Enalapril

About enalapril

Enalapril is a medicine used to reduce high blood pressure and to prevent or treat heart failure.

If you have high blood pressure, taking enalapril will help prevent a future heart attack or stroke.

This medicine is only available on prescription. It comes as tablets. It also comes as a liquid for people who find it hard to swallow tablets but your pharmacist will have to order this for you.

Enalapril is also available mixed with another blood pressure medicine called hydrocholorothiazide.

Key facts

Enalapril lowers your blood pressure and makes it easier for your heart to pump blood around your body.
Your first dose of enalapril may make you feel dizzy, so it's best to take it at bedtime. After that, if you don't feel dizzy, you can take it at any time of day.
Some people get a dry, irritating cough with enalapril.
Drinking alcohol with enalapril can make you feel dizzy or light-headed.
Enalapril is also called by the brand name Innovace. When it's mixed with hydrochlorothiazide, its brand name is Innozide.

Who can and can't take enalapril

Enalapril can be taken by adults and children.

If you have diabetes, check your blood sugar (glucose) more often, particularly in the first few weeks. This is because enalapril can lower the sugar level in your blood.

Enalapril isn't suitable for everyone.

To make sure it is safe for you, tell your doctor or other health professional if you:

have had an allergic reaction to enalapril or any other medicine in the past
are trying to get pregnant, are already pregnant, or you're breastfeeding
are having dialysis or any other type of blood filtration
have heart, liver or kidney problems
have unstable or low blood pressure
have diabetes
have recently had diarrhoea or vomiting
are on a low-salt diet
are going to have desensitisation treatment to reduce your allergy to insect stings
are going to have a major operation or a general anaesthetic to put you to sleep
have a blood problem such as too few white blood cells (neutropenia or agranulocytosis)

How and when to take it

It's usual to take enalapril once or twice a day.

Your doctor may advise you to take your first dose before bedtime, because it can make you dizzy. After the first dose, if you do not feel dizzy, you can take enalapril at any time of day. Try to take it at the same time every day.

If you have enalapril twice a day, try to take it once in the morning and once in the evening. Leave 10 to 12 hours between doses if you can.

How much will I take?

The dose of enalapril you take depends on why you need the medicine. Take it as your doctor tells you to.

To decide the correct dose for you, your doctor will check your blood pressure and ask you if you are getting any side effects. You may also have blood tests to check how well your kidneys are working and the amount of potassium in your blood.

Depending on why you're taking enalapril, the usual starting dose is between 2.5mg and 20mg once a day.

This will be increased gradually over a few weeks to a usual dose of:

20mg once a day for high blood pressure
10mg once a day or 20mg once a day for heart failure

The maximum dose is 20mg twice a day.

Doses are usually lower for children or people with kidney problems.

How to take it

You can take enalapril with or without food. Swallow the tablets whole with a drink.

If you're taking enalapril as a liquid, it will come with a plastic syringe or spoon to help you measure out the right dose. If you don't have one, ask your pharmacist for one. Don't use a kitchen teaspoon as it won't give you the right amount of medicine.

Will my dose go up or down?

You will probably be prescribed a low dose of enalapril at first so it doesn't make you feel dizzy. This will usually be increased gradually until you reach the right dose for you. If you're bothered by side effects with enalapril you can stay on a lower dose.

Take enalapril even if you feel well, as you will still be getting the benefits of the medicine.

What if I get ill while I'm taking it?

If you get severe diarrhoea or vomiting for any reason, stop taking enalapril. When you're able to eat and drink normally, wait for 24 to 48 hours, then start to take it again.

If you have questions about this, contact your doctor or pharmacist.

What if I forget to take it?

If you miss a dose of enalapril, leave out that dose and take your next dose at the usual time. Do not take a double dose to make up for the forgotten dose.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember your medicine.

What if I take too much?

If you take too many enalapril tablets, contact your doctor or nearest hospital straight away. An overdose of enalapril can cause dizziness, sleepiness and a pounding heartbeat.

The amount of enalapril that can lead to an overdose varies from person to person.

If you take too much enalapril by accident, call your doctor or go to your nearest hospital straight away.

If you need to go to hospital, don't drive yourself - get someone else to drive you or call for an ambulance. Take the enalapril packet or leaflet inside it plus any remaining medicine with you.

Side effects

Like all medicines, enalapril can cause side effects in some people, but many people have no side effects or only minor ones.

Side effects often get better as your body gets used to the medicine.

Common side effects

These common side effects happen in more than 1 in 100 people. They are usually mild and short-lived.

Talk to your doctor or pharmacist if these side effects bother you or don't go away:

dry, tickly cough that does not go away
feeling dizzy or light headed, especially when you stand up or sit up quickly. This is more likely to happen when you start taking enalapril or move onto a higher dose
headache
diarrhoea
mild skin rash
blurred vision

Serious side effects

Some people have serious side effects after taking enalapril.

