EnalaprilEnalapril Maleate

About Enalapril

Enalapril is a prodrug that the body converts to enalaprilat, which blocks the enzyme that makes angiotensin II, a hormone that narrows blood vessels and makes the body retain salt and water. It is approved for high blood pressure, for symptomatic heart failure, where it improves survival and reduces hospital admissions, and for people with a weak left ventricle but no symptoms, where it slows the onset of heart failure.

A dry, persistent cough is the side effect people notice most; it clears once the drug is stopped. Blood pressure can drop too far, especially after the first dose, in people with heart failure, on high-dose diuretics or low in salt or fluid. Potassium and kidney function are checked. Swelling of the face, lips, tongue, throat or intestine (angioedema) can occur at any time during treatment, more often in Black patients, and the label also warns of rare liver injury and drops in white blood cells.

The boxed warning is about pregnancy: it can injure or kill a developing baby, so it is stopped as soon as pregnancy is detected. It must not be taken by anyone who has had angioedema on an ACE inhibitor or has hereditary or unexplained angioedema, with aliskiren in people with diabetes, or within 36 hours of sacubitril-valsartan (Entresto). Epaned is not recommended for newborns or for children with severely reduced kidney function.

Taking Enalapril

How to take it

Once or twice a day for blood pressure, usually twice a day for heart failure, with or without food. Keep taking it even if you feel well, and do not stop without talking to your prescriber.

If you miss a dose

Take it when you remember, unless the next dose is nearly due; then skip the missed dose. Do not take a double dose to make up for it.

Storage

Tablets at room temperature, tightly closed and protected from moisture. The oral solution goes in the refrigerator, or at room temperature for up to 60 days, after which any left is thrown away.

Interactions to know about

Potassium supplements, potassium salt substitutes and potassium-sparing diuretics can raise potassium too high; anti-inflammatories can weaken its effect and harm the kidneys; and it raises lithium levels. Sirolimus and other mTOR inhibitors raise the risk of angioedema. Seek urgent care for swelling of the face, lips, tongue or throat.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Enalapril differs from pharmacy to pharmacy

Enalapril tablets have many makers and cost pharmacies little, so the cash price is mostly the dispensing fee and margin, and twice-daily heart failure doses double the count for pharmacies that price per tablet. The oral solution has fewer makers, is kept refrigerated until dispensed and costs much more per dose, and a pharmacy that stocks only Epaned will quote the brand. A bottle kept at room temperature must be discarded after 60 days, so larger fills can be wasted.

Ways to pay less for Enalapril without insurance

• If you can swallow tablets, ask the prescriber whether tablets would suit you instead of the liquid.
• For the liquid, ask for a generic quote as well as Epaned, and make sure the prescription allows substitution.
• Once the dose is stable, ask for a ninety-day supply, one tablet per dose.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Enalapril

1. 1.What should I do if I develop a dry cough?
2. 2.Should I avoid potassium supplements or salt substitutes?
3. 3.When will my potassium and kidney function be checked?
4. 4.How do I measure the oral solution?
5. 5.What should I do if I am planning a pregnancy or am breastfeeding?

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