tell the surgeon ahead of time that you are using enalapril.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

Store the liquid medicine in the refrigerator, do not freeze. Throw away any liquid medicine not used within 60 days.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking enalapril?

Drinking alcohol can further lower your blood pressure and may increase certain side effects of enalapril.

Do not use salt substitutes or potassium supplements while taking enalapril, unless your doctor has told you to.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Enalapril side effects

Get emergency medical help if you have signs of an allergic reaction to enalapril: hives; severe stomach pain; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • a light-headed feeling, like you might pass out;

  • slow heartbeats;

  • pounding heartbeats or fluttering in your chest;

  • little or no urination;

  • jaundice (yellowing of the skin or eyes);

  • numbness, tingling, or burning pain in your hands or feet;

  • fever, chills, cold or flu symptoms;

  • easy bruising, unusual bleeding; or

  • high potassium – nausea, weakness, tingly feeling, chest pain, irregular heartbeats, loss of movement.

Common enalapril side effects may include:

  • dizziness, feeling tired;

  • cough; or

  • feeling light-headed.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect enalapril?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with enalapril, especially:

This list is not complete. Other drugs may interact with enalapril, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use enalapril only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2020 Cerner Multum, Inc. Version: 11.03.

Medical Disclaimer

More about enalapril

  • Side Effects
  • During Pregnancy or Breastfeeding
  • Dosage Information
  • Patient Tips
  • Drug Images
  • Drug Interactions
  • Support Group
  • En Español
  • 19 Reviews
  • Drug class: Angiotensin Converting Enzyme Inhibitors
  • FDA Alerts (1)

Consumer resources

  • Enalapril Tablets
  • Enalapril Oral Solution
  • Enalapril (Advanced Reading)

Other brands: Vasotec, Epaned

Professional resources

  • Enalaprilat/Enalapril Maleate (AHFS Monograph)
  • … +3 more

Related treatment guides

  • Alport Syndrome
  • Diabetic Kidney Disease
  • Heart Failure
  • High Blood Pressure
  • … +3 more

Vasotec

Generic Name: enalapril (e NAL a pril)
Brand Names: Vasotec

Medically reviewed by Sanjai Sinha, MD Last updated on Jun 17, 2019.

  • Overview
  • Side Effects
  • Dosage
  • Professional
  • Interactions
  • More

What is Vasotec?

Vasotec (enalapril) is an ACE inhibitor. ACE stands for angiotensin converting enzyme.

Vasotec is used to treat high blood pressure (hypertension) in adults and children who are at least 1 month old.

Vasotec is also used to treat congestive heart failure in adults.

Vasotec is also used to treat a disorder of the ventricles (the lower chambers of the heart that allow blood to flow out of the heart). This disorder can decrease the heart’s ability to pump blood to the body.

Important Information

Do not use Vasotec if you are pregnant. If you become pregnant, stop taking this medicine and tell your doctor right away.

You should not use Vasotec if you have ever had angioedema. Do not take Vasotec within 36 hours before or after taking medicine that contains sacubitril (such as Entresto).

If you have diabetes, do not use enalapril together with any medication that contains aliskiren (a blood pressure medicine).

Vasotec can affect your heart or your electrolyte levels. Call your doctor if you have chest pain, pounding heartbeats or fluttering in your chest, a slow heart rate or weak pulse, a tingly feeling, muscle weakness, or muscle tightness or contraction.

You should not use Vasotec if you are allergic to enalapril:

  • you have hereditary angioedema;

  • you recently took a heart medicine called sacubitril; or

  • you have ever had a severe allergic reaction to any ACE inhibitor (benazepril, captopril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, or trandolapril).

Do not take Vasotec within 36 hours before or after taking medicine that contains sacubitril (such as Entresto).

If you have diabetes, do not use enalapril together with any medication that contains aliskiren (a blood pressure medicine).

You may also need to avoid taking enalapril with aliskiren if you have kidney disease.

To make sure this medicine is safe for you, tell your doctor if you have:

  • kidney disease (or if you are on dialysis);

  • liver disease; or

  • an electrolyte imbalance (such as high levels of potassium in your blood).

Do not use if you are pregnant. If you become pregnant, stop taking this medicine and tell your doctor right away. Enalapril can cause injury or death to the unborn baby if you take the medicine during your second or third trimester.

You should not breast-feed while you are using Vasotec.

Enalapril is not approved for use by anyone younger than 1 month old.

How should I take Vasotec?

Take Vasotec exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Your blood pressure will need to be checked often. Your kidney or liver function may also need to be tested.

Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking Vasotec. This can lead to very low blood pressure, electrolyte disorders, or kidney failure.

If you need surgery, tell the surgeon ahead of time that you are using enalapril.

If you are being treated for high blood pressure, keep using this medicine even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medicine for the rest of your life.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

Vasotec dosing information

Usual Adult Dose for Hypertension:

Initial dose: 5 mg orally once a day
Maintenance dose: 10 to 40 mg orally per day as a single dose or in 2 divided doses
Maximum dose: 40 mg orally daily as a single dose or in 2 divided doses
In combination with diuretics:
Initial dose: 2.5 mg orally once a day
If feasible, the diuretic should be discontinued 2 to 3 days prior to initiation of therapy with enalapril. If required, diuretic therapy may be gradually resumed.

Usual Adult Dose for Congestive Heart Failure:

Initial dose: 2.5 mg orally once a day
Maintenance dose: 2.5 to 20 mg daily in 2 divided doses
Maximum dose: 40 mg orally per day in 2 divided doses

-Treatment is usually combined with diuretics and digitalis.
-Doses should be titrated upward, as tolerated, over a period of a few days or weeks.

Usual Adult Dose for Left Ventricular Dysfunction:

Initial dose: 2.5 mg orally twice a day
Maintenance dose: 20 mg orally per day in 2 divided doses

-After the initial dose, the patient should be observed for at least 2 hours and until blood pressure has stabilized for at least an additional hour.
-If possible, the dose of any concomitant diuretic should be reduced which may diminish the likelihood of hypotension.

Usual Pediatric Dose for Hypertension:

Children 1 month to 17 years:
Initial dose: 0.08 mg/kg/day (up to 5 mg) in 1 to 2 divided doses. Adjust dosage based on patient response.
Maximum dose: Doses greater than 0.58 mg/kg (40 mg) have not been evaluated in pediatric patients.
Comment:
-Not recommended in neonates and in pediatric patients with glomerular filtration rate less than 30 mL/min, as no data are available.

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking Vasotec?

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids. Enalapril can decrease sweating and you may be more prone to heat stroke.

Drinking alcohol can further lower your blood pressure and may increase certain side effects of enalapril.

Do not use potassium supplements or salt substitutes, unless your doctor has told you to.

Vasotec side effects

Get emergency medical help if you have signs of an allergic reaction to Vasotec: hives; severe stomach pain; difficulty breathing; swelling of your face, lips, tongue, or throat. You may be more likely to have an allergic reaction if you are African-American.

Call your doctor at once if you have:

  • a light-headed feeling, like you might pass out;

  • chest pain;

  • jaundice (yellowing of the skin or eyes);

  • little or no urination;

  • fever, chills, sore throat; or

  • high potassium – nausea, weakness, tingly feeling, chest pain, irregular heartbeats, loss of movement.

