|Manufacturer:||Multichem NZ Ltd manufactures M-Enalapril.|
|Uses:||The uses of M-Enalapril include:|
#All grades of essential hypertension.
#All degrees of heart failure.
#In patients with symptomatic heart failure, m-Enalapril is also indicated to improve survival, retard the progression of heart failure and reduce hospitalisation for heart failure.
#The prevention of symptomatic heart failure.
#In asymptomatic patients with left ventricular dysfunction m-
#Enalapril is indicated to retard development of symptomatic heart failure and reduce hospitalisation for heart failure.
#Prevention of coronary ischemic events in patients with left ventricular dysfunction.
#Reduce the incidence of myocardial infarction.
#Reduce hospitalisation for unstable angina pectoris.
The initial dose is 5mg once daily. The usual maintenance dose is 20mg once daily. The dosage should be adjusted according to the needs of the patient to a maximum of 40mg daily.
Because blood pressure and renal function in such patients may be particularly sensitive to ACE inhibition, therapy should be initiated with a lower starting dose of 2.5mg to 5mg. The dosage should then be adjusted according to the patient's needs. Most patients may be expected to respond to one 20mg tablet taken once daily. For patients with hypertension who have been treated recently with diuretics, caution is recommended (see next paragraph).
Concomitant diuretic therapy in hypertension:
Symptomatic hypotension may occur following the initial dose of enalapril. This is more likely in patients who are being treated currently with diuretics. Caution is recommended as these patients may be volume or salt depleted. The diuretic therapy should be discontinued for 2-3 days prior to initiation of therapy with enalapril. If this is not possible, the initial dose of enalapril should be low (2.5mg) to determine the initial effect on the blood pressure. Dosage should then be adjusted according to the patient's needs.
Heart failure/asymptomatic left ventricular dysfunction:
The initial dose of enalapril in patients with symptomatic heart failure or asymptomatic left ventricular dysfunction is 2.5mg, and it should be administered under close medical supervision to determine the initial effect on the blood pressure. Enalapril may be used in the management of symptomatic heart failure usually with diuretics and, where appropriate, digitalis. In the absence of, or after effective management of, symptomatic hypotension following initiation of therapy with enalapril in heart failure, the dose should be increased gradually to the usual maintenance dose of 20mg, given in a single dose or two divided doses, as tolerated by the patient. This dose titration may be performed over a 2 to 4 week period, or more rapidly if indicated by the presence of residual signs and symptoms of heart failure. In patients with symptomatic heart failure this dosage regimen was effective in reducing mortality.
Blood pressure and renal function should be monitored closely both before and after starting treatment with enalapril (see Warnings and Precautions) because hypotension and (more rarely) consequent renal failure have been reported. In patients treated with diuretics the dose should be reduced if possible, if possible, before beginning treatment with enalapril. The appearance of hypotension after the initial dose of enalapril does not imply that hypotension will recur during chronic therapy with enalapril and does not preclude continued use of the medicine. Serum potassium should also be monitored