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Enalapril (Maleate)

Overview

Enalapril (Maleate) is ACE inhibitor. It prevents the conversion of certain enzymes in the body and prevents contraction of blood vessels. It decreases the blood pressure and makes the heart beat stronger. Enalapril (Maleate) is used to treat hypertension (high blood pressure), heart failure or in diabetic patients to prevent kidney problems.

Category:

Primary Characterstics

Molecular Structure of Enalapril (Maleate)
. It is of Synthetic origin and belongs to Phenylpropyl Amino acid. It belongs to Angiotensin converting enzyme inhibitor-ACEI pharmacological group on the basis of mechanism of action and also classified in Antihypertensive Agents pharmacological group.The Molecular Weight of Enalapril (Maleate) is 492.50.
Its pKa is 3.0, 5.4.

Pharmacokinetics

Oral absorption of Enalapril (Maleate) is found to be 67.5% ±7.5. Volume of distribution is found to be 1.7l/kg and plasma protien binding is 60%. Presystemic metabolism is noted to be 20% and metabolism is reported rapid & extensively via liver. Renal Excretion accounts for 61% and plasma half life is 35 hr.

Indications

Contraindications

Enalapril (Maleate) is contraindicated in conditions like Angioneurotic edema,Aortic stenosis,Bilateral renal artey stenosis.

Drug Interactions

Enalapril (Maleate) is known to interact with other drugs, the details of drug interactions is as follows:

DrugDetailsSeverityOnsetManagement
Alcohol
Allopurinol
AlprostadilEnhanced hypotensive effects when alprostadil given with ACE inhibitors (e.g Enalapril)
Amiloride (HCl)enalapril can reduce potassium loss with thiazide diuretics (e.g amiloride, spiranolactone, triametrene) may result in hyperkalemia
AspirinRisk of renal impairment when Aspirin (in doses over 300mg daily) given with ACE inhibitors (e.g Fosinopril), also hypotensive effects antagonized by aspirin and other NSaids by blocking prostraglandins production. the combination of aspirin with enalapril may result in nephrotoxity
Cyclosporin A
DiazoxideEnhanced hypotensive effect when Diazoxide given with Enalapril.
Digoxinenalapril reduce clearance of digoxin leading to increase serum level of digoxin in patients with heart failure
EplerenoneEplerenone may enhance hyperkalaemic effect of ACE inhibitors, angiotensin II receptor blockers, potassium-sparing diuretics or potassium salts.Monitor serum potassium levels and adjust doses.
Indomethacin
Iron Dextran
Iron Sorbitol
Lithiumcoadministration may increase lithium plasma level and lithium toxcity occurlithium levels should be monitored
Potassium GlycerophosphateConcurrent use may cause too much potassium in the blood.
Rifampicin
Technetium Succimer Tc-99mIn patients with unilateral renal artery stenosis, use of Enalapril (Maleate) may result in decreased uptake of technetium Tc 99m succimer by the affected kidney because of a loss of effective trans-membrane filtration pressure.

These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.

Interference in Pathology

  • Increased Serum Potassium Level

Side Effects

The severe or irreversible adverse effects of Enalapril (Maleate), which give rise to further complications include Hepatotoxicity, Anaphylactoid reactions, Angioedema, Acute renal failure.

The signs and symptoms that are produced after the acute overdosage of Enalapril (Maleate) include Hypotension.

The symptomatic adverse reactions produced by Enalapril (Maleate) are more or less tolerable and if they become severe, they can be treated symptomatically, these include Dizziness, Fatigue, Rashes, Dry cough, Taste disturbances, Azotemia.

Available Brands

Click on the appropriate strength of the dosage form to view its available brands.

Single Ingredient

Tabs: 5 mg, 10 mg, 20 mg,

Multi ingredient

Tabs: 10 mg,

Dosage

Enalapril (Maleate)'s dosage details are as follows:
Dose Single Dose Frequency Route Instructions

Adult Dosage

2.5 mg2.5 (2.5)24 hourlyPOInitial
10 to 20 mg15 (15)24 hourlyPOMaintenance

Paedriatic Dosage ( 20 Kg. )

80 to 50 mcg/kg65 (65)24 hourly

Neonatal Dosage ( 3 Kg. )

No data regarding the neonatal dosage details of Enalapril (Maleate) is available.

High Risk Groups

Drug should not be given to Paediatrics, Pregnant Mothers, Geriatrics, and Neonates.

If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.

Warning / Precautions

Enalapril should be used with caution in patients of renal insufficiency, severe liver dysfunction, hypervolemia, angioedema and in pre-existing bone marrow depression. Enalapril therapy can cause neutropenia or agranulocytosis. Patients with renal disease, patients with immunosuppression or receiving immunosuppressives, and patients with collagen vascular disease or autoimmune disease are at a greater risk for developing these complications. The dose should be adjusted in patients with renal impairment. It should be used cautiously in patients with congestive heart failure. Initial doses should be lower than in the treatment of hypertension becauseof a greater risk of developing hypotension. It should not be administered to patients with pre-existing renal artery stenosis. Renal function should be monitored closely during the first 2 weeks after initiating therapy. It should be discontinued if renal function worsens acutely. Other types of renal disease can actually improve during Enalapril therapy. The dose should be adjusted in patients with renal impairment. It should be used with caution patients with hyperkalemia. It is classified as pregnancy category C and should be used with caution during pregnancy only if clearly needed.

Storage Conditions

Tab, Inj

Store at room temperature, Below 30°C.

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