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Enalapril Maleate - Learn about Enalapril Maleate Side Effects and Precautions

Enalapril Maleate Information

The pharmacology action of Enalapril Maleate is that it competitively inhibits angiotensin I-converting enzyme, preventing conversion of angiotensin I to angiotensin II, a potent vasoconstrictor that also stimulates release of aldosterone. Results in decrease in BP, reduced sodium absorption, and potassium retention.

Enalapril Maleate is used in treatment of hypertension and symptomatic CHF in combination with diuretics and digitalis and asymptomatic left ventricular dysfunction. Treatment of diabetic nephropathy, childhood hypertension, hypertension related to scleroderma, and renal crisis scleroderma.

Interaction and Contraindication of Enalapril Maleate

Interaction of Enalapril Maleate - Capsaicin:  Cough may be exacerbated.
Digoxin:  May increase or decrease plasma levels of digoxin.
Indomethacin, salicylates (eg, aspirin):  Hypotensive effects may be reduced, especially in low-renin or volume-dependent hypertensive patients.
Lithium:  Increased lithium levels and symptoms of lithium toxicity may occur.
Phenothiazines:  May increase pharmacologic effect of enalapril.
Potassium preparations, potassium-sparing diuretics:  May increase serum potassium levels.
Rifampin:  Pharmacologic effects of enalapril may be decreased.

Contraindication of Enalapril Maleate - History of angioedema related to previous treatment with an ACE inhibitor and in patients with hereditary or idiopathic angioedema; hypersensitivity to ACE inhibitors

Side Effects of Enalapril Maleate

Here are the list of some common side effects of Enalapril Maleate :

• Hypotension (7%); angina, chest pain, orthostatic hypotension, syncope (2%); myocardial infarction (1%); tachycardia (less than 1%).
• Headache (5%); dizziness (4%); fatigue (3%); vertigo (2%); asthenia (1%).
• Rash (1%); photosensitivity (less than 1%).
• Abdominal pain, diarrhea (2%); nausea, vomiting (1%).
• Decreased hemoglobin and hematocrit, neutropenia, agranulocytosis, thrombocytopenia, pancytopenia, eosinophilia
• Bronchitis, cough, dyspnea (1%).

Precaution and Warning while taking Enalapril Maleate

The precaution and warnings of Enalapril Maleate drug is as follows:

• Advise patient to take prescribed dose without regard to meals but to take with food if stomach upset occurs.
• Advise patient to try to take each dose at about the same time each day.
• Advise patient or caregiver to shake suspension well before measuring each dose.
• Inform hypertensive patient that drug controls, but does not cure, hypertension and to continue taking drug as prescribed even when BP is not elevated.
• Caution patient not to change the dose or stop taking unless advised by health care provider.
• Instruct patient to continue taking other medications for the condition as prescribed by health care provider.
• Instruct patient in BP and pulse measurement skills.
• Advise patient to monitor and record BP and pulse at home and to inform health care provider if abnormal measurements are noted. Also advise patient to take record of BP and pulse to each follow-up visit.
• Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
• Instruct patient to lie or sit down if experiencing dizziness or lightheadedness when standing.
• Emphasize to hypertensive patient the importance of other modalities on BP control: weight control, regular exercise, smoking cessation, and moderate intake of alcohol and salt.
• Emphasize to heart failure patient the importance of other modalities that can help control heart failure symptoms: weight control, progressive exercise program, smoking cessation, and moderate intake of alcohol and salt.
• Advise heart failure patient to weigh daily, keep a record of daily weights, and notify health care provider if rapid weight gain (eg, 5 pounds in 1 wk) is noted or if edema or shortness of breath are getting worse.
• Caution patient that inadequate fluid intake, excessive perspiration, diarrhea, or vomiting can lead to excessive fall in BP resulting in lightheadedness or fainting.
• Advise patient that medication may cause dizziness or lightheadedness and to use caution while driving or performing other tasks requiring mental alertness until tolerance is determined.
• Caution patient to avoid unnecessary exposure to UV light (sunlight, tanning booths) and to use sunscreen and wear protective clothing when exposed to UV light to avoid photosensitivity reaction.
• Instruct women to inform health care provider if pregnant, planning to become pregnant, or breastfeeding.

How to store Enalapril Maleate

• Administer alone or in combination with other antihypertensives.
• Do not administer to pregnant women during second and third trimesters as fetal and neonatal morbidity and death can occur.
• Follow manufacturer's recommendations when converting from IV to PO therapy or from PO to IV therapy