Common Vasotec side effects may include:

  • dizziness;

  • tiredness; or

  • feeling light-headed.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Vasotec?

Tell your doctor about all your current medicines. Many drugs can interact with enalapril, especially:

This list is not complete and many other drugs may interact with Vasotec. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

More about Vasotec (enalapril)

  • Side Effects
  • During Pregnancy or Breastfeeding
  • Dosage Information
  • Drug Images
  • Drug Interactions
  • Pricing & Coupons
  • En Español
  • 4 Reviews
  • Generic Availability
  • Drug class: Angiotensin Converting Enzyme Inhibitors
  • FDA Alerts (1)
  • Vasotec
  • Vasotec (Advanced Reading)

Other brands: Epaned

  • Vasotec (AHFS Monograph)
  • … +1 more
  • Diabetic Kidney Disease
  • Heart Failure
  • High Blood Pressure
  • Hypertensive Emergency
  • Left Ventricular Dysfunction
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  • Dosage forms

    Form Route Strength
    Tablet Oral
    Tablet Oral 10 mg/1
    Tablet Oral 2.5 mg/1
    Tablet Oral 20 mg/1
    Tablet Oral 5 mg/1
    Tablet, soluble Oral 10 mg/1
    Tablet, soluble Oral 2.5 mg/1
    Tablet, soluble Oral 20 mg/1
    Tablet, soluble Oral 5 mg/1
    Tablet Oral
    Solution Oral 1 mg/1mL
    Tablet, extended release Oral
    Tablet Oral 16 mg
    Tablet Oral 2 mg
    Tablet Oral 4 mg
    Tablet Oral 8 mg

    Prices

    Unit description Cost Unit
    Enalapril maleate powder 9.18USD g
    Enalaprilat 1.25 mg/ml vial 3.6USD ml
    Vasotec 20 mg tablet 3.36USD tablet
    Vaseretic 10-25 mg tablet 3.15USD tablet
    Vasotec 10 mg tablet 2.63USD tablet
    Vasotec 5 mg tablet 2.08USD tablet
    Vasotec 2.5 mg tablet 1.65USD tablet
    Enalapril maleate 20 mg tablet 1.56USD tablet
    Vaseretic 5-12.5 mg tablet 1.49USD tablet
    Vasotec 20 mg Tablet 1.34USD tablet
    Vasotec 10 mg Tablet 1.11USD tablet
    Enalapril maleate 10 mg tablet 1.09USD tablet
    Enalapril maleate 5 mg tablet 1.03USD tablet
    Vasotec 5 mg Tablet 0.92USD tablet
    Enalapril maleate 2.5 mg tablet 0.82USD tablet
    Vasotec 2.5 mg Tablet 0.78USD tablet
    Apo-Enalapril 20 mg Tablet 0.75USD tablet
    Co Enalapril 20 mg Tablet 0.75USD tablet
    Mylan-Enalapril 20 mg Tablet 0.75USD tablet
    Novo-Enalapril 20 mg Tablet 0.75USD tablet
    Pms-Enalapril 20 mg Tablet 0.75USD tablet
    Ratio-Enalapril 20 mg Tablet 0.75USD tablet
    Sandoz Enalapril 20 mg Tablet 0.75USD tablet
    Taro-Enalapril 20 mg Tablet 0.75USD tablet
    Apo-Enalapril 10 mg Tablet 0.62USD tablet
    Co Enalapril 10 mg Tablet 0.62USD tablet
    Mylan-Enalapril 10 mg Tablet 0.62USD tablet
    Novo-Enalapril 10 mg Tablet 0.62USD tablet
    Pms-Enalapril 10 mg Tablet 0.62USD tablet
    Ratio-Enalapril 10 mg Tablet 0.62USD tablet
    Sandoz Enalapril 10 mg Tablet 0.62USD tablet
    Taro-Enalapril 10 mg Tablet 0.62USD tablet
    Apo-Enalapril 5 mg Tablet 0.52USD tablet
    Co Enalapril 5 mg Tablet 0.52USD tablet
    Mylan-Enalapril 5 mg Tablet 0.52USD tablet
    Novo-Enalapril 5 mg Tablet 0.52USD tablet
    Pms-Enalapril 5 mg Tablet 0.52USD tablet
    Ratio-Enalapril 5 mg Tablet 0.52USD tablet
    Sandoz Enalapril 5 mg Tablet 0.52USD tablet
    Taro-Enalapril 5 mg Tablet 0.52USD tablet
    Apo-Enalapril 2.5 mg Tablet 0.44USD tablet
    Co Enalapril 2.5 mg Tablet 0.44USD tablet
    Mylan-Enalapril 2.5 mg Tablet 0.44USD tablet
    Novo-Enalapril 2.5 mg Tablet 0.44USD tablet
    Pms-Enalapril 2.5 mg Tablet 0.44USD tablet
    Ratio-Enalapril 2.5 mg Tablet 0.44USD tablet
    Sandoz Enalapril 2.5 mg Tablet 0.44USD tablet
    Taro-Enalapril 2.5 mg Tablet 0.44USD tablet

    DrugBank does not sell nor buy drugs. Pricing information is supplied for informational purposes only. Patents Additional Data Available

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    Properties

    State Solid Experimental Properties Predicted Properties

    Property Value Source
    Water Solubility 0.213 mg/mL ALOGPS
    logP 0.19 ALOGPS
    logP 0.59 ChemAxon
    logS -3.2 ALOGPS
    pKa (Strongest Acidic) 3.67 ChemAxon
    pKa (Strongest Basic) 5.2 ChemAxon
    Physiological Charge -1 ChemAxon
    Hydrogen Acceptor Count 5 ChemAxon
    Hydrogen Donor Count 2 ChemAxon
    Polar Surface Area 95.94 Å2 ChemAxon
    Rotatable Bond Count 10 ChemAxon
    Refractivity 99.57 m3·mol-1 ChemAxon
    Polarizability 40.41 Å3 ChemAxon
    Number of Rings 2 ChemAxon
    Bioavailability 1 ChemAxon
    Rule of Five Yes ChemAxon
    Ghose Filter Yes ChemAxon
    Veber’s Rule No ChemAxon
    MDDR-like Rule No ChemAxon

    Predicted ADMET features

    Property Value Probability
    Human Intestinal Absorption + 0.7428
    Blood Brain Barrier 0.9659
    Caco-2 permeable 0.8956
    P-glycoprotein substrate Substrate 0.7691
    P-glycoprotein inhibitor I Non-inhibitor 0.6681
    P-glycoprotein inhibitor II Non-inhibitor 0.5136
    Renal organic cation transporter Non-inhibitor 0.8442
    CYP450 2C9 substrate Non-substrate 0.8632
    CYP450 2D6 substrate Non-substrate 0.9116
    CYP450 3A4 substrate Non-substrate 0.5696
    CYP450 1A2 substrate Non-inhibitor 0.9125
    CYP450 2C9 inhibitor Non-inhibitor 0.9154
    CYP450 2D6 inhibitor Non-inhibitor 0.9231
    CYP450 2C19 inhibitor Non-inhibitor 0.9025
    CYP450 3A4 inhibitor Non-inhibitor 0.8309
    CYP450 inhibitory promiscuity Low CYP Inhibitory Promiscuity 0.6825
    Ames test Non AMES toxic 0.9383
    Carcinogenicity Non-carcinogens 0.9216
    Biodegradation Not ready biodegradable 0.8686
    Rat acute toxicity 1.8269 LD50, mol/kg Not applicable
    hERG inhibition (predictor I) Weak inhibitor 0.9719
    hERG inhibition (predictor II) Non-inhibitor 0.7456

