Enalapril can affect your heart or your electrolyte levels. Call your doctor if you have chest pain, pounding heartbeats or fluttering in your chest, a slow heart rate or weak pulse, a tingly feeling, muscle weakness, or muscle tightness or contraction. Before taking this medicine You should not use enalapril if you are allergic to it, or if you have: Do not take enalapril within 36 hours before or after taking medicine that contains sacubatril such as Entresto.

If you have diabetes, do not use enalapril together with any medication that contains aliskiren Amturnide, Tekturna, Tekamlo. You may also need to avoid taking enalapril with aliskiren if you have kidney disease. To make sure enalapril is safe for you, tell your doctor if you have: Do not use if you are pregnant. Enalapril can cause injury or death to the unborn baby if you take the medicine during your second or third trimester.

Enalapril can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using this medicine. How should I take enalapril? Take enalapril exactly as prescribed by your doctor.

Follow all directions on your prescription label. Your doctor may occasionally change your dose. Do not take this medicine in larger or smaller amounts or for longer than recommended. You may take enalapril with or without food. Shake the oral suspension liquid well just before you measure a dose. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup.

If you do not have a dose-measuring device, ask your pharmacist for one. Your blood pressure will need to be checked often. Your kidney or liver function may also need to be tested. Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking enalapril.

This can lead to very low blood pressure, electrolyte disorders, or kidney failure. If you are being treated for high blood pressure, keep using this medicine even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medicine for the rest of your life. If you need surgery, tell the surgeon ahead of time that you are using enalapril.

Store at room temperature away from moisture and heat. Most epidemiologic studies examining fetal abnormalities after exposure to antihypertensive use in the first trimester have not distinguished drugs affecting the renin-angiotensin system from other antihypertensive agents. Appropriate management of maternal hypertension during pregnancy is important to optimize outcomes for both mother and fetus.

In the unusual case that there is no appropriate alternative to therapy with drugs affecting the renin-angiotensin system for a particular patient, apprise the mother of the potential risk to the fetus. Perform serial ultrasound examinations to assess the intra-amniotic environment. If oligohydramnios is observed, discontinue enalapril maleate, unless it is considered lifesaving for the mother.

Fetal testing may be appropriate, based on the week of pregnancy. Patients and physicians should be aware, however, that oligohydramnios may not appear until after the fetus has sustained irreversible injury. No teratogenic effects of enalapril were seen in studies of pregnant rats and rabbits. On a body surface area basis, the doses used were 57 times and 12 times, respectively, the maximum recommended human daily dose MRHDD. Impaired Renal Function As a consequence of inhibiting the renin-angiotensin-aldosterone system, changes in renal function may be anticipated in susceptible individuals.

In clinical studies in hypertensive patients with unilateral or bilateral renal artery stenosis, increases in blood urea nitrogen and serum creatinine were observed in 20 percent of patients. In such patients renal function should be monitored during the first few weeks of therapy.

Some patients with hypertension or heart failure with no apparent pre-existing renal vascular disease have developed increases in blood urea and serum creatinine, usually minor and transient, especially when enalapril maleate has been given concomitantly with a diuretic.

This is more likely to occur in patients with pre-existing renal impairment. Hyperkalemia Elevated serum potassium greater than 5. In most cases these were isolated values which resolved despite continued therapy.

Hyperkalemia was a cause of discontinuation of therapy in 0. In clinical trials in heart failure, hyperkalemia was observed in 3. Cough Presumably due to the inhibition of the degradation of endogenous bradykinin, persistent nonproductive cough has been reported with all ACE inhibitors, always resolving after discontinuation of therapy.

ACE inhibitor-induced cough should be considered in the differential diagnosis of cough. If hypotension occurs and is considered to be due to this mechanism, it can be corrected by volume expansion. Information for Patients Angioedema Angioedema, including laryngeal edema, may occur at any time during treatment with angiotensin converting enzyme inhibitors, including enalapril.

Patients should be so advised and told to report immediately any signs or symptoms suggesting angioedema swelling of face, extremities, eyes, lips, tongue, difficulty in swallowing or breathing and to take no more drug until they have consulted with the prescribing physician. Hypotension Patients should be cautioned to report lightheadedness, especially during the first few days of therapy. If actual syncope occurs, the patients should be told to discontinue the drug until they have consulted with the prescribing physician.

All patients should be cautioned that excessive perspiration and dehydration may lead to an excessive fall in blood pressure because of reduction in fluid volume. Other causes of volume depletion such as vomiting or diarrhea may also lead to a fall in blood pressure; patients should be advised to consult with the physician.

Hyperkalemia Patients should be told not to use salt substitutes containing potassium without consulting their physician.

