Enalapril – Use | Dose | Side Effects

Enalapril belongs to the group of medicines called ACE inhibitors (angiotensin converting enzyme inhibitors). It works by blocking the angiotensin converting enzyme and prevents the formation of angiotensin II. Angiotensin II is a substance that narrows the blood vessels (vasoconstriction) and therefore increases the blood pressure. Therefore, blocking formation of angitensin II, enalapril reduces high blood pressure.

This medicine is one of the most commonly used in the treatment of:

  • High blood pressure (hypertension)
  • Heart failure (heart failure)


It cannot be used in the following conditions:

  • If you are allergic to enalapril or other similar medications. Symptoms of allergy are:
    • skin rash,
    • itching of the skin,
    • redness of the skin,
    • swelling of the face,
    • swelling of the tongue,
    • difficulty breathing.
  • If you have or have had angioedema (swelling of the blood vessels)
  • Pregnant or breast-feeding

It should be used only with great caution in the following situations:

  • If you have liver or kidney disorders
  • If you have high potassium levels in the blood (hyperkalemia)

Use during pregnancy and breast feeding

According to the FDA, enalapril belongs to the group D (FDA: Group D). This means that studies has shown that this drug is harmful to the fetus and cannot be used during pregnancy!

Enalapril passes into breast milk and may harm your baby. Avoid breast-feeding while using this drug.

Enalapril dosage

It is usually applied at an initial dose of Enalapril 5 mg. The dose should be determined individually for each patient. At the beginning of the treatment, doctor will recommend you lower doses, and then gradually increase the dose until the suitable dose is achieved. The dose can be increased to a maximum of 20 mg per day.


It should be taken once a day, with or without meal.

When you start using this medicine, it can suddenly lower your blood pressure, especially if you prior already used some other medicines called diuretics (e.g. furosemide (Lasix), spironolactone, hydrochlorothiazide and others).

It is very important to use as long as your doctor recommended, even if you feel better. High blood pressure usually gives no symptoms and you may feel good, but high blood pressure is still a big danger for your health and can lead to the heart attack and stroke.

Enalapril medication should not be used in combination with alcoholic beverages.

In patients with liver or kidney damage and elderly patients, the dose should be adjusted.

Use with other medications (Interactions)

It cannot be used in combination with the following medications:

  • Potassium. Enalapril increases potassium levels in the blood and the concomitant use of potassium with enalapril can lead to a dangerous arrhythmias (irregular heart beat).
  • Potassium sparing diuretics such as:
    • spironolactone,
    • triamterene,
    • amiloride. These diuretics can increase the potassium level in the blood as same as enalapril, which can lead to a dangerous increase of potassium levels in the blood.
  • Lithium, used to treat depression. Enalapril may increase the concentration of lithium in the blood and increase the risk of lithium side effects.
  • Non-steroidal anti-inflammatory medications such as:
    • diclofenac (Diklofen),
    • ibuprofen (Brufen),
    • meloxicam (Movalis),
    • acetylsalicylic acid used to treat pain (Aspirin, Andol),
    • celecoxib,
    • rofecoxib,
    • ketoprofen and others. These medicines also increase the potassium level in the blood, and cannot be used in combination with enalapril.
  • Tricyclic antidepressants such as:
    • imipramine,
    • desipramine,
    • amitriptyline,
    • nortriptyline and others. These medicines enhance the effect of enalapril.
  • Gold, used to treat rheumatic disorders.
  • Medications used to treat diabetes mellitus. Enalapril can increase the effect of these medicines and cause hypoglycemia (low blood sugar).

ACE inhibitors can be safely used with acetyl salicylic acid (Asprin, Andol) just in a Enalapril dose of 100 mg used to treat heart disorders.

ACE inhibitors are often combined with beta-blockers and diuretics such as hydrochlorothiazide, furosemide, and others.

Tell your doctor about all medications and herbal medicines you are taking.

Enalapril side effects

It can cause high potassium level in the blood that is manifested with symptoms such as:

  1. tingling,
  2. slow heart rate,
  3. muscle weakness. If you notice these symptoms, contact your doctor immediately.

Often, it can cause cough (usually dry cough). If your cough persists, consult your doctor.

It can rarely cause anemia.

Enalapril can also cause the following side effects:

  1. redness,
  2. headache,
  3. dizziness,
  4. arrhythmia,
  5. tachycardia (rapid heartbeat),
  6. low blood pressure (hypotension),
  7. chest pain,
  8. dizziness,
  9. mood changes,
  10. nausea,
  11. vomiting,
  12. diarrhea,
  13. abdominal pain,
  14. kidney damage,
  15. allergy and others.


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