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stomatitis,
glossitis,
Raynaud’s syndrome,
pulmonary
infiltrates,
allergic alveolitis,
dream abnormalities,
gynaecomastia,
Stevens-Johnson syndrome,
toxic
epidermal necrolysis,
exfoliative dermatitis,
pemphi-
gus;
very rarely
gastro-intestinal angioedema
Dose
. Hypertension,
used alone,
initially 5 mg once daily;
if
used in addition to diuretic (see notes above),
or in
renal impairment, lower initial doses may be required;
usual maintenance dose 20 mg once daily;
max.
40 mg once daily
. Heart failure (adjunct), asymptomatic left ventricular
dysfunction,
initially 2.5 mg once daily under close
medical supervision (see notes above), increased
gradually over 2–4 weeks to 10–20 mg twice daily if
tolerated
Enalapril Maleate
(Non-proprietary) A
Tablets
,
enalapril maleate 2.5 mg,
net price 28-tab
pack = £1.05; 5 mg, 28-tab pack = 96p; 10 mg, 28-tab
pack = £1.05;
20 mg,
28-tab pack = £1.24
Brands include
Ednyt
c
Innovace
c
(MSD) A
Tablets
,
enalapril maleate 2.5 mg,
net price 28-tab
pack = £5.35;
5 mg (scored),
28-tab pack = £7.51;
10 mg (red), 28-tab pack = £10.53; 20 mg (peach), 28-
tab pack = £12.51
With diuretic
Note
For mild to moderate hypertension in patients stabilised
on the individual components in the same proportions.
For
prescribing information on thiazides, see section 2.2.1
Innozide
c
(MSD) A
Tablets
,
yellow,
scored,
enalapril maleate 20 mg,
hydrochlorothiazide 12.5 mg,
net price 28-tab pack =
£12.82
Note
Non-proprietary tablets containing enalapril
maleate
(20 mg) and hydrochlorothiazide (12.5 mg) are available
FOSINOPRIL SODIUM
Indications
hypertension;
congestive heart failure
(adjunct—see section 2.5.5)
Cautions
see notes above
Contra-indications
see notes above
Hepatic impairment
see notes above
Renal impairment
see notes above
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see notes above;
chest pain;
musculo-
skeletal pain
Dose
. Hypertension,
initially 10 mg daily,
increased if
necessary after 4 weeks; usual dose range 10–40 mg
(doses over 40 mg not shown to increase efficacy);
if
used in addition to diuretic see notes above
. Heart failure (adjunct), initially 10 mg once daily
under close medical supervision (see notes above),
increased gradually to 40 mg once daily if tolerated
Fosinopril sodium
(Non-proprietary) A
Tablets
,
fosinopril sodium 10 mg,
net price 28-tab
pack = £2.18;
20 mg,
28-tab pack = £2.53
IMIDAPRIL HYDROCHLORIDE
Indications
essential hypertension
Cautions
see notes above
Contra-indications
see notes above
Hepatic impairment
see notes above
Renal impairment
see notes above;
initial dose
2.5 mg daily if eGFR 30–80 mL/minute/1.73 m
2
;
avoid if eGFR less than 30 mL/minute/1.73 m
2
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see notes above;
dry mouth,
glossitis,
ileus;
bronchitis,
dyspnoea;
sleep disturbances,
depression,
confusion,
blurred vision,
tinnitus,
impo-
tence
Dose
. Initially 5 mg daily before food; if used in addition to
diuretic (see notes above), in elderly,
in patients with
heart failure,
angina or cerebrovascular disease,
or in
renal or hepatic impairment,
initially 2.5 mg daily; if
necessary increase dose at intervals of at least 3
weeks; usual maintenance dose 10 mg once daily;
max.
20 mg daily (elderly,
10 mg daily)
Tanatril
c
(Chiesi) A
Tablets
,
scored,
imidapril hydrochloride 5 mg,
net
price 28-tab pack = £6.40; 10 mg, 28-tab pack = £7.22;
20 mg,
28-tab pack = £8.67
LISINOPRIL
Indications
hypertension (but see notes above);
symptomatic heart failure (adjunct—see section
2.5.5);
short-term treatment following myocardial
infarction in haemodynamically stable patients;
renal
complications of diabetes mellitus
Cautions
see notes above
Contra-indications
see notes above
Renal impairment
see notes above; max. initial doses
5–10 mg daily if eGFR 30–80 mL/minute/1.73 m
2
(max. 40 mg daily); 2.5–5 mg daily if eGFR 10–30 mL/
minute/1.73 m
2
(max.
40 mg daily);
2.5 mg daily if
eGFR less than 10 mL/minute/1.73 m
2
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see notes above;
also
less commonly
tachycardia, palpitation,
cerebrovascular accident,
myocardial infarction,
Raynaud’s syndrome,
confu-
sion,
mood changes,
vertigo,
sleep disturbances,
asthenia,
impotence;
rarely
dry mouth,
gynaecomas-
tia,
alopecia,
psoriasis;
very rarely
allergic alveolitis,
pulmonary infiltrates,
profuse sweating, pemphigus,
Stevens-Johnson syndrome,
and toxic epidermal
necrolysis
Dose
. Hypertension,
initially 10 mg once daily;
if used in
addition to diuretic (see notes above) or in cardiac
decompensation or in volume depletion, initially 2.5–
5 mg once daily; usual maintenance dose 20 mg once
daily; max.
80 mg once daily
. Heart failure (adjunct), initially 2.5 mg once daily
under close medical supervision (see notes above);
increased in steps no greater than 10 mg at intervals
of at least 2 weeks up to max.
35 mg once daily if
tolerated
. Prophylaxis after myocardial infarction, systolic blood
pressure over 120 mmHg,
5 mg within 24 hours,
fol-
lowed by further 5 mg 24 hours later, then 10 mg after
a further 24 hours, and continuing with 10 mg once
daily for 6 weeks (or continued if heart failure);
sys-
118
2.5.5 Drugs affecting the renin-angiotensin system
BNF 61
2
Cardiovascular system