Neutropenia Patients should be told to report promptly any indication of infection e. Pregnancy Female patients of childbearing age should be told about the consequences of exposure to enalapril maleate during pregnancy.

Discuss treatment options with women planning to become pregnant. Patients should be asked to report pregnancies to their physicians as soon as possible. As with many other drugs, certain advice to patients being treated with enalapril is warranted.

This information is intended to aid in the safe and effective use of this medication. It is not a disclosure of all possible adverse or intended effects. Dual Blockade of the Renin-Angiotensin System RAS Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren is associated with increased risks of hypotension, hyperkalemia, and changes in renal function including acute renal failure compared to monotherapy.

Most patients receiving the combination of two RAS inhibitors do not obtain any additional benefit compared to monotherapy. In general, avoid combined use of RAS inhibitors. Closely monitor blood pressure, renal function, and electrolytes in patients on enalapril maleate and other agents that affect the RAS. Do not coadminister aliskiren with enalapril maleate in patients with diabetes.

Hypotension — Patients on Diuretic Therapy Patients on diuretics and especially those in whom diuretic therapy was recently instituted, may occasionally experience an excessive reduction of blood pressure after initiation of therapy with enalapril. The possibility of hypotensive effects with enalapril can be minimized by either discontinuing the diuretic or increasing the salt intake prior to initiation of treatment with enalapril. Agents Causing Renin Release The antihypertensive effect of enalapril maleate is augmented by antihypertensive agents that cause renin release e.

Non-Steroidal Anti-Inflammatory Agents including Selective Cyclooxygenase-2 Inhibitors COX-2 Inhibitors In patients who are elderly, volume-depleted including those on diuretic therapy , or with compromised renal function, coadministration of NSAIDs, including selective COX-2 inhibitors, with ACE inhibitors, including enalapril, may result in deterioration of renal function, including possible acute renal failure.

These effects are usually reversible. In a clinical pharmacology study, indomethacin or sulindac was administered to hypertensive patients receiving enalapril maleate. In this study there was no evidence of a blunting of the antihypertensive action of enalapril maleate. Other Cardiovascular Agents Enalapril maleate has been used concomitantly with beta adrenergic-blocking agents, methyldopa, nitrates, calcium-blocking agents, hydralazine, prazosin and digoxin without evidence of clinically significant adverse interactions.

Agents Increasing Serum Potassium Enalapril maleate attenuates potassium loss caused by thiazide-type diuretics. Therefore, if concomitant use of these agents is indicated because of demonstrated hypokalemia, they should be used with caution and with frequent monitoring of serum potassium.

Potassium-sparing agents should generally not be used in patients with heart failure receiving enalapril maleate. Lithium Lithium toxicity has been reported in patients receiving lithium concomitantly with drugs which cause elimination of sodium, including ACE inhibitors. A few cases of lithium toxicity have been reported in patients receiving concomitant enalapril maleate and lithium and were reversible upon discontinuation of both drugs.

It is recommended that serum lithium levels be monitored frequently if enalapril is administered concomitantly with lithium. Gold Nitritoid reactions symptoms include facial flushing, nausea, vomiting and hypotension have been reported rarely in patients on therapy with injectable gold sodium aurothiomalate and concomitant ACE inhibitor therapy including enalapril maleate. These doses are 26 times in rats and female mice and 13 times in male mice the maximum recommended human daily dose MRHDD when compared on a body surface area basis.

Indications and Usage for Enalapril Tablets Hypertension Enalapril maleate is indicated for the treatment of hypertension. Closely monitor blood pressure, renal function, and electrolytes in patients on enalapril maleate and other agents that affect the RAS. Your doctor may occasionally change your dose. If you become pregnant, enalapril d precio, stop taking this medicine and tell your doctor right away. As with many other drugs, certain advice to patients being treated with enalapril is warranted. You may also need to avoid taking enalapril with aliskiren if you have kidney disease, enalapril d precio. Appropriate buy mirtazapine (remeron) of maternal hypertension during pregnancy is important to optimize outcomes enalapril both mother and fetus. Enalapril side effects Get emergency medical help if you have signs of an allergic reaction to enalapril: Precio not use if you are pregnant. In clinical studies in hypertensive patients with unilateral or bilateral renal artery stenosis, increases in blood urea nitrogen and serum creatinine were observed in 20 percent of patients. Before taking this medicine You should not use enalapril if you are allergic to it, or if you have: If you have precio, do not use enalapril together with any medication that contains aliskiren enalapril as Tekturna or Tekamlo. You may take enalapril with or without food. Enalapril is an ACE inhibitor. Periodic monitoring of white blood cell counts in patients with collagen vascular disease and renal disease should be considered.

Medicamentos Antihipertensivos, efectos secundarios frecuentes

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