Enalapril Maleate

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Mar 09, 2023

Warnings

Enalapril (Vasotec) Risks, Warnings, and Complications

Enalapril can cause serious problems in some people. Talk to your doctor or pharmacist about taking some other blood pressure medicine if you are at increased risk of complications from enalapril use.

BIRTH DEFECTS: If a pregnant woman takes enalapril, it can harm the unborn baby and cause birth defects. Tell your doctor if you’re pregnant before starting enalapril. Stop taking enalapril and call your doctor if you become pregnant while on this medicine. Women of childbearing age should use appropriate birth control during treatment with enalapril.
ANGIOEDEMA: Patients receiving enalapril or other ACE inhibitors can develop sudden swelling of the face, eyes, lips, tongue, throat, or other parts of the body (this is called angioedema). Seek immediate medical attention if this happens because the swelling can cause difficulty breathing. African-Americans are at greater risk of this happening.
WORSENING KIDNEY OR LIVER FUNCTION: Rarely, enalapril can lead to increased serum creatinine, worsening kidney function, and kidney failure. The risk is greater in people with pre-existing renal insufficiency or compromised renal function. Enalapril can also cause blockage of the bile duct, jaundice, and liver failure. Your doctor will order blood tests before starting you on enalapril. They will monitor renal function periodically thereafter. Tell your doctor right away if you develop urinary difficulties (little or no urination) or yellowing of the skin while on this medicine.
DRY COUGH: Patients receiving ACE inhibitors like enalapril can develop minor throat irritation and a dry cough. This is more likely to happen in the first few months of starting enalapril. The cough usually goes away a few weeks after stopping the medicine. Tell your doctor if the cough is bothersome - they may recommend another blood pressure medicine.
HIGH POTASSIUM: Enalapril affects the renin angiotensin aldosterone system in the body and can lead to increased potassium levels, which can cause serious health complications. Risk factors include kidney problems, diabetes, and taking other medications that also increase potassium (for example, salt substitutes, potassium supplements, and potassium sparing diuretics). Tell your doctor right away if you develop irregular heartbeats, chest pain, muscle weakness, nausea, or vomiting.
ORTHOSTATIC HYPOTENSION: Enalapril can lower a patient’s blood pressure and cause dizziness, lightheadedness, and fainting. Get up slowly from a sitting or lying position to prevent falls. Risk factors include heart failure, dialysis, and taking other blood pressure medications, for example, concomitant diuretic therapy.

Precautions Before Starting Enalapril (Vasotec)

Tell your doctor if you are allergic to enalapril; any of the active or inactive ingredients in enalapril formulations; other ACE inhibitors such as captopril (Capoten), lisinopril (in Prinzide, in Zestoretic), fosinopril (Monopril), benazepril (Lotensin, in Lotrel), moexipril (Univasc, in Uniretic), ramipril (Altace), quinapril (Accupril, in Quinaretic, in Accuretic), perindopril (Aceon), and trandolapril (Mavik, in Tarka); or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, vitamins, supplements, and herbal products. This can help avoid possible drug interactions.

Give your doctor a complete medical history. Enalapril may not be right for people with certain medical conditions such as heart disease, kidney disease, liver disease, diabetes, lupus, scleroderma, collagen vascular disease, and angioedema.

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding.

Precautions During Use of Enalapril (Vasotec)

Keep all your medical appointments while on enalapril. Your doctor may adjust your dose based on your response to the medicine. They may order certain laboratory tests during treatment with this medicine to keep an eye on kidney or liver function.

Enalapril can cause low blood pressure and make you lightheaded and dizzy, especially when arising from a sitting or lying position. Get up slowly to lower your risk of falls.

Do not take potassium salt substitutes while on enalapril without talking to your doctor. This can lead to electrolyte imbalance and serious health complications.

Drink enough fluids during enalapril therapy. Diarrhea, vomiting, sweating too much, and not drinking enough fluids can lead to dehydration, which can cause low blood pressure, dizziness, and lightheadedness.

Call your doctor if you develop urinary problems such as little or no urination while on this medicine. This could be a sign of renal impairment or acute renal failure.

Tell your doctor if you become pregnant while on enalapril.

Tell all your healthcare providers you are on enalapril before any surgery, including dental procedures.

Enalapril (Vasotec) Drug Interactions

Certain other drugs can affect how enalapril works. Possible interactions between enalapril and other medicines can increase the risk of severe adverse effects. The following medications can have possible interactions with enalapril:

A heart medicine called sacubitril (do not take enalapril within 36 hours of taking sacubitril/valsartan)
Your doctor will advise you not to take this medicine if you have diabetes and you are also taking aliskiren (Tekturna, in Amturnide, in Tekamlo, in Tekturna HCT).
Nonsteroidal anti-inflammatory drugs
Potassium supplements
Diuretic therapy (water pills)
Lithium

The above list may not describe all the medications that can have potentially dangerous interactions with enalapril. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, OTC medications, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

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