Enalapril
- Atc Codes:C09AA02
- CAS Codes:76095-16-4#75847-73-3#84680-54-6#76420-72-9
- PHARMGKB ID:76095-16-4#75847-73-3#84680-54-6#76420-72-9
Table of contents
- Brand Names
- Drug Combinations
- Chemistry
- Pharmacologic Category
- Mechanism of Action
- Therapeutic Use
- Unlabeled Use
- Pregnancy and Lactation Implications
- Contraindications
- Warnings and Precautions
- Adverse Reactions
- Toxicological Effects
- Caution and personalized dose adjustment in patients with the following genotypes
- Other genes that may be involved
- Substrate of
- Inhibits
- Drug Interactions
- Nutrition/Nutraceutical Interactions
- Dosage
- Pharmacokinetics and Pharmacodynamics
- Special Considerations
Brand Names
Europe
Austria: Alapril, Enac, Enalapril, Enapril, Mepril, Renistad, Renitec; Belgium: Enalapril, Renitec; Bulgaria: Berlipril, Enahexal, Enalapril, Enap, Enpril, Laprilen, Renapril, Renitec; Cyprus: Enalapril, Istopril, Kalpiren, Korandil, Renitec; Czech Republic: Berlipril, Ednyt, Enalapril, Enalatin, Enap, Enapril, Renitec; Denmark: Corodil, Enacodan, Enalapril; Estonia: Berlipril, Ednyt, Enahexal, Enalapril, Enamax, Enap, Renitec; Finland: Enalapril, Enalatin, Linatil, Renitec; France: Enalapril, Renitec; Germany: Benalapril, Cardiotab, Corvo, Ena-Hennig, Enabeta, Enadigal, Enadog, Enadura, Enahexal, Enalagamma, Enalapril, Enalatab, EnaLich, Enapril, EnaSandoz, Enastad, Jutaxan, Prilenal, Renitec, Xanef; Greece: Analept, Antiprex, Arnaril, Enalapril, Karpalon-S, Leovinezal, Renitec, Stadelant, Vitobel; Hungary: Acepril, Berlipril, Ednyt, Enalapril, Enalatidin, Enap, Enapril, Renitec; Ireland: Enalapril, Enap, Enapril, Innomel, Innovace; Italy: Converten, Enalapril, Enapren, Lanex, Naprilene, Prilenor, Silverit, Vasoretic; Latvia: Berlipril, Dilvas, Ednyt, EnaHexal, Enamax, Enap, Enarenal; Lithuania: Berlipril, Ednyt, Enahexal, Enamax, Enap, Enarenal; Malta: Innovace, Kalpiren, Kaparlon-S, Korandil, Renil, Stadelant, Ulticadex; Netherlands: Enalaprilmaleaat, Renitec; Poland: Benalapril, Ednyt, Enalapril, Enap, Enapress, Enarenal, Enazil, Epril, Mapryl; Portugal: Cetampril, Denapril, Diasistol, Enalapril, Enapress, Prilan, Renitec, Tensazol; Romania: Berlipril, Ednyt, Enala Tab, Enalap, Enalapril, Enap, Invoril, Munever, Olinapril, Renitec; Slovakia: Berlipril, Ednyt, Enalapril, Enalatin, Enap; Slovenia: Enalatin, Enap, Olinapril, Olivin, Vasotec; Spain: Acentesil, Baripril, Bitensil, Clipto, Controlvas, Dabonal, Enalapril, Herten, Hipoartel, Iecatec, Insup, Naprilene, Neotensin, Pressitan, Reca, Renitec; Sweden: Enalapril, Linatil, Renitec; UK: Enalapril, Innovace.
North America
Canada: Enalapril, Vasotec; USA: Enalapril, Vasotec.
Latin America
Argentina: Baypril, Defluin, Dentromin, Drepatil, Ecaprilat, Eitan, Enalafel, Enalapoten, Enalapril, Enaldun, Enatral, Eritril, Fabotensil, Gadopril, Glioten, Kinfil, Lotrial, Maxen, Nalapril, Presi Regul, Priltenk, Renitec, Sulocten, Tencas, Vapresan, Vasopril; Brazil: Atens, Enalabal, Enalamed, Enalatec, Enalil, Enapril, Enatil, Eupressin, Glioten, Multipressim, Pressel, Pressotec, Prodopressin, Pryltec, Renalapril, Renitec, Sanvapress-Enalaprila, Vasopril; Mexico: Adytenn, Apo-Pyl, Bimetdad, Bionafil, Blocatril, EK-3, Enaladil, Enalapril, Enoval, Euronal, Feliberal, Glioten, Imotoran, Lipraken, Nalabest, Norpril, Palane, Pulsol, Ralser, Renitec, Vexotil.
