II. Indications

III. Mechanism

  1. See ACE Inhibitor
  2. Dicarbocyl-containing peptide
  3. Angiotensin-converting enzyme (ACE) inhibitor
  4. Enalapril is a prodrug, converted to its active form Enalaprilat in the liver via de-esterification
    1. Lisinopril is a synthetic Lysine derivative of Enalaprilat

IV. Dosing: Adults

  1. Hypertension
    1. Start Enalapril 5 mg orally daily
      1. Start 2.5 mg/day if GFR <30 ml/min
    2. Target 10 to 40 mg/day divided once to twice daily
    3. Maximum 40 mg/day
  2. Congestive Heart Failure
    1. Start Enalapril 2.5 mg orally twice daily
    2. Target 10 to 20 mg orally twice daily
    3. Maximum 40 mg/day
  3. Hypertensive Emergency (or unable to take oral medications)
    1. Start Enaprilat 1.25 mg to 5 mg IV every 6 hours
  4. Diabetic Nephropathy (not FDA approved)
    1. Enalapril 10 to 20 mg orally daily

V. Dosing: Children (age >1 month old)

  1. Hypertension
    1. Start 0.1 mg/kg/day divided once to twice daily and titrate
    2. Maximum: 0.5 mg/kg/day
  2. Hypertensive Emergency (or unable to take oral medications, Not FDA approved)
    1. Enalaprilat 0.005 to 0.01 mg/kg/dose IV every 8 to 24 hours

VI. Supplied

  1. Available as scored tablets: 2.5, 5, 10 and 20 mg
  2. Enaprilat is available IV
  3. To make Enalapril oral suspension (0.2 mg/ml)
    1. Dissolve 2.5 mg tablet in 12.5 ml sterile water
    2. Use immediately

VII. Metabolism

  1. Excretion both renal and hepatic

VIII. Adverse Effects

IX. Safety

  1. See ACE Inhibitor
  2. Pregnancy Category X
  3. Enalapril is among only two ACE Inhibitors labeled by AAP as compatible with Breast Feeding
    1. However, Enalapril is excreted in Breast Milk and may be associated with newborn adverse effects

XI. References

  1. (2016) Presc Lett, Resource #321151, ACE Inhibitor Antihypertensive Dose Comparison
  2. (2020) Med Lett Drugs Ther 62(1598): 73-80
  3. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 68-9
  4. Hamilton (2020) Tarascon Pocket Pharmacopoeia

Images: Related links to external sites (from Bing)

Related Studies

Cost: Medications

enalapril (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
ENALAPRIL 1 MG/ML ORAL SOLN Generic $1.89 per ml
ENALAPRIL MALEATE 10 MG TAB Generic $0.11 each
ENALAPRIL MALEATE 2.5 MG TAB Generic $0.10 each
ENALAPRIL MALEATE 20 MG TAB Generic $0.13 each
ENALAPRIL MALEATE 5 MG TABLET Generic $0.11 each
ENALAPRIL-HYDROCHLOROTHIAZIDE 10-25 MG TABLET Generic $0.17 each
ENALAPRIL-HYDROCHLOROTHIAZIDE 5-12.5 MG TAB Generic $0.15 each

Ontology: Enalapril (C0014025)

