Enalapril

The recommended starting dose for high blood pressure is 2.5 mg to 5 mg taken once a day. The usual treatment dose ranges from 2.5 mg once daily to 20 mg twice daily, depending on the needs and circumstances of the person using the medication. The dose may need to be adjusted according to how well the kidneys are functioning and the effectiveness of the medication.

The starting dose for children less than 16 years of age is based on body weight and will be calculated by your child’s doctor.

The recommended starting dose to treat congestive heart failure is 2.5 mg taken once a day. The dose may be increased gradually to a maximum of 40 mg daily, depending on the effectiveness of the medication.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important to use Enalapril exactly as prescribed by your doctor. If you miss a dose, and it is within 6 hours of your regularly scheduled time, administer it as soon as possible and continue with your regular schedule. If more than 6 hours has passed, skip the missed dose and continue with your regular dosing schedule. Do not administer a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Enalapril at room temperature, protect it from moisture and keep out of reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may cause headaches; it may cause dizziness - use caution when getting up from a lying or sitting position and use caution if driving; it may cause unusual tiredness; it may alter your sense of taste; on occasion, it may cause a dry cough - contact your pharmacist or doctor if it becomes bothersome. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

2.5 mg
Each white, oval, flat, beveled edged tablet engraved "EN" score "2.5" on one side and "APO" on the other contains 2.5 mg of enalapril maleate. Nonmedicinal ingredients: lactose and zinc stearate.

5 mg
Each white, rounded triangle-shaped, biconvex tablet scored on one side and engraved "APO" over "EN5" on the other contains 5 mg of enalapril maleate. Nonmedicinal ingredients: lactose and zinc stearate.

10 mg
Each reddish-pink, rounded triangle-shaped, biconvex tablet scored on one side and engraved "APO" over "EN10" on the other contains 10 mg of enalapril maleate. Nonmedicinal ingredients: lactose, zinc stearate, and orange ferric oxide.

20 mg
Each peach-coloured, rounded triangle-shaped, biconvex tablet scored on one side and engraved "APO" over "EN20" on the other contains 20 mg of enalapril maleate. Nonmedicinal ingredients: lactose, zinc stearate, yellow ferric oxide and orange ferric oxide.

Do not take Enalapril if you:

• are allergic to enalapril or any ingredients of the medication
• are pregnant or planning to get pregnant
• have been diagnosed with hereditary angioedema
• have had angioedema (a serious allergic reaction which causes the area around the throat and tongue to swell) after taking any other ACE inhibitors (e.g., Captopril, enalapril, Ramipril)
• have Diabetes or Kidney Disease and are taking Aliskiren

There may be an interaction between enalapril and any of the following:

• acetylsalicylic acid (Asa)
• Aldesleukin
• aliskiren
• Allopurinol
• alpha blockers (e.g., Alfuzosin, Doxazosin, Tamsulosin)
• alpha agonists (e.g., Clonidine, methyldopa)
• amifostine
• Amiodarone
• amphetamines (e.g., Dextroamphetamine, lisdexamphetamine)
• angiotensin II receptor blockers (ARBs; e.g., Candesartan, Losartan)
• antidiabetes medications (e.g., insulin, Metformin, Glyburide)
• atypical anti-psychotics (e.g., Clozapine, Olanzapine, Quetiapine, Risperidone)
• Azathioprine
• barbiturates (e.g., butalbital, pentobarbital Phenobarbital)
• beta-adrenergic blockers (e.g., Atenolol, Propranolol, Sotalol)
• brimonidine
• Bromocriptine
• calcium channel blockers (e.g., Amlodipine, Diltiazem, Nifedipine, Verapamil)
• Canagliflozin
• ciprofloxacin
• conivaptan
• diuretics (water pills; e.g., Furosemide, Hydrochlorothiazide, triamterene)
• drospirenone
• Duloxetine
• Eplerenone
• Everolimus
• "gliptin" diabetes medications (e.g., Linagliptin, Saxagliptin, Sitagliptin)
• grass pollen allergen extract
• Guanfacine
• Heparin
• iron dextran complex
• iron gluconate
• levodopa
• lithium
• low-molecular-weight heparins (e.g., Dalteparin, Enoxaparin, Tinzaparin)
• medications that increase potassium levels (e.g., potassium supplements, Spironolactone, Amiloride, and salt substitutes containing potassium)
• metformin
• Methylphenidate
• Minoxidil
• nitrates (e.g., Nitroglycerin, isosorbide dinitrate, isosorbide mononitrate)
• nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., Ibuprofen, Indomethacin, Naproxen)
• other angiotensin-converting-enzyme inhibitors (ACEIs; e.g., captopril, ramipril)
• Pentoxifylline
• phosphodiesterase-5 inhibitors (e.g., Sildenafil, Tadalafil, Vardenafil)
• Pregabalin
• quinine
• Ropinirole
• sacubitril
• Selegiline
• Sirolimus
• sodium phosphates
• Temsirolimus
• Tizanidine
• tolcapone
• Tolvaptan
• Trimethoprim
• Yohimbine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

