Enalapril Maleate / Hydrochlorothiazide

Pronunciation: (EH-NAL-uh-prill MAL-ee-ate/high-droe-klor-oh-THIGH-uh-zide)Class: Antihypertensive combination

Trade Names:Vaseretic 5-12.5- Tablets 12.5 mg hydrochlorothiazide, 5 mg enalapril maleate

Trade Names:Vaseretic 10-25- Tablets 25 mg hydrochlorothiazide, 10 mg enalapril maleate

Vaseretic (Canada)

Pharmacology

Enalapril causes vasodilation and decreased BP; hydrochlorothiazide causes loss of body water and increases urine output.

Indications and Usage

Treatment of hypertension.

Contraindications

Hypersensitivity to any component or to other sulfonamide-derived drugs; history of angioedema related to previous treatment with ACE inhibitor; anuria.

Dosage and Administration

Adults

PO 1 to 2 tablets (each containing 10 mg enalapril maleate and 25 mg hydrochlorothiazide) per day.

Storage/Stability

Store at room temperature in sealed container.

Drug Interactions

Cholestyramine and colestipol resins

May bind to hydrochlorothiazide and decrease its bioavailability.

Diazoxide

Hyperglycemia may occur.

Digitalis glycosides

Arrhythmias may occur.

Indomethacin

Hypotensive effects may be reduced.

Lithium

Toxicity risk is greater; avoid use.

Loop diuretics

Synergistic effects may cause profound diuresis and electrolyte abnormalities.

Potassium preparations, potassium-sparing diuretics

May increase serum potassium levels.

Sulfonylureas

May require dose adjustment.

Laboratory Test Interactions

PBI levels may be decreased without signs of thyroid disturbances; diagnostic interference with serum electrolyte levels, blood and urinary glucose levels, serum bilirubin levels and serum uric acid levels.

Adverse Reactions

Cardiovascular

Hypotension; orthostatic effects; palpitations; tachycardia; chest pain.

CNS

Dizziness; headache; insomnia; nervousness; paresthesia; somnolence; vertigo; syncope.

Dermatologic

Rash, pruritus.

EENT

Tinnitus; dry mouth.

GI

Nausea; diarrhea; abdominal pain; vomiting; dyspepsia; constipation; flatulence.

Genitourinary

Impotence; decreased libido; urinary tract infections.

Hematologic

Neutropenia; agranulocytosis.

Metabolic

Hyperkalemia; hyponatremia; hypercalcemia; hypochloremic alkalosis; hypokalemia; gout; hypomagnesemia; hyperglycemia; increased triglyceride and cholesterol levels.

Respiratory

Chronic cough; dyspnea.

Miscellaneous

Angioedema; fatigue; weakness; muscle cramps; back pain; sweating.

Precautions

Warnings 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, discontinue therapy as soon as possible.

Pregnancy

Category D (second, third trimester); Category C (first trimester).

Lactation

Excreted in breast milk.

Children

Safety and efficacy not established.

Renal Function

Use drug with caution in patients with renal disease and monitor renal function periodically; may precipitate azotemia; may alter renal function in susceptible individuals (including those with severe CHF). Use drug with caution in patients with impaired hepatic function or progressive liver disease, because changes in fluid and electrolyte balance can precipitate hepatic coma.

Angioedema

Angioedema of face, extremities, lips, tongue, glottis, or larynx has been reported in patients treated with enalapril. Discontinue drug.

Bone marrow depression

Other ACE inhibitors have caused bone marrow depression, particularly in patients with renal function impairment and collagen vascular disease. Monitor hematopoietic system.

Diabetes

Monitor closely, because adjustments may be needed in hypoglycemic agents.

Systemic lupus erythematosus

May be activated or exacerbated.

Overdosage

Symptoms

Hypotension, orthostatic hypotension, dizziness, drowsiness, syncope, electrolyte abnormalities, hemoconcentration, confusion, muscular weakness, nausea, vomiting, depressed respiration, lethargy, coma.

Patient Information

• Advise patient to take with food or milk if nausea occurs.
• Caution patient that medication increases urination and to take as early in day as possible.
• Advise patient that lethargy may be experienced until body adjusts.
• Caution patient to take missed dose as soon as possible but not to take missed dose with next dose. If 1 or more doses are missed, tell patient to contact health care provider.
• Advise patient not to use salt substitutes unless approved by health care provider.
• Instruct patient to report these symptoms to health care provider: weakness, muscle cramps, dizziness, nausea, neck or facial swelling, faintness on standing, sore throat or dry, persistent cough.

Copyright © 2009 Wolters Kluwer Health.