From the Guidelines
Enalapril is contraindicated in patients with a history of angioedema, pregnancy, bilateral renal artery stenosis, and hypersensitivity to the medication or its components. The use of enalapril, an angiotensin-converting enzyme (ACE) inhibitor, is associated with several important contraindications that must be considered to minimize the risk of adverse outcomes.
Key Contraindications
- Pregnancy: Enalapril is absolutely contraindicated during pregnancy, particularly in the second and third trimesters, due to the risk of fetal injury and death 1.
- Bilateral Renal Artery Stenosis: Patients with bilateral renal artery stenosis should avoid enalapril because it can precipitate acute kidney injury by reducing efferent arteriolar pressure 1.
- Hypersensitivity: Hypersensitivity to enalapril or any component of the formulation represents another absolute contraindication 1.
- Angioedema: Patients with a history of angioedema related to previous ACE inhibitor therapy should never receive enalapril, as recurrent angioedema can be life-threatening 1.
Additional Considerations
- Concomitant Use with Aliskiren: Enalapril should not be used concomitantly with aliskiren in patients with diabetes or renal impairment due to increased risk of hyperkalemia and renal dysfunction.
- Dialysis with High-Flux Membranes: Patients on dialysis with high-flux membranes may experience anaphylactoid reactions with enalapril.
- Severe Renal Impairment, Aortic Stenosis, Hypertrophic Cardiomyopathy, or Severe Heart Failure: Caution is warranted in these conditions, as they may increase sensitivity to the hypotensive effects of the medication.
- Hyperkalemia or Conditions Predisposing to Hyperkalemia: Enalapril should be used cautiously in patients with hyperkalemia or conditions predisposing to hyperkalemia, as ACE inhibitors can raise potassium levels.
From the FDA Drug Label
CONTRAINDICATIONS Enalapril maleate is contraindicated in patients who are hypersensitive to this product and in patients with a history of angioedema related to previous treatment with an angiotensin converting enzyme inhibitor and in patients with hereditary or idiopathic angioedema. The contraindications of Enalapril are:
- Hypersensitivity to the product
- History of angioedema related to previous treatment with an angiotensin converting enzyme inhibitor
- Hereditary or idiopathic angioedema
- Do not co-administer aliskiren with enalapril maleate in patients with diabetes 2
From the Research
Contraindications of Enalapril
The contraindications of Enalapril, an Angiotensin-Converting Enzyme Inhibitor, include:
- A history of angioedema, as it can be a life-threatening side effect of ACEIs 3, 4, 5, 6
- Patients with a history of drug rash, as they are at an increased risk for ACEI-induced angioedema 5
- Patients older than 65 years, as they are at an increased risk for ACEI-induced angioedema 5
- Patients with seasonal allergies, as they are at an increased risk for ACEI-induced angioedema 5
- Patients with heart failure or proteinuric nephropathic states, as they may require alternative treatments if they experience ACEI-related angioedema 4
- Black patients, as they are at an increased risk for ACEI-induced angioedema 4, 5
- Women, as they are at an increased risk for ACEI-induced angioedema 5
- Smokers, as they are at an increased risk for ACEI-induced angioedema 5
Diagnostic Considerations
When diagnosing ACEI-induced angioedema, the following factors should be considered:
- Number of angioedema episodes between the introduction of ACEI and consultation ≤3 7
- Duration of angioedema strictly greater than 24 hours regardless of treatments administered 7
- Hospitalization in intensive care unit 7
- No recurrence of angioedema after stopping ACEI, regardless of the delay 7 A diagnostic score can be used to identify patients with a low or high probability of ACEI-induced angioedema 7