Enalapril Tablets for Hypertension and Heart Failure

What Enalapril Is and How It Works

Enalapril is an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure, symptomatic heart failure, and asymptomatic left ventricular dysfunction. It is taken by mouth as tablets, commonly in 2.5 mg, 5 mg, 10 mg, and 20 mg strengths. Many treatment plans use once-daily dosing, but some require twice-daily dosing. Doses such as enalapril 20 mg are frequently used during maintenance once response is established.

ACE inhibitors block the conversion of angiotensin I to angiotensin II. This relaxes blood vessels, lowers aldosterone levels, and reduces blood pressure and afterload. The result helps lower cardiovascular risk, eases heart failure symptoms, and supports kidney protection in appropriate patients.

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Dosage and Usage

• Hypertension (adults): Typical starting dose is 5 mg once daily if not on a diuretic. If taking a diuretic, an initial 2.5 mg may be considered. Titrate every 1–2 weeks as tolerated. Usual maintenance is 10–40 mg daily in one or two divided doses.
• Heart failure or left ventricular dysfunction: Common starting dose is 2.5 mg twice daily. Increase gradually to a typical target of 10–20 mg per day in divided doses, as tolerated and guided by clinical response.
• Kidney impairment: Lower starting doses and slower titration may be needed. For severe impairment (e.g., creatinine clearance below about 30 mL/min), prescribers often start at 2.5 mg once daily with careful monitoring.
• Pediatrics (hypertension): Weight-based dosing is used. A common initial dose is 0.08 mg/kg once daily (up to 5 mg) with cautious titration. Pediatric dosing requires specialist guidance.
• Administration: Swallow tablets with water, with or without food. Take at the same time each day. Do not crush unless the tablet is scored and a pharmacist confirms it is suitable to split.
• Missed dose: If a dose is missed, take it when remembered. If it is near the next dose, skip the missed dose. Do not double doses.
• Monitoring and interactions: Blood pressure, kidney function, and potassium should be checked during titration and maintenance. Use caution with diuretics, potassium supplements or substitutes, NSAIDs, lithium, and aliskiren (especially in diabetes).

• Storage: Store tablets at 20–25°C (68–77°F). Short excursions 15–30°C (59–86°F) are acceptable.
• Moisture protection: Keep in the original, tightly closed container. Protect from humidity.
• Light and heat: Avoid direct sunlight and hot environments. Do not leave tablets in a car.
• Travel: Carry medication in hand luggage in the original labeled bottle. Keep a copy of the prescription.
• Safety: Store out of reach of children and pets. Discard expired tablets safely.

Benefits and Savings

Enalapril lowers blood pressure and reduces the risk of heart attack and stroke when part of a long-term plan. In heart failure, it helps reduce hospitalizations, supports better functional capacity, and improves symptoms over time. It is well studied and widely used across many care settings.

Convenient once-daily dosing is common, and twice-daily schedules can be used when needed to improve control. Multiple strengths support tailored titration. As a generic ACE inhibitor, enalapril offers strong clinical value with broad availability.

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See our promotions page for current offers, including any enalapril discount if available.

Side Effects and Safety

• Cough (dry, persistent)
• Dizziness or lightheadedness, especially after the first doses
• Headache, fatigue, or weakness
• Nausea, diarrhea, or taste changes
• Rash or itching
• Low blood pressure
• High potassium (hyperkalemia)
• Increased creatinine or changes in kidney function tests

Serious reactions can include angioedema (swelling of face, lips, tongue, or throat), severe hypotension, kidney problems, liver issues including cholestatic jaundice, and high potassium. Pregnancy is contraindicated due to fetal risk. Avoid use with aliskiren in diabetes. Seek urgent care for signs of angioedema or severe allergic reactions.

Onset Time

Blood pressure reduction generally begins within about 1 hour of a dose, with peak effect around 4–6 hours. A steadier response develops over 1–2 weeks as dosing is adjusted. Heart failure symptom improvements build gradually over weeks to months. Renal-protective effects may take months of consistent therapy. Titration pace, baseline status, and concomitant therapies influence these timelines.

Compare With Alternatives

Within ACE inhibitors, lisinopril and ramipril offer similar blood pressure and heart failure benefits. Lisinopril is often dosed once daily. Ramipril is also used in cardiovascular risk reduction and hypertension. See Ramipril for a closely related option.

Angiotensin receptor blockers (ARBs) such as losartan or valsartan provide comparable blood pressure control and kidney benefits in many settings. ARBs may be considered if cough or angioedema occurs with an ACE inhibitor. Dual ACE inhibitor and ARB therapy is generally avoided due to higher risks without added benefit for most patients.

Fixed-dose combinations with a thiazide diuretic can improve blood pressure control when monotherapy is not enough. Some patients also use calcium channel blockers alongside a renin–angiotensin agent to achieve targets with fewer side effects than higher single-drug doses.

Combination Therapy

• Thiazide diuretics (e.g., hydrochlorothiazide) are commonly paired to enhance blood pressure lowering. Starting doses of both drugs may need adjustment to avoid symptomatic hypotension.
• Calcium channel blockers can be added when additional control is needed without raising the risk of high potassium.
• Beta-blockers, loop diuretics, and mineralocorticoid receptor antagonists (e.g., Spironolactone) are often used with ACE inhibitors in heart failure. Monitor potassium and kidney function closely when combining with potassium-sparing agents.
• Avoid dual renin–angiotensin blockade (ACE inhibitor + ARB or aliskiren) due to higher risk of kidney injury, hyperkalemia, and hypotension.
• Allow a 36-hour washout when switching between an ACE inhibitor and sacubitril/valsartan to reduce angioedema risk.

Patient Suitability and Cost-Saving Tips

Adults with primary hypertension, those with heart failure with reduced ejection fraction, or those with asymptomatic left ventricular dysfunction may be candidates. Enalapril is also used in pediatric hypertension under specialist guidance. It may help protect kidneys in patients with proteinuric kidney disease under a clinician’s care.

Do not use during pregnancy, and stop immediately if pregnancy occurs. A history of angioedema with ACE inhibitors, bilateral renal artery stenosis, or severe hyperkalemia makes use inappropriate. Extra caution is needed with advanced kidney disease, dehydration, low sodium, or concurrent NSAIDs. People of African ancestry may have a higher angioedema risk.

To reduce overall costs, consider multi-month quantities when appropriate, compare strengths to match prescribed daily totals efficiently, and align refills to consolidate shipments. Generic enalapril provides strong value, and timely reorders help prevent last-minute purchases.

Authoritative Sources

FDA Prescribing Information: Enalapril (Vasotec, enalapril maleate)

Health Canada Drug Product Database: Enalapril

DailyMed listings for Enalapril maleate

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This page is for educational purposes and does not replace advice from a licensed healthcare professional. Always discuss individual questions with a qualified clinician or pharmacist.