Dosage of M-Enalapril in details
Since absorption of Tablets M-Enalapril MALEATE (M-Enalapril) is not affected by food, the tablets may be administered before, during, or after meals.
Essential Hypertension: The initial dose is 10 to 20 mg, depending on the degree of hypertension, and is given once daily. In mild hypertension the recommended initial dose is 10 mg daily. For other degrees of hypertension the initial dose is 20 mg daily. The usual maintenance dose is one 20 mg tablet taken once daily. The dosage should be adjusted according to the needs of the patient to a maximum of 40 mg daily.
Renovascular Hypertension: Since blood pressure and renal function in such patients may be particularly sensitive to ACE inhibition, therapy should be initiated with a lower starting dose (e.g. 5 mg or less). The dosage should then be adjusted according to the needs of the patient. Most patients may be expected to respond to one 20 mg tablet taken once daily. For patients with hypertension who have been treated recently with diuretics, caution is recommended.
Concomitant Diuretic Therapy in Hypertension: Symptomatic hypotension may occur following the initial dose of M-Enalapril MALEATE (M-Enalapril); this is more likely in patients who are being treated currently with diuretics. Caution is recommended, therefore, since these patients may be volume- or salt-depleted. The diuretic therapy should be discontinued for 2-3 days prior to initiation of therapy with M-Enalapril MALEATE (M-Enalapril). If this is not possible, the initial dose of M-Enalapril MALEATE (M-Enalapril) should be low (5 mg or less) to determine the initial effect on the blood pressure. Dosage should then be adjusted according to the needs of the patient.
Dosage in Renal Insufficiency: Generally, the intervals between the administration of M-Enalapril should be prolonged and/or the dosage reduced.
Heart Failure/Asymptomatic Left Ventricular Dysfunction: The initial dose of M-Enalapril MALEATE (M-Enalapril) in patients with symptomatic heart failure or asymptomatic left ventricular dysfunction is 2.5 mg, and it should be administered under close medical supervision to determine the initial effect on the blood pressure. M-Enalapril MALEATE (M-Enalapril) may be used in the management of symptomatic heart failure usually with diuretics and, where appropriate, digitalis. In the absence of, or after effective management of, symptomatic hypotension following initiation of therapy with M-Enalapril MALEATE (M-Enalapril) in heart failure, the dose should be increased gradually to the usual maintenance dose of 20 mg, given in a single dose or two divided doses, as tolerated by the patient. This dose titration may be performed over a 2 to 4 week period, or more rapidly if indicated by the presence of residual signs and symptoms of heart failure. In patients with symptomatic heart failure, this dosage regimen was effective in reducing mortality.
Blood pressure and renal function should be monitored closely both before and after starting treatment with M-Enalapril MALEATE (M-Enalapril) because hypotension and (more rarely) consequent renal failure have been reported. In patients treated with diuretics, the dose should be reduced if possible before beginning treatment with M-Enalapril MALEATE (M-Enalapril). The appearance of hypotension after the initial dose of M-Enalapril MALEATE (M-Enalapril) does not imply that hypotension will recur during chronic therapy with M-Enalapril MALEATE (M-Enalapril) and does not preclude continued use of the drug. Serum potassium also should be monitored.
Administration: M-Enalapril MALEATE (M-Enalapril) is available for oral administration as tablets. Since absorption of Tablets M-Enalapril MALEATE (M-Enalapril) is not affected by food, the tablets, may be administered before, during, or after meals.
What other drugs will affect M-Enalapril?
Tell your doctor about all medicines you use, and those you start or stop using during your treatment with M-Enalapril, especially:
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lithium;
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a diuretic or "water pill";
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gold injections to treat arthritis;
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a potassium supplement such as Cytra, Epiklor, K-Lyte, K-Phos, Kaon, Klor-Con, or Polycitra; or
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aspirin or NSAIDs (non-steroidal anti-inflammatory drugs)--ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.
This list is not complete. Other drugs may interact with M-Enalapril, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.
M-Enalapril interactions
Hypotension: Patients on Diuretic Therapy: Patients on diuretics and especially those in whom diuretic therapy was recently instituted, may occasionally experience an excessive reduction of blood pressure after initiation of therapy with M-Enalapril or enalaprilat. The possibility of hypotensive effects with M-Enalapril or enalaprilat can be minimized by either discontinuing the diuretic or increasing the salt intake prior to initiation of treatment with M-Enalapril or enalaprilat. If it is necessary to continue the diuretic, provide close medical supervision after the initial dose for at least two hours and until blood pressure has stabilized for at least an additional hour..
Agents Causing Renin Release: The antihypertensive effect of M-Enalapril and M-Enalapril IV is augmented by antihypertensive agents that cause renin release (e.g., diuretics).
Non-steroidal Anti-inflammatory Agents: In some patients with compromised renal function who are being treated with nonsteroidal anti-inflammatory drugs, the co-administration of M-Enalapril may result in a further deterioration of renal function. These effects are usually reversible.
In a clinical pharmacology study, indomethacin or sulindac was administered to hypertensive patients receiving VASOTEC. In this study there was no evidence of a blunting of the antihypertensive action of VASOTEC. However, reports suggest that NSAIDs may diminish the antihypertensive effect of ACE inhibitors. This interaction should be given consideration in patients taking NSAIDs concomitantly with ACE inhibitors.
Other Cardiovascular Agents: M-Enalapril Bp and M-Enalapril IV have been used concomitantly with beta adrenergic-blocking agents, methyldopa, nitrates, calcium-blocking agents, hydralazine, prazosin and digoxin without evidence of clinically significant adverse interactions.
M-Enalapril Bp IV has been used concomitantly with digitalis without evidence of clinically significant adverse reactions.
Agents Increasing Serum Potassium: M-Enalapril Bp and M-Enalapril IV attenuate potassium loss caused by thiazide-type diuretics. Potassium-sparing diuretics (e.g., spironolactone, triamterene, or amiloride), potassium supplements, or potassium-containing salt substitutes may lead to significant increases in serum potassium. Therefore, if concomitant use of these agents is indicated because of demonstrated hypokalemia, they should be used with caution and with frequent monitoring of serum potassium. Potassium sparing agents should generally not be used in patients with heart failure receiving M-Enalapril.
Lithium: Lithium toxicity has been reported in patients receiving lithium concomitantly with drugs which cause elimination of sodium, including ACE inhibitors. A few cases of lithium toxicity have been reported in patients receiving concomitant M-Enalapril/M-Enalapril IV and lithium and were reversible upon discontinuation of both drugs. It is recommended that serum lithium levels be monitored frequently if M-Enalapril is administered concomitantly with lithium.
References
- DailyMed. "ENALAPRIL MALEATE; HYDROCHLOROTHIAZIDE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- FDA/SPL Indexing Data. "69PN84IO1A: The UNique Ingredient Identifier (UNII) is an alphanumeric substance identifier from the joint FDA/USP Substance Registration System (SRS).". https://www.fda.gov/ForIndustry/Data... (accessed September 17, 2018).
- MeSH. "Antihypertensive Agents". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
Reviews
The results of a survey conducted on ndrugs.com for M-Enalapril are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking M-Enalapril. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.User reports
Consumer reported frequency of use
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Information checked by Dr. Sachin Kumar, MD Pharmacology
