What is the dose of Enalapril (Angiotensin-Converting Enzyme (ACE) inhibitor)?

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From the Guidelines

The recommended dose of Enalapril is 5 mg daily, with a goal dose of 10-40 mg daily in 1-2 divided doses. This is based on the guidelines provided by the American Journal of Kidney Diseases 1, which outlines the doses of ACE inhibitors and ARBs for adults. The starting dose of 5 mg daily can be increased gradually to achieve the goal dose, taking into account the patient's response to the medication and any potential side effects.

Key Considerations

  • The goal dose of Enalapril should be at the higher end of the dose range when possible, as stated in the guidelines 1.
  • Patients with hypertension or heart failure may require different starting doses and titration schedules, as noted in the European Journal of Heart Failure 1.
  • Elderly patients and those with kidney impairment may require lower starting doses, typically 2.5 mg daily.
  • Common side effects of Enalapril include dry cough, dizziness, and elevated potassium levels, and patients should be monitored regularly for these adverse effects.

Monitoring and Titration

  • Blood pressure should be monitored regularly, especially when starting therapy or adjusting doses.
  • Kidney function and potassium levels should be monitored periodically during treatment.
  • The dose of Enalapril can be adjusted based on the patient's response to the medication and any potential side effects.

Clinical Context

  • Enalapril is an ACE inhibitor that works by reducing the production of angiotensin II, a potent vasoconstrictor, thereby lowering blood pressure and decreasing cardiac workload.
  • The medication is effective in slowing the progression of kidney disease characterized by microalbuminuria in hypertensive patients with type 1 or type 2 diabetes, as noted in the guidelines 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Hypertension In patients who are currently being treated with a diuretic, symptomatic hypotension occasionally may occur following the initial dose of enalapril maleate. The recommended initial dose in patients not on diuretics is 5 mg once a day. Dosage should be adjusted according to blood pressure response The usual dosage range is 10 to 40 mg per day administered in a single dose or two divided doses. Heart Failure Enalapril maleate is indicated for the treatment of symptomatic heart failure, usually in combination with diuretics and digitalis. In the placebo-controlled studies that demonstrated improved survival, patients were titrated as tolerated up to 40 mg, administered in two divided doses. The recommended initial dose is 2.5 mg. The recommended dosing range is 2. 5 to 20 mg given twice a day.

The dose of Enalapril is:

  • Initial dose: 2.5 mg (for heart failure) or 5 mg (for hypertension, in patients not on diuretics)
  • Usual dosage range: 10 to 40 mg per day (for hypertension) or 2.5 to 20 mg given twice a day (for heart failure)
  • Maximum daily dose: 40 mg in divided doses 2

From the Research

Dose of Enalapril

  • The dose of Enalapril is not explicitly stated in the provided studies as a specific value for all patients, but rather as a range or in comparison to other medications.
  • In the study 3, enalapril maleate was administered at a dose of 5 mg daily for the treatment of mild to moderate essential hypertension.
  • The study 4 compared the efficacy and safety of enalapril versus extended-release nifedipine, with enalapril starting at 5 mg once daily and titrated up to a maximum of 40 mg.
  • The dose of enalapril can vary depending on the patient's condition, with the study 5 suggesting that dose adjustment is required in patients with renal insufficiency, but not in liver diseases.

Comparison to Other ACE Inhibitors

  • The study 6 compared lisinopril to other ACE inhibitors, including enalapril, but did not provide a specific dose for enalapril.
  • The study 7 compared the efficacy and safety of different ACE inhibitors, including enalapril, but did not provide a specific dose for enalapril.
  • The study 5 discussed the pharmacokinetic and pharmacodynamic properties of different ACE inhibitors, including enalapril, but did not provide a specific dose.

Clinical Use

  • Enalapril is used in the treatment of heart failure, hypertension, and other conditions, with the dose varying depending on the specific condition and patient response.
  • The studies 3 and 4 demonstrated the efficacy and safety of enalapril in the treatment of mild to moderate essential hypertension, with enalapril being well tolerated and effective in lowering blood pressure.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Research

[Comparative evaluation of ACE inhibitors: which differences are relevant?].

Schweizerische medizinische Wochenschrift, 1999

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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