II. Indications
- See ACE Inhibitor
III. Mechanism
- See ACE Inhibitor
- Dicarbocyl-containing peptide
- Angiotensin-converting enzyme (ACE) inhibitor
- Enalapril is a prodrug, converted to its active form Enalaprilat in the liver via de-esterification
- Lisinopril is a synthetic Lysine derivative of Enalaprilat
IV. Dosing: Adults
-
Hypertension
- Start Enalapril 5 mg orally daily
- Start 2.5 mg/day if GFR <30 ml/min
- Target 10 to 40 mg/day divided once to twice daily
- Maximum 40 mg/day
- Start Enalapril 5 mg orally daily
-
Congestive Heart Failure
- Start Enalapril 2.5 mg orally twice daily
- Target 10 to 20 mg orally twice daily
- Maximum 40 mg/day
-
Hypertensive Emergency (or unable to take oral medications)
- Start Enaprilat 1.25 mg to 5 mg IV every 6 hours
-
Diabetic Nephropathy (not FDA approved)
- Enalapril 10 to 20 mg orally daily
V. Dosing: Children (age >1 month old)
-
Hypertension
- Start 0.1 mg/kg/day divided once to twice daily and titrate
- Maximum: 0.5 mg/kg/day
-
Hypertensive Emergency (or unable to take oral medications, Not FDA approved)
- Enalaprilat 0.005 to 0.01 mg/kg/dose IV every 8 to 24 hours
VI. Supplied
- Available as scored tablets: 2.5, 5, 10 and 20 mg
- Enaprilat is available IV
- To make Enalapril oral suspension (0.2 mg/ml)
- Dissolve 2.5 mg tablet in 12.5 ml sterile water
- Use immediately
VII. Metabolism
- Excretion both renal and hepatic
VIII. Adverse Effects
- See ACE Inhibitor
IX. Safety
- See ACE Inhibitor
- Pregnancy Category X
- Enalapril is among only two ACE Inhibitors labeled by AAP as compatible with Breast Feeding
- However, Enalapril is excreted in Breast Milk and may be associated with newborn adverse effects
X. Resources
XI. References
- (2016) Presc Lett, Resource #321151, ACE Inhibitor Antihypertensive Dose Comparison
- (2020) Med Lett Drugs Ther 62(1598): 73-80
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 68-9
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
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Related Studies
| 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 |