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Enalapril maleate is a prominent angiotensin-converting enzyme inhibitor approved by the US Food and Drug Administration (FDA) for the treatment of heart failure, chronic hypertension, and asymptomatic left ventricular dysfunction. The FDA has approved a fixed-dose combination of enalapril with hydrochlorothiazide. Enalapril is utilized in asymptomatic left ventricular dysfunction as it mitigates progression to symptomatic heart failure and reduces mortality. This activity focuses on various aspects of enalapril, including its indications, mechanism of action, adverse event profile, dosing considerations, monitoring strategies, and potential drug interactions, specifically emphasizing its crucial role as an effective agent in managing hypertension and associated disorders. This activity also highlights the significance of a collaborative approach involving an interprofessional healthcare team in effectively utilizing and managing enalapril, ensuring shared decision-making and patient safety while delivering optimal care to patients with hypertension and related conditions. Objectives: Identify patients who would benefit from enalapril therapy based on indications such as heart failure, chronic hypertension, and asymptomatic left ventricular dysfunction. Screen patients for potential contraindications and risk factors associated with enalapril therapy, including age-related considerations and drug interactions. Assess patient response to enalapril therapy by regularly monitoring renal function as well as blood pressure and electrolyte levels in patients. Collaborate with interprofessional healthcare teams to coordinate follow-up care and monitoring for patients receiving enalapril therapy, thereby optimizing treatment outcomes and safety. Access free multiple choice questions on this topic.

Enalapril toxicity is rare, with hypotension being a major complication. Management typically involves symptomatic treatment, while fluid resuscitation can be utilized to increase intravascular volume. In neonates, peritoneal dialysis can remove enalapril from circulation, while hemodialysis is effective in general cases. A recent case report demonstrated the successful use of naloxone for ACE inhibitor overdose, suggesting a potential mechanism involving the endogenous opioid system and accumulation of enkephalins. However, due to the opioid epidemic, concomitant opioid intoxication cannot be excluded. Further research is warranted to explore the use of naloxone in ACE inhibitor poisoning.[44][45]

Enalapril is a frequently prescribed medication by clinicians for treating chronic hypertension, heart failure, asymptomatic LV dysfunction, and diabetic nephropathy. Today, approximately 66% of the older population suffers from hypertension.[46] According to The Centers for Disease Control and Prevention (CDC), approximately 6.2 million adults in the United States were diagnosed with heart failure in 2020, with ACE inhibitors commonly used in treatment.[47] Healthcare providers should be mindful during routine checkups that patients using ACE inhibitors and those aged 70 or older are at a higher risk of developing hyperkalemia.[48] In contrast, patients younger than 70 and on ACE inhibitors typically develop only mild-to-moderate hyperkalemia. Patients taking ACE inhibitors with blood urea nitrogen (BUN) higher than 8.9 mmol/L are at an increased risk of developing hyperkalemia.[48] As severe hyperkalemia can precipitate life-threatening complications, healthcare providers should provide adequate counseling to such patients about these risks. Chronic hyperkalemia can manifest as entirely asymptomatic, with no discernible ECG changes. Thus, relying solely on ECG for diagnosing hyperkalemia may be insufficient. Timely diagnosis of severe hyperkalemia is imperative, as it can lead to life-threatening complications such as cardiac arrest.[49] Although enalapril is a widely used and generally well-tolerated medication, its proper utilization and management necessitate the collaboration of an interprofessional healthcare team comprising clinicians, specialists, nurses, and pharmacists. This collaboration facilitates shared decision-making and ensures patient safety. Participating clinicians can deliver optimal care to patients with hypertension and related conditions through effective communication and essential information obtained from this activity.