Actions: competitive inhibitor or angiotensin-converting enzyme (ACE); results in lower levels of angiotensin II which causes an increase in plasma renin activity and a reduction in aldosterone secretion.
Indications: hypertension, congestive heart failure, left ventricular dysfunction after myocardial infarction. Preparation: enalapril is PO; enalaprilat is IV. Dose (hypertension): adult: 2.5-5 mg/day PO (enalapril) then increase as required (usual dose: 1040 mg/day in 1-2 divided doses); 0.625-5 mg/dose IV (enalaprilat) over 5 minutes every 6 hours Dose (heart failure): adult: initiate with 2.5 mg PO (enalapril) 1-2 times daily (usual dose: 5-20 mg/day). Dose (ped): enalapril (PO): 0.1 mg/kg/day increasing as needed over 2 weeks to 0.5 mg/kg./day; enalaprilat (IV): 5-10 mcg/kg/dose administered q8-24 hrs.
Clearance: hepatic metabolism of enalapril to active metabolite (enalaprilat); renal and fecal elimination. Contraindications: idiopathic or hereditary angioedema, bilateral renal artery stenosis, primary hyperaldosteronism, pregnancy. Adverse effects: causes increased serum potassium, increased renal blood flow volume-responsive hypotension; can cause angioedema, blood dyscrasia, cough, lithium toxicity, worsening of renal impairment; subsequent doses are additive. Comments: dosing needs to be adjusted in renal and hepatic impairment.
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