Enalapril side effects, dosage, interactions
September 6 2016 by
Ray Sahelian, M.D.


Enalapril is an ACE inhibitor used alone or in combination with other medications to treat high blood pressure. Enalapril is also used in combination with other medications to treat heart failure. Enalapril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. It works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart can pump blood more efficiently.

Enalapril Side Effect

Enalapril may cause side effects. Some of these side effects include: cough, dizziness, rash,  and weakness. Some enalapril side effects can be serious. These serious enalapril side effects are: swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs, difficulty breathing or swallowing, fever, sore throat, chills, and other signs of infection, dizziness of fainting.


West Indian Medical Journal. 2014. Potentiation of Endocrine Adverse Effects of Lithium by Enalapril and Verapamil. Lithium, which is widely used in the management of patients with bipolar disorder, may alter the function of some endocrine organs, particularly the thyroid and parathyroid glands, as well as it may reduce the sensitivity of the kidneys to vasopressin. In most lithium-treated patients, endocrine abnormalities are limited to one endocrine organ and are observed only after long-term lithium therapy. The patient reported in this study developed hypothyroidism, hyperparathyroidism and nephrogenic diabetes insipidus. However, the last two disorders were induced by a small increase in plasma lithium levels as a result of the treatment with enalapril and verapamil. This case shows that patients at high risk of thyroid, parathyroid or renal disorders receiving lithium should not be treated with drugs known to interfere with plasma lithium levels.


Enalapril comes as a tablet to take by mouth. It is usually taken once or twice a day with or without food.


Enalapril for hypertension
Enalapril controls high blood pressure and heart failure but does not cure them.


Clin Drug Investig. 2013. Randomized trial of perindopril, enalapril, losartan and telmisartan in overweight or obese patients with hypertension. Obesity exacerbates hypertension and stimulates the renin-angiotensin-aldosterone system (RAAS). Full-dose RAAS inhibition could be a therapeutic option in overweight or obese patients with hypertension. This study compared four RAAS inhibitors at full therapeutic doses to determine their effect on blood pressure (BP) and cardiovascular risk factors in these patients. We conducted a 24-week, single-blind, randomized, parallel-group study in 120 overweight or obese patients (body mass index ≥27 kg/m(2)) with hypertension, aged 18-60 years. The primary endpoint was the change in mean 24-h systolic BP and diastolic BP from baseline to study end. Central BP, arterial stiffness, and metabolic and cardiac indices were also investigated. Patients were randomly allocated to perindopril 10 mg/day, enalapril 20 mg/day, losartan 100 mg/day or telmisartan 80 mg/day.  Full-dose RAAS inhibition, particularly with perindopril, effectively reduces BP, improves arterial structure and regulates cardiovascular risk factors in overweight or obese patients with hypertension.



Enalapril after Cardiac Surgery

Treatment with ACE inhibitors interferes with red blood cell formation and increases the risk of prolonged episodes of anemia after heart surgery. A study of 42 men with anemia after cardiac surgery was conducted at Istituto Maria Nascente Fondazione Don Carlo Gnocchi in Milan by Dr. Vittorino Ripamonti and colleagues. Approximately nine days after surgery, patients were randomized to enalapril maleate or not. All patients received ferrous sulfate 325 mg plus standard post-cardiac surgical therapy, including beta-blockers and antiplatelet drugs if coronary artery disease was the setting, or diuretics and anticoagulants if it was valvular disease. At 16 days, patients receiving enalapril had peak hemoglobin levels 1 g/dL lower and red blood cell counts 444 RBCs/mL lower than patients not receiving the ACE inhibitor. By 60 days after randomization, hemoglobin and RBC counts were moving toward normal in both groups, but remained lower in those on enalapril. "In the postoperative period, when a prompt erythropoietic response is crucial, the positive actions of (ACE inhibitors) may be counterbalanced by persistent anemia, thus leading to a slower functional recovery," Dr. Ripamonti and colleagues conclude. Chest 2006.