Enalapril

Sounds like 'en-al-ah-pril'

Enalapril is used to treat high blood pressure and heart failure and to prevent kidney problems for people with diabetes. Enalapril is also called Acetec.

What is enalapril?

Enalapril has many different effects on your body, so it's used to treat a range of conditions. It belongs to a group of medicines called ACE inhibitors.

Enalapril may be used for the following conditions:

  • High blood pressure – by relaxing and widening your blood vessels it lowers your blood pressure.
  • Heart failure – to help your heart pump blood more easily. This can help to relieve symptoms such as shortness of breath and swelling in your feet, legs and abdomen (tummy).
  • Diabetic kidney disease (diabetic nephropathy) – to protect your kidneys and help them to function.

Enalapril can work quickly for hypertension (high blood pressure). If you have heart failure it may be a few weeks before you notice an improvement in your symptoms.  

Dose

In Aotearoa New Zealand enalapril is available as tablets (5mg, 10mg and 20mg). 

  • The dose of enalapril will be different for different people depending on your condition.
  • Your doctor will usually start you on a low dose so it doesn't make you feel dizzy. Your dose will be increased slowly over a few weeks depending on how you respond. This allows your body to get used to the medicine and reduces side effects.
  • Always take your enalapril exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much to take, how often to take it and any special instructions.
  • Check with your pharmacist if your tablets are different to what you expect.

My dose

You can use the table below to keep track of dose changes when you start taking enalapril.

Date Dose
   
   
   
Notes:


How to take enalapril

  • Timing: Enalapril is usually taken once a day but some people may take their doses twice a day. Take your enalapril dose at the same time each day. You can take enalapril with or without food.
  • Limit or avoid alcohol while you are taking enalapril. Alcohol can increase your chance of side effects such as dizziness and light-headedness.
  • Missed dose: If you forget to take your dose, take it as soon as you remember. But if it's nearly time for your next dose, just take the next dose at the right time. Don't take double the dose.

Who can't take enalapril?

Enalapril isn't suitable if you're pregnant or planning a pregnancy. It's also not suitable if you've had a severe allergic reaction to an ACE inhibitor in the past, eg, swelling of your lips, eyes or tongue (called angioedema). Read more about who can't take ACE inhibitors. If you're already taking diuretics (water pills), your doctor will monitor you very closely when you first start taking enalapril.

Things to consider while you are taking enalapril

Monitoring

Your doctor will arrange for you to have blood tests and blood pressure checks before you start taking enalapril and during your treatment, especially when you first start taking it. This is to check how it is working and to check your kidneys and potassium levels.

Have a sick day plan

If you have diarrhoea (runny poo) or are vomiting (being sick) from a stomach bug, or are dehydrated from another illness, it’s important to let your healthcare provider know. They may advise you to decrease your dose or stop taking your enalapril for a few days, and start again when you feel better.

Be careful when taking some pain relief medicines

ACE inhibitors can be used to protect your kidneys from damage if you have diabetes. However, if you are taking enalapril and diuretics (water pills), the combination of these with NSAIDs (anti-inflammatory pain relief medicines) can be very harmful to your kidneys. It can cause acute kidney injury. This combination is called the ‘dangerous trio’ or ‘triple whammy’. There's a higher risk of harm to your kidneys if you are also an older adult (over 65 years) or are dehydrated. 

If you are taking an ACE inhibitor with a diuretic, don't use NSAIDs for pain relief. Ask your doctor or pharmacist for a safer option. Read more about NSAIDs and protecting your kidneys.

Examples of diuretics Examples of NSAIDs
  • Bendroflumetazide (Arrow-Bendrofluazide)
  • Chlortalidone (Hygroton)
  • Indapamide (Dapa-Tabs)
  • Metolazone (Zaroxolyn)
  • Furosemide (Lasix, Urex Forte)
  • Bumetanide (Burinex)
  • Spironolactone (Spiractin)
  • Ibuprofen (Nurofen, Brufen SR)
  • Diclofenac (Voltaren)
  • Naproxen (Noflam, Naprosyn)
  • Mefenamic acid (Ponstan)
  • Celecoxib (Celebrex)
  • Tenoxicam (Tilcotil)

Are you pregnant or planning a pregnancy?

Tell your doctor if you become pregnant or are planning a pregnancy while you are taking enalapril.

What are the side effects of enalapril?

Like all medicines enalapril can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Side effects What should I do?
  • Dizziness
  • Feeling light-headed
  • Feeling faint when you stand up
  • Headache
  • This is quite common when you first start taking enalapril and usually goes way with time.
  • These effects put you at risk of falls and injuries, especially if you are an older adult. Be careful when getting up from either lying down or sitting. 
  • Stand up slowly. If you do feel dizzy, sit or lie down for a few moments.
  • Tell your doctor if this continues.
  • Tickle in your throat
  • Dry, irritating cough


  • This is quite common when you first start taking enalapril and usually goes away with time.
  • Tell your doctor if the cough is troublesome and persistent.
  • Upset tummy or feeling sick
  • Constipation or diarrhoea
  • These are common when you first start taking enalapril but should go away with time.
  • Tell your doctor if this continues.
  • Skin that is sensitive to sunlight
  • Take care in the sun, cover up and wear sunblock on sunny days or if spending a lot of time outside, even on a cloudy day.
  • Allergic reaction such as skin rash, itching, swelling of your lips, face and mouth, or difficulty breathing, such as chest tightness or wheezing
  • Tell your doctor immediately or phone Healthline 0800 611 116.
  • Signs of problems with your liver, such as yellowing of your skin or eyes, dark pee or pain in your abdomen (tummy)
  • Tell your doctor immediately or phone Healthline 0800 611 116.
Did you know that you can report a side effect from a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product.

Learn more

The following links provide more information on enalapril.

Enalapril (Māori) NZ Formulary Patient Information
Acetec, Renitec Medsafe Consumer Information, NZ

Reference

  1. Enalapril New Zealand Formulary
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 19 Dec 2022