Enalapril
Dosing in kidney impairment
Dosage Adjustment in Hypertensive Patients with Renal Impairment The usual dose of enalapril is recommended for patients with a creatinine clearance more than 30 mL/min (serum creatinine of up to approximately 3 mg/dL). For patients with creatinine clearance less than or equal to 30 mL/min (serum creatinine more than or equal to 3 mg/dL), the first dose is 2.5 mg once daily.
The dosage may be titrated upward until blood pressure is controlled or to