(for veterinary information only)
BRAND NAME: VASOTEC
Enalapril is an “Angiotensin Converting Enzyme Inhibitor” also called an “ACE inhibitor” or simply an “ACEI.” Angiotensin Converting Enzyme is an enzyme involved in the final stage of angiotensin II production, angiotensin II being an extremely powerful constrictor of blood vessels. The ACE inhibitor blocks angiotensin II production and is helpful in the treatment of heart failure, high blood pressure and in urinary protein loss.
ANGIOTENSIN II CONSTRICTS BLOOD VESSELS
WHY WOULD WE EVER WANT TO BLOCK ANGIOTENSI II?
When blood pressure drops from heart failure, there is no blood loss; the amount of blood is the same as always. The problem in heart failure is that the heart is not pumping enough blood forward. When the Renin-Angiotensin system centralizes the blood, it effectively confines the same amount of blood to a smaller circulatory route, essentially forcing the already diseased heart to pump blood faster to keep up. This amounts to more work for the already overworked heart.
ENALAPRIL FOR URINARY PROTEIN LOSS
In heart failure patients, when enalapril is commonly given in conjunction
Enalapril may be given with or without food.
Enalapril is given once or twice daily and the dose is commonly altered depending on response.
Nausea, appetite loss, or diarrhea are sometimes observed with this medication. In some patients, these effects are severe enough to preclude the use of enalapril.
In some patients, blood pressure can drop too low as the peripheral blood vessels are dilated. This manifests as listlessness and lethargy. Often the dose of enalapril can be modified should this side effect occur.
Enalapril may lead to elevations in potassium blood levels.
INTERACTIONS WITH OTHER DRUGS
Enalapril is commonly used in combination with diuretics, especially furosemide. In this situation, monitoring kidney parameters is especially important as both these medications serve to decrease blood supply to the kidney as they support the heart. Should a heart failure crisis occur while a patient is on these two medications, it will become necessary to rely on the diuretic to resolve the crisis. High doses of diuretic are typically needed. This can potentially lead to kidney failure though there is no alternative when the heart is failing.
Blood potassium levels can become dangerously high when enalapril is used with other medications that elevate blood potassium level. Such drugs might include: potassium supplements (Polycitra, or Urocit-K) or spironolactone (a potassium sparing diuretic.)
Enalapril is less effective in the presence of aspirin or other NSAIDs (Non-Steroidal Anti-Inflammatory Drugs).
Enalapril may increase the risk of hypoglycemia (low blood sugar) when used concurrently with insulin.
CONCERNS AND CAUTIONS
Enalapril is inactive when it is consumed and must be activated into “enalaprilat” (its active form) by the liver. If the patient’s liver is in failure and cannot reliably perform this conversion, an ACE inhibitor that does not require conversion can be used.
Enalapril probably should not be used in patients with impaired kidney function.
This medication should not be used in pregnancy or lactation.
Store enalapril at room temperature and away from light.
Enalapril should not be used in dehydrated patients.
If a dose of enalapril is accidentally skipped, do not double up on the next dose but give the next dose when it is remembered normally.
Last updated: 7/21/2022