Can You Combine Amlodipine 5mg with Enalapril 5mg?
Yes, you can and should combine amlodipine 5mg with enalapril 5mg—this is a guideline-recommended, evidence-based combination for hypertension management that provides complementary mechanisms of action with superior blood pressure control compared to either agent alone. 1, 2
Why This Combination Works
The combination of a calcium channel blocker (amlodipine) and an ACE inhibitor (enalapril) is explicitly listed as one of the preferred two-drug combinations for hypertension treatment by the European Society of Cardiology and European Society of Hypertension. 1
The American College of Cardiology specifically recommends adding an ACE inhibitor to amlodipine as it provides complementary mechanisms of action, and this combination has demonstrated superior blood pressure control compared to either agent alone. 2
The combination targets different pathways: amlodipine causes vasodilation through calcium channel blockade, while enalapril blocks the renin-angiotensin system, resulting in additive blood pressure reduction. 1, 2
Clinical Evidence Supporting This Combination
A double-blind study directly comparing this combination showed that adding amlodipine 10mg to enalapril resulted in significantly larger falls in both supine and standing blood pressure compared to enalapril plus placebo, with good tolerability. 3
Multiple long-term studies (up to 50 weeks) demonstrated that both amlodipine and enalapril are similarly effective as monotherapy, with comparable efficacy and tolerability profiles, making their combination logical and safe. 4, 5, 6
The combination was well tolerated with only class-typical side effects: peripheral edema with amlodipine (which may actually be attenuated by adding the ACE inhibitor) and dry cough with enalapril. 2, 4, 5
Specific Dosing Guidance
Start with amlodipine 5mg plus enalapril 5mg once daily, then titrate upward based on blood pressure response. 2, 7
Enalapril can be increased to 10-40mg daily, and amlodipine can be increased to 10mg daily if needed to achieve target blood pressure. 4, 7, 5
Target blood pressure should be <140/90 mmHg for most patients, ideally <130/80 mmHg for higher-risk patients. 2
Monitoring Parameters
Reassess blood pressure within 2-4 weeks after initiating this combination, with the goal of achieving target blood pressure within 3 months. 2
Monitor for peripheral edema (more common with amlodipine), dry cough (occurs in ~20% with enalapril), hyperkalemia, and acute kidney injury. 2, 5
Check serum potassium and creatinine 2-4 weeks after starting enalapril to detect potential hyperkalemia or changes in renal function. 2
When to Add a Third Agent
If blood pressure remains uncontrolled after optimizing doses of both amlodipine and enalapril, add a thiazide or thiazide-like diuretic as the third agent to achieve guideline-recommended triple therapy. 1, 2
The sequence for non-Black patients is: ACE inhibitor → add calcium channel blocker → optimize doses → add thiazide diuretic. 2
Important Clinical Considerations
This combination is particularly beneficial for patients with chronic kidney disease, heart failure, diabetes, or coronary artery disease. 2
For Black patients specifically, while this combination is effective, the combination of amlodipine plus a thiazide diuretic may be more effective than amlodipine plus an ACE inhibitor. 2
The addition of an ACE inhibitor to amlodipine may help reduce amlodipine-induced peripheral edema, which is a common side effect. 2
Do not combine enalapril with an ARB (like losartan or valsartan), as this increases adverse events without additional benefit. 2