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Enalapril Maleate belongs to a group of medicines known as angiotensin converting enzyme (ACE) inhibitors. It is widely used to treat high blood pressure and heart failure and may be prescribed after a heart attack. It also lowers the chances of having a heart attack or stroke. Enalapril Maleate can be prescribed either alone or in combination with other medicines. It should be taken on an empty stomach. This medicine should be taken at the same time each day to get the most benefit. It is important to continue taking it regularly even if you feel well or even if your blood pressure is controlled. Most people with high blood pressure do not feel ill, but if you stop taking this medicine, your condition could get worse. This is a widely used medicine and is considered safe for long-term use. Making some changes in your lifestyle will also help lower your blood pressure. These may include regular exercise, losing weight, smoking cessation, reducing alcohol intake, and reducing the amount of salt in your diet as advised by your doctor. The most common side effects of this medicine include feeling dizzy or drowsy, headache, dry cough, fatigue, nausea, vomiting, diarrhea, stomach pain, and low blood pressure. Most of these are temporary and resolve with time. Talk to your doctor if any of the side effects bother you or do not go away. Before taking this medicine, let your doctor know if you have any kidney or liver problems. Pregnant or breastfeeding mothers should also consult their doctor before taking it. Your doctor may check your kidney function, blood pressure and potassium levels in your blood at regular intervals while you are taking this medicine. Enalapril Maleate is an angiotensin converting enzyme (ACE) inhibitor. It works by reducing stress on the heart and relaxing blood vessel so that blood flows more smoothly and the heart can pump blood more efficiently.

• Hypertension (high blood pressure) • Prevention of heart attack and stroke • Heart failure

Enalapril, a prodrug of enalaprilat, competitively inhibits ACE from converting angiotensin I to angiotensin II (a potent vasoconstrictor) resulting in increased plasma renin activity and reduced aldosterone (a hormone that causes water and Na retention) secretion. This promotes vasodilation and BP reduction.

Adult Dose: Hypertension Oral Initial: 2.5-5 mg PO qDay Maintenance: 10-40 mg/day PO qDay or divided q12hr Left Ventricular Dysfunction Initial: 2.5 mg PO q12hr May titrate up to 20 mg/day Congestive Heart Failure Initial: 2.5 mg PO qDay or q12hr Maintenance: 5-40 mg/Day PO divided q12hr; titrate slowly q2Weeks Hepatic impairment: No dosage adjustment required Child Dose: Hypertension 1 month to 16 years (oral) Initial: 0.08 mg/kg/day PO or divided q12hr; not to exceed 5 mg/day May increase PRN q2Weeks according to blood pressure not to exceed 0.58 mg/kg/day (or 40 mg/day) Renal Dose: Renal impairment CrCl <30 mL/min: (PO) Initiate 2.5 mg; titrate to response; not to exceed 40 mg Dialysis: 2.5 mg PO on day of dialysis; adjust dose on nondialysis days according to BP CrCl <30 mL/min: (IV) Initiate 0.625 mg q6hr; titrate based on response CrCl ?30 mL/min: (PO) Initiate 5 mg/day; titrate to maximum of 40 mg CrCl ?30 mL/min: (IV) 1.25 mg q6hr; titrate based on response

Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Enalapril Maleate may be taken with or without food, but it is better to take it at a fixed time.

If you miss a dose of Enalapril Maleate, skip it and continue with your normal schedule. Do not double the dose.

Common: • Decreased blood pressure • Cough • Increased potassium level in blood • Fatigue • Weakness • Dizziness

[UNSAFE] Enalapril Maleate may decrease alertness, affect your vision or make you feel sleepy and dizzy. Do not drive if these symptoms occur. It should be taken with or without food, preferably at the same time each day. Enalapril Maleate can make you feel dizzy for the first few days, so rise slowly if you have been sitting or lying down. You can also prefer taking it at bedtime to avoid dizziness throughout the day. Let your doctor know about any cough, or throat irritation that does not go away. It may increase the level of potassium in blood. Avoid taking potassium supplements and potassium-rich foods such as banana and broccoli. Inform your doctor if you are pregnant, planning pregnancy or breastfeeding.

Hypersensitivity. History of angioedema due to previous treatment with ACE inhibitors; bilateral renal artery stenosis. Pregnancy.

May potentiate hypotensive action w/ diuretics, other antihypertensives, TCAs, nitrates or anaesth. Concomitant admin w/ lithium carbonate may cause lithium toxicity. Increased risk of renal impairment w/ NSAIDs. May increase hyperkalaemic effect w/ K-sparing diuretics and supplements.

[UNSAFE] It is unsafe to consume alcohol with Enalapril Maleate.

[CONSULT YOUR DOCTOR] Enalapril Maleate is unsafe to use during pregnancy as there is definite evidence of risk to the developing baby. However, the doctor may rarely prescribe it in some life-threatening situations if the benefits are more than the potential risks. Please consult your doctor.

[SAFE IF PRESCRIBED] Enalapril Maleate is probably safe to use during breastfeeding. Limited human data suggests that the drug does not represent any significant risk to the baby. Use of Enalapril Maleate immediately after childbirth should be avoided.

[CAUTION] Enalapril Maleate should be used with caution in patients with kidney disease. Dose adjustment of Enalapril Maleate may be needed. Please consult your doctor. Regular monitoring of blood pressure, kidney function test, and potassium levels is recommended while you are taking this medicine. [CAUTION] Enalapril Maleate should be used with caution in patients with liver disease. Dose adjustment of Enalapril Maleate may be needed. Please consult your doctor. Inform your doctor if you experience fatigue, develop yellowing of the skin and eyes or white stools while taking this medicine.

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