Drug Class: ACE inhibitors with thiazides
Usual Adult Dose for Hypertension
Enalapril 5 to 10 mg-Hydrochlorothiazide 12.5 to 25 mg orally once a day
Maximum dose: Enalapril 20 mg-Hydrochlorothiazide 50 mg per day
Comments: Hydrochlorothiazide may be increased after 2 to 3 weeks.
Use: Treatment of hypertension only after failure to achieve the desired effect with monotherapy or the titrated components.
Renal Dose Adjustments
Mild to moderate renal dysfunction (CrCl 30 mL/min or greater): No adjustment recommended
Severe renal dysfunction (CrCl less than 30 mL/min): Not recommended
Liver Dose Adjustments
Use with caution
Precautions
US BOXED WARNING:
- FETAL TOXICITY: If pregnancy is detected, discontinue this drug as soon as possible. Drugs that act directly on the renin-angiotensin system (RAS) can cause injury and death to the developing fetus.
Safety and efficacy have not been established in patients younger than 18 years.
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
Other Comments
Monitoring:
- Monitor serum electrolytes periodically.
- Monitor renal function during the first few weeks of therapy.
- Consider monitoring white blood cell counts periodically in patients with collagen vascular disease, especially if the disease is associated with impaired renal function.
Patient advice:
- Advise patients to immediately report any signs or symptoms of angioedema (breathing difficulty or swelling of face, eyes, lips, or tongue) and to stop taking this drug until consulting a physician.
- Encourage patients to report any lightheadedness that may occur during treatment initiation and to stop taking this drug until consulting a physician.
- Caution patients to consult their physician if excessive perspiration, dehydration, vomiting, or diarrhea occurs as it may lead to excessive blood pressure reduction due to reduced fluid volume.
- Advise patients against using potassium-sparing diuretics, potassium supplements or potassium-containing salt substitutes without consulting their physician.
- Tell patients to promptly report any sign of infection (e.g., sore throat, fever), which may be a sign of neutropenia.
- Females of childbearing age should be informed of the consequences of exposure to this drug during pregnancy; ask these patients to report pregnancies as soon as possible.
