Enalapril

By Lauren R. Forsythe, PharmD, MBA, DICVP; Rania Gollakner, BS, DVM, MPH

What is enalapril?

Enalapril (brand names: Enacard®, Vasotec®, Glioten®, Lotrial®, Pres®, Renitec®, Reniten®, Xanef®, Epaned®) is an ACE (angiotensin-converting enzyme) inhibitor used to treat heart failure, high blood pressure, and protein in the urine (proteinuria). It is also used in the treatment of chronic kidney disease.

"Many drugs are commonly prescribed for off-label use in veterinary medicine."

Its use in cats, dogs, ferrets, and birds to treat certain conditions is “off label” or “extra label”. Many drugs are commonly prescribed for off-label use in veterinary medicine. In these instances, follow your veterinarian’s directions and cautions carefully, as they may be significantly different from those on the label.

How is enalapril given?

  • Enalapril is given by mouth, in the form of a tablet or liquid. It may also be given as an injection into the vein at the hospital.
  • Measure liquid doses carefully.
  • Tablets and oral liquid may be given with or without food. 
  • If vomiting occurs after dosing on an empty stomach, give future doses with food or a treat.
  • While your pet is on this medication, make sure there is always plenty of clean water available. 
  • Do not stop this medication abruptly unless instructed by your veterinarian.

This medication should take effect within 1 to 2 hours; however, effects may not be noticeable and so laboratory tests may be required to evaluate this medication’s effectiveness.

What if I miss giving my pet the medication?

Give the missed dose as soon as you remember, and then wait the recommended amount of time between doses. Never give your pet two doses at once or give extra doses.

Are there any potential side effects?

Common side effects of enalapril include:

  • loss of appetite
  • vomiting
  • diarrhea 
  • tiredness

In cats, common side effects include:

  • lethargy 
  • loss of appetite 

Serious adverse reactions may occur, including:

  • signs of infection (fever)
  • rash
  • collapse
  • weakness
  • low blood pressure
  • kidney dysfunction
  • elevated potassium levels

This short-acting medication should stop working within 24 hours, although effects can be longer in pets with liver or kidney disease.

Are there any risk factors for this medication?

Enalapril should NOT BE USED in pets that:

  • are allergic to it 
  • have an acute kidney injury 
  • have certain heart conditions

Enalapril should be USED WITH EXTREME CAUTION in:

  • pregnant or lactating pets.

Enalapril should be USED WITH CAUTION in pets:

  • with kidney disease
  • with liver disease 
  • with heart failure 
  • with dehydration
  • with low sodium levels
  • with blood abnormalities
  • with collagen vascular disease
  • undergoing gas anesthesia

Are there any drug interactions I should be aware of?

The following medications should be used with caution when given with enalapril:

  • anesthetics
  • antacids
  • antihypertensive agents
  • corticosteroids
  • digoxin
  • diphenhydramine
  • diuretics
  • erythropoietin
  • NSAIDs (nonsteroidal anti-inflammatory agents)
  • opioids
  • potassium
  • potassium sparing diuretics
  • sildenafil 
  • vasodilators

Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking.

Is any monitoring needed with this medication?

  • Electrolytes, kidney values, and urine protein levels should be monitored 1–2 weeks after starting the medication, and then every 3 months once your pet is stable.
  • Complete blood counts and blood pressure should also be monitored, depending on the reason for using this medication. 
  • Your veterinarian will also monitor your pet to be sure that the medication is working.
  • At home, monitor your pet for signs of congestive heart failure (difficulty breathing, increased breathing rate, cough) or serious side effects.

How do I store enalapril?

  • Store enalapril at room temperature, less than 30°C (86°F). 
  • Store away from moisture and light.

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility.

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