Enalapril

  1. About enalapril

    Enalapril is a medicine used to reduce high blood pressure and to prevent or treat heart failure.

    If you have high blood pressure, taking enalapril will help prevent a future heart attack or stroke

    This medicine is only available on prescription. It comes as tablets. It also comes as a liquid for people who find it hard to swallow tablets but your pharmacist will have to order this for you.

    Enalapril is also available mixed with another blood pressure medicine called hydrocholorothiazide.

  2. Key facts

    • Enalapril lowers your blood pressure and makes it easier for your heart to pump blood around your body.
    • Your first dose of enalapril may make you feel dizzy, so it's best to take it at bedtime. After that, if you don't feel dizzy, you can take it at any time of day.
    • Some people get a dry, irritating cough with enalapril.
    • Drinking alcohol with enalapril can make you feel dizzy or light-headed.
    • Enalapril is also called by the brand name Innovace. When it's mixed with hydrochlorothiazide, its brand name is Innozide.
  3. Who can and can't take enalapril

    Enalapril can be taken by adults and children.

    If you have diabetes, check your blood sugar (glucose) more often, particularly in the first few weeks. This is because enalapril can lower the sugar level in your blood.

    Enalapril isn't suitable for everyone.

    To make sure it is safe for you, tell your doctor or other health professional if you:

    • have had an allergic reaction to enalapril or any other medicine in the past
    • are trying to get pregnant, are already pregnant, or you're breastfeeding
    • are having dialysis or any other type of blood filtration
    • have heart, liver or kidney problems
    • have unstable or low blood pressure
    • have diabetes  
    • have recently had diarrhoea or vomiting
    • are on a low-salt diet
    • are going to have desensitisation treatment to reduce your allergy to insect stings
    • are going to have a major operation or a general anaesthetic to put you to sleep
    • have a blood problem such as too few white blood cells (neutropenia or agranulocytosis)
  4. How and when to take it

    It's usual to take enalapril once or twice a day.

    Your doctor may advise you to take your first dose before bedtime, because it can make you dizzy. After the first dose, if you do not feel dizzy, you can take enalapril at any time of day. Try to take it at the same time every day.

    If you have enalapril twice a day, try to take it once in the morning and once in the evening. Leave 10 to 12 hours between doses if you can.

    How much will I take?

    The dose of enalapril you take depends on why you need the medicine. Take it as your doctor tells you to.

    To decide the correct dose for you, your doctor will check your blood pressure and ask you if you are getting any side effects. You may also have blood tests to check how well your kidneys are working and the amount of potassium in your blood. 

    Depending on why you're taking enalapril, the usual starting dose is between 2.5mg and 20mg once a day.

    This will be increased gradually over a few weeks to a usual dose of:

    • 20mg once a day for high blood pressure
    • 10mg once a day or 20mg once a day for heart failure

    The maximum dose is 20mg twice a day.

    Doses are usually lower for children or people with kidney problems.

    How to take it

    You can take enalapril with or without food. Swallow the tablets whole with a drink.

    If you're taking enalapril as a liquid, it will come with a plastic syringe or spoon to help you measure out the right dose. If you don't have one, ask your pharmacist for one. Don't use a kitchen teaspoon as it won't give you the right amount of medicine.

    Will my dose go up or down?

    You will probably be prescribed a low dose of enalapril at first so it doesn't make you feel dizzy. This will usually be increased gradually until you reach the right dose for you. If you're bothered by side effects with enalapril you can stay on a lower dose.

    Take enalapril even if you feel well, as you will still be getting the benefits of the medicine.

    What if I get ill while I'm taking it?

    If you get severe diarrhoea or vomiting for any reason, stop taking enalapril. When you're able to eat and drink normally, wait for 24 to 48 hours, then start to take it again.

    If you have questions about this, contact your doctor or pharmacist.

    What if I forget to take it?

    If you miss a dose of enalapril, leave out that dose and take your next dose at the usual time. Do not take a double dose to make up for the forgotten dose.

    If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember your medicine.

    What if I take too much?

    If you take too many enalapril tablets, contact your doctor or nearest hospital straight away. An overdose of enalapril can cause dizziness, sleepiness and a pounding heartbeat.

    The amount of enalapril that can lead to an overdose varies from person to person.

    If you take too much enalapril by accident, call your doctor or go to your nearest hospital straight away.

    If you need to go to hospital, don't drive yourself – get someone else to drive you or call for an ambulance. Take the enalapril packet or leaflet inside it plus any remaining medicine with you.

  5. Side effects

    Like all medicines, enalapril can cause side effects in some people, but many people have no side effects or only minor ones. 

    Side effects often get better as your body gets used to the medicine.

    Common side effects

    These common side effects happen in more than 1 in 100 people. They are usually mild and short-lived.

