Enalapril should be used with caution in: patients with kidney or liver problems, dialysis patients, patients on a low saltdiet or water tablets (diuretics), patients who have been very sick or had diarrhoea recently, patients who have had a recent kidney transplant, blood problems, the heart conditions aortic stenosis, hypertrophic cardiomyopathy or outflow obstruction, collagenvascular disease, diabetes, intolerance to some sugars including lactose, patients with an ongoing cough.
It should not be used in: patients who have had an allergic reaction to enalapril or to any other ingredients in the medicine or an allergic reaction to any other ACE inhibitor, second and third trimester of pregnancy, neonates (very young babies), children with kidney problems, patients with a history of angioedema (symptoms such as itching, nettle rash, wheezing or swelling of the hands, throat mouth or eyelids) while taking enalapril or other ACE inhibitors, patients who have hereditary angioedema (affecting other family members) or have had angioedema for which the cause is not known.
Also see list of precautions and interactions
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- Enalapril is used to widen the blood vessels making it easier for the heart to pump blood around the body.
- It is an angiotensin converting enzyme inhibitor, sometimes known as an ACE inhibitor.
- It is used to lower blood pressure.
- In general this drug is used to lower blood pressure in patients with high blood pressure (hypertension). It is also used to treat the heart condition known as heart failure which occurs when the heart is unable to pump blood around your body as well as it used to. If you have heart failure you my feel tired after light physical activity, feel breathless and have swollen ankles and feet. Enalapril can also prevent symptoms such as shortness of breath and swelling from developing in patients who have a damaged heart muscle but no symptoms.
Benefits of being on this drug can include making the heart work better and relief from the symptoms of heart failure such as tiredness, breathlessness and swollen ankles and feet. In patients without symptoms enalapril can prevent the heart from weakening further and developing heart failure.
Listed below are the typical uses of enalapril.
- High blood pressure (hypertension)
- Heart failure
- Prevention of symptoms in patients with a damaged heart muscle (heart failure) who do not currently have symptoms.
On occasion your doctor may prescribe this medicine to treat a condition not on the above list. Such conditions are listed below.
HOW TO USE/TAKE
How often do I take it?
- Take this medication orally usually once or twice daily, with or without food, with a drink of water. The number of tablets you take each day and how often you take them will depend on your condition.
- Use this medication regularly in order to get the most benefit from it.
- Remember to use it at the same time each day - unless specifically told otherwise by your doctor.
- It may take up to 6 hours before the full benefit of this drug takes effect.
- Certain medical conditions may require different dosage instructions as directed by your doctor.
- Dosage is based on your age, gender, medical condition, response to therapy, and use of certain interacting medicines.
Do I need to avoid anything?
- You may feel dizzy or tired when taking enalapril. If you have these symptoms then do not drive or operate machinery. Consult your doctor or pharmacist for more details. Ask your doctor how much exercise you should do as too much exercise may make you feel dizzy or faint particularly in hot weather.
When can I stop?
- It is important to continue taking this medication even if you feel well, unless your doctor tells you to stop.
ENALAPRIL SIDE EFFECTS
If any of these persist or you consider them severe then inform your doctor or pharmacist. Further information on other side effects can be found in the patient information leaflet.
Tell your doctor immediately if you develop any of the following symptoms:
- Feeling itchy, short of breath and wheezy with swelling of the hands, mouth, face, throat or eyes (stop taking enalapril immediately and seek immediate medical attention)
- Feeling very dizzy and lightheaded particularly at the start of treatment or when the dose is increased or when you stand up (stop taking enalapril immediately and seek immediate medical attention)
- Infection particularly if it is with a high temperature and fever
- Yellowing of the skin or whites of the eyes (jaundice)
- A dry cough which lasts for a long time
- Very red skin, blisters and skin peeling off in sheets
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.
The Yellow Card Scheme allows you to report suspected side effects from any type of medicine (which includes vaccines, herbals and over the counter medicines) that you are taking. It is run by the medicines safety watchdog called the Medicines and Healthcare products Regulatory agency (MHRA). Please report any suspected side effect on the Yellow Card Scheme website.
