Enalapriil

Enalapriil is a common misspelling of enalapril. Enalapril is an oral angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension and congestive heart failure, and to reduce cardiovascular mortality after myocardial infarction. It is also employed to slow the progression of kidney disease in adults with diabetic nephropathy.

Mechanism and overview

Enalapril lowers levels of angiotensin II and aldosterone by inhibiting ACE, leading to vasodilation, reduced salt and water retention, and lower blood pressure. It is a prodrug that is converted in the liver to the active metabolite enalaprilat, which provides the ACE-inhibiting effect.

Indications and usage

Primary indications include hypertension; symptomatic heart failure; and improvement in survival following myocardial infarction. It is also used to protect renal function in adults with diabetic nephropathy, when indicated, by reducing intraglomerular pressure and proteinuria.

Pharmacokinetics and administration

Enalapril is taken orally; enalaprilat can be given intravenously for patients unable to take oral medications. After ingestion, enalapril is metabolized to enalaprilat, the active form. Peak concentrations and onset of action occur within hours, with a half-life of approximately 11 hours for both forms, varying with renal function. It is primarily excreted by the kidneys.

Adverse effects and precautions

Common side effects include cough, dizziness, hyperkalemia, and hypotension. Angioedema is rare but serious. Contraindications include a history of ACE-inhibitor–associated angioedema, pregnancy, and bilateral renal artery stenosis. Caution is advised with other blood pressure–lowering drugs, potassium-sparing diuretics, and NSAIDs.

Brand and forms

Enalapril is marketed under various brand names, including Vasotec, and is available as oral tablets; intravenous enalaprilat is used in specific clinical settings.