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Enalapril (Enalapril Maleate) - Summary



When used in pregnancy during the second and third trimesters, ACE inhibitors can cause injury and even death to the developing fetus. When pregnancy is detected, enalapril maleate should be discontinued as soon as possible. SeeĀ  WARNINGS, Fetal / Neonatal Morbidity and Mortality .



Enalapril maleate is the maleate salt of enalapril, the ethyl ester of a long-acting angiotensin converting enzyme inhibitor, enalaprilat.


Enalapril maleate is indicated for the treatment of hypertension.

Enalapril maleate is effective alone or in combination with other antihypertensive agents, especially thiazide-type diuretics. The blood pressure lowering effects of enalapril maleate and thiazides are approximately additive.

Heart Failure

Enalapril maleate is indicated for the treatment of symptomatic congestive heart failure, usually in combination with diuretics and digitalis. In these patients enalapril maleate improves symptoms, increases survival, and decreases the frequency of hospitalization (see CLINICAL PHARMACOLOGY, Heart Failure, Mortality Trials for details and limitations of survival trials).

Asymptomatic Left Ventricular Dysfunction

In clinically stable asymptomatic patients with left ventricular dysfunction (ejection fraction ?35 percent), enalapril maleate decreases the rate of development of overt heart failure and decreases the incidence of hospitalization for heart failure. (See CLINICAL PHARMACOLOGY, Heart Failure, Mortality Trials for details and limitations of survival trials.)

In using enalapril maleate, consideration should be given to the fact that another angiotensin converting enzyme inhibitor, captopril, has caused agranulocytosis, particularly in patients with renal impairment or collagen vascular disease, and that available data are insufficient to show that enalapril maleate does not have a similar risk. (See WARNINGS.)

In considering use of enalapril maleate, it should be noted that in controlled clinical trials ACE inhibitors have an effect on blood pressure that is less in black patients than in non-blacks. In addition, it should be noted that black patients receiving ACE inhibitors have been reported to have a higher incidence of angioedema compared to non-blacks. (See WARNINGS, Head and Neck Angioedema.)

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Published Studies Related to Enalapril

Prevention of chemotherapy-induced left ventricular dysfunction with enalapril and carvedilol: rationale and design of the OVERCOME trial. [2011.08]
BACKGROUND: The current treatment of hematologic malignancies includes diverse potentially cardiotoxic chemotherapy agents, including high-dose myeloablative regimens used in autologous hematopoietic stem cell transplantation (HSCT). Many of these treatments could induce left ventricular dysfunction (LVD), and limit their efficacy. Angiotensin-converting enzime inhibitors and beta-blockers prevent LVD and prolong survival after infarction, and recent animal and pilot clinical studies suggest that they can prevent the development of chemotherapy-induced cardiac toxicity... CONCLUSIONS: The OVERCOME study will be the first clinical trial to test the preventive efficacy on LVD of combined treatment with enalapril and carvedilol administered to patients with hematologic malignancies submitted to current treatment with intensive chemotherapy. Copyright (c) 2011 Elsevier Inc. All rights reserved.

Influence of order and type of drug (bisoprolol vs. enalapril) on outcome and adverse events in patients with chronic heart failure: a post hoc analysis of the CIBIS-III trial. [2011.07]
CONCLUSION: The order of drug administration plays an important role in whether CHF patients reach target doses of bisoprolol and enalapril. For both study drugs, the dose level reached was associated with baseline characteristics and adverse events. In CHF patients not treated with an ACE-I or a beta-blocker, the duration of monotherapy with either type of drug should be shorter than 6 months.

Enalapril improves endothelial function in patients with migraine: A randomized, double-blind, placebo-controlled trial. [2011.01]
BACKGROUND: There are increasing evidences of endothelial dysfunction in migraine. The ACE-inhibitors have previously been shown to be effective in migraine prophylaxis. Furthermore, ACE inhibitors have beneficial effects on endothelial dysfunction. We therefore investigated whether Enalapril is effective in endothelial function improvement... CONCLUSIONS: These results indicate that ACE inhibition can improve endothelial function in patients with migraine, as it has been shown by both FMD and serum levels of nitric oxide. The mechanism could be either that Enalapril limits the angiotensin IIinduced production of superoxide radicals which would normally inactivate nitric oxide, or that it may increase bradykinin-mediated nitric oxide release.

Effect of combined spironolactone-beta-blocker +/- enalapril treatment on occurrence of symptomatic atrial fibrillation episodes in patients with a history of paroxysmal atrial fibrillation (SPIR-AF study). [2010.12.01]
Angiotensin II and aldosterone are key factors responsible for the structural and neurohormonal remodeling of the atria and ventricles in patients with atrial fibrillation (AF). The aim of the present study was to evaluate the antiarrhythmic effects of spironolactone compared to angiotensin-converting enzyme inhibitors in patients with recurrent AF...

