From the Guidelines
Enalapril, an angiotensin-converting enzyme (ACE) inhibitor, does not typically cause hypercalcemia. In fact, ACE inhibitors like enalapril are generally not associated with significant alterations in calcium metabolism. Hypercalcemia (elevated blood calcium levels) is more commonly associated with other conditions such as hyperparathyroidism, certain malignancies, excessive vitamin D intake, or medications like thiazide diuretics and lithium. Enalapril works primarily by inhibiting the conversion of angiotensin I to angiotensin II, leading to vasodilation and reduced blood pressure. While ACE inhibitors can affect electrolyte balance, particularly causing hyperkalemia (elevated potassium) in some patients, they do not directly impact calcium homeostasis in a way that would lead to hypercalcemia. If a patient taking enalapril develops hypercalcemia, other causes should be investigated rather than attributing it to the ACE inhibitor therapy, as supported by studies such as 1 and 1, which focus on the management of hyperkalemia and the use of RAAS inhibitors in patients with heart failure and diabetes, but do not mention hypercalcemia as a side effect of enalapril. Key points to consider include:
- The primary action of enalapril is on the renin-angiotensin-aldosterone system, which does not directly influence calcium levels.
- Hypercalcemia has a different set of common causes, including hyperparathyroidism and certain medications, which should be investigated if a patient on enalapril develops elevated calcium levels.
- The provided evidence, such as 1 and 1, discusses the management of hyperkalemia and the use of RAAS inhibitors but does not support a link between enalapril and hypercalcemia. Given the information from studies like 1 and 1, it's clear that the concern with ACE inhibitors is more about hyperkalemia rather than hypercalcemia, emphasizing the need to monitor potassium levels rather than calcium levels in patients on enalapril.
From the Research
Enalapril and Hypercalcemia
- There is no direct evidence in the provided studies that enalapril causes hypercalcemia 2, 3, 4, 5, 6.
- Hypercalcemia is typically associated with primary hyperparathyroidism, malignancy, granulomatous disease, endocrinopathies, immobilization, genetic disorders, and certain medications such as thiazide diuretics and supplements like calcium, vitamin D, or vitamin A 2.
- Enalapril is an angiotensin-converting enzyme inhibitor used to treat hypertension and congestive heart failure, and it is not listed as a cause of hypercalcemia in the provided studies 3, 5.
- One study mentions that high plasma calcium levels can sensitize arterioles to intermittent increases in angiotensin II levels, which could be relevant to enalapril therapy, but this does not directly imply that enalapril causes hypercalcemia 6.
- Another study notes that enalapril can cause hyperkalemia, particularly at high doses, but it does not mention hypercalcemia as a potential side effect 3.