Enalapril
Renitec · Enalapril Sandoz
Prodrug hydrolysed to enalaprilat. Reduces mortality in heart failure with reduced ejection fraction — the effect is dose-dependent, and underdosing is more often than adverse effects the reason for absent benefit.
Contraindicated in pregnancy — foetal harm in the second and third trimester. Angioedema can occur at any time during treatment.
Dosing in adults
| Indication | Regimen | Comment |
|---|---|---|
| Heart failure (HFrEF) | 2,5 mg × 2 orally, doubled every two weeks to 10–20 mg × 2 | target dose, not symptom dose |
| Hypertension | 5–10 mg orally daily, up to 40 mg | may be given once daily |
| Diabetic nephropathy | 10–20 mg daily | titrate against albuminuria |
| Initiation in volume depletion | 1,25–2,5 mg as a test dose | risk of marked first-dose blood pressure fall |
Reduce dose at eGFR < 30. A creatinine rise of up to 30 % after initiation is expected and not a reason to discontinue.
Caution — activation occurs in the liver.
0,08 mg/kg daily as starting dose, managed by paediatric nephrologist or cardiologist.
Do not combine ACE inhibitor with ARB. In angioedema, switching to an ARB is possible but requires careful counselling — the risk of recurrence is not zero.
Pharmacokinetics
- BIOAVAIL.
- 60 %
- Vd
- 1,7 l/kg
- t½
- 11 h (enalaprilat)
- PROTEIN BINDING
- 50–60 %
- METABOLISM
- Hepatic hydrolysis
- EXCRETION
- Renal
- ONSET
- 1 h · peak 4–6 h
- DURATION
- 12–24 h