INTRODUCTION
EL contains Enalapril which belongs to the group of medicines called Angiotensin Converting Enzyme (ACE) Inhibitors. It is used for the treatment of high blood pressure and heart failure. It can also be used to prevent the signs and symptoms of heart failure (such as difficulty in breathing, swollen ankles and feet or extreme tiredness even after a mild physical activity). Hypertension is defined as persistently increased blood pressure, that can show symptoms like headache, sweating, fast heartbeat, or throbbing sensation.
Enalapril lowers your blood pressure by relaxing your blood vessels. It also makes it easier for the heart to pump blood throughout your body. Your doctor may want to check your response to EL by monitoring your blood pressure and through some blood tests.
Avoid consumption of alcohol while taking EL, as it may decrease your blood pressure further and make you feel dizzier. Before taking EL, inform your doctor if you have any liver, kidney, or heart disease (other than high blood pressure or heart failure), a blood disorder, diabetes, you are on a salt-restricted diet or if you are about to undergo any surgery.
EL is not recommended for pregnant or breastfeeding women, therefore consult your doctor before taking it. There is a limited information for use in children, consult your doctor for advice. The most common side effects of taking EL are blurred vision, dizziness, cough, nausea, and weakness. Consult your doctor if any of these symptoms gets worse.
USES OF EL
- Treats high blood pressure (hypertension)
HOW EL WORKS
EL effectively reduces blood pressure and signs of heart failure. It acts by relaxing the blood vessels supplying the heart and other organs, which makes it easier for the heart to pump blood throughout your body.
DIRECTIONS FOR USE
Take EL as advised by your physician. Swallow the medicine with a glass of water. Do not crush or chew the medicine. Your doctor will decide the correct dose and duration for you depending upon your age, body weight and disease condition. Do not stop taking EL unless your doctor advises you to stop.
SIDE EFFECTS OF EL
COMMON
- blurred vision, dizziness, headache
- cough
- change in taste senses, nausea, diarrhoea, stomach pain
- weakness, fainting, tiredness
- depression
- low blood pressure causing light-headedness
- heart rhythm changes
- chest pain, difficulty breathing
- rash, allergic reaction with swelling of face, lips, tongue, or throat with difficulty in swallowing or breathing
UNCOMMON
- anaemia (tiredness, weakness, pale or yellowish skin, irregular heartbeat, shortness of breath, dizziness, or lightheadedness)
- low blood sugar levels that may make you feel shaky with heightened awareness
- sudden drop in blood pressure
- confusion, nervousness
- sleepy or inability to sleep
- tingling sensation in your skin, feeling like its numb
- spinning sensation, ringing in ears
- fast, forceful, or irregular heartbeats
- runny nose, sore throat and hoarseness, coughing, wheezing, or breathing difficulties
- gradual movement of food through your intestine
- vomiting, indigestion, constipation, lack of appetite
- stomach irritation, dry mouth, peptic ulcer
- excessive sweating, hair loss
- itching, rash
- signs of kidney damage (lower back pain and decrease in amount of urine passed)
- difficulty getting an erection
- muscle cramps, flushing
- generally feeling unwell
RARE
- abnormal dreams, sleep problems
- pale/patchy red/blue skin due to contraction of small blood vessels, like in fingers and toes
- pneumonia (cough, fever, breathlessness), inflammation of your nose
- pain, inflammation of in gums, cheeks, tongue, lips, throat
- liver or gall bladder problems (yellowing of skin or eyes, high level of liver enzymes)
- enlargement of breasts in men
- bone marrow depression, autoimmune diseases
- tiny fluid-filled bumps on the skin
- swelling of glands in neck, underarms, or groin
Stop taking EL and contact your doctor immediately if you experience any of the following side effects:
- allergic reaction (such as itching, developing a raised red skin rash)
- rash that looks like targets, blisters, skin peeling off in sheets, which may be also seen on the lips, eyes, mouth, nose and/or genitals, and if you have fever or joint pain
- severe skin reaction (such as reddening of the skin, skin scaling, blistering or raw sores, detachment of the top layer of the skin from bottom layers)
- bloating and cramps in the stomach
- heart attack or stroke like symptoms
- stomach and back pain due to inflammation of the pancreas
- blood disorders having symptoms like tiredness, weakness, shortness of breath, inability to exercise, feeling run down, having constant or recurring colds, fever, chills, prolonged bleeding, bruising where cause is unknown, red, or purple spots
- fluid in the lung having symptoms such as cough, difficulty breathing
- hepatitis or bile duct obstruction (fever, tiredness, loss of appetite, stomach pain, nausea, yellowing of the skin or eyes and liver failure)
- fever, inflammed blood vessels, pain and swelling of muscles or joints
- rash, increased sensitivity to sunlight and other effects on your skin
HOW TO MANAGE SIDE EFFECTS
Dizziness:
When you start taking EL, you may feel faint or dizzy. If this happens, resting or lying down for some time can help. This is caused by your blood pressure decreasing. Talk to you physician in case of any concerns.
