General Toxicity Notes
Blood pressure is the best guide to dose and interval. Hypotensive effects magnified by natriuretic agents or sodium depletion. May cause hyperkalemia, metabolic acidosis. Acute renal dysfunction with bilateral or transplant renal artery stenosis, low renal perfusion pressure. Dry cough in 5-10% of patients.
Half-Life (Normalesrd) Hours
11-24/34-60
Plasma Protein Binding %
50-60
Volume Of Distribution L/Kg
1-2.4
Dose For Normal Renal Function
5-20 mg q12-24h
Adjustment For Renal Failure Method
D
Adjustment For Renal Failure Gfr, Ml/Min >50 [Recommended Level]
100% [A]
Adjustment For Renal Failure Gfr, Ml/Min 10-50 [Recommended Level]
50-100% [A]
Adjustment For Renal Failure Gfr, Ml/Min <10 [Recommended Level]
25% [A]
Supplement For Dialysis [Recommendation Level]: Ihd
IHD: Dose after dialysis, [A]
Supplement For Dialysis [Recommendation Level]: Pd
PD: Dose for GFR <10,[D]
Supplement For Dialysis [Recommendation Level]: Crrt
CRRT: Dose for GFR 10-50,titrate, [D]
References
Kelly JG, Doyle GD, Carmody M, Glover DR, Cooper WD. Pharmacokinetics of lisinopril, enalapril and enalaprilat in renal failure: effects of haemodialysis. Br J Clin Pharmacol. 1988; 26: 781-6. [PMID: 2853960] / Mujais SK, Quintanilla A, Zahid M, Koch K, Shaw W, Gibson T. Renal handling of enalaprilat. Am J Kidney Dis. 1992; 19: 121-5. [PMID: 1310827] / Todd PA, Goa KL. Enalapril. A reappraisal of its pharmacology and therapeutic use in hypertension. Drugs. 1992; 43: 346-81. [PMID: 1374319]
Toxicity Notes
Enalaprilat is active moiety formed in liver.