    ADMET data is predicted using admetSAR, a free tool for evaluating chemical ADMET properties. (23092397)

    Spectra

    Mass Spec (NIST) Not Available Spectra

    Taxonomy

    Description This compound belongs to the class of organic compounds known as dipeptides. These are organic compounds containing a sequence of exactly two alpha-amino acids joined by a peptide bond. Kingdom Organic compounds Super Class Organic acids and derivatives Class Carboxylic acids and derivatives Sub Class Amino acids, peptides, and analogues Direct Parent Dipeptides Alternative Parents Proline and derivatives / Alpha amino acid esters / N-acyl-L-alpha-amino acids / Alpha amino acid amides / Pyrrolidine carboxylic acids / N-acylpyrrolidines / Aralkylamines / Fatty acid esters / Benzene and substituted derivatives / Dicarboxylic acids and derivativesTertiary carboxylic acid amides / Carboxylic acid esters / Amino acids / Dialkylamines / Carboxylic acids / Azacyclic compounds / Carbonyl compounds / Organic oxides / Organopnictogen compounds / Hydrocarbon derivatives show 10 more Substituents Alpha-dipeptide / N-acyl-alpha amino acid or derivatives / N-acyl-alpha-amino acid / N-acyl-l-alpha-amino acid / Proline or derivatives / Alpha-amino acid ester / Alpha-amino acid amide / Alpha-amino acid or derivatives / Pyrrolidine carboxylic acid or derivatives / Pyrrolidine carboxylic acidN-acylpyrrolidine / Fatty acid ester / Aralkylamine / Dicarboxylic acid or derivatives / Fatty acyl / Benzenoid / Monocyclic benzene moiety / Pyrrolidine / Tertiary carboxylic acid amide / Amino acid or derivatives / Carboxamide group / Carboxylic acid ester / Amino acid / Azacycle / Secondary aliphatic amine / Carboxylic acid / Organoheterocyclic compound / Secondary amine / Hydrocarbon derivative / Amine / Organopnictogen compound / Organic oxygen compound / Carbonyl group / Organic oxide / Organic nitrogen compound / Organonitrogen compound / Organooxygen compound / Aromatic heteromonocyclic compound show 28 more Molecular Framework Aromatic heteromonocyclic compounds External Descriptors dicarboxylic acid monoester, dipeptide (CHEBI:4784)

    Targets

    Binding Properties

    × Details Binding Properties1. Angiotensin-converting enzyme Kind Protein Organism Humans Pharmacological action Yes Actions Inhibitor General Function Zinc ion binding Specific Function Converts angiotensin I to angiotensin II by release of the terminal His-Leu, this results in an increase of the vasoconstrictor activity of angiotensin. Also able to inactivate bradykinin, a potent… Gene Name ACE Uniprot ID P12821 Uniprot Name Angiotensin-converting enzyme Molecular Weight 149713.675 Da

    1. Andujar-Sanchez M, Jara-Perez V, Camara-Artigas A: Thermodynamic determination of the binding constants of angiotensin-converting enzyme inhibitors by a displacement method. FEBS Lett. 2007 Jul 24;581(18):3449-54. Epub 2007 Jun 27.
    2. Chen X, Ji ZL, Chen YZ: TTD: Therapeutic Target Database. Nucleic Acids Res. 2002 Jan 1;30(1):412-5.
    3. Liu YH, Liu LY, Wu JX, Chen SX, Sun YX: Comparison of captopril and enalapril to study the role of the sulfhydryl-group in improvement of endothelial dysfunction with ACE inhibitors in high dieted methionine mice. J Cardiovasc Pharmacol. 2006 Jan;47(1):82-8.
    4. Natesh R, Schwager SL, Evans HR, Sturrock ED, Acharya KR: Structural details on the binding of antihypertensive drugs captopril and enalaprilat to human testicular angiotensin I-converting enzyme. Biochemistry. 2004 Jul 13;43(27):8718-24.

    Carriers

    Details1. Serum albumin Kind Protein Organism Humans Pharmacological action No Actions Binder General Function Toxic substance binding Specific Function Serum albumin, the main protein of plasma, has a good binding capacity for water, Ca(2+), Na(+), K(+), fatty acids, hormones, bilirubin and drugs. Its main function is the regulation of the colloid… Gene Name ALB Uniprot ID P02768 Uniprot Name Serum albumin Molecular Weight 69365.94 Da

    1. Trbojevic-Stankovic J, Aleksic M, Odovic J: Estimation of angiotensin-converting enzyme inhibitors protein binding degree using chromatographic hydrophobicity data. Srp Arh Celok Lek. 2015 Jan-Feb;143(1-2):50-5.

    Transporters

    Kind Protein Organism Humans Pharmacological action Unknown Actions Inhibitor General Function Xenobiotic-transporting atpase activity Specific Function Energy-dependent efflux pump responsible for decreased drug accumulation in multidrug-resistant cells. Gene Name ABCB1 Uniprot ID P08183 Uniprot Name Multidrug resistance protein 1 Molecular Weight 141477.255 Da ×

    Property Measurement pH Temperature (°C)
    IC 50 (nM) 15000000 N/A N/A 9706043
    IC 50 (nM) 4500000 N/A N/A 10052994

    Details Binding Properties2. Solute carrier family 15 member 1 Kind Protein Organism Humans Pharmacological action Unknown Actions Substrate Inhibitor General Function Proton-dependent oligopeptide secondary active transmembrane transporter activity Specific Function Proton-coupled intake of oligopeptides of 2 to 4 amino acids with a preference for dipeptides. May constitute a major route for the absorption of protein digestion end-products. Gene Name SLC15A1 Uniprot ID P46059 Uniprot Name Solute carrier family 15 member 1 Molecular Weight 78805.265 Da Kind Protein Organism Humans Pharmacological action Unknown Actions Inhibitor General Function Sodium-independent organic anion transmembrane transporter activity Specific Function Involved in the renal elimination of endogenous and exogenous organic anions. Functions as organic anion exchanger when the uptake of one molecule of organic anion is coupled with an efflux of one … Gene Name SLC22A6 Uniprot ID Q4U2R8 Uniprot Name Solute carrier family 22 member 6 Molecular Weight 61815.78 Da

    1. Kuze K, Graves P, Leahy A, Wilson P, Stuhlmann H, You G: Heterologous expression and functional characterization of a mouse renal organic anion transporter in mammalian cells. J Biol Chem. 1999 Jan 15;274(3):1519-24.

