Experiences with
Enalapril

Enalapril is a medicine used to reduce high blood pressure and to prevent or treat heart failure.

If you have high blood pressure, taking enalapril will help prevent a future heart attack or stroke.

Enalapril lowers your blood pressure and makes it easier for your heart to pump blood around your body.

This medicine is only available on prescription. It comes as tablets.

Enalapril is also available combined with another blood pressure medicine called hydrocholorothiazide (Innozide).

Who can take enalapril

Most adults and children can take enalapril.

If you have diabetes, check your blood sugar (glucose) more often, particularly in the first few weeks. This is because enalapril can lower the sugar level in your blood.

Who may not be able to take enalapril

Enalapril is not suitable for everyone. To make sure it's safe for you, tell your doctor if you:

have ever had an allergic reaction to enalapril or any other medicine
are trying to get pregnant, are already pregnant, or you're breastfeeding
are having dialysis or any other type of blood filtration
have heart, liver or kidney problems
have unstable or low blood pressure
have diabetes
are going to have a major operation (surgery) or general anaesthetic to put you to sleep
have recently had diarrhoea or vomiting
are on a low-salt diet
are going to have desensitisation treatment to reduce your allergy to insect stings
have a blood problem such as a low white blood cell count (neutropenia or agranulocytosis)

Dosage

Your dose of enalapril depends on why you need the medicine. Take it as your doctor tells you to.

To decide the right dose for you, your doctor will check your blood pressure and ask you if you are getting any side effects. You may also have blood tests to check how well your kidneys are working and the amount of potassium in your blood.

Depending on why you're taking enalapril, the usual starting dose for adults is between 2.5mg and 5mg once a day. This will be increased gradually over a few weeks to a usual dose of:

10mg, taken once a day for high blood pressure
10mg taken twice a day, or 20mg taken once a day, for heart failure

The maximum dose is 40mg a day, taken as a single dose or in divided doses.

Doses are usually lower for children or people with kidney problems.

The doctor will work out the dose of enalapril that is right for your child. The dose will be based on your child's age and weight and why they need this medicine.

Changes to your dose

You will probably be prescribed a low dose of enalapril at first so it does not make you feel dizzy. This will usually be increased gradually until you reach the right dose for you.

Your child will usually be started on a low dose of enalapril. This dose may gradually increase depending on your child's blood pressure and other symptoms.

Speak to your pharmacist or doctor if you're worried about side effects with enalapril.

How to take it

You'll usually take enalapril once or twice a day.

Your doctor may advise you to take your first dose before bedtime, because it can make you dizzy. After the first dose, if you do not feel dizzy, you can take enalapril at any time of day. Try to take it at the same time every day.

If you take enalapril twice a day, try to take it once in the morning and once in the evening. Leave 10 to 12 hours between doses if you can.

You can take enalapril with or without food. Swallow the tablets whole with a drink.

How long to take it for

Usually, treatment with enalapril is long term and you may have to take it for the rest of your life.

If you get ill while taking it

Contact your doctor if you get ill with symptoms including:

a high temperature
sweats and shaking
severe diarrhoea or vomiting

Your doctor may recommend you stop taking enalapril until you are better and eating and drinking normally.

If you forget to take it

If you miss a dose of enalapril, leave out that dose and take your next dose at the usual time.

Do not take 2 doses to make up for the forgotten dose.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

An overdose of enalapril can cause dizziness, sleepiness and a pounding heartbeat.

The amount of enalapril that can lead to an overdose varies from person to person.

you take more than your prescribed dose of enalapril

Go to 111.nhs.uk or call 111

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the enalapril packet or leaflet inside it, any remaining medicine, and any other medicines you take.

Talk to your doctor if you want to stop taking enalapril.

Stopping it may cause your blood pressure to rise and this may increase your risk of heart attack and stroke.

If you're bothered by side effects, your doctor may be able to prescribe you a different medicine.

Take enalapril even if you feel well, as you will still be getting the benefits of the medicine.