Nausea:
Take EL with, or immediately followed by meals. Have light meals and eat them slowly and in a frequent manner. Avoid oily and sweet foods. Consult your doctor if the symptom does not improve.
Vomiting:
Get adequate rest. Drink sufficient amount of fluids. Have small sips if you feel sick. Eat when you feel hungry. Do not take any medicine other than EL without asking your doctor.
Diarrhoea:
Drink lots of fluids, such as water or fruit juice to keep yourself hydrated. Do not consume any medicine other than EL without consulting your doctor.
Stomach pain:
Try to rest and relax. Eat and drink slowly or try to consume smaller and frequent meals. Keep a heat pad on your stomach. If the symptom does not improve, contact your doctor.
WARNING & PRECAUTIONS
PREGNANCY
EL is not recommended in early pregnancy and must not be taken when more than 3 months pregnant as it may be seriously harmful for your baby. Consult your doctor before taking it.
BREASTFEEDING
EL is not recommended in breast-feeding women. Consult your doctor before taking it.
DRIVING AND USING MACHINES
EL may make you feel tired or dizzy. In such case, do not drive or use any tools or machines.
ALCOHOL
Avoid consumption of alcohol while taking EL as it may decrease your blood pressure too much and you may feel dizzy, light-headed, or faint.
KIDNEY
EL is not recommended for use in patients with severe kidney impairment (including dialysis). EL should be used with caution among patients with other kidney problems including kidney transplantation. Consult your doctor before taking it.
LIVER
EL should be used with caution in patients with liver problem. Consult your doctor before taking it.
ALLERGY
Do not take EL if you are allergic to Enalapril, or if any member of your family had an allergic reaction to this medicine, or you ever had swelling of your face, eyelids, lips, mouth, tongue, or throat that caused trouble in swallowing or breathing when the reason was not known, or it was inherited.
HEART DISEASE
EL is to be used cautiously if you have low blood pressure or a heart problem. Consult your doctor before taking it.
OTHERS
EL is not recommended for use if you:
- have diabetes (high blood sugar level)
Before taking EL, inform your doctor if you:
- have a condition that involves the blood vessels in the brain
- have a blood problem such as low count of white blood cells, red blood cells or platelets
- are on dialysis
- are on a salt-restricted diet
- have been experiencing recurring episodes of vomiting or diarrhea recently
- have diabetes (high blood sugar levels)
- have collagen vascular disease (Ex. lupus erythematosus, rheumatoid arthritis, or scleroderma)
- have scheduled surgery
- LDL apheresis (a treatment to remove cholesterol from your blood)
- adesensitization treatment (used to reduce the effect of an allergy to bee or wasp stings)
Use in paediatrics:
EL is not recommended for use in very young infants (first few weeks after birth), and in children with kidney problems. There is very limited experience in use of EL in children with high blood pressure, so consult your doctor before taking it.
Use in geriatrics:
EL should be used with caution in elderly patients. Proper dose adjustment and careful monitoring is required, so consult your doctor before taking it.
INTERACTIONS
A. Drug-Drug interactions:
Before taking EL, inform your doctor if you are taking any of the following medicine:
- racecadotril (medicine used to treat diarrhoea)
- medicines that supplements potassium to the body (Ex. spironolactone, triamterene, or amiloride)
- trimethoprim containing antibiotics (used for infections)
- medicines used to prevent organ transplant rejection (Ex. ciclosporin, temsirolimus, sirolimus, everolimus)
- heparin (used to thin blood to prevent blood clots)
- medicines used for heart conditions (to reduce blood pressure, treat chest pain, irregular heartbeats, or a type of long term-chronic heart failure) Ex. atenolol, propranolol, furosemide, bumetanide, nitroglycerin, valsartan, aliskiren, procainamide, sacubitril/valsartan
- lithium (used in some types of mental illness)
- tricyclic antidepressants (used to treat depression) Ex. amiptriptyline
- antipsychotics (used to treat serious mental illnesses) Ex. clozapine, resperidone
- anaesthetics (used to prevent pain during surgery) (Ex. propofol, thiopental)
- medicines used to relieve pain (Ex. morphine, aspirin, ibuprofen, celecoxib)
- thrombolytics (used to dissolve blood clots) Ex. reteplase, tenecteplase
- cough and cold medicines and weight loss medicines which contain something called a 'sympathomimetic agent’
- anti-diabetic medicines and insulin (used to lower the blood glucose level) Ex. vildagliptin, metformin
- allopurinol (used to reduce blood uric acid levels)
Overdosage:
If you or anyone else accidentally take too much of EL, contact your doctor immediately or visit the nearby hospital. Symptoms of EL overdose are drop in blood pressure, stupor (a state of almost complete lack of consciousness), dizziness or light-headedness, fast heartbeat, anxiety, cough, kidney failure, and fast breathing.
