How to administer Enalapril (ACE inhibitor)?

From the Guidelines

Enalapril should be administered orally once or twice daily, with or without food, starting at a dose of 5 mg once daily for hypertension, which can be titrated up to 10-40 mg daily based on blood pressure response, as recommended by the most recent guidelines 1. The dosing regimen for Enalapril can vary depending on the patient's condition, such as heart failure, where treatment often begins at a lower dose of 2.5 mg twice daily, gradually increasing to a target of 10-20 mg twice daily as tolerated 1. Key considerations for administration include:

• Starting with a lower dose in patients with renal impairment or those taking diuretics, typically 2.5 mg daily 1.
• Monitoring blood pressure within 1-2 hours after the first dose to check for first-dose hypotension, especially in patients with heart failure or salt/volume depletion 1.
• Regular monitoring of kidney function and potassium levels, particularly during the first few weeks of therapy, to mitigate potential adverse effects such as hypotension and dizziness 1. Enalapril's mechanism of action involves inhibiting the angiotensin-converting enzyme, which reduces the formation of angiotensin II and decreases aldosterone secretion, leading to vasodilation, reduced blood pressure, and improved cardiac output in heart failure patients 1. Given the potential for hypotension, especially during the initial stages of treatment or with dose increments, careful management and monitoring are crucial to ensure patient safety and optimize therapeutic outcomes 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Enalapril and hydrochlorothiazide are effective treatments for hypertension. The usual dosage range of enalapril is 10 to 40 mg per day administered in a single or two divided doses; The recommended dosage of Enalapril is 10 to 40 mg per day, given in a single dose or two divided doses 2.

• The daily dose should be adjusted according to the patient's clinical response.
• Dose titration should be guided by the patient's clinical effect.
• The maximum daily dose of Enalapril should not exceed 40 mg.

From the Research

Administration of Enalapril

• Enalapril is an orally active angiotensin-converting enzyme inhibitor, typically administered once or twice daily 3.
• The usual dosage of enalapril is 10 to 40 mg/day, which is effective in lowering blood pressure in all grades of essential and renovascular hypertension 3.
• Enalapril can be administered alone or in combination with other antihypertensive agents, such as hydrochlorothiazide, beta-blockers, or calcium antagonists 3, 4.

Special Considerations

• In patients with severe congestive heart failure, enalapril can improve cardiac performance by reducing both preload and afterload 3.
• In patients with chronic renal insufficiency, enalapril can reduce blood pressure and proteinuria, and may slow the progression of diabetic nephropathy 5.
• However, ACE inhibitors like enalapril can also induce acute renal failure in certain patients, such as those with post-stenotic kidney or severe depletion of circulating volume 6.
• Careful dosage titration and monitoring of renal function and serum potassium levels are recommended, especially in patients at high risk for renal adverse effects 6.

Dosage and Titration

• The initial dose of enalapril for hypertensive crisis is recommended to be 0.625 mg, as higher doses do not alter response rates or blood pressure reduction 7.
• In patients with chronic renal insufficiency, enalapril can be administered alone or in combination with other antihypertensive agents, with careful monitoring of renal function and serum potassium levels 5.