    Kind Protein Organism Humans Pharmacological action Unknown Actions Inhibitor General Function Sodium-independent organic anion transmembrane transporter activity Specific Function Plays an important role in the excretion/detoxification of endogenous and exogenous organic anions, especially from the brain and kidney. Involved in the transport basolateral of steviol, fexofenad… Gene Name SLC22A8 Uniprot ID Q8TCC7 Uniprot Name Solute carrier family 22 member 8 Molecular Weight 59855.585 Da

    1. Kobayashi Y, Ohshiro N, Tsuchiya A, Kohyama N, Ohbayashi M, Yamamoto T: Renal transport of organic compounds mediated by mouse organic anion transporter 3 (mOat3): further substrate specificity of mOat3. Drug Metab Dispos. 2004 May;32(5):479-83.

    Kind Protein Organism Humans Pharmacological action Unknown Actions Inhibitor General Function Sodium-independent organic anion transmembrane transporter activity Specific Function Mediates sodium-independent multispecific organic anion transport. Transport of prostaglandin E2, prostaglandin F2, tetracycline, bumetanide, estrone sulfate, glutarate, dehydroepiandrosterone sulf… Gene Name SLC22A7 Uniprot ID Q9Y694 Uniprot Name Solute carrier family 22 member 7 Molecular Weight 60025.025 Da

    1. Kobayashi Y, Ohshiro N, Shibusawa A, Sasaki T, Tokuyama S, Sekine T, Endou H, Yamamoto T: Isolation, characterization and differential gene expression of multispecific organic anion transporter 2 in mice. Mol Pharmacol. 2002 Jul;62(1):7-14.
    2. Sekine T, Cha SH, Tsuda M, Apiwattanakul N, Nakajima N, Kanai Y, Endou H: Identification of multispecific organic anion transporter 2 expressed predominantly in the liver. FEBS Lett. 1998 Jun 12;429(2):179-82.

    Kind Protein Organism Humans Pharmacological action Unknown Actions Substrate General Function Sodium-independent organic anion transmembrane transporter activity Specific Function Mediates the Na(+)-independent transport of organic anions such as sulfobromophthalein (BSP) and conjugated (taurocholate) and unconjugated (cholate) bile acids (By similarity). Selectively inhibit… Gene Name SLCO1A2 Uniprot ID P46721 Uniprot Name Solute carrier organic anion transporter family member 1A2 Molecular Weight 74144.105 Da ×Unlock Data

    There is additional data available for commercial users including Adverse Effects, Contraindications, and Blackbox Warnings. Contact us to learn more about these and other features.

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    Drug created on June 13, 2005 07:24 / Updated on February 02, 2020 04:15

    Top ten drug interactions in dogs and cats (Proceedings)

    In humans, the risk of adverse drug interactions multiplies as the number of administered drugs increases. Interactions can occur during IV drug administration, during oral absorption, at the target site, or during hepatic or renal elimination, and may lead to loss of efficacy or increased toxicity. Although most of our knowledge of drug interactions is from data in humans, many of these interactions are likely to occur in dogs and cats as well.

    Cimetidine

    Cimetidine is a major P450 enzyme inhibitor, and decreases the clearance of many drugs, which may lead to drug toxicity:

    • Chloramphenicol: dose-dependent leukopenia

    • Metronidazole: neurologic side effects

    • Lidocaine: GI and neurologic side effects

    • Theophylline and aminophylline: theophylline toxicity

    • Warfarin, propranolol, diazepam, midazolam, many others….

    Because of many potential cimetidine interactions, alternative H2 blockers such as ranitidine, famotidine, or nizatidine (which are not P450 inhibitors at therapeutic concentrations), should be chosen over cimetidine for patients treated with multiple drugs. Ranitidine and nizatidine have the added advantage of prokinetic effects, which may counteract gastric atony in clinically ill patients.

    Sucralfate

    Aluminum-containing drugs such as sucralfate can form complexes with many other drugs in the GI tract, markedly decreasing drug absorption:

    • Fluoroquinolones: poor bioavailability even 6 hours after sucralfate in humans

    • Tetracycline and doxycycline: marked inhibition of oral absorption by sucralfate

    • H2 blockers: sucralfate delays, but does not decrease the extent of, the absorption of H2 blockers; therefore staggering of dosing is probably NOT required for sucralfate and H2 blockers

    • Theophylline, aminophylline, digoxin, azithromycin: sucralfate may decrease efficacy

    • This is a physicochemical interaction that is likely to occur in dogs and cats as it does in humans.

    Ketoconazole

    Ketoconazole and itraconazole are best absorbed at acidic pH; therefore, do not combine these drugs with:

    • Omeprazole, H2 blockers, or other antacids

    • Interestingly, increased gastric pH does not affect the absorption of fluconazole 1

    Ketoconazole inhbits a cytochrome P450 enzyme, CYP3A, with a wide substrate range and high potential for drug-drug interactions. Ketoconazole is also an inhibitor of p-glycoprotein, an important drug efflux transporter in the intestine, kidney, and biliary tree. Ketroconazole can therefore decrease the bioavailability and/or clearance of many drugs:

    • Cyclosporine: a favorable interaction; ketoconazole can allow lower doses of cyclosporine.

    Recommended dosages: cyclosporine, 5 mg/kg once to twice daily, depending on disease being treated; ketoconazole, 10 mg/kg/day. Monitor ALT and clinical response. Whole blood cyclosporine can be measured at steady state (by one week). Target levels for immunosuppression in humans are 400-600 ng/ml.

    • Digoxin: ketoconazole can lead to digoxin toxicity

    • Amitriptyline, midazolam: ketoconazole could increase sedation

    • Warfarin: ketoconazole may prolong its toxicity

    Note: Itraconazole, like ketoconazole, also inhibits the P450 metabolism of the same drugs in humans.

    Fluoroquinolones

    The absorption of oral fluoroquinolones is markedly impaired by drugs that contain divalent or trivalent cations, such as:

    • Sucralfate, aluminum hydroxide, aluminum carbonate

    • Calcium carbonate

    • Oral iron, oral zinc

    In humans and dogs, fluoroquinolones inhibit the CYP1A2 metabolism, of theophylline. This has lead to theophylline toxicity in humans. In dogs, enrofloxacin leads to higher plasma theophylline concentrations by about 30-50%.2

    Metoclopramide

    As a dopaminergic (D2) antagonist and prokinetic agent, metoclopramide has several important drug interactions:

    • Enhanced absorption of acetaminophen, aspirin, and alcohol overdoses via increased gastric emptying (shown in humans).

    • Enhanced extrapyramidal side effects (tremor) in combination with phenothiazines (e.g. chlorpromazine, acepromazine) or selective serotonin reuptake inhibitors (e.g. fluoxetine), or with renal insufficiency.

    • Metoclopramide reduces the amount of propofol needed for anesthetic induction in humans by 20-25% (mechanism unknown).

    It has been suggested that metoclopramide may antagonize the effects of dopamine on renal hemodynamics. However:

    • Metoclopramide has no effect on low dose dopamine-induced increases in GFR or effective renal plasma flow in humans.