Before taking enalapril, tell your doctor or pharmacist if you are allergic to it; or to other ACE inhibitors; or if you have any other allergies.
This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: had an allergic reaction to enalapril or to any other ingredients in the medicine or an allergic reaction to any other ACE inhibitor, are pregnant or breast feeding, had a recent kidney transplant, a history of angioedema (symptoms such as itching, nettle rash, wheezing or swelling of the hands, throat mouth or eyelids) while taking enalapril or other ACE inhibitors, hereditary angioedema (affecting other family members) or had angioedema for which the cause is not known.
Before using this medication, tell your doctor or pharmacist your medical history, especially any of the following: kidney or liver problems, dialysis, you are on a low saltdiet or water tablets (diuretics), have been very sick or had diarrhoea recently, blood problems, the heart conditions aortic stenosis, hypertrophic cardiomyopathy or outflow obstruction, collagen vascular disease, diabetes, intolerance to some sugars including lactose, an ongoing cough.
Before having surgery, tell your doctor or dentist that you are taking this medication. If you are about to have a treatment called LDL apheresis (which involves using a machine to remove cholesterol from the blood) or desensitisation treatment (this is used to reduce the effect of an allergy to bee or wasp stings) tell your doctor who is treating you that you are taking enalapril.
Does alcohol intake affect this drug?
- Drinking alcohol whilst taking enalapril may make you feel dizzy, light-headed or faint. Avoid alcohol while taking enalapril.
The elderly: enalapril should be used with caution in the elderly. The dose of enalapril used in an elderly patient is dependent on how well their kidneys are working.
Pregnancy and breastfeeding - please ensure you read the detailed information below
Enalapril is not recommended in early pregnancy and must not be taken in the second and third trimester of pregnancy.
It is sensible to limit use of medication during pregnancy whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
Enalapril is not recommended if you are breastfeeding.
It is sensible to limit use of medication during breastfeeding whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.
This drug should not be used with the following medications because very serious, possibly fatal interactions may occur:
- There are no medicines listed with absolute contraindications for enalapril
- If you are currently using any of these medications, tell your doctor or pharmacist before starting enalapril.
Before using this medication, tell your doctor or pharmacist of all prescription and non-prescription/herbal products you may use, especially of:
- Water tablets (diuretics)
- Other medicines that lower blood pressure or are used to treat heart failure (such as nitroglycerine, nitrates, vasodilators, beta blockers, methyldopa, calcium antagonists, guanethidine)
- Medicines to suppress your immune system (such as ciclosporin)
- Allopurinol (for gout)
- Tricyclic antidepressants (used for depression)
- Antipsychotics such as phenothiazines (used for severe anxiety)
- Pain killers such as morphine or anaesthetics
- Procainamide (for unusual heart rhythm)
- Medicines for diabetes (including insulin)
- Potassium supplements
- Salt substitutes containing potassium
- Lithium (for some psychiatric illnesses)
- Medicines used for stiffness, inflammation and pain associated with muscles, bones and joints (including gold and NSAIDs such as diclofenac)
- Ephedrine (contained in some cough and cold preparations)
- Noradrenaline and adrenaline (for low blood pressure, heart problems, asthma and allergies)
- Medicines used to treat cancer
- Epoetin for anaemia
- Levodopa for Parkinson's disease
- Moxisylyte for blood problems
- Hormonal drugs including prostaglandins, oestrogens and drospirenone
- The muscle relaxants baclofen and tizanidine
- Antacids for indigestion
This information does not contain all possible interactions. Therefore, before using enalapril, tell your doctor or pharmacist of all the products you use.
Signs and symptoms of overdose include low blood pressure, dizziness, light-headedness, fast heartbeat, feeling anxious, cough, kidney problems, fast breathing and unconsciousness. Contact your doctor immediately if you think you have taken more enalapril tablets than you should.
If you think you, or someone you care for, might have accidentally taken more than the recommended dose of enalapril or intentional overdose is suspected, contact your local hospital, GP or if in England call 111. In Scotland call NHS 24. In Wales, call NHS Direct Wales. In the case of medical emergencies, always dial 999.
If you miss a dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.