Asia
Japan: Alicante, Calnate, Cinbenon, Enalamerck, Enalapril, Enalart, Enalin, Intonis, Lariludon, Lenaberic, Lenimec, Lerite, Pharpril, Prylkicin, Renivace, Reniveze, Renopent, Revinbace, Selis, Spaciol, Zacool.
Drug combinations
Enalapril and Amlodipine
Enalapril and Diltiazem
Enalapril and Felodipine
Enalapril and Hydrochlorothiazide
Enalapril and Lercanidipine
Enalapril and Nitrendipine
Chemistry
Enalapril Maleate: C~20~H~28~N~2~O~5~ C~4~H~4~O~4~. Mw: 492.52. (1) L-Proline, 1-[N-[1-(ethoxycarbonyl)-3-phenylpropyl]-L-alanyl]-, (S)-, (Z)-2-butenedioate (1:1); (2) 1-[N-[(S)-1-Carboxy-3-phenylpropyl]-L-alanyl]-L-proline 1′-ethyl ester, maleate (1:1). CAS-76095-16-4; CAS-75847-73-3 (enalapril)(1981).
Enalaprilat: C~18~H~24~N~2~O~5~ 2H~2~O. Mw: 384.42. L-Proline, 1-[N-(1-carboxy-3-phenylpropyl)-L-alanyl]-, dihydrate, (S)-. CAS-84680-54-6; CAS-76420-72-9 (anhydrous)(1984).
Pharmacologic Category
Angiotensin-Converting Enzyme Inhibitors. (ATC-Code: C09AA02).
Mechanism of action
Competitive inhibitor of angiotensin-converting enzyme (ACE). Prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Results in lower levels of angiotensin II, which causes an increase in plasma renin activity and a reduction in aldosterone secretion.
Therapeutic use
Treatment of hypertension, symptomatic heart failure, or asymptomatic left ventricular dysfunction.
Pregnancy and lactiation implications
ACEIs can cause injury and death to the developing fetus when used in the 2^nd^ and 3^rd^ trimesters. ACEIs should be discontinued as soon as possible once pregnancy is detected. Enalapril and enalaprilat are excreted in breast milk. Caution during lactation.
Unlabeled use
To delay the progression of nephropathy and reduce risks of cardiovascular events in hypertensive patients with type 1 or 2 diabetes mellitus. Hypertensive crisis, diabetic nephropathy, hypertension secondary to scleroderma renal crisis, diagnosis of aldosteronism, idiopathic edema, Bartter’s syndrome, postmyocardial infarction for prevention of ventricular failure. Investigational: Severe congestive heart failure in infants, neonatal hypertension, acute cardiogenic pulmonary edema (enalaprilat).
Contraindications
Hypersensitivity to enalapril or enalaprilat. Angioedema related to previous treatment with an ACEI. Patients with idiopathic or hereditary angioedema. Pregnancy (2^nd^ and 3^rd^ trimesters).
Warnings and precautions
Angioedema may occur (rarely) and may involve head and neck (potentially compromising airway) or intestine (African-Americans may be at increased risk). Use in idiopathic or hereditary angioedema or previous angioedema associated with ACEI therapy is contraindicated. Cholestatic jaundice, which may progress to fulminant hepatic necrosis, may occur. Cough usually occurs within the first few months of treatment. Hyperkalemia, or anaphylactic/anaphylactoid reactions, may occur. Symptomatic hypotension with or without syncope can occur with ACEIs (effects most often observed in volume-depleted patients). Another ACEI, captopril, associated with rare cases of agranulocytosis, neutropenia, or leukopenia with myeloid hypoplasia. Patients with renal impairment are at high risk of developing neutropenia. Patients with both renal impairment and collagen vascular disease (e.g. systemic lupus erythematosus) are at an even higher risk of developing neutropenia. May be associated with deterioration of renal function and/or increases in serum creatinine, particularly in low renal blood flow. Small increases in serum creatinine may occur. Use with caution in severe aortic stenosis (may reduce coronary perfusion resulting in ischemia). Blood pressure may fall. Use with caution in collagen vascular disease, especially with concomitant renal impairment (may be at increased risk for hematologic toxicity). Use with caution in hypertrophic cardiomyopathy and outflow tract obstruction (reduction in afterload may worsen symptoms). Use with caution in unstented unilateral/bilateral renal artery stenosis (avoid use in unstented bilateral renal artery stenosis). Use with caution in pre-existing renal insufficiency. ACEIs can cause injury and death to the developing fetus when used in the second and third trimesters. Use with caution before, during, or immediately after major surgery. Perioperative use of ACEI will blunt angiotensin II formation and may result in hypotension.