Enalapril/Hydrochlorothiazide

DEA Class; Rx

Common Brand Names; Vaseretic

• ACEI/Diuretic Combos; 
• ACEI/HCTZ Combos

ACE inhibitor and thiazide diuretic; additive efficacy in HTN; given once or twice daily; counters the potassium loss from HCTZ; more effective than ACE monotherapy in black patients.

Indicated for the treatment of hypertension.

Hypersensitivity to ACE inhibitors, thiazides or sulfonamides

ACE-inibitor induced angioedema, hereditary or idiopathic angioedema

Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan

Renal stenosis or anuria

Do not coadminister with aliskiren in patients with diabetes

Enalapril

• Dizziness (4-8%)

• Hypotension (0.9-6.7%)

• Headache (2-5%)

• Chest pain (2%)

• Cough (1-2%)

• Rash (1.5%)

Hydrochlorothiazide

• Hypotension

• Anorexia

• Epigastric distress

• Hypokalemia

• Phototoxicity

Begin combination therapy only after failed monotherapy

Severe renal impairment, hepatic impairment

Risk of hypotension, especially in CHF patients

Dual blockade of the renin angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for hypotension, hyperkalemia, and renal function changes (including acute renal failure) compared to monotherapy

Angioedema of the face, extremities, lips, tongue, glottis, and larynx has been reported in patients treated with angiotensin-converting enzyme inhibitors

If laryngeal stridor or angioedema of the face, tongue, or glottis occurs discontinue therapy and institute appropriate therapy immediately

Patients receiving coadministration of ACE inhibitor and mTOR (mammalian target of rapamycin) inhibitor (e.g. temsirolimus, sirolimus, everolimus) therapy may be at increased risk for angioedema

Intestinal angioedema has been reported in patients treated with ACE inhibitors

Cholestatic jaundice may occur, which may progress to fulminant hepatic necrosis; discontinue

Dry hacking nonproductive cough may occur within few months of treatment; consider other causes of cough prior to discontinuation

Hyperkalemia may occur with ACE inhibitors; risk factors include renal dysfunction, diabetes mellitus, and concomitant use of potassium sparing diuretics and potassium supplements; use cautiously if at all with these agents

Thiazide diuretics may cause hypokalemia, hypochloremic alkalosis, hypomagnesemia, and hyponatremia

Pregnancy Category: C (1st trimester); D (2nd and 3rd trimesters)

Lactation: Enters breast milk/not recommended