Vasotec (enalapril maleate) is an angiotensin-converting enzyme (ACE) inhibitor prescribed for the management of hypertension, heart failure, and certain renal conditions. As a cornerstone therapy in cardiovascular medicine, it works by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, thereby promoting vasodilation and reducing systemic vascular resistance. This mechanism offers targeted blood pressure control while providing organ-protective effects, making it a first-line choice for clinicians managing complex cardiovascular cases. The medication represents a well-established therapeutic option with decades of clinical evidence supporting its efficacy and safety profile.

Features

• Contains enalapril maleate as the active pharmaceutical ingredient
• Available in multiple tablet strengths: 2.5 mg, 5 mg, 10 mg, and 20 mg
• Film-coated tablets for ease of administration
• Demonstrated 24-hour duration of action with once or twice-daily dosing
• Proven bioavailability with approximately 60% oral absorption
• Exhibits dual elimination pathway (renal and hepatic)

Benefits

• Effectively lowers both systolic and diastolic blood pressure
• Reduces afterload in heart failure patients, improving cardiac output
• Demonstrates nephroprotective properties in diabetic nephropathy
• Decreases mortality in post-myocardial infarction patients
• Provides long-term cardiovascular risk reduction
• Shows minimal metabolic interference with glucose or lipid profiles

Common use

Vasotec is primarily indicated for the treatment of hypertension, either as monotherapy or in combination with other antihypertensive agents. It is also approved for management of symptomatic heart failure, often as part of a comprehensive treatment regimen including diuretics and digitalis. Additionally, it is used in the management of asymptomatic left ventricular dysfunction to prevent progression to overt heart failure. Physicians may prescribe Vasotec for diabetic nephropathy to slow the progression of renal impairment in patients with type 1 diabetes mellitus and albuminuria.

Dosage and direction

The initial dosage for hypertension typically ranges from 5 mg once daily to 20 mg divided into two doses, adjusted based on blood pressure response. For heart failure, starting doses are usually lower (2.5 mg once or twice daily) with gradual titration. Tablets should be swallowed whole with water, with or without food, though consistency in administration relative to meals is recommended. Dosage adjustments are necessary in renal impairment, with recommended reductions of 50-75% in patients with creatinine clearance below 30 mL/min. Regular blood pressure monitoring is essential during dosage titration periods.

Precautions

Patients should be monitored for hypotension, especially during initial dosing and titration. Renal function should be assessed prior to initiation and periodically during therapy, particularly in patients with pre-existing renal impairment, heart failure, or collagen vascular diseases. Serum potassium levels require monitoring, especially in patients receiving potassium supplements, potassium-sparing diuretics, or with renal impairment. Angioedema may occur at any time during treatment, requiring immediate discontinuation if involvement of the tongue, glottis, or larynx occurs. Use with caution in patients with aortic stenosis or outflow obstruction.

Contraindications

Vasotec is contraindicated in patients with a history of angioedema related to previous ACE inhibitor treatment. It should not be used in patients with hereditary or idiopathic angioedema. Concomitant use with aliskiren-containing products is contraindicated in patients with diabetes mellitus. The medication is contraindicated during the second and third trimesters of pregnancy due to potential fetal injury and death. It should not be administered to patients who have demonstrated hypersensitivity to any component of this product or other ACE inhibitors.

Possible side effect

Common adverse reactions include dizziness (4-8%), headache (2-5%), fatigue (2-4%), and cough (1-2%). Less frequently, patients may experience orthostatic hypotension, rash, nausea, or impaired renal function. Serious but rare side effects include angioedema (0.1-0.5%), neutropenia/agranulocytosis, hepatic failure, and pancreatitis. Approximately 0.5-1% of patients may develop hyperkalemia, particularly those with renal impairment or diabetes. Taste disturbance, though uncommon, may occur early in treatment and typically resolves with continued therapy.

Drug interaction

Vasotec may potentiate the hypotensive effects of other antihypertensive agents, particularly diuretics. Concomitant use with potassium-sparing diuretics, potassium supplements, or salt substitutes containing potassium may lead to significant hyperkalemia. Nonsteroidal anti-inflammatory drugs may reduce the antihypertensive effect and increase the risk of renal impairment. Lithium levels may increase with concurrent use, requiring close monitoring. Dual blockade of the renin-angiotensin system with ARBs or aliskiren increases risks of hypotension, hyperkalemia, and renal impairment.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed administration. Consistent daily dosing is important for maintaining stable blood pressure control, so patients should establish routine medication habits. Healthcare providers should educate patients about the importance of adherence while providing guidance for occasional missed doses.

Overdose

Symptoms of overdose include pronounced hypotension, which may progress to shock, bradycardia, electrolyte disturbances, and renal failure. Management primarily consists of volume expansion with intravenous normal saline to restore blood pressure. Hemodialysis may be effective in removing enalaprilat, the active metabolite. Patients should be placed in supine position and receive supportive care with continuous hemodynamic monitoring. Vasopressor therapy may be necessary in severe cases. Gastric lavage may be considered if ingestion occurred recently, though activated charcoal administration has limited efficacy due to the drug’s rapid absorption.

Storage

Store at controlled room temperature (20-25°C or 68-77°F) with excursions permitted between 15-30°C (59-86°F). Protect from moisture and light by keeping tablets in their original container with the lid tightly closed. Keep out of reach of children and pets. Do not use if the blister pack is damaged or tablets show signs of deterioration. Do not transfer tablets to other containers without proper labeling. Discard any unused medication after the expiration date printed on the packaging.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Vasotec is available by prescription only and should be used under appropriate medical supervision. Individual response to medication may vary, and healthcare providers should consider each patient’s complete medical profile when prescribing. Patients should not alter their dosage or discontinue treatment without consulting their physician. The full prescribing information contains complete details regarding indications, warnings, and precautions.

Reviews

Clinical studies demonstrate that Vasotec effectively reduces blood pressure in 60-70% of patients with mild to moderate hypertension. In heart failure trials, it has shown significant mortality reduction of approximately 16% compared to placebo. Long-term follow-up studies indicate sustained efficacy over years of treatment with maintained tolerability profile. Many clinicians report satisfactory patient outcomes with once-daily dosing convenience. The cough side effect, while bothersome to some patients, typically resolves upon discontinuation and does not diminish the drug’s cardiovascular benefits for most users.