Enalapril tablets 20 mg What Enalapril is and what it is used for: Enalapril belongs to the class of medicines called Angiotensin converting enzyme inhibitors (ACE inhibitors). It works by causing blood vessels to relax, lowering blood pressure and increasing the supply of blood and oxygen to the heart. Enalapril is used to: • treat high blood pressure (hypertension) • treat heart failure (weakening of heart function). It can lower the need to go to hospital and can help some patients live longer. • prevent signs of heart failure. The signs include shortness of breath, tiredness after light physical activity such as walking, or swelling of the ankles and feet. This medicine works by widening your blood vessels. This lowers your blood pressure. The medicine usually starts to work within an hour, and the effect lasts for at least 24 hours. Some people will require several weeks of treatment until the best effect on your blood pressure is seen. What you need to know before you use Enalapril: Do not use Enalapril • If you are allergic (hypersensitive) to enalapril maleate, any of the other ingredients in these tablets or other ACE inhibitors • If you have ever had swelling of your face, lips, mouth, tongue or throat which caused difficulty in swallowing or breathing (angioedema) when the reason why was not known or it was inherited. • If you are more than 3 months pregnant. (It is also better to avoid Enalapril maleate tablets in early pregnancy) • If you have diabetes or impaired kidney function and you are treated with a blood pressure lowering medicine containing aliskiren. • If you have ever had an allergic reaction to a type of medicine similar to this medicine called an ACE inhibitor • If you have taken or are currently taking sacubitril/ valsartan, a medicine used to treat a type of long-term (chronic) heart failure in adults, as the risk of angioedema (rapid swelling under the skin in an area such as the throat) is increased. Warnings and precautions: You should let your doctor know: • If you have a heart problem • If you have a condition involving the blood vessels in the brain • If you have a blood problem such as low or lack of white blood cells, low blood platelet count or a decreased number of red blood cells (anaemia) • If you have a kidney problem (including kidney transplantation). These may lead to higher levels of potassium in your blood which can be serious. Your doctor may need to adjust your dose of Enalapril or monitor you blood level of potassium • If you have been very sick (excessive vomiting) or had bad diarrhoea recently • If you have diabetes. • If you have a liver problem or develop jaundice (yellowing of the skin and white of the eye) • If you are having dialysis • If you are over 70 years of age • If you have low blood pressure (you may notice this as faintness or dizziness, especially when standing) • If you have collagen vascular disease (e.g. lupus erythematosus, rheumatoid arthritis or scleroderma), are on therapy that suppresses immune system, are taking drugs allopurinol or procainamide, or any combinations of these • If you think you are (or might become) pregnant. Other medicines and Enalapril: It is especially important to tell your doctor if you are taking any of the following: • an angiotensin II receptor blocker (ARB) or aliskiren • Other medicines that lower blood pressure, such as beta blockers, vasodilators or water tablets (diuretics) • Potassium supplements (including salt substitutes), potassium-sparing diuretics and other medicines that can increase the amount of potassium in your blood (e.g. trimethoprim and co-trimoxazole for infections caused by bacteria; ciclosporin, an immunosuppressant medicine used to prevent organ transplant rejection; and heparin, a medicine used to thin blood to prevent clots) • Lithium, used for the treatment of certain kind of depression • Tricyclic antidepressants such as amitriptyline used for treating depression • Medicines for mental problems called ‘antipsychotics’ • Certain cough and cold medicines and weight reducing medicines which contain substances called ‘sympathomimetic agents’ • Certain pain or arthritis medicines including gold therapy. • Antidiabetic drugs including oral agents to lower blood sugar and insulin • Non-steroidal anti-inflammatory drugs (NSAIDs), including COX-2-inhibitors (medicines that reduce inflammation, and can be used to help relieve pain) • Aspirin (acetylsalicylic acid) • Medicines used to dissolve blood clots (thrombolytics) • Medicines which are most often used to avoid rejection of transplanted organs (sirolimus, everolimus and other medicines belonging to the class of mTOR inhibitors). • A medicine containing a neprilysin inhibitor such as sacubitril (available as fixed-dose combination with valsartan), used in patients with heart failure, and racecadotril. The risk of angioedema (swelling of the face, lips, tongue or throat with difficulty in swallowing or breathing) may be increased How to use Enalapril: Always take your medicine exactly as your doctor told you. If you are unsure about how to take your tablets, ask your doctor or pharmacist. • Do not take more tablets than prescribed. • You should take your tablet at the same time each day unless your doctor tells you otherwise. • If you are taking your medicine twice daily (2 tablets a day), take one tablet in the morning and one in the evening, unless your doctor has told you otherwise. Recommended dose to be swallowed with a glass of water: Adults High blood pressure: • The recommended starting dose is from 5mg to 20mg taken once a day • Some patients may need lower starting dose • The long term dose is 20mg taken once daily • The maximal long term dose is 40mg once a day Heart failure: • The starting dose is 2.5mg taken once a day • Your doctor will raise this amount step by step until the dose that us right for you has been achieved • The long term dose is 20mg taken in one or two doses • The maximal long term dose is 40mg each day, divided in two doses Elderly (65 years and over) Your dose will be decided by your doctor and will be based on how well your kidneys are working. Patients with kidney problems Your dose of medicine will be changed depending on how well your kidneys are working Use in children and adolescents Experience in the use of this medicine in children with high blood pressure is limited. If the child can swallow tablets, the dose will be worked out using the child’s weight and blood pressure. The recommended starting doses are: • Between 20 kg and 50 kg – 2.5 mg each day • More than 50 kg – 5 mg each day. Possible side effects: Stop using the product and seek immediate medical attention if • Swelling of the face, lips, tongue or throat which may cause difficulty in breathing or swallowing • Swelling of your hands, feet or ankles • A sudden, unexpected rash or burning, red or peeling skin • Ringing in your ears (tinnitus) • Bone marrow depression (reduction in blood cell count) • Heart attack (possibly due to very low blood pressure in certain high-risk patients, including those with blood flow problems of the heart or brain) • Stroke (possibly due to very low blood pressure in high-risk patients) You should be aware that black patients are at increased risk of these types of reactions How to store Enalapril: • Keep this medicine out of the sight and reach of children. • Do not take Enalapril after the expiry date on the carton; the expiry date refers to the last day of the month. • Do not store above 25°C. • Store in the original packaging. • Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment. A valid prescription should be available upon delivery