Definition (CHV) a drug used to treat hypertension
Definition (NCI) A dicarbocyl-containing peptide and angiotensin-converting enzyme (ACE) inhibitor with antihypertensive activity. As a prodrug, enalapril is converted by de-esterification into its active form enalaprilat. Enalaprilat competitively binds to and inhibits ACE, thereby blocking the conversion of angiotensin I to angiotensin II. This prevents the potent vasoconstrictive actions of angiotensin II and results in vasodilation. Enalapril also decreases angiotensin II-induced aldosterone secretion by the adrenal cortex, which leads to an increase in sodium excretion and subsequently increases water outflow.
Definition (NCI_NCI-GLOSS) An antihypertensive agent that can also be used to slow or prevent the progression of heart disease in people with childhood cancer treated with drugs that may be harmful to the heart.
Definition (CSP) 1-carboxy-3-phenylpropyl-L-alanyl- L-proline (as 1'-ethyl ester, maleate 1:1), is an ACE inhibitor used as an antihypertensive.
Definition (MSH) One of the ANGIOTENSIN-CONVERTING ENZYME INHIBITORS that is used to treat hypertension.
Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116)
MSH D004656
SnomedCT 15222008, 372658000
LNC LP171394-2
English Enalapril, L-Proline, 1-(N-(1-(ethoxycarbonyl)-3-phenylpropyl)-L-alanyl)-, (S)-, Enalapril [Chemical/Ingredient], ENALAPRIL, enalapril, Enalapril (product), Enalapril (substance)
Swedish Enalapril
Czech enalapril
Finnish Enalapriili
Russian ANALAPRILA MALEAT, ENALAPRIL, MK-421, АНАЛАПРИЛА МАЛЕАТ, ЭНАЛАПРИЛ
Japanese エナラート, レリート, エナリン, ラリルドン, レニベース, レニベーゼ, レニメック, エナラプリルMEEK, レノペント, エナラプリルM, エナラメルク, カルネート, シンベノン, ファルプリル, スパシオール, マレイン酸エナラプリル, ザクール, セリース, レビンベース, エナラプリルマレイン酸塩, アリカンテ, エナラプリル
Croatian ENALAPRIL
Spanish enalaprilo, enalapril (producto), enalapril (sustancia), enalapril, Enalapril
Polish Enalapryl
French Énalapril
German Enalapril
Italian Enalapril
Portuguese Enalapril

Ontology: Enalaprilat (C0014027)

Definition (NCI) The active metabolite of the pro-drug enalapril, a dicarboxylate-containing angiotensin-converting enzyme (ACE) inhibitor with antihypertensive activity. Enalaprilat prevents the conversion of angiotensin I into angiotensin II by inhibiting ACE, thereby leading to decreased vasopressor activity and resulting in vasodilation. This agent also decreases aldosterone secretion by the adrenal cortex, which leads to an increase in natriuresis.
Definition (MSH) The active metabolite of ENALAPRIL and a potent intravenously administered angiotensin-converting enzyme inhibitor. It is an effective agent for the treatment of essential hypertension and has beneficial hemodynamic effects in heart failure. The drug produces renal vasodilation with an increase in sodium excretion.
Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116)
MSH D015773
SnomedCT 48052001, 414092003
English Enalaprilat, Enalaprilic Acid, N-(1(S)-Carboxy-3-phenylpropyl)-L-alanyl-L-proline, enalaprilat, enalaprilat (medication), ENALAPRILAT, Enalaprilat [Chemical/Ingredient], Enalaprilat (substance), Enalaprilat (product)
Swedish Enalaprilat
Czech enalaprilát
Finnish Enalaprilaatti
French Énalaprilate, Acide énalaprilique
Italian Acido enalaprilico, Enalaprilato
Russian ENALAPRILOVAIA KISLOTA, ENALAPRILAT, MK-422, ЭНАЛАПРИЛАТ, ЭНАЛАПРИЛОВАЯ КИСЛОТА
Japanese エナラプリラート, エナラプリル酸
Spanish enalaprilato (producto), enalaprilato, enalaprilat, enalaprilat (sustancia), enalaprilat (producto), enalaprilato (sustancia), Enalaprilato, Ácido Enalaprílico
Polish Kwas enalaprylowy, MK-422, Enalaprilat
Portuguese Enalaprilat, Ácido Enalaprílico, Enalaprilate
German Enalaprilat, Enalaprilsäure

Ontology: Vasotec (C0728763)

Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116)
MSH D015773
English Vasotec, vasotec, Biovail Brand of Enalaprilat Anhydrous, Merck Frosst Brand of Enalaprilat Anhydrous