BLACK BOX WARNING
- fetal toxicity
enalapril
Brand: Vasotec
⚠ BBW Prototype: lisinopril
Drug Class: ACE inhibitor
Drug Family: antihypertensive
Subclass: prodrug ACE inhibitor
Organ Systems: cardiovascularrenal
Mechanism of Action
Prodrug hydrolyzed to enalaprilat, which inhibits ACE; reduces angiotensin II and aldosterone.
ACE (angiotensin-converting enzyme)
Indications
- hypertension
- heart failure
- asymptomatic LV dysfunction
Contraindications
- pregnancy
- history of ACE-inhibitor angioedema
- bilateral renal artery stenosis
Adverse Effects
Common
- dry cough
- hyperkalemia
- dizziness
Serious
- angioedema
- AKI
- teratogenicity
Pharmacokinetics (ADME)
| Absorption | 60% oral bioavailability; converted to enalaprilat in liver |
| Distribution | low CNS penetration |
| Metabolism | hepatic ester hydrolysis to enalaprilat |
| Excretion | renal |
| Half-life | 11 hours (enalaprilat) |
| Onset | 1 hour |
| Peak | 4-6 hours |
| Duration | 24 hours |
| Protein Binding | 50% |
| Vd | moderate |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| potassium-sparing diuretics | additive hyperkalemia | major |
| NSAIDs | reduced efficacy; AKI | moderate |
| lithium | reduced lithium clearance | major |
Nursing Considerations
- Monitor BP and potassium
- Available IV as enalaprilat for hypertensive urgency
- Hold for systolic BP <90 mmHg
- Monitor renal function
Clinical Pearls
- IV form (enalaprilat) used in hypertensive urgency
- Prodrug requiring hepatic activation unlike lisinopril
Safety Profile
Pregnancy contraindicated
Lactation avoid
Renal Adjustment Required
Hepatic Adjustment Required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.