Enalapril is a type of medicine called an ACE inhibitor. It is used to treat high blood pressure (hypertension) and is often prescribed to patients who have experienced heart failure or a heart attack, or whose high blood pressure puts them at risk of a heart attack, heart failure or stroke in future. The generic drug enalapril is also sold under the brand name Innovace.
Enalapril works by reducing the production of a hormone in the body called angiotensin II. Angiotensin II helps to maintain the body’s blood pressure system and its function is to make the arteries narrow, which in turn raises the blood pressure. When angiotensin II production is inhibited, the arteries are wider, which helps to reduce blood pressure. Enalapril is one of a number of drugs that work in this way, known as angiotensin-converting enzyme (ACE) inhibitors.
Enalapril starts working to reduce your blood pressure within hours of taking your first dose. However, you may need to wait a few weeks before it has the full effect. It’s important to keep taking the medicine consistently, as prescribed, during this time.
The active ingredient in enalapril tablets is enalapril maleate.
The inactive ingredients in enalapril tablets are lactose, magnesium stearate, sodium bicarbonate, and starch.
Please note: different generic brands of enalapril could contain different inactive ingredients than those listed here.
Patients are often advised to take their first dose of enalapril before bed, because it can make you feel dizzy.
You may be prescribed a low dosage of enalapril to start with, which might be increased over time. This gives your body a chance to get used to the medication and reduces the chances of side effects like dizziness.
Enalapril is normally taken in tablet form, with a glass of water.
Enalapril is available in 2.5mg, 5mg, 10mg and 20mg tablets. The recommended dosage of enalapril varies, depending on:
The usual dosage for high blood pressure is 20mg once a day. The usual dosage for heart failure is one 10-20mg once a day.
When you first start taking enalapril, your dosage may be as low as 2.5mg once a day, which will be increased gradually if all goes well.
Enalapril is available in tablet or liquid form. If you wish to make the medicine more palatable by mixing it with food, you can either use a liquid form, or the tablet can be crushed. Always use the measuring spoon provided when measuring out a liquid dose of enalapril.
Like all medications, enalapril can cause side effects. If you experience any of the serious side effects listed below, stop taking enalapril and seek immediate medication attention:
Common side effects (affecting up to 1 in 10 people) include:
Uncommon side effects can affect up to 1 in 100 people and include:
The following rare side effects can affect up to 1 in 1,000 people:
Other side effects (frequency not known)
Do NOT take enalapril if you:
Before taking enalapril, tell your doctor if any of the following applies to you:
Before taking enalapril, tell your doctor if you are taking any other medicines, including those purchased over the counter without a prescription.
In particular, tell your doctor if you are taking any of the following:
Most people won’t experience side effects when taking enalapril, but if you do, there are some things that can help you cope.
Dizziness is a relatively common side effect when you start your medication or increase your dose. Start with a small dosage and gradually build up, to help your body get used to it, and take your dose before bed. If you do feel dizzy, stop what you are doing and find somewhere safe to lie down until you feel better.
Some people experience a dry, tickly cough when taking enalapril. If this persists, talk to your doctor. You might be able to switch to a different type of medicine.
Headaches can be a side effect of enalapril. If you have headaches when taking this medication, the usual advice applies; drink plenty of fluids and take a painkiller if you need to. Talk to your doctor if the headaches last for longer than a week or are particularly severe.
Some people experience diarrhoea when they take enalapril. If this happens, drink lots of fluids but do not take any medication to treat diarrhoea without talking to your doctor first.
If you get a mild skin rash, talk to your pharmacist. They may be able to recommend an antihistamine to treat the rash.
Blurred vision is a side effect that sometimes occurs when first starting medication. If you experience this, do not drive or operate machinery. If it persists for more than a few days, speak to your doctor, as you may need to change to an alternative blood pressure medication.