    • Dopamine increases urine output in cats 3 as in humans, but this is not inhibited by dopamine antagonists. 4

    Cisapride

    Like ketoconazole, cisapride is a substrate of CYP3A. High plasma concentrations of cisapride can lead to potentially fatal cardiac arrhythmias in humans. Drugs that inhibit CYP3A may increase cisapride concentrations and increase the risk of cardiac side effects in humans:

    • Clarithromycin, erythromycin (but not azithromycin)

    • Fluconazole, itraconazole, ketoconazole

    •Note: in one study in dogs, erythromycin did not alter cisapride pharmacodynamics.5

    Furosemide

    Several drug combinations with furosemide can lead to enhanced toxicity:

    • Amikacin and gentamicin: nephrotoxicity is enhanced by furosemide; mannitol may be preferable to furosemide for treatment of acute renal failure due to aminoglycosides.

    • Enalapril, benazapril: may cause hemodynamic changes leading to acute renal failure, when given with high doses of furosemide. Use conservative initial doses of ACE inhibitors when also starting furosemide, and monitor clinical status and renal function over the first 1-2 weeks.

    • Digoxin: furosemide increases serum digoxin levels (independent of dehydration). Furosemide can also lead to hypokalemia and hypomagnesemia, both of which exacerbate the cardiac toxicity of digoxin. In addition, furosemide can lead to pre-renal azotemia, leading to decreased digoxin excretion. All of these interactions can lead to digoxin toxicity unless serum digoxin levels are monitored.

    • Renal function and serum electrolytes should be routinely evaluated in all patients on furosemide.

    Other drug combinations with furosemide can affect efficacy:

    • Lidocaine: hypokalemia secondary to furosemide can blunt the antiarrhythmic effects of lidocaine. Serum potassium should be evaluated in patients with ventricular arrhythmias, and potassium supplementation should be considered if patients do not respond to lidocaine.

    • Bromide: furosemide administration will increase the renal loss of bromide, and lower serum bromide concentrations, which may lead to seizure breakthrough

    Omeprazole

    Omeprazole is an inhibitor of some P450’s in humans, and may inhibit the metabolism, and possibly increase the toxicity, of:

    • Diazepam, midazolam

    • Warfarin

    As an inhibitor of gastric acid secretion, omeprazole can also decrease the absorption of:

    • Iron supplements

    • Ketoconazole and itraconazole (but not fluconazole, which does not require an acidic pH for absorption)

    Phenobarbital

    Phenobarbital is a major P450 enzyme inducer in humans and dogs. Phenobarbital speeds the metabolism of many drugs in dogs, including:

    • Glucocorticoids

    • Mitotane – phenobarbital can lead to higher mitotane dosage requirements in dogs being treated for hyperadrenocorticism

    • Ketoconazole

    • Clomipramine

    • Chloramphenicol – conversely, chloramphenicol is a major inhibitor of phenobarbital clearance, and can lead to sedation in dogs on phenobarbital

    • Lidocaine

    • Etodolac

    • Theophylline

    • Digoxin, propranolol, and many others…

    However, phenobarbital causes minimal cytochrome P450 enzyme induction in the cat, 6,7 and therefore these P450-mediated drug interactions are unlikely in the cat.

    Clomipramine

    As a tricyclic antidepressant that inhibits norepinephrine reuptake, clomipramine can have pharmacologic interactions with monoamine oxidase inhibitors (which decrease the breakdown of norepinephrine and serotonin)

    • L-deprenyl (selegiline): MAO inhibitors like L-deprenyl used in combination with clomipramine or amitriptyline can lead to “serotonin syndrome” (twitching, tremor, seizures) in humans

    • Amitraz: an MAO inhibitor found in tick dips and collars; potential for interaction with tricyclic antidepressants like clomipramine

    The metabolism of clomipramine can be inhibited by:

    • Fluoxetine (Prozac): can lead to increased clomipramine levels and cardiac conduction disturbances in humans

    • Ketoconazole, itraconazole

    Drug interactions in humans that may also affect dogs and cats

    Cited references

    Zimmermann, et al. The influence of gastric pH on the pharmacokinetics of fluconazole: the effect of omeprazole. Int J Clin Pharmacol Ther 1994;32:491-496.

    Intorre, et al. Enrofloxacin-theophylline interaction: influence of enrofloxacin on theophylline steady-state pharmacokinetics in the beagle dog. J Vet Pharmacol Ther 1995;18:352-356.

    Wassermann, et al. Dopamine-induced diuresis in the cat without changes in renal hemodynamics. Naunyn Schmiedebergs Arch Pharmacol 1980;312:77-83.

    Wright, et al. Pharmacokinetics of gentamicin after intravenous and subcutaneous injection in obese cats. J Vet Pharmacol Ther 1991;14:96-100.

    Al-Wabel, et al. Electrocardiographic and hemodynamic effects of cisapride alone and combined with erythromycin in anesthetized dogs. Cardiovasc Toxicol 2002;2:195-208.

    Maugras, et al. The hepatic cytochrome level in the cat (Felis catus): normal value and variations in relation to some biological parameters. Comp Biochem Physiol B 1979;64:125-127.

    Truhaut, et al. . C R Acad Sci Hebd Seances Acad Sci D 1978;286:371-373.

    About enalapril

    Type of medicine An angiotensin-converting enzyme (ACE) inhibitor
    Used for High blood pressure; heart failure
    Also called Innovace®; Innozide® (contains enalapril with hydrochlorothiazide)
    Available as Tablets

    Enalapril belongs to a class of medicines called angiotensin-converting enzyme (ACE) inhibitors. You may have been prescribed it to reduce high blood pressure (hypertension), or to prevent (or treat) heart failure. Heart failure is a condition where your heart does not work as well as it should.

    ACE inhibitors like enalapril prevent your body from creating a hormone known as angiotensin II. They do this by blocking (inhibiting) a chemical called angiotensin-converting enzyme. This widens your blood vessels and helps to reduce the amount of water put back into your blood by your kidneys. These actions help to decrease blood pressure. Although people with high blood pressure often do not feel unwell, if left untreated, high blood pressure can harm the heart and damage blood vessels, leading to a heart attack or stroke. Enalapril can be used on its own or alongside other medicines which reduce blood pressure. A combination brand called Innozide® (which contains enalapril with another medicine called hydrochlorothiazide) can help to reduce the total number of tablets people with high blood pressure need to take each day.

    In heart failure, there can be too much circulating fluid in your blood vessels because your heart is not working as efficiently as it once did. Enalapril helps to reduce this. It also appears to have a protective effect on the heart and slows the progression of the heart failure.

    Before taking enalapril

    Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken. For these reasons, before you start taking enalapril it is important that your doctor knows:

    • If you are pregnant or breastfeeding.
    • If you have any problems with the way your kidneys work, or any problems with the way your liver works.
    • If you are lacking in fluid in the body (dehydrated) – for example, if you have had diarrhoea or sickness very recently.
    • If you have been told you have a build-up of fatty deposits on the walls of your arteries, a condition called atherosclerosis.
    • If you have a particular type of poor circulation called peripheral arterial disease.
    • If you have collagen vascular disease – this includes conditions such as systemic lupus erythematosus (SLE) and scleroderma.
    • If you have been told you have heart muscle disease (cardiomyopathy), or narrowing of the main blood vessel from your heart (aortic stenosis).
    • If you have ever had a reaction where your face, tongue or throat swells (angio-oedema).
    • If you are having desensitisation treatment to protect against bee and wasp stings.
    • If you are having dialysis treatment, or treatment to remove cholesterol from your blood by a machine (LDL apheresis).
    • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
    • If you have ever had an allergic or unusual reaction to any other ACE inhibitor (such as captopril, ramipril or perindopril), or to any other medicine.