Effects of telmisartan on markers of ventricular remodeling in patients with acute myocardial infarction: comparison with enalapril. [2010.11]
Enalapril is effective in the suppression of left ventricular remodeling after acute myocardial infarction (AMI), but the effect of telmisartan is unclear. The consecutive 163 AMI patients underwent primary percutaneous coronary intervention and were randomized to telmisartan (n = 82) or enalapril (n = 81)...

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Clinical Trials Related to Enalapril

Comparison of the Antihypertensive Efficacy of Valsartan and Enalapril After Missing One Dose [Completed]
This study was designed in order to evaluate the blood pressure lowering effect of valsartan compared to enalapril over 24 hours after skipping one daily dose. Both drugs act on the renin-angiotensin-aldosterone system (RAAS) and are widely use for the treatment of hypertension. Previous studies had a significant limitation: the effect of a missing dose was not evaluated after the whole 24 hours post missing dose period (48 hours after last taken dose), and as a result, it does not imitate the real life situation of a missing dose.

Effect of Enalapril Plus Folic Acid on Blood Pressure and Glycometabolism [Completed]
Combinded therapy with folic acid and enalapril may significantly decrease plasma total homocysteine level and had beneficial effect on blood pressure reduction and glycometabolism.

Efficacy and Safety of Aliskiren and Aliskiren/Enalapril Combination on Morbi-mortality in Patients With Chronic Heart Failure [Recruiting]
The study will evaluate the efficacy and safety of both aliskiren monotherapy and aliskiren/enalapril combination therapy as compared to enalapril monotherapy, on morbidity

and mortality in patients with chronic heart failure (NYHA Class II - IV.

Efficacy and Safety of Lercanidipine and Enalapril in Patients With Essential Hypertension [Recruiting]
The poupose of this study is to evaluate the efficacy and safety of various dosage combinations of lercanidipine (10 and 20 mg)and enalapril (10 and 20 mg) in comparison with their respective components and with placebo.

Drug Interaction Study of Avanafil and Enalapril or Amlodipine [Recruiting]
The purpose of this study is to determine the change in the blood pressure and pulse rate, pharmacokinetics and the safety when avanafil is taken with either enalapril or amlodipine.

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Reports of Suspected Enalapril Side Effects

Dementia (4)Drug Interaction (3)Completed Suicide (3)Renal Failure Acute (3)Intraocular Pressure Increased (2)Hypertension (2)Rhabdomyolysis (1)Intentional Overdose (1)Blood Triglycerides Increased (1)Headache (1)more >>


Based on a total of 2 ratings/reviews, Enalapril has an overall score of 5. The effectiveness score is 8 and the side effect score is 9. The scores are on ten point scale: 10 - best, 1 - worst.

Enalapril review by 55 year old male patient

Overall rating:  
Effectiveness:   Moderately Effective
Side effects:   No Side Effects
Treatment Info
Condition / reason:   high blood pressure
Dosage & duration:   10 mg X 1 p/d taken 1 p/d for the period of 5 yrs
Other conditions:   none
Other drugs taken:   dizothiazide
Reported Results
Benefits:   The treatment reulted in significantly lower blood pressure - in total a drop of over 30 points on both the upper and lower readings.
Side effects:   none
Comments:   The pharmaceutical therapy was combined with moderate excercise (eg. walking 3 miles 3-4 times a week) and life style modification such as meditation, enhanced body-mind awareness and diet changes, such as cutting eliminating red meat and cutting down on hot spices, wheat, processed grains and sugar and milk products, while significantly increasing complex carbohydrates, lentils, and dietary fiber.


Enalapril review by 26 year old female patient

Overall rating:  
Effectiveness:   Highly Effective
Side effects:   Mild Side Effects
Treatment Info
Condition / reason:   management of Congestive heart failure
Dosage & duration:   2.5mg/day taken 2 doses for the period of one month
Other conditions:   mental health and liver problems
Other drugs taken:   aspirin
Reported Results
Benefits:   slowed the progression of left ventricular dysfunction into overt heart failure alone or with other agents in the managment of hypertension mangagement of congestive heart failur
Side effects:   cough, hypotension , proteinuria, impotence , renal failure , angina pectoris , tachycardia , eosinophilic pneumonitis, tastes disturbances , anusease anorecia , weakness fatigue insominca weakness
Comments:   monitor blood pressure , weight and asses for resolution of fluid

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Page last updated: 2011-12-09

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