Enalapril and other ACE inhibitors are not recommended during pregnancy, due to the risk of harm to the foetus. However, high blood pressure is undesirable during pregnancy, so talk to your GP about the relative risks. You may be prescribed an alternative medication to keep your blood pressure down.
As well as enalapril, a number of other ACE inhibitor drugs that also work in the same way to reduce high blood pressure. These include:
The main difference between these drugs is how long-acting they are; Captopril, for example, needs to be taken 3 times a day because its effects only last a short time, whereas wnalapril and some others can be taken just once a day.
ACE inhibitors are not the only type of drug available to treat high blood pressure.
Angiotensin receptor blockers (ARBs) also work to lower blood pressure and reduce the risk of heart failure by stopping angiotensin II from narrowing the arteries. Unlike ACE inhibitors, they do this by blocking the receptor that allows angiotensin II to work. ARBs include candesartan, irbesartan, losartan and valsartan. They may be recommended if you are experiencing a persistent dry cough as a side effect of enalapril or other ACE inhibitors.
Calcium-channel blockers (CCBs) work by stopping calcium from narrowing the blood vessels. Because ACE inhibitors like enalapril are less effective in over-55s and in people of Afro-Caribbean origin, CCBs may be prescribed as an alternative if you are in either of these groups.
Beta-blockers reduce blood pressure by slowing down your heart rate, as well as blocking vascular constriction. They are normally used as an alternative for people who cannot take other high blood pressure medicines, such as pregnant women.
Diuretics help lower blood pressure by altering water balance. Like CCBs, they may be prescribed to people over 55 or of Afro-Caribbean origin, because ACE inhibitors may not be so effective for these patients. Sometimes diuretics are taken in combination with enalapril for example enalapril combined with the diuretic hydrochlorothiazide is available under the brand name Innozide, and perindopril with indapamide is sold as Coversyl Arginine Plus.
You won’t need to make any significant changes to your diet when you start taking enalapril. The only foods to avoid are those containing salt substitutes such as Lo-Salt. These salt substitutes have high levels of potassium, and when combined with enalapril could make the levels of potassium in your blood too high.
You won’t need to make many lifestyle changes when taking enalapril, but when you first start treatment, you may feel dizzy or experience blurred vision. For this reason, it’s a good idea to take your first dose at a time when you do not need to drive, ride a bicycle or operate machinery. You should also avoid alcohol until your body adapts to the medication because this could make the dizziness worse.
If you have high blood pressure, making changes to your lifestyle can make a difference to your blood pressure and heart health. These include:
Yes, possibly. Enalapril is a long-term treatment to regulate your blood pressure and you may need to take it for the rest of your life.
If you have a stressful and anxious lifestyle, this may affect your blood pressure. Enalapril will bring down your blood pressure, but this in itself may not help you to feel less anxious. Speak to your GP or therapist if you are concerned about anxiety.
Yes, enalapril is designed for long term use, and most patients are advised to take it on a long term basis.
Because of the way ACE inhibitors work, enalapril can affect the function of your kidneys. It should still be safe to take, but just to make sure, you will have regular blood tests for the duration of your treatment if you are at risk of lowered kidney function.
Even if your blood pressure goes down when you take enalapril, you are likely to be advised to keep taking it. That’s because, without the drug, your blood pressure could rise again. High blood pressure poses big risks to your health, including an increased risk of heart attack or stroke.
You may need to stop taking enalapril 24 hours before you are due to undergo surgery. That’s because when combined with anaesthetic, it could make your blood pressure too low. Always tell your doctor that you are taking enalapril if a surgical procedure is planned.
No, enalapril will not affect your contraception. If you have high blood pressure, however, you are advised against taking hormonal forms of contraception such as the combined pill and the hormonal patch. Talk to your GP about alternative options.
There are no studies linking enalapril with a drop in fertility in either men or women. If you are trying to conceive, it’s a good idea to discuss this with your GP and follow their advice, because enalapril is not normally recommended during pregnancy.
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