enalapril maleate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
enalapril maleate: clinical details
Prescribing considerations
- Assess volume status and initial hypotension risk, particularly with heart failure, diuretics, vomiting, diarrhoea or salt restriction.
- Use additional caution with renal impairment, renovascular disease, significant outflow obstruction, diabetes or hyperkalaemia risk.
- Review pregnancy intentions and concurrent NSAIDs, potassium-raising agents and renin–angiotensin system blockers.
- Aqumeldi initiation should be supervised by a clinician experienced in paediatric heart failure.
Contraindications and cautions
- Hypersensitivity to enalapril, an excipient or another ACE inhibitor
- Previous ACE-inhibitor-associated angioedema, or hereditary or idiopathic angioedema
- Second or third trimester of pregnancy
- Concomitant sacubitril/valsartan use
- Aliskiren use in patients with diabetes or specified renal impairment
- For Aqumeldi, severe paediatric renal impairment
Monitoring
- Check blood pressure, renal function, potassium and sodium before treatment.
- Repeat checks after initiation or treatment changes, and when acutely unwell.
- Continue periodic monitoring, more frequently with heart failure, renal impairment, older age, diabetes or interacting medicines.
- Consider white-cell monitoring when risk factors for neutropenia are present.
Clinical pharmacology
Enalapril is an oral prodrug hydrolysed to enalaprilat. ACE inhibition suppresses angiotensin II formation and aldosterone secretion; reduced bradykinin breakdown may contribute to vasodilation and cough.
Formulation and product differences
- Standard tablets are licensed for hypertension and adult heart-failure-related indications. The specified tablet contains lactose, and its score line is for easier swallowing rather than equal division.
- The oral solution supports measured administration and contains sodium benzoate; use the supplied device.
- Aqumeldi is an orodispersible paediatric formulation licensed for heart failure from birth to under 18 years. It can be given in the mouth or through a feeding tube using product instructions.
enalapril maleate preparations and strengths
Dispersible tablet
Route: Oral
Strengths: 0.25 mg, 1 mg
Oral solution
Route: Oral
Strengths: 5 mg/5 mL
Tablet
Route: Oral
Strengths: 2.5 mg, 5 mg, 10 mg, 20 mg
enalapril maleate interactions
Check prescribed, over-the-counter and complementary products with a pharmacist or prescriber. Important interactions include:
Sacubitril/valsartan
Using these together is contraindicated because it substantially increases angioedema risk.
Potassium supplements, potassium salt substitutes and potassium-sparing diuretics
These can cause dangerous hyperkalaemia.
Trimethoprim or co-trimoxazole
These may raise potassium further.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.