Tell a doctor straight away if you get:

weak arms and legs or problems speaking - it's important to check these out in case they are signs of a stroke
yellow skin or eyes - this could be a sign of liver problems
paleness, feeling tired, faint or dizzy, any sign of bleeding (like bleeding from the gums or bruising more easily), sore throat and fever and getting infections more easily - these could be signs of a blood or bone marrow disorder
a faster or irregular heart rate, chest pain and tightness in your chest - these could be signs of heart problems
shortness of breath, wheezing and tightening of the chest - these could be signs of lung problems
severe tummy pain which could reach through to your back - this could be a sign of an inflamed pancreas (pancreatitis)
swollen ankles, blood in your pee or not peeing at all - these could be signs of kidney problems

Serious allergic reaction

A serious allergic reaction is an emergency. Contact a doctor straight away if you think you or someone around you is having a serious allergic reaction.

It is possible to have a serious allergic reaction to enalapril. The warning signs of a serious allergic reaction are:

getting a skin rash that may include itchy, red, swollen, blistered or peeling skin
wheezing
tightness in the chest or throat
having trouble breathing or talking
swelling of the mouth, face, lips, tongue or throat

These are not all the side effects of enalapril. For a full list see the leaflet inside your medicines packet.

You can report any suspected side effects to the UK safety scheme.

How to cope with side effects

What to do about:

dry, tickly cough - cough medicines don't usually help for coughs caused by enalapril. Sometimes the cough will get better on its own if you keep taking enalapril. Talk to your doctor if it carries on, bothers you or stops you from sleeping. Another medicine may suit you better. If your doctor recommends that you stop taking enalapril, the cough may take a few days to a month to go away.
feeling dizzy - if enalapril makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you don't faint, then sit until you feel better. Don't drive or use tools or machines while you're feeling dizzy or shaky.
headaches - make sure you rest and drink plenty of fluids. Don't drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if the headaches last longer than a week or are severe.
diarrhoea - it may help to take oral rehydration solutions. You can buy these from a pharmacy or supermarket to prevent dehydration. Don't take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
itching or a mild rash - it may help to take an antihistamine which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you.
blurred vision - avoid driving or using tools or machines while this is happening. If it lasts for more than a day or two speak to your doctor as they may need to change your treatment.

Pregnancy and breastfeeding

Enalapril is not normally recommended in pregnancy. However, your doctor may prescribe it if they think the benefits of the medicine outweigh the risks.

If you're trying to get pregnant or you're already pregnant, talk to your doctor about the benefits and possible harms of taking enalapril. These will depend on how many weeks pregnant you are and the reason you need to take it. There may be other treatments that are safer for you.

Enalapril and breastfeeding

Small amounts of enalapril may get into breast milk. This can cause low blood pressure in the baby.

If your baby was born full term and healthy, it's generally safe to take enalapril while you're breastfeeding.
If your baby was premature, has a low birth weight or other health problems, talk to your doctor.

Your baby's blood pressure may be monitored, especially if your baby was premature or is newborn.

Talk to your doctor, as another medicine might be better while you're breastfeeding.

Tell your doctor if you're trying to get pregnant, are already pregnant or if you're breastfeeding.

Cautions with other medicines

There are some medicines that may interfere with the way enalapril works.

Tell your doctor if you're taking:

anti-inflammatory medicines such as ibuprofen, indomethacin or a high dose of aspirin for pain relief. A daily low dose of aspirin - 75mg - is safe to take with enalapril
medicines to treat low blood pressure, heart failure, asthma or allergies, such as ephedrine, noradrenaline or adrenaline
medicines to treat high blood pressure, such as aliskeren
other medicines which can lower your blood pressure such as some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), anaesthetics or medicines for an enlarged prostate gland
medicines to damp down the body's immune system such as ciclosporin or tacrolimus
water tablets such as furosemide
medicines which can increase the amount of potassium in your blood such as spironolactone, triamterene, amiloride, potassium supplements, trimethoprim (for infections) and heparin (for thinning blood)
steroid medicines such as prednisolone
allopurinol (for gout)
procainamide (for heartbeat problems)
medicines for diabetes
racecadotril (for diarrhoea)
lithium (for mental health problems)

Mixing enalapril with herbal remedies or supplements

There's very little information about taking herbal remedies and supplements with enalapril.

For safety, speak to your pharmacist or doctor before taking any herbal or alternative remedies with enalapril.

Tell your doctor or pharmacist if you are taking any other medicines, including herbal medicines and supplements.

Common questions

How does enalapril work?

Enalapril is a type of medicine called an ACE (angiotensin-converting enzyme) inhibitor.

Like other ACE inhibitors, it relaxes and widens your blood vessels. This lowers your blood pressure and makes it easier for your heart to pump blood around your body.

How long does enalapril take to work?

Enalapril starts to reduce your high blood pressure within a few hours, but it may take a few weeks to fully take effect.

If you're taking enalapril for heart failure, it may take weeks, even months, before you feel better.

If you're taking enalapril for high blood pressure, you may not have any symptoms. In this case, you may not feel any different when you take enalapril. This doesn't mean that the medicine isn't working and it's important to keep taking it.

How long will I take enalapril for?

Usually, treatment with enalapril is long term and you may have to take it for the rest of your life.

