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Enalaprilat injection is used in the management of hypertension when oral therapy is not practical. Enalaprilat is the active metabolite of the oral prodrug enalapril maleate. Enalaprilat is poorly absorbed orally and requires intravenous administration. It inhibits angiotensin I to angiotensin II conversion via competitive inhibition of the angiotensin-converting enzyme (ACE). This activity will highlight the mechanism of action, adverse event profile, pharmacology, dosing, contraindications, warning and precautions, monitoring, toxicity, and relevant interactions of enalaprilat, pertinent for members of the interprofessional team in the treatment of patients with conditions where this agent is indicated. Objectives: Review the mechanism of action of enalaprilat and its conversion to enalapril. Discuss the contraindication for enalaprilat therapy. Review the adverse event profile for enalaprilat. Review interprofessional team strategies for improving care coordination and communication to advance enalaprilat and improve outcomes in hypertensive care. Access free multiple choice questions on this topic.

Cholestatic jaundice progressing to fulminant hepatic necrosis may occur. Enalaprilat should be discontinued if a marked elevation of hepatic transaminases or jaundice occurs. Following the first dose or at any time during treatment, angioedema can occur.[12] Angioedema of the face, extremities, lips, tongue, glottis, or larynx can lead to airway compromise. African Americans may be at an increased risk of developing angioedema.[13] If angioedema occurs, immediately discontinue enalaprilat and initiate appropriate therapy with antihistamines and monitoring as needed. When the tongue, glottis, or larynx is involved, subcutaneous epinephrine 1:1000 may be administered to reverse airway obstruction. A persistent, dry, hacking, nonproductive cough that occurs within the first few months of treatment can also occur with enalaprilat therapy. ACE inhibitor-induced cough is the result of the inhibition of the degradation of bradykinin and generally resolves within 1 to 4 weeks after discontinuation.[5] Symptomatic hypotension, including syncope, can occur with ACE inhibitor therapy. Close monitoring and correction of volume depletion are necessary before initiating treatment. If hypotension occurs, consider reducing the enalaprilat dose, but do not abruptly discontinue therapy.

Enalaprilat is a widely used drug in the ICU for the management of hypertension. It is often prescribed by nurse practitioners, intensivists, cardiologists, and internists. The drug is effective with a rapid onset of action. However, nurses need to monitor the patient as hypotension can develop quickly. It is preferable to have an arterial line for continuous blood pressure monitoring while using enalaprilat. Nursing should verify the dose before administering the dose to patients and also inform the patients of potential adverse reactions. Pharmacists need to perform medication reconciliation and inform clinicians of any issues. Open communication and collaborative work among health care providers can result in the successful treatment of patients needing treatment with enalaprilat while in hospital. Clinicians need to verify that patient is converted to an equivalent oral dose of enalapril before discharge if needed to continue anti hypertensive treatment with it. [Level 5]