    How to take enalapril

    • Before you start the treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about enalapril and will provide you with a full list of side-effects which you could experience from taking it.
    • Take the tablets exactly as your doctor tells you to.
    • If you are being treated for high blood pressure: enalapril is taken once a day. You will be advised to take your very first dose at bedtime. This is because you can feel quite dizzy when you first start taking it. After the first dose, you can generally take enalapril at a time of day you find easy to remember. For most people this will be in the morning.
    • If you are being treated for heart failure: your doctor will give you a small once-daily dose to begin with, and then your dose will be increased gradually over a few weeks. Once the dose has been increased, enalapril is commonly taken as two doses a day, one taken in the morning and the other in the evening. Increasing your dose slowly like this helps to avoid unwanted side-effects, such as dizziness.
    • Try to take your doses at the same time(s) of day each day as this will help you to remember to take your doses regularly. You can take enalapril tablets either with or without food. It is best to swallow the tablet with a drink of water.
    • There are several strengths of enalapril tablet. Your doctor will prescribe the strength which is suitable for your condition. Each time you collect a new supply, check to make sure the tablets are the strength that you are expecting.
    • If you forget to take a dose at your usual time, take it as soon as you remember (unless it is nearly time for your next dose, in which case do not take the forgotten dose but take the next dose when it is due). Do not take two doses together to make up for a missed dose.

    Getting the most from your treatment

    • Try to keep your regular appointments with your doctor. This is so your progress can be monitored. Your doctor will want you to have some blood tests from time to time to check that your kidneys are working well.
    • It is very important that you follow any dietary and lifestyle advice that you have been given by your doctor. This can include advice about eating a healthy diet, not smoking, and taking regular exercise.
    • If you buy any medicines, check with a pharmacist that they are suitable to take with enalapril. This is because some medicines (such as anti-inflammatory painkillers and indigestion remedies) can interfere with your treatment.
    • It is likely that your doctor will advise that you do not use salt substitutes while you are taking enalapril. These products have a high content of potassium which could be harmful for you.
    • If you drink alcohol, ask your doctor for advice about drinking alcohol while you are on enalapril. Alcoholic drinks can make you feel light-headed or dizzy, and they may not be advisable for you.
    • If you have diabetes you may need to check your blood glucose more frequently, as the tablets can lower the levels of sugar in your blood. Your doctor will advise you about this.
    • If you are having an operation or dental treatment, tell the person carrying out the treatment that you are taking enalapril. This is because some anaesthetics could cause your blood pressure to drop too low.
    • Treatment with enalapril is often long-term unless you experience an adverse effect. Continue to take the tablets unless you are advised otherwise.

    If you are also taking hydrochlorothiazide in combination with this medicine

    • Studies have suggested that taking higher doses of hydrochlorothiazide for long periods of time may increase the risk of certain skin cancers.
    • Tell your doctor if you have ever been treated for skin cancer before.
    • Tell your doctor about any new or changed moles or worrying marks on your skin.
    • Use a sunscreen in strong sunlight. Do not use sunbeds.

    Can enalapril cause problems?

    Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the more common ones associated with enalapril. The best place to find a full list of the side-effects which can be associated with your medicine, is from the manufacturer’s printed information leaflet supplied with the medicine. Alternatively, you can find an example of a manufacturer’s information leaflet in the reference section below. Speak with your doctor or pharmacist if any of the following continue or become troublesome.

    Very common enalapril side-effects (these affect more than 1 in 10 people) What can I do if I experience this?
    Dry irritating cough If this continues, speak with your doctor, as a different type of medicine may be more suitable for you
    Feeling dizzy or weak Getting up more slowly should help. If you begin to feel dizzy, lie down so that you do not faint, then sit for a few moments before standing. If this continues beyond the first few days, speak with your doctor. Do not drive and do not use tools or machines while you feel dizzy
    Blurred eyesight Do not drive and do not use tools or machines while affected
    Feeling sick (nausea) Stick to simple foods – avoid fatty or spicy meals
    Common enalapril side-effects (these affect less than 1 in 10 people) What can I do if I experience this?
    Headache Drink plenty of water and ask a pharmacist to recommend a suitable painkiller. If the headaches continue, let your doctor know
    Tummy (abdominal) pain, diarrhoea Stick to simple foods – avoid fatty or spicy meals
    Low mood, feeling short of breath, taste disturbances, feeling faint, skin rash If any of these become troublesome, speak with your doctor
    Changes to the results of some blood tests Your doctor will check for this

    Important: if you experience any of the following potentially serious symptoms, stop taking enalapril and contact your doctor for advice straightaway:

    • Any difficulty breathing, or swelling of your face, mouth, tongue or throat. These are signs of an allergic reaction.
    • Any yellowing of your skin or the whites of your eyes. These may be signs of a liver problem called jaundice, which is a rare side-effect.
    • A severe skin rash.

    If you experience any other symptoms which you think may be due to the tablets, speak with your doctor or pharmacist for further advice.

    How to store enalapril

    • Keep all medicines out of the reach and sight of children.
    • Store in a cool, dry place, away from direct heat and light.

    Important information about all medicines

    Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

    This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

    Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

    If you have any questions about this medicine ask your pharmacist.

    What should I discuss with my healthcare provider before taking enalapril (Epaned, Vasotec)?

    You should not use enalapril if you are allergic to it, or if:

    • you have hereditary angioedema;
    • you recently took a heart medicine called sacubitril; or
    • you have ever had a severe allergic reaction to any ACE inhibitor (benazepril, captopril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, or trandolapril).

    Do not take enalapril within 36 hours before or after taking medicine that contains sacubitril (such as Entresto).

    If you have diabetes, do not use enalapril together with any medication that contains aliskiren (a blood pressure medicine).

    You may also need to avoid taking enalapril with aliskiren if you have kidney disease.

    Tell your doctor if you have ever had:

    • kidney disease (or if you are on dialysis);
    • liver disease; or
    • an electrolyte imbalance (such as high levels of potassium in your blood).

    Do not use if you are pregnant. If you become pregnant, stop taking this medicine and tell your doctor right away. Enalapril can cause injury or death to the unborn baby if you take the medicine during your second or third trimester.

    You should not breast-feed while you are using enalapril.

    Enalapril is not approved for use by anyone younger than 1 month old.

    How should I take enalapril (Epaned, Vasotec)?

    Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

    Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

    Enalapril is usually given by injection only if you are unable to take the medicine by mouth. A healthcare provider will give you this injection as an infusion into a vein.

    Your blood pressure will need to be checked often. Your kidney or liver function may also need to be tested.

    Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking enalapril. This can lead to very low blood pressure, electrolyte disorders, or kidney failure.

    If you need surgery, tell the surgeon ahead of time that you are using enalapril.

    If you are being treated for high blood pressure, keep using this medicine even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medicine for the rest of your life.

    Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

    Store the liquid medicine in the refrigerator, do not freeze. Throw away any enalapril liquid not used within 60 days.

