Enalapril (Maleate)

Enalapril should be used with caution in patients of renal insufficiency, severe liver dysfunction, hypervolemia, angioedema and in pre-existing bone marrow depression. Enalapril therapy can cause neutropenia or agranulocytosis. Patients with renal disease, patients with immunosuppression or receiving immunosuppressives, and patients with collagen vascular disease or autoimmune disease are at a greater risk for developing these complications. The dose should be adjusted in patients with renal impairment. It should be used cautiously in patients with congestive heart failure. Initial doses should be lower than in the treatment of hypertension becauseof a greater risk of developing hypotension. It should not be administered to patients with pre-existing renal artery stenosis. Renal function should be monitored closely during the first 2 weeks after initiating therapy. It should be discontinued if renal function worsens acutely. Other types of renal disease can actually improve during Enalapril therapy. The dose should be adjusted in patients with renal impairment. It should be used with caution patients with hyperkalemia. It is classified as pregnancy category C and should be used with caution during pregnancy only if clearly needed.