From the Guidelines
When converting from amlodipine to enalapril (Vasotec), a typical conversion would involve discontinuing amlodipine and starting enalapril at 2.5 mg twice daily, as indicated by the most recent and highest quality study 1. This recommendation is based on the understanding that there is no direct equivalent dosing between amlodipine, a calcium channel blocker, and enalapril, an ACE inhibitor, due to their different mechanisms of action.
- The initial dose of enalapril can be adjusted based on the patient's blood pressure response, with a maximum dose of 10 to 20 mg twice daily 1.
- It is essential to monitor blood pressure closely for 1-2 weeks after the conversion, as the full effect of amlodipine may take 7-10 days to wash out, while enalapril begins working within hours.
- The conversion should be supervised by a healthcare provider who can adjust dosing based on individual response and monitor for potential side effects, such as a dry cough, which is more common with enalapril than with amlodipine.
- Additionally, enalapril requires more cautious use in patients with kidney disease and may cause higher potassium levels, requiring appropriate monitoring during the transition.
- The choice of enalapril as an alternative to amlodipine is supported by its established benefits in reducing hospitalizations and mortality in patients with heart failure, as demonstrated in several studies 1.
From the Research
Conversion from Amlodipine to Vasotec (Enalapril)
- The conversion from Amlodipine (a calcium channel blocker) to Vasotec (Enalapril, an angiotensin-converting enzyme inhibitor) is not directly addressed in the provided studies.
- However, studies have compared the effects of Amlodipine and Enalapril on blood pressure control and renal outcomes in patients with hypertension 2, 3.
- One study found that the combination of Enalapril and Amlodipine controlled arterial pressure more adequately than Enalapril alone or Amlodipine alone in cyclosporine-treated renal transplant recipients 2.
- Another study compared the effects of Ramipril (an ACE inhibitor) and Amlodipine on renal outcomes in hypertensive nephrosclerosis, and found that Ramipril retards renal disease progression in patients with hypertensive renal disease and proteinuria 3.
- While these studies do not provide a direct conversion guide, they suggest that Enalapril may be a suitable alternative to Amlodipine in certain patients, and that the combination of Enalapril and Amlodipine may be effective in controlling blood pressure and reducing renal disease progression.
- The dosage of Enalapril used in these studies varied, but one study used a dosage of 2.5 to 10 mg/d 3.
- It is essential to note that the conversion from Amlodipine to Enalapril should be done under the guidance of a healthcare professional, as the optimal dosage and treatment strategy may vary depending on individual patient characteristics and medical history.