Enalapril is a type of drug called an ACE inhibitor, which works to lower the blood pressure by stopping the formation of the angiotensin II hormone. Angiotensin II usually causes the blood pressure to increase, so when enalapril prevents it from being produced, the blood pressure will get lower.
If you or someone you know needs to take enalapril to help lower your blood pressure or improve your heart health, most of the details you need can be found here.
Brand Names and Doses
Enalapril is the name of the actual drug in the medication you are taking, called the generic name. There are several different brand names containing the same drug that you might be more familiar with:
Each of these brand medications contains enalapril and do exactly the same thing in your body. They’ve just got different names because they are produced by different companies.
There are four different doses available: 2.5mg, 5mg , 10mg and 20mg. Most people starting on enalapril will take a low dose in the beginning, as their body adjust to taking the drug. Over the next few weeks or months, the dose can gradually be increased until you find the best dose for you to keep you blood pressure in the healthy range. This helps to decrease the risk of side effects that can occur if you take a higher dose straight away.
Enalapril is also available in combination with other drugs to lower your blood pressure, under these brand names:
- Renitec Plus (enalapril 20mg / hydrochlorothiazide 6mg)
- Zan-Extra (enalapril 20mg / lercanidipine 10mg)
This can help to keep your medical regimen more simple when you need to take a lot of medications. Rather than taking two tablets, you can just take one. You do need to be careful that you don’t continue to take the regular brand and accidentally double up on doses, though.
What type of drug is it?
Enalapril is a type of drug called an angiotensin-converting enzyme (ACE) inhibitor, a group of medications that work in a similar way. Other medicines in the same class are:
Although each of these medications work in the same way, there are subtle differences between them – if you’d like to know more about a specific one, just click on the link.
How does enalapril work?
The way enalapril works in the body helps is to lower blood pressure and strengthen the heart. Like the other ACE inhibitor drugs, it stops an enzyme in the body from converting angiotensin I to angiotensin II. Angiotensin II is the active form, which usually helps to keep the blood pressure higher by tightening the blood vessels and increasing the amount of blood travelling through them.
When you take enalapril, you don’t have as much angiotensin II in your body and it can’t work its effect of increasing the blood pressure as usual. This is what happens:
- The muscles around your blood vessels relax, creating more room for the blood to pass through.
- Your kidneys reabsorb less water and you excrete more in your urine, which means you will have less blood in your blood system.
This means that you will have less blood pumping around blood vessels that are roomier than usual. If you think of it like a plumbing system, that means there is going to be less pressure and help your heart.
ACE inhibitors have a broad action on the body, which means there are several side effects that can occur when you take enalapril. Although you should check the medicine information leaflet for the complete list, the most important side effects are explained below.
Low blood pressure
The most common side effects happen because the drug is working too well – you end up with low blood pressure. This is called hypotension and symptoms you might notice are:
These effects are most common when you first start taking enalapril or if you have recently increased the dose. They get better in a few days, as your body gets used to the drug. If you still have these effects for more than a week, your blood pressure might be too low, usually because you are taking a dose higher than you need. You can test your blood pressure to make sure (most pharmacies help you to do this for free) and you can talk to your doctor about lowering the dose, if needed.
Excess Potassium (Hyperkalaemia)
Enalapril causes more water to be excreted in the urine that usual, which can disrupt the normal balance of potassium and other salts in your body. Less potassium is excreted in your urine when you take enalapril and it can build-up in your body, causing symptoms of tiredness and muscle weakness.
The best way to check if you have high potassium levels is to take a simple blood test, so simply have a chat with your doctor if you think you might have hyperkalemia.
Enalapril can cause some people to get a dry cough, which can be quite frustrating as it does not seem to go away. If you experience a cough and it annoys you, you can talk to your doctor about alternative medications, such as an angiotensin II channel blocker.
There are a couple of things you should be aware of before you start taking enalapril, as they can have serious consequences for some people. It’s best to know in advance if you shouldn’t be taking it!
Enalapril can rarely lead to swelling on the mouth and throat called angioedema. This can stop you from breathing as normal, which can have very serious results.
If you have suffered from angioedema before, you should not take enalapril because you are more likely to experience it again. If you are taking the medication and you notice swelling around your mouth and face, stop taking it straight away and see a doctor as soon as possible.
Enalapril puts extra pressure on the kidneys and increases the risk of renal impairment, particularly when used with other medications such as NSAIDS and diuretics. If you have poor kidney function, this is not likely to be the best choice of drug for you.
Enalapril is a long-term solution to manage high blood pressure and should be taken every day for a continuous effect. If you suddenly stop taking it, the amount of angiotensin II in your body will increase rapidly once again and cause more blood to push through smaller blood vessels. Your hypertension might be even worse than in the beginning because of the sudden change!
If you want to stop taking enalapril, you should gradually reduce your dose over a few weeks, just as you increased the dose when you first started. For example, if you are taking 10 mg daily at the moment, you can reduce the dose to 5 mg, then 2.5mg daily until your body adjusts and you can stop completely.
Enalapril can interact with several different drugs in your body. Depending on the combination, sometimes we can simply change the doses when taking two drugs together but sometimes the combination shouldn’t be used at all.
Lithium + Enalapril Interaction
Enalapril can decrease the amount of lithium that is excreted from the body, leading to high concentrations and increased risk of side effects. The dose of lithium can be reduced to manage this, or an alternative blood pressure medication can be used.
Loop Diuretic + Enalapril Interaction
Taking a loop diuretic drug and enalapril together increases your risk of side effects related to blood pressure that is too low, particularly for the first few doses of enalapril. You can take them together, but you may need a lower dose or to stop taking the loop diuretic for a few days in the beginning. Using both together may also increase risk of renal impairment.
NSAID + Enalapril Interaction
NSAIDs and enalapril can sometimes be used together in young otherwise healthy patients, but enalapril might not work as well to reduce your blood pressure. the risk of renal impairment and hyperkalamia is increased with both together.
Thiazide Diuretic + Enalapril Interaction
Taking a thiazide diuretic and enalapril together increases your risk of side effects related to blood pressure that is too low, particularly for the first few doses of enalapril and may increase the risk of renal impairment. Sometimes using a lower is okay but the combination is not recommended in some cases.
Pregnancy and Breastfeeding
You should not take enalapril if you are pregnant, breastfeeding or planning to become pregnant in the future. Doses in the first trimester may cause birth defects and later in the pregnancy can lead to renal dysfunction in your baby.
You can take enalapril when you are breastfeeding. Very small amounts may be excreted in the breast milk, but no side effects have been reported. It is best to monitor for possible signs of low blood pressure in your baby, however, such as tiredness and irritability.