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Name: Enalapril maleate

Pregnancy Category C

Drug classes

• Antihypertensive
• Angiotensin-converting enzyme (ACE) inhibitor

Mechanism of action

Renin, synthesized by the kidneys, is released into the circulation where it acts on a plasma precursor to produce angiotensin I, which is converted by angiotensin-converting enzyme to angiotensin II, a potent vasoconstrictor that also causes release of aldosterone from the  adrenals; both of these actions increase blood pressure. Enalapril blocks the conversion of angiotensin I to angiotensin II, decreasing blood pressure, decreasing aldosterone secretion, slightly increasing serum potassium levels, and causing sodium and fluid loss; increased  prostaglandin synthesis also may be involved in the antihypertensive action.

Indications

• Treatment of hypertension alone or in combination with thiazide-type diuretics
• Treatment of acute and chronic CHF

Contraindications/cautions

• Contraindicated in the presence of allergy to enalapril.
• Use caution in the presence of impaired renal function; salt/volume depletion-hypotension may occur; lactation.

Adverse effects

• CNS: Headache, dizziness, fatigue, insomnia, paresthesias
• GI: Gastric irritation, nausea, vomiting, diarrhea, abdominal pain, dyspepsia, elevated liver enzymes
• CV: Syncope, chest pain, palpitations, hypotension in salt/volume depleted patients
• Hematologic: Decreased hematocrit and hemoglobin
• GU: Proteinuria, renal insufficiency, renal failure, polyuria, oliguria, urinary frequency, impotence
• Other: Cough, muscle cramps, hyperhidrosis

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