    Talk to your doctor or pharmacist if these side effects bother you or don't go away:

    • dry, tickly cough that does not go away
    • feeling dizzy or light headed, especially when you stand up or sit up quickly. This is more likely to happen when you start taking enalapril or move onto a higher dose
    • headache
    • diarrhoea 
    • mild skin rash
    • blurred vision

    Serious side effects

    Some people have serious side effects after taking enalapril.

    Tell a doctor straight away if you get:

    • weak arms and legs or problems speaking  it's important to check these out in case they are signs of a stroke
    • yellow skin or eyes – this could be a sign of liver problems
    • paleness, feeling tired, faint or dizzy, any sign of bleeding (like bleeding from the gums or bruising more easily), sore throat and fever and getting infections more easily  these could be signs of a blood or bone marrow disorder
    • a faster or irregular heart rate, chest pain and tightness in your chest  these could be signs of heart problems
    • shortness of breath, wheezing and tightening of the chest  these could be signs of lung problems
    • severe tummy pain which could reach through to your back – this could be a sign of an inflamed pancreas (pancreatitis)
    • swollen ankles, blood in your pee or not peeing at all  these could be signs of kidney problems

    Serious allergic reaction

    A serious allergic reaction is an emergency. Contact a doctor straight away if you think you or someone around you is having a serious allergic reaction.

    It is possible to have a serious allergic reaction to enalapril. The warning signs of a serious allergic reaction are:

    • getting a skin rash that may include itchy, red, swollen, blistered or peeling skin
    • wheezing
    • tightness in the chest or throat
    • having trouble breathing or talking
    • swelling of the mouth, face, lips, tongue or throat

    These are not all the side effects of enalapril. For a full list see the leaflet inside your medicines packet.You can report any suspected side effects to the UK safety scheme.

  6. How to cope with side effects

    What to do about:

    • dry, tickly cough – cough medicines don't usually help for coughs caused by enalapril. Sometimes the cough will get better on its own if you keep taking enalapril. Talk to your doctor if it carries on, bothers you or stops you from sleeping. Another medicine may suit you better. If your doctor recommends that you stop taking enalapril, the cough may take a few days to a month to go away.
    • feeling dizzy – if enalapril makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you don't faint, then sit until you feel better. Don't drive or use tools or machines while you're feeling dizzy or shaky.
    • headaches – make sure you rest and drink plenty of fluids. Don't drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if the headaches last longer than a week or are severe.
    • diarrhoea  it may help to take oral rehydration solutions. You can buy these from a pharmacy or supermarket to prevent dehydration. Don't take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor. 
    • itching or a mild rash – it may help to take an antihistamine which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you.
    • blurred vision  avoid driving or using tools or machines while this is happening. If it lasts for more than a day or two speak to your doctor as they may need to change your treatment.
  7. Pregnancy and breastfeeding

    Enalapril is not normally recommended in pregnancy. However, your doctor may prescribe it if they think the benefits of the medicine outweigh the risks.

    If you're trying to get pregnant or you're already pregnant, talk to your doctor about the benefits and possible harms of taking enalapril. These will depend on how many weeks pregnant you are and the reason you need to take it. There may be other treatments that are safer for you.

    Enalapril and breastfeeding

    Small amounts of enalapril may get into breast milk. This can cause low blood pressure in the baby.

    • If your baby was born full term and healthy, it's generally safe to take enalapril while you're breastfeeding.
    • If your baby was premature, has a low birth weight or other health problems, talk to your doctor.

    Your baby's blood pressure may be monitored, especially if your baby was premature or is newborn.

    Talk to your doctor, as another medicine might be better while you're breastfeeding.

    Tell your doctor if you're trying to get pregnant, are already pregnant or if you're breastfeeding.

  8. Cautions with other medicines

    There are some medicines that may interfere with the way enalapril works.

    Tell your doctor if you're taking:

    • anti-inflammatory medicines such as ibuprofen, indomethacin or a high dose of aspirin for pain relief. A daily low dose of aspirin  75mg  is safe to take with enalapril
    • medicines to treat low blood pressure, heart failure, asthma or allergies, such as ephedrine, noradrenaline or adrenaline
    • medicines to treat high blood pressure, such as aliskeren
    • other medicines which can lower your blood pressure such as some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), anaesthetics or medicines for an enlarged prostate gland
    • medicines to damp down the body's immune system such as ciclosporin or tacrolimus 
    • water tablets such as furosemide
    • medicines which can increase the amount of potassium in your blood such as spironolactone, triamterene, amiloride, potassium supplements, trimethoprim (for infections) and heparin (for thinning blood) 
    • steroid medicines such as prednisolone
    • allopurinol (for gout)
    • procainamide (for heartbeat problems)
    • medicines for diabetes
    • racecadotril (for diarrhoea)
    • lithium (for mental health problems)

    Mixing enalapril with herbal remedies or supplements

    There's very little information about taking herbal remedies and supplements with enalapril.

    For safety, speak to your pharmacist or doctor before taking any herbal or alternative remedies with enalapril.

    Tell your doctor or pharmacist if you are taking any other medicines, including herbal medicines and supplements.

  9. Common questions

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