Adults: Maximum daily dose: 40 mg. Food does not affect the absorption of Enalapril.
Essential and renovascular hypertension: Treatment is usually started with 5 mg once a day. If the patient is also taking a diuretic, the recommended starting dose of Enalapril is 2.5 mg. The dose should then be titrated to achieve optimum blood pressure control. The usual maintenance dose is 10 to 20 mg given once daily. In severe hypertension, the dose may be increased step by step to a maximum of 40 mg once daily. Doses of other antihypertensive drugs taken alongside Enalapril may need adjustment. When Enalapril is used to replace a beta blocking drug, the beta blocker should not be stopped suddenly; instead, its dose should be tapered down after Enalapril therapy begins.
With concomitant diuretic therapy: The recommended starting dose of Enalapril is 2.5 mg. Symptomatic hypotension can occur after the first dose of Enalapril, and this is more likely when Enalapril is added to existing diuretic treatment. Caution is advised, as these patients may already be depleted of volume or salt. Where possible, diuretic treatment should be stopped for 2 to 3 days before starting Enalapril. Enalapril also helps limit thiazide induced low potassium and raised uric acid levels.
Use in the elderly, over 65 years: The starting dose should be 2.5 mg. Enalapril is effective for treating hypertension in elderly patients, and some older patients may respond more strongly to it than younger patients do. The dose should be titrated according to the patient's need for blood pressure control.
Heart failure: Enalapril can be used alongside non potassium sparing diuretics and/or digitalis. It should be introduced only after the patient has been stabilised on diuretic therapy, and treatment should begin under close medical supervision, with hospital supervision for severe heart failure. The recommended starting dose is 2.5 mg once daily. The dose should then be increased gradually, as tolerated, up to the recommended maintenance dose of 10 to 20 mg, given as a single dose or split into two daily doses. This dosing schedule has been shown to improve survival. To reduce the risk of symptomatic hypotension, patients who have been on high dose diuretics should have that dose reduced before starting Enalapril. If hypotension appears after the first dose, this does not rule out careful dose titration afterward, once the hypotension has been properly treated.
Use in impaired renal function: Enalapril is excreted by the kidneys, so it should be used with caution in patients with renal impairment. The recommended starting dose is 2.5 mg. The dose should be titrated according to response and kept as low as possible while still maintaining adequate control of blood pressure or heart failure. Enalapril can be removed by dialysis. Dialysis patients may be given the usual dose of Enalaprilon dialysis days. On days when the patient is not undergoing dialysis, the dose should be adjusted according to blood pressure response.
Children: The use of Enalapril in children has not been studied.