    If you have hypertension, you may be prescribed an angiotensin-converting enzyme inhibitor, or ACE inhibitor for short. This class of drugs is one of the most commonly used drugs for hypertension and is recommended as first-line treatment for people with hypertension, alongside two other types of drugs: calcium channel blockers and thiazide diuretics. However, there are many different ACE inhibitors, and you may wonder what the difference is between all of them. Three of the most popular are lisinopril, enalapril, and benazepril. Let’s take a look at how they compare.

    What are lisinopril, enalapril, and benazepril?

    As mentioned, lisinopril, enalapril, and benazepril are all ACE inhibitors. They’ve been around for over 20 years and are all available as generics. Here are some of their brand-name counterparts.

    • Lisinopril: Prinivil, Zestril
    • Enalapril: Vasotec
    • Benazepril: Lotensin

    These medications work on the kidneys to help lower blood pressure. They target an enzyme known as angiotensin converting enzyme (ACE), which normally activates a chemical that makes blood vessels contract and the body retain fluid. By blocking ACE from working, ACE inhibitors are able to help blood vessels relax, among other things. This can help in many ways, but the primary use of these drugs is to lower blood pressure.

    How effective are lisinopril, enalapril, and benazepril?

    All three drugs are highly beneficial for lowering blood pressure and treating hypertension. For people with diabetes who develop hypertension, these drugs are often the first blood pressure medications to be prescribed because along with lowering blood pressure, they can also protect the kidneys from damage that high blood sugar can cause.

    However, although they all work relatively quickly (within 1 to 2 hours), they differ in how long they stay effective. Enalapril and benazepril, the older drugs of the three, tend to only work for a few hours depending on the person, whereas lisinopril is newer and generally lasts longer. This affects how often you need to take each drug. More on that below.

    The three drugs also differ in how what conditions they can treat. Lisinopril can be used for heart failure and for people who’ve had a heart attack. Enalapril can also be used for heart failure but not heart attacks. Benazepril can only be used for hypertension. This is because although these three drugs work in a similar way, they were studied differently and as such, the FDA has different approved uses for each one.

    Lastly, while these drugs work well in most people, research has shown that they may not work as well for hypertension in African American patients and that other blood pressure drugs like calcium channel blockers and thiazide diuretics might work better in this population.

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    How are lisinopril, enalapril, and benazepril taken?

    All three drugs are fairly convenient to use. They are all taken by mouth, and you can take them with or without food. Like with most hypertension medications, avoid drinking alcohol while taking ACE inhibitors, as the combination can cause a dramatic drop in blood pressure. You do not need to avoid any types of food or non-alcoholic drinks when taking these medications, and they can be taken with most of your other medications at the same time.

    Dosing

    How often lisinopril, enalapril, and benazepril are taken will depend on the drug and your specific health needs. They also come in different strengths.

    • Lisinopril is taken once a day. Dosing will depend on whether it is being used for hypertension, heart failure, or after a heart attack. Generally, it starts at 2.5 mg to 5 mg a day and can be increased to up to 40 mg a day.
    • Enalapril is taken either once or twice a day, again, depending on what it’s being used for. For hypertension, dosing starts at 5 mg a day and can be increased up to 40 mg a day (either as 40 mg once a day or 20 mg twice a day, depending on what your provider thinks will work best for you). For heart failure, dosing starts at 2.5 mg twice a day (for a total of 5 mg a day), but it can be increased to 20 mg twice a day (for a total of 40 mg a day).
    • Benazepril is a little different—it’s only used for hypertension. Usually, dosing starts at 5 mg to 10 mg once a day by mouth, and it can be increased up to 40 mg in one dose or two doses of 20 mg twice a day. Your provider will determine if once or twice a day dosing works for you.

    One thing to note is that if you are over 65 years of age or are more likely to have blood pressure that is too low, your provider may start you at a lower dose than what’s listed above and increase the dose slowly from there to ensure your safety.

    What drugs interact with lisinopril, enalapril, and benazepril?

    All three of these ACE inhibitors share similar drug interactions, and a few are worth highlighting below. Keep in mind that this is not an all-inclusive list. Always talk to your provider and pharmacist about what drugs and supplements you are taking before starting a new medication.

    • NSAIDs – Non-steroidal anti-Inflammatory drugs (NSAIDs for short), like ibuprofen and naproxen, are commonly used pain medications. These drugs interact with ACE inhibitors and if used together, they can cause kidney problems. Talk to your doctor about alternatives to NSAIDs if you are taking an ACE inhibitor.
    • Other hypertension medications – While it is common to be on multiple drugs that lower your blood pressure to control your hypertension, they can dramatically lower your blood pressure when used together. Always watch out for symptoms of hypotension (e.g., fainting, dizziness) if your provider increases the dose of one of your drugs or gives you a new medication, and let them know if you notice any such symptoms.
    • Potassium supplements – While potassium supplements are not technically drugs, they can interact dangerously with ACE inhibitors. ACE inhibitors can raise your potassium levels as a side effect, and any extra potassium will increase your risk for symptoms of high potassium such as weakness, trouble breathing, and heart palpitations, which can be life-threatening. Avoid extra potassium unless directed to take them by your provider. This goes for other sources of extra potassium too like salt substitutes and potassium-containing medications (like Klor-Con and K-Tab).

    What are the most common side effects of lisinopril, enalapril, and benazepril?

    As lisinopril, enalapril, and benazepril are all ACE inhibitor drugs and work on the body in similar ways, they share similar side effects. These are the most common:

    • Cough – Unfortunately, you may experience a cough with these drugs, either right after starting the drug or after increasing its dose. This can happen in about 10% of people who take these drugs. This cough doesn’t go away and cannot be treated with cough suppressants. The cough is not dangerous but can be highly annoying. Let your provider know if this bothers you; they may be able to recommend a different drug.
    • High potassium – These drugs can all cause your potassium blood levels to increase, which can lead to symptoms like weakness, trouble breathing, and heart palpitations. If you take an ACE inhibitor, avoid eating extra potassium, whether through high-potassium foods, dietary supplements, or salt replacement additives that use potassium instead of sodium (like this one for example).
    • Facial swelling – All ACE inhibitors come with the rare but dangerous risk of swelling of the tongue, lips, mouth, and throat (also known as angioedema). This swelling can be so serious that it can block your airways and stop you from breathing. If you notice any such swelling, let your provider know right away.
    • Kidney problems – While these drugs can protect the kidneys in patients with kidney disease and diabetes, they can also make kidney problems worse in some people. Your healthcare provider will closely monitor your kidney function because of this.

    Do lisinopril, enalapril, and benazepril need any special monitoring?

    Because these drugs lower your blood pressure, your doctor may ask you to monitor your blood pressure at home and to let them know if you have any symptoms of hypotension, including headaches, dizziness, lightheadedness, and fainting. You can see our post here about how to monitor your blood pressure at home and how to tell if your numbers are good or bad.

    Also, since these drugs work on the kidneys and may affect your potassium levels, your provider may ask you to get a blood test every few months. This is to make sure your kidneys are doing well, especially if you have a history of kidney disease or diabetes, and to make sure your potassium stays within a normal range. If your numbers come back irregular, your provider may need to lower the dose of your drug or switch you to another one.

    Who shouldn’t take lisinopril, enalapril, and benazepril?

