II. Indications
- See ACE Inhibitor
III. Mechanism
- See ACE Inhibitor
- Synthetic Lysine derivative of Enalaprilat (active form of Enalapril)
-
Angiotensin Converting Enzyme (ACE) inhibitor
- Long acting ACE Inhibitor that may be dosed daily
- Other ACE Inhibitors (other than Enalapril) often are best dosed more than once daily
IV. Dosing: Adults
-
Hypertension
- Start 10 mg orally daily
- Target 20 to 40 mg/day
- Maximum 40 mg/day
-
Congestive Heart Failure (CHF)
- Start 2.5 to 5 mg orally daily
- Target 5 to 20 mg/day
- Maximum 40 mg/day
- Acute MI
- Start 5 mg orally daily for 2 days then increase to 10 mg orally daily
-
Diabetic Nephropathy
- Take 10 to 20 mg orally daily
-
Renal Dosing
- GFR 10-30
- Start 2.5 to 5 mg orally daily
- GFR <10 or on Hemodialysis
- Start 2.5 mg orally daily to start
- GFR 10-30
- Maximum 80 mg/day (but no added benefit above 40 mg/day)
V. Dosing: Children (age >=6 years)
- Contraindicated under age 6 years or GFR <30 ml/min
-
Hypertension
- Give 0.07 mg/kg up to 5 mg/day orally daily
VI. Supplied
- Available as generic/Prinivil scored tablets (10, 20 and 40 mg)
- Available as generic/Zestril unscored tabs (2.5, 5, 10, 20, 30 and 40 mg)
- Available as oral solution 1 mg/ml (Qbrelis)
VII. Metabolism
- Primarily renal excretion
VIII. Adverse Effects
- See ACE Inhibitor
IX. Safety
- See ACE Inhibitor
- Pregnancy Category X
- Avoid in Lactation
X. Resources
XI. References
- (2016) Presc Lett, Resource #321151, ACE Inhibitor Antihypertensive Dose Comparison
- (2020) Med Lett Drugs Ther 62(1598): 73-80
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 68-9
- Hamilton (2020) Tarascon Pocket Pharmacopoeia