What is the appropriate Enalapril (Angiotensin-Converting Enzyme Inhibitor) dosing for a 62 kilogram child with an adjusted weight of 46 kilograms?

From the Guidelines

For a 62 kg child with an adjusted weight of 46 kg, the recommended enalapril dosing would be 0.07 mg/kg per day up to 5 mg/day, which translates to approximately 3.22 mg per day based on the adjusted weight, as per the guidelines outlined in the expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents 1. The dosing interval for enalapril is once daily (QD) as indicated in the table for ACE inhibitors in the provided evidence 1. Some key considerations for enalapril dosing in pediatric patients include:

• Starting at the lower end of the dosing range to minimize side effects such as hypotension, dizziness, and hyperkalemia
• Gradual titration based on blood pressure response and tolerability
• Consistent administration with respect to meals
• Regular monitoring of renal function and potassium levels
• Potential dose adjustments based on clinical response, with the goal of achieving target blood pressure while minimizing adverse effects. It's also important to note that all ACE inhibitors, including enalapril, are contraindicated in pregnancy, and women of childbearing age should use reliable contraception 1. Additionally, the preparation of a suspension for enalapril is possible, as indicated in the comments section of the ACE inhibitors table in the provided evidence 1.

From the FDA Drug Label

The usual recommended starting dose is 0. 08 mg/kg (up to 5 mg) once daily. Dosage should be adjusted according to blood pressure response. Doses above 0.58 mg/kg (or in excess of 40 mg) have not been studied in pediatric patients

The appropriate Enalapril dosing for a 62 kilogram child with an adjusted weight of 46 kilograms is 0.08 mg/kg (up to 5 mg) once daily, which would be 3.68 mg (0.08 mg/kg x 46 kg) once daily. The dose should be adjusted according to blood pressure response, and should not exceed 0.58 mg/kg (or 40 mg) as this dose has not been studied in pediatric patients 2.

From the Research

Enalapril Dosing for a 62 Kilogram Child with an Adjusted Weight of 46 Kilograms

• The appropriate dosing of Enalapril for a child can be determined based on their weight, with studies suggesting different methods for calculation 3, 4, 5.
• For children weighing less than 50 kg, an initial dose of 2.5 mg of Enalapril is recommended, while for those weighing more than 50 kg, an initial dose of 5 mg is suggested 4.
• However, since the child in question has an adjusted weight of 46 kg, which is less than 50 kg, the initial dose of 2.5 mg can be considered 4.
• It is also important to consider the dose-response relationship, which suggests that larger doses of Enalapril are associated with a greater reduction in blood pressure 4.
• Additionally, the use of adjusted weight or ideal body weight for dosing in overweight or obese children is recommended to avoid potential medication errors 5.

Considerations for Dosing

• The dose of Enalapril should be individualized based on the child's response to the medication and their blood pressure readings 6, 4.
• The medication should be administered once daily, and the dose can be adjusted as needed to achieve the desired blood pressure reduction 7, 6.
• It is essential to monitor the child's blood pressure and adjust the dose accordingly to minimize the risk of adverse effects 7, 6, 4.