Can I take enalapril for a long time?

Enalapril is generally safe to take for a long time. In fact, it works best when you take it for a long time.

Taking enalapril for a long time can sometimes cause your kidneys to not work as well as they should. Your doctor will check how well your kidneys are working with regular blood tests.

What will happen if I come off it?

Talk to your doctor if you want to stop taking enalapril.

Stopping it may cause your blood pressure to rise – and this may increase your risk of heart attack and stroke.

If you're bothered by side effects, your doctor may be able to prescribe you a different medicine.

Can I come off enalapril now my blood pressure is lower?

Even if enalapril brings down your blood pressure successfully, it's best to carry on taking it. If you stop taking it, your blood pressure could go back up again.

If you need medicines to lower your blood pressure, you'll probably need them for the rest of your life.

Remember, by keeping your blood pressure low, you're protecting yourself against having a heart attack or stroke in the future.

Can I drink alcohol with it?

Enalapril lowers your blood pressure and drinking alcohol can increase its effects. This can make you feel dizzy or light-headed.

During the first few days of taking enalapril or after a dose increase, it's best to stop drinking alcohol until you see how the medicine affects you.

If you find enalapril makes you feel dizzy, it's best to stop drinking alcohol.

Are there similar medicines to enalapril?

There are several other ACE inhibitor medicines which work in the same way as enalapril. They include ramipril, lisinopril and perindopril.

There are also lots of other types of blood pressure-lowering medicines:

calcium-channel blockers – for example amlodipine
angiotensin receptor blockers – for example candesartan
beta-blockers – for example bisoprolol
diuretics (water tablets) – for example bendroflumethiazide

If you can't take enalapril or other ACE inhibitor medicines because of side effects such as a dry cough, you may be able to switch to another blood pressure-lowering medicine. This will usually be a medicine called an angiotensin receptor blocker such as candesartan, irbesartan, losartan and valsartan.

What are the differences between enalapril and other ACE inhibitors?

Enalapril works as well as other ACE inhibitors when you take it to lower blood pressure and for heart failure. The side-effects are also similar to those of other ACE inhibitors.

There are a few differences between enalapril and other ACE inhibitors:

some ACE inhibitors are officially approved to be used after a heart attack to prevent further ones, but enalapril isn't
some ACE inhibitors are officially approved to be used in diabetic kidney disease, but enalapril isn't

Can I take enalapril before surgery?

Tell your doctor that you're taking enalapril if you're going to be put to sleep with a general anaesthetic for an operation or are going to have a major operation, such as a Caesarean section, without a general anaesthetic.

Enalapril can reduce your blood pressure when it's used with a general anaesthetic.

Your doctor may advise you to stop taking enalapril 24 hours before surgery.

Is enalapril addictive?

No, there's no evidence that enalapril is addictive.

Will it affect my contraception?

Enalapril won't affect any type of contraception.

However, some types of hormonal contraception, like the combined contraceptive pill and contraceptive patch, aren't usually recommended for women taking enalapril. This is because some hormonal contraceptives can raise your blood pressure and stop the medicine working properly.

Talk to your doctor if you're taking hormonal contraceptives.

Will it affect my fertility?

There's no evidence that enalapril reduces fertility in men or women. However, if you're a woman and you're trying to get pregnant, talk to your doctor first as this medicine is usually not recommended in pregnancy.

Is there any food or drink I need to avoid?

Don't use salt substitutes such as Lo-Salt. This is because they are high in potassium. When mixed with enalapril they may make the level of potassium in your blood too high.

There is nothing else you need to avoid while taking enalapril. Eating a healthy, balanced diet can help if you have high blood pressure or heart failure.

Can I drive or ride a bike?

Enalapril can cause blurred vision and can make some people feel dizzy or weak. If this happens to you, don't drive a car, ride a bike, or use tools or machines.

Feeling dizzy is more likely to happen when you first start taking enalapril or after increasing your dose. It's best to stop driving, riding a bike and using tools or machines during these times.

Can lifestyle changes help?

You can boost the health of your heart by making some key lifestyle changes. These will also help if you have high blood pressure or heart failure.

Stop smoking – smoking increases your heart rate and blood pressure. Quitting smoking brings down your blood pressure and relieves heart failure symptoms. Try and avoid secondhand smoke too.
Drink alcohol sensibly – drinking too much alcohol raises blood pressure over time. It makes heart failure worse too. Men and women shouldn't drink more than 14 units of alcohol a week.
Be more active – regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. It doesn't need to be too energetic – walking every day is enough.
Eat healthily – aim to eat a diet that includes plenty of fruit and veg, wholegrains, fat-free or low-fat dairy products and lean proteins. It's a good idea to cut down on salt too. Eating too much salt is the biggest cause of high blood pressure – the more salt you eat, the higher your blood pressure will be. Aim for no more than 6g of salt a day.
Manage stress – when you're anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse too. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help avoid stress.
Vaccinations – if you have heart failure, it's recommended that you have a flu jab every year and a pneumonia vaccination every 5 years. Ask your doctor about these vaccinations. You can have them free on the NHS.