Generic Name: Enalapril
Common Brand Names: Vasotec, Renitec
Introduction
Enalapril is an angiotensin-converting enzyme (ACE) inhibitor used primarily for the treatment of hypertension and heart failure. It reduces morbidity and mortality in patients with chronic heart failure and post-myocardial infarction with left ventricular dysfunction.
Conditions of Use (Indications)
1. Hypertension:
- First-line therapy for essential hypertension.
2. Heart Failure (HF):
- Reduces symptoms, hospitalizations, and mortality in systolic heart failure (HFrEF).
3.Post-Myocardial Infarction:
- Improves survival in patients with reduced ejection fraction.
4.Diabetic Nephropathy:
- Slows progression of kidney disease in diabetic patients.
Mechanism of Action
Enalapril is a prodrug converted to enalaprilat, which inhibits ACE. This prevents the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. It also decreases aldosterone secretion, leading to reduced sodium and water retention, vasodilation, and reduced blood pressure.
Side Effects
- Common Side Effects:
- Dry cough (due to increased bradykinin levels), dizziness, headache.
- Hyperkalemia, fatigue, orthostatic hypotension.
- Serious Side Effects:
- Angioedema (rare but potentially life-threatening).
- Acute renal failure in patients with bilateral renal artery stenosis.
- Severe hypotension, especially after the first dose.
Harmful Interactions
1.Potassium-Sparing Diuretics (e.g., spironolactone):
- Increases risk of hyperkalemia.
2.NSAIDs:
- Can reduce the antihypertensive effect and increase the risk of renal impairment.
3.Lithium:
- Increases lithium levels, leading to toxicity.
Contraindications
- History of angioedema related to ACE inhibitors.
- Bilateral renal artery stenosis.
- Pregnancy (teratogenic effect).
Latest References
- American Heart Association (AHA) Guidelines for Hypertension Management (2023).
- ESC Guidelines on Heart Failure (2023).
- Journal of Clinical Hypertension (2023): ACE inhibitors and renal outcomes.