    These drugs are safe and effective for most people. However, they should be avoided in women who are pregnant or are planning to become pregnant as they can be harmful to a growing fetus.

    How much do lisinopril, enalapril, and benazepril cost?

    Lisinopril, enalapril, and benazepril are all generic medications and are relatively inexpensive. Most insurance companies cover them as well. On GoodRx, you can find prices for these drugs at around $10 for a typical monthly prescription or less. Just type in your drug’s name, quantity, and strength on goodrx.com or the GoodRx mobile app, and set your location to see GoodRx prices at pharmacies in your area.

    – – –

    The bottom line

    As you have seen, lisinopril, enalapril, and benazepril can all be used for hypertension and possibly other heart-related issues. They generally work really well, are recommended by many health organizations as first-line treatment, and are relatively cheap. However, they do have some side effects that require close monitoring. The final decision on which one to use will come down to what health problems you have and how often you want to take your medications each day (once or twice a day).

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    • Enalapril Maleate is an oral medication prescribed to help manage the symptoms of heart failure, whether mild, moderate or severe, high blood pressure and some other heart conditions. It may be prescribed to treat other cardiac diseases such as cardiomyopathy (a heart muscle disease) and the management of kidney (renal) failure. Customers may receive this drug under the names Enacard, Vasotec.

      Uses

      Enalapril is indicated in the management of symptoms associated with hypertension (high blood pressure), heart failure, dilated cardiomyopathy, kidney disease, and other types of heart diseases.

      Possible Side Effects

      The most common side effects are decreased appetite, stomach upset, lethargy, and incoordination. Hypotension (low blood pressure) can also occur. Signs of low blood pressure include weakness/collapse, other kidney problems, increased drinking/urination, slowed heart rate, and a weak pulse. Contact your veterinarian if you notice any behaviors or symptoms that seem unusual after beginning Enalapril.

      Drug & Food Interactions

      Always tell your veterinarian about medications and supplements your pet is taking before using Enalapril. Interactions are possible when Enalapril is used along with vasodilators or non-steroidal anti-inflammatory drugs. Tell your veterinarian if your pet is using a diuretic medication, such as furosemide, as dosage may need to be altered when it is given with Enalapril.

      Precautions

      Enalapril should not be given to pets who are allergic to ACE inhibitors. Pregnant or nursing females should not take Enalapril. This medication should be taken with caution by pets with kidney disease.

      This drug is FDA-approved for human use. However, it is common practice for veterinarians to prescribe such drugs for use in dogs and cats.

      NOTE: For Generic Medications, picture displayed may not depict actual product. Generic medications may vary from one order to the next by size, color and shape depending on manufacturer. Customers may receive the same drug under the names Enacard, Vasotec.

      1. Prescribing Information

      See all items by Enalapril

      (Picture Credit: Getty Images)

      Enalapril is a drug that can be used to treat heart failure and high blood pressure in dogs, as well as other heart conditions and chronic kidney failure. It’s sometimes known by the brand names Enacard and Vasotec.

      Enalapril is a powerful ACE-inhibitor considered to be one of the most effective medications for dogs who suffer from cardiac and blood illnesses, though it’s powerful and can cause serious side effects.

      It works by blocking an enzyme in the body that creates a substance that causes blood vessels to constrict. As blood vessels relax, blood pressure decreases, and more oxygen and blood can pass to the heart. This helps reduce stress on the heart and fluid build-up in the lungs.

      Veterinarians often combine enalapril with other medications such as Furosemide or Digoxin. If your vet prescribes enalapril for your dog, then you must follow dosage instructions carefully and report any concerning reactions or side effects.

      Here’s what you should know about the uses, dosage, and side effects of enalapril in dogs.

      Uses Of Enalapril For Dogs

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      Enalapril can treat mild to severe heart failure and high blood pressure in dogs. It can also treat heart murmurs, chronic kidney failure, and other heart and blood illnesses.

      By lowering blood pressure, the drug helps the heart beat more efficiently and prevents fluid from building up in the lungs, improving exercise tolerance.

      It’s a powerful medication that can only be obtained with a veterinary prescription.

      Dosage Of Enalapril For Dogs

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      The usual dosage of enalapril for dogs is 0.25 mg per pound of body weight given once per day. Dogs who take enalapril should always have access to fresh water because dehydration can lead to dangerously low blood pressure, electrolyte disorders, or kidney failure.

      Enalapril is available in 2.5 mg, 5 mg, 10 mg, and 20 mg tablets. Follow your veterinarian’s instructions for dosage closely, as they may adjust it based on your dog’s reaction to the medication.

      Overdose can result in an unsafe drop in blood pressure or kidney failure.

      Side Effects Of Enalapril For Dogs

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      There are several potential side effects that have been observed in dogs who take enalapril that range from mild to serious. If you see concerning side effects in your dog, then you should consult your vet immediately, as they may wish to adjust the dosage or seek an alternative form of treatment.

      Here are some of the side effects of enalapril for dogs:

      • Weakness
      • Vomiting
      • Cough
      • Nausea
      • Dizziness
      • Drowsiness
      • Dry mouth
      • Diarrhea
      • Mild itching or rash
      • Loss of appetite
      • Increased or decreased urination
      • Fainting
      • Fever
      • Easy bruising or bleeding
      • Swelling
      • Weight gain
      • Drop in blood pressure
      • Kidney failure

      Make sure your vet knows about any medical conditions your dog has, especially diabetes, lupus, rheumatoid arthritis, kidney disease, or liver disease.

      Also, let them know about any other medications your dog takes, especially other ACE inhibitors, potassium supplements, or aspirin, as these may decrease the effectiveness or react poorly with enalapril.

      This drug may cause birth defects or harm puppies who are nursing.

      As with all medications, there’s a risk of allergic reaction that can lead to anaphylaxis, a potentially life-threatening condition. Contact your vet right away if you see itchiness, hives, swelling, difficulty breathing, or other signs of an allergic reaction, and stop giving your dog enalapril.

      Has your dog ever taken enalapril? Was it effective? Then let us know in the comments below!

      Enalapril
      Rx

      Generic Enalapril Tablets for Cats and Dogs

      What is enalapril?

      This product requires a prescription from your pet’s veterinarian.

      Enalapril is a medication classified as an ACE inhibitor (angiotensin-converting-enzyme inhibitor). It is designed to relax the blood vessels in order to lower blood pressure and to reduce how hard the heart needs to work. It is used primarily in the treatment of heart failure in dogs. It can also be used in cats, ferrets, and birds in many formulations. In combination with furosemide, a diuretic, enalapril has been shown to improve the quality of life in dogs with heart failure.

      Enalapril can be given with or without food. Do not stop giving your animal enalapril without talking with your pet’s veterinarian. If you miss giving your pet the dose, give it as soon as you remember. If it is close to the next dose, skip the missed dose and continue on your normal schedule. Do not double up on doses. If you are unsure when to give the missed dose, contact your pet’s veterinarian.

      Do not give enalapril to pregnant or lactating dogs or cats.

      Possible Side Effects (for dogs): vomiting, diarrhea, anorexia, low blood pressure, weakness

      Possible Side Effects (for cats): lethargy, lack of appetite

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