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
11/28
Plasma Protein Binding %
50-60
Volume Of Distribution L/Kg
1-2.4
Dose For Normal Renal Function
1.25-5 mg IV over 5 min q6h
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]
25-50% [D]
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,[D]
References
Hersh AD, Kelly JG, Laher MS, Carmody M, Doyle GD. Effect of hydrochlorothiazide on the pharmacokinetics of enalapril in hypertensive patients with varying renal function. J Cardiovasc Pharmacol. 1996; 27: 7-11. [PMID: 8656661] / 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]
Toxicity Notes
Dialysis patients are at risk of excessive hypotension. Treatment should be started under very close supervision. The starting dose should be no greater than 0.625 mg administered intravenously over a period of up to one hour.