Highest Dose of Enalapril Available Per Tablet
The highest dose of enalapril available per tablet is 40 mg. This is the maximum tablet strength available for enalapril as an angiotensin-converting enzyme (ACE) inhibitor. 1
Dosage Information for Enalapril
Available Tablet Strengths
Dosing Considerations
- The usual dosage range for hypertension is 10 to 40 mg per day administered in a single dose or two divided doses 1
- For heart failure, the recommended dosing range is 2.5 to 20 mg given twice a day, with a maximum daily dose of 40 mg in divided doses 1
- In clinical trials for heart failure, patients were titrated as tolerated up to 40 mg daily, administered in two divided doses 1
Clinical Applications and Dosing Algorithms
Hypertension Management
- Initial dose: 5 mg once daily for patients not on diuretics 1
- Titration: Adjust according to blood pressure response 1
- Maximum dose: 40 mg daily (single dose or divided) 1
- For patients on diuretics: Consider starting with 2.5 mg under medical supervision 1
Heart Failure Management
- Initial dose: 2.5 mg 2
- Target dose: 10-20 mg twice daily 2
- Mean dose achieved in clinical trials: 16.6 mg total daily 2
- Titration should occur gradually over a period of days or weeks 1
Dosing in Renal Impairment
- For creatinine clearance ≤30 mL/min: Initial dose of 2.5 mg once daily 1
- Maximum dose in renal impairment: Can still be titrated up to 40 mg daily if tolerated and needed for blood pressure control 1
Important Clinical Considerations
Target Dosing for Optimal Outcomes
- Guidelines recommend titrating ACE inhibitors to target doses shown to be effective in clinical trials 2
- For enalapril, the target dose is 10 mg twice daily (20 mg total daily) 2
- At least 50% of target dose (10 mg daily) should be achieved for clinical benefit in heart failure 2
Monitoring and Titration
- After initial dose, patients should be observed under medical supervision for at least two hours 1
- Titration should occur no more frequently than every 2 weeks 2
- Monitor for hypotension, hyperkalemia, and changes in renal function 1
Adverse Effects to Monitor
- Common: Cough, headache, dizziness, asthenia 2
- Serious: Hyperkalemia, acute kidney injury, angioedema, fetal toxicity 2
- Contraindications: Pregnancy, history of angioedema 2
Clinical Pearls
- The 40 mg tablet represents the highest single tablet strength, though the maximum daily dose can be achieved through multiple tablets 1
- Studies have supported a dose-response relationship of ACE inhibitors with improved outcomes in heart failure patients 2
- Despite guideline recommendations to achieve target doses, many patients in clinical practice do not reach these doses 2
- For patients who cannot tolerate once-daily dosing due to diminishing effect toward the end of the dosing interval, twice-daily administration should be considered 1