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What Are Enalapril Side Effects and How Much Should I Take?

Enalapril Side Effects

Different types of medications are used to treat high blood pressure. Among them, there are some called ACE inhibitors or Angiotensin Converting Enzyme Inhibitors. These, as the name implies, prevent the enzyme from doing its job, which is to transform angiotensin I into angiontensin II. For its part, angiotensin II fulfills a vasopressor function and also increases the blood volume, by stimulating the production of aldosterone in the adrenal glands. Then, by inhibiting the production of Angiotensin II, ACE inhibitors prevent this molecule from fulfilling its functions and thus help to lower the pressure.



The first inhibitory substance of Angiotensin Converting Enzyme was discovered by a group of Brazilian scientists in the snake venom Bothrops jararaca, in 1939. Other studies, together with an English team, gave more light on the molecules and finally a US company designed captopril, commercial name of the first ACEI, in the 70s. This produced strong side effects, so then enalapril, ramipril, lisinopril, with milder effects were created. Read also Losartan Side Effects


Enalapril Side Effects
Enalapril Side Effects

What is Enalapril for?

Currently, ACEIs are widely used drugs throughout the world. In Spain, enalapril is the most widely used medication to treat hypertension, and it is ranked number ten on the list of active principles; It is the antihypertensive agent par excellence. Enalapril can be a very good treatment option in about 75% of people with high blood pressure, since this percentage corresponds to patients with high levels of angiotensin II.



The mechanism of action of enalapril, and other molecules of the family of ACEIs, is to prevent the formation of this enzyme that acts by increasing blood pressure, acting by contracting blood vessels and favoring the passage of sodium to the kidneys. The remaining 25% is formed, in part, by people of African descent and elderly people who suffer from high blood pressure but with low levels of angiotensin II. This group will not benefit from an exclusive treatment with enalapril or another ACEI. If this treatment is used, it will probably be prescribed at the same time as a diuretic.



Enalapril, in addition, is indicated as part of the treatment of heart failure and to treat the asymptomatic functional deficit of the left ventricle, as it slows the process of enlargement of the ventricle. The investigations in this regard show that the medication in these cases helps to improve and prolong the life of patients. As it also does when used after a myocardial infarction.



On the other hand, enalapril fulfills a protective function of the kidneys in people with diabetes, avoiding the disposal of proteins or proteinuria. Therefore, it is used in cases of diabetic nephropathy and chronic renal failure.



How much should I take?


Enalapril is marketed in different presentations whose composition changes from one country to another. Its active ingredient is enalapril maleate and is usually combined with sodium bicarbonate, lactose, corn starch, red and yellow iron oxide and magnesium stearate in different proportions. It can be found in 5 mg, 10 mg and 20 mg tablets. To prescribe the proper dose, the doctor should review the patient’s symptoms and the medications they take.



Depending on the condition to be treated, different doses are used and in any case it is recommended not to exceed 40 mg / day:

  • For hypertensive patients 5 to 20 mg are used once a day. Although some patients may need to start treatment with less amount.
  • To treat heart failure it is recommended to start with 2.5 mg and adjust until you reach the appropriate amount, which is usually 20 mg daily taken in one or two parts.
  • To protect the kidney in diabetic patients, the creatinine concentration presented by the patient will be taken into account and doses ranging between 2.5 and 10 mg will be recommended, depending even if it is a dialyzed patient.


This treatment requires a time to get used, that is why it starts with low doses that are adjusted. Side effects can occur that prevent the person from performing certain activities safely, so it is necessary to be vigilant and know what are the side effects and contraindications of this medicine.



Enalapril Side Effects :

The use of captopril, the first ACEI, gave very strong side effects, so the researchers concentrated their efforts on reducing them. Thus, the other ACEIs were created, which although they continue to generate adverse effects, these are milder. Enalapril is considered a well-tolerated medication, although it often produces the following side effects:


  • Cough and burning in the throat: affects 5 to 10% of people treated. This effect arises 1 to 2 weeks after having started the use of enalapril and can last up to 6 months. It can even cause difficulty breathing.
  • Hypotension: about 2% of patients will be affected by the decrease in tension, which will be reflected in dizziness, weakness, fatigue, blurred vision and malaise. This unwanted effect is more frequent when starting with a very high dose or if people have: More than 60 years, have dehydration, use diuretics at the same time or suffer from heart failure.
  • High blood potassium or hyperkalemia: this unwanted effect results in severe arrhythmias and affects 3 to 4% of patients. In some cases, adjusting the diet, decreasing the consumption of foods rich in potassium, can minimize this effect. But treatment is usually suspended because it is a dangerous condition.
  • Exanthemas and urticaria: both are skin reactions that may present as an adverse effect. The rash occurs in 0.1% to 1% of cases and urticaria can affect up to 10%. Although the skin conditions do not usually become greater, it can happen that the patient develops other allergic reactions such as swelling of the face, extremities, lips, tongue, glottis or larynx.
  • Other common side effects are headache, depression, nausea, diarrhea, abdominal pain and taste disturbance.



It is very important when taking any medical treatment to be attentive to changes that appear in the body, however slight they may appear. In the specific case of enalapril, do not hesitate to call your specialist if you suffer any effect such as an important allergic reaction with either:

  • Swelling that makes it impossible to breathe or swallow.
  • Itch.
  • Reddened skin.
  • It is also a warning sign that swells.

If you are Afro-descendant, stay even more alert because these effects may be greater.

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