Common side effects

These common side effects of enalapril happen in more than 1 in 100 people. They are usually mild and only last for a short time. There are things you can do to help cope with them:

Cough medicines do not usually help coughs caused by enalapril. Sometimes the cough will get better on its own if you keep taking enalapril.

Talk to your doctor if it carries on, bothers you or stops you from sleeping. Another medicine may suit you better. If your doctor recommends that you stop taking enalapril, the cough may take a few days to a month to go away.

If enalapril makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you do not faint, then sit until you feel better.

Do not drive, ride a bike or use tools or machinery while you're feeling dizzy.

Make sure you rest and drink plenty of fluids. Try not to drink too much alcohol. Ask your pharmacist to recommend a painkiller.

Talk to your doctor if the headaches last longer than a week or are severe.

Drink lots of fluids, such as water or squash, to avoid dehydration. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.

If you take the combined contraceptive pill or the progestogen-only pill and you have severe diarrhoea for more than 24 hours, your contraception may not protect you from pregnancy. If this happens, follow the instructions in the leaflet that comes with your pills.

It may help to take an antihistamine which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you

Avoid driving, cycling or using tools or machines while this is happening. If it lasts for more than a day or two speak to your doctor as they may need to change your treatment.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects

Some people have serious side effects after taking enalapril.

Call a doctor or call 111 now if:

the whites of your eyes turn yellow, or your skin turns yellow (this may be less noticeable on brown or black skin) – this could be a sign of liver problems
you look paler than usual, feel tired, faint or dizzy, have signs of bleeding (like bleeding from the gums or bruising more easily), sore throat and a high temperature and get infections more easily – these could be signs of a blood or bone marrow disorder
you have severe stomach pain that could reach through to your back – this could be a sign of an inflamed pancreas (pancreatitis)
you have swollen ankles, blood in your pee or you're not peeing at all – these could be signs of kidney problems

you get weakness in your arms or legs or problems speaking – it's important to get these checked in case they are signs of a stroke
you get a faster or irregular heart rate, chest pain and tightness in your chest – these could be signs of heart problems
you are short of breath, are wheezing and your chest feels tight – these could be signs of lung problems

A&E safety messaging (for 999 only)

It is possible to have a serious allergic reaction (anaphylaxis) to enalapril.

Meds New IA (H4) - serious allergic reaction

Taking enalapril for a long time can sometimes cause your kidneys to not work as well as they should. Your doctor will check how well your kidneys are working with regular blood tests.

Other side effects

These are not all the side effects of enalapril. For a full list see the leaflet inside your medicines packet.

Enalapril and pregnancy

Enalapril is not recommended in pregnancy. It can reduce the level of fluid around your baby, particularly if you take it in the second and third trimesters. This can result in long-term damage to your baby's kidneys and lungs and a number of other problems.

If you're already pregnant, stop taking enalapril and talk to your doctor straight away. Usually your doctor will be able to prescribe a different medicine that is safe to take in pregnancy. Enalapril should be stopped by the time you're 12 weeks pregnant.

It's important to use contraception if you're taking enalapril and carefully plan any pregnancy with your doctor or a specialist. They will want to review your condition and medicine before you get pregnant.

Most women stop taking enalapril before getting pregnant, but some may continue up until they have a positive pregnancy test and then stop. Your doctor will discuss what's best for you, based on your condition and the risks and benefits of enalapril.

Enalapril and breastfeeding

It is OK to take enalapril while breastfeeding, but talk to your doctor or pharmacist first. If your baby was born prematurely, other medicines might be better, but your doctor will help you decide.

Only tiny amounts of enalapril pass into breast milk, which is unlikely to cause side effects in your baby. However, there is a very small risk that it could also lower your baby's blood pressure.

If you notice that your baby is not feeding as well as usual, seems unusually sleepy, seems much paler than usual, or if you have any other concerns about your baby, talk to your health visitor, midwife or doctor as soon as possible.