SYNOPSIS
| Drug | : | Enalapril |
| Pharmacological Category | : | ACE (Angiotensin Converting Enzyme) inhibitors |
| Therapeutic Indication | : | Hypertension, Heart failure |
| Dosage Forms | : | Tablet |
MORE INFORMATION
- Keep EL away from children
- Do not store above 25°C
FAQs ABOUT EL
Can EL be used during pregnancy?
EL is not recommended for use in early pregnancy and must not be taken when more than 3 months pregnant, as it may cause serious harm to your baby if used past the third month of pregnancy. Consult your doctor before taking EL.
Can EL be crushed?
No. Do not crush EL. Take EL as advised by your physician. Swallow the medicine with a glass of water. Do not crush or chew the medicine. Your doctor will decide the correct dose and duration for you depending upon your age, body weight and disease condition.
Can EL cause erectile dysfunction?
Erectile dysfunction is an uncommon side effect of EL that might occur in men. Consult your doctor if you have trouble getting an erection or related symptoms.
Can EL cause hyperkalemia?
Yes. Hyperkalemia (increase in potassium levels) is a common side effect of EL. It is usually detected by blood test. If you experience any symptoms such as nausea, stomach pain, irregular heartbeat, or muscle pain, consult your doctor.
How fast will EL work?
EL usually starts to act within an hour, and its effect lasts upto 24 hours. Some people may require several weeks of treatment until the optimum effect on their blood pressure is observed.
What EL is used for?
EL is used to treat high blood pressure, also used to treat and prevent signs of heart failure such as shortness of breath, tiredness after light physical activities like walking.
What are the common side effects of EL?
The most common side effects of taking EL are blurred vision, dizziness, cough, nausea, weakness, headache, depression, fainting, fast heartbeat, and chest pain. Consult your doctor if any of these symptoms gets worse.
What kind of foods should be avoided while taking EL?
EL has the capacity to increase blood potassium level which can lead to irregular heartbeat. To prevent any such occurrence, it is advisable to avoid potassium rich foods such as bananas, oranges, green leafy vegetables, and potassium containing salt while taking EL.
Can alcohol be taken with EL?
Avoid consumption of alcohol while taking EL since it might lower blood pressure and make you feel dizzy, light-headed, or faint. Consult your doctor before taking EL.
What happens if you stop taking EL?
If you stop taking EL, your blood pressure may increase and affects the functioning of your heart and kidneys. Hence, it is advised not to stop the medicine on your own and instead seek advice from your consulting doctor.
REFERENCES
1. Barbara G. Wells, Joseph T. DiPiro, Terry L. Shwinghammer, Cecily V. DiPiro. Hypertension. Pharmacotherapy Handbook. Ninth edition. Page-87.
2. Arjumand Faruqi, Ashish Jain.Enalapril. StatPearls [Internet]. StatPearls Publishing. July 2021. [Accessed on 7th April 2022] https://www.ncbi.nlm.nih.gov/books/NBK557708/
3. H Gavras. A multicenter trial of enalapril in the treatment of essential hypertension. NIH National Library of Medicine, National center for biotechnology information. Pubmed.gov. 1986. [Accessed on 7th April 2022] https://pubmed.ncbi.nlm.nih.gov/3028633/
4. Dexcel Pharma. Electronic Medicines Compendium (EMC). [Revised in October 2021] [Accessed on 7th April 2022] https://www.medicines.org.uk/emc/files/pil.2671.pdf
USEFUL DIAGNOSTIC TESTS
- Complete Blood Count (CBC)
- ECG
- Kidney function test
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