Vasotec (enalapril maleate) is an angiotensin-converting enzyme (ACE) inhibitor prescribed for the management of hypertension, heart failure, and certain kidney conditions. As a cornerstone therapy in cardiovascular medicine, it works by relaxing blood vessels to improve blood flow and reduce cardiac workload. This medication represents a well-established option with decades of clinical evidence supporting its efficacy and safety profile when used under proper medical supervision.

Features

• Active ingredient: enalapril maleate
• Available in tablet formulations: 2.5 mg, 5 mg, 10 mg, and 20 mg strengths
• Mechanism: inhibits angiotensin-converting enzyme (ACE)
• Bioavailability: approximately 60% following oral administration
• Half-life: 11 hours for enalaprilat (active metabolite)
• Excretion: primarily renal
• Pregnancy category: D (contraindicated in second and third trimesters)

Benefits

• Effectively lowers high blood pressure to reduce stroke and heart attack risk
• Improves survival rates in patients with congestive heart failure
• Slows progression of kidney disease in diabetic patients
• Reduces cardiac workload and oxygen demand
• May decrease hospitalizations for heart failure exacerbations
• Provides 24-hour blood pressure control with once or twice daily dosing

Common use

Vasotec is primarily indicated for the treatment of hypertension, either as monotherapy or in combination with other antihypertensive agents. It is also FDA-approved for symptomatic heart failure, often used alongside diuretics and digitalis. Additionally, physicians may prescribe Vasotec for diabetic nephropathy to slow the progression of renal impairment. Off-label uses include management of left ventricular dysfunction following myocardial infarction and certain forms of scleroderma renal crisis.

Dosage and direction

For hypertension: Initial dose typically ranges from 5 mg once daily, adjustable to maintenance dose of 10-40 mg daily in single or divided doses. For heart failure: Starting dose is usually 2.5 mg once daily, gradually titrated upward as tolerated to target dose of 10-20 mg twice daily. Dosage adjustment required for patients with renal impairment: CrCl <30 mL/min typically starts with 2.5 mg daily. Tablets should be swallowed whole with water, with or without food, though consistency in administration relative to meals is recommended. Blood pressure monitoring during dosage titration is essential.

Precautions

Monitor renal function and electrolytes periodically, particularly during initial therapy. Assess for hypotension, especially in volume-depleted patients or those taking diuretics. Regular monitoring of white blood cell counts recommended in patients with collagen vascular disease or renal impairment. Caution advised in patients with renal artery stenosis, as acute renal failure may occur. Avoid rapid dosage escalation in elderly patients. Angioedema may occur at any time during treatment, requiring immediate discontinuation. Patients should report persistent dry cough, as this may necessitate therapy modification.

Contraindications

History of angioedema related to previous ACE inhibitor treatment. Hypersensitivity to enalapril or any component of the formulation. Concomitant use with aliskiren in patients with diabetes. Pregnancy, particularly second and third trimesters, due to risk of fetal injury and death. Bilateral renal artery stenosis. Patients with hereditary or idiopathic angioedema.

Possible side effect

Common: dizziness (2-8%), headache (2-5%), fatigue (2-3%), cough (1-2%), nausea (1-2%). Less frequent: orthostatic hypotension, hyperkalemia, rash, impaired renal function, taste disturbance. Rare but serious: angioedema, neutropenia/agranulocytosis, hepatotoxicity, Stevens-Johnson syndrome. Most side effects are dose-dependent and often diminish with continued therapy. Cough typically resolves within 1-4 weeks after discontinuation.

Drug interaction

Potassium supplements or potassium-sparing diuretics: increased risk of hyperkalemia. Diuretics: enhanced hypotensive effect, especially with recent diuretic therapy initiation. NSAIDs: may reduce antihypertensive effect and increase renal impairment risk. Lithium: increased lithium levels and toxicity risk. Oral hypoglycemics: enhanced hypoglycemic effect. Gold injections: nitritoid reactions reported. Dual blockade of RAS with ARBs or aliskiren: increased adverse events.

Missed dose

If a dose is missed, take it as soon as remembered unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed one. Maintain regular dosing schedule to ensure consistent blood pressure control. If multiple doses are missed, contact healthcare provider for guidance on resumption of therapy.

Overdose

Symptoms primarily include marked hypotension, which may progress to shock. Bradycardia, electrolyte disturbances, and renal failure may occur. Management involves supportive care with volume expansion with normal saline. Vasopressors may be required for profound hypotension. Enalaprilat is not significantly removed by hemodialysis. Patients should seek immediate medical attention if overdose is suspected.

Storage

Store at controlled room temperature (20-25°C or 68-77°F). Protect from moisture and light. Keep container tightly closed. Do not store in bathroom medicine cabinet due to humidity fluctuations. Keep out of reach of children and pets. Properly discard expired medication or unused portions according to FDA-recommended disposal methods.

Disclaimer

This information does not replace professional medical advice. Vasotec requires a prescription and should be used only under appropriate medical supervision. Dosage and administration must be determined by a qualified healthcare provider based on individual patient characteristics. Patients should not initiate, discontinue, or modify therapy without consulting their physician. Report any adverse effects or concerns to healthcare provider promptly.

Reviews

Clinical studies demonstrate Vasotec’s efficacy with 60-70% of hypertensive patients achieving blood pressure control. Meta-analyses show 20% reduction in mortality in heart failure patients. Long-term users report consistent blood pressure management with established safety profile. Some patients note cough as a limiting factor, while others appreciate the once-daily convenience. Physician surveys indicate high satisfaction with its predictable pharmacokinetics and well-characterized drug interaction profile.