HEALTH CANADA ADVISORY

February 4, 2014

Health Canada has issued new restrictions concerning the use of enalapril. To read the full Health Canada Advisory, visit Health Canada's web site at www.hc-sc.gc.ca.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Angioedema: Angioedema (a serious allergic reaction that causes the area around the throat and tongue to swell) may occur with ACE inhibitors, including enalapril, although uncommonly. If you experience swelling of the face, tongue, or throat, you should stop taking Enalapril at once and get immediate medical attention. People who have had angioedema caused by other substances may be at increased risk of angioedema while receiving an ACE inhibitor such as enalapril.

Cough: People taking enalapril may develop a dry, persistent cough that usually disappears only after stopping or lowering the enalapril dose. Be sure to tell your doctor of any cough that does not seem to be related to a usual cause.

Diabetes: Enalapril may cause a loss of blood glucose control, and glucose tolerance may change. People with diabetes may find it necessary to monitor their blood sugar more frequently while using Enalapril. If you have diabetes or are at risk for developing diabetes, discuss with your doctor how Enalapril may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: Changes in kidney function have been seen in certain people taking Enalapril. The use of diuretics (water pills) or aliskiren may further increase the risk of kidney problems for those already at risk for this problem. If you have kidney disease, discuss with your doctor how Enalapril may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Enalapril, and whether any special monitoring is needed.

Liver function: Changes in liver function have occurred in people with or without preexisting liver problems during treatment with Enalapril. In most cases, the changes were reversed when the medication was stopped. If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Low blood pressure: Occasionally, blood pressure drops too low after taking enalapril. This usually happens after the first or second dose or when the dose is increased. It is more likely to occur in those who take aliskiren, are on dialysis, are experiencing diarrhea or vomiting, are sweating excessively and not drinking enough fluids, have a salt-restricted diet, or are taking water pills. People with these conditions should be monitored closely by their doctor for the first weeks of treatment and whenever the dose of the medication is increased. To reduce the risk of dizziness, get up slowly from a lying down or sitting position. If low blood pressure causes you to faint or feel lightheaded, contact your doctor.

Excessive sweating and lack of fluid intake may lead to an excessive fall in blood pressure because of reduced fluid in your blood vessels. Vomiting or diarrhea may also lead to a fall in blood pressure. Consult your doctor if you feel your blood pressure is too low.

Potassium levels: Increases in blood levels of potassium occur for a small percentage of people taking enalapril. This rarely causes problems, but potassium levels should be monitored by your doctor. Avoid using salt substitutes that contain potassium while you are taking enalapril.

Pregnancy: ACE inhibitors such as enalapril may cause severe harm or death to the developing fetus if taken by the mother during pregnancy. Enalapril should not be used during pregnancy. If you become pregnant while taking Enalapril, contact your doctor immediately.

Breast-feeding: Enalapril passes into breast milk in small amounts. If you are a breast-feeding mother and are taking enalapril, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of Enalapril have not been established for infants and children with decreased kidney function.

Seniors: Seniors have an increased risk of experiencing side effects when taking enalalpril due to reduced kidney function. Lower doses may be necessary to minimize side effects.

This medication is typically used only once a day. However, your pharmacist may have suggested a different schedule that is more appropriate for you. You should take this medication at approximately the same time each day. It must be used regularly and continuously to maintain its beneficial effects. Be sure to keep an adequate supply on hand. If you remember missing a dose within 6 hours of the time it is usually taken, take the missed dose as soon as possible, then take the next dose at the regularly scheduled time. If the dose is missed by more than 6 hours, skip the missed dose. Do not double the next dose to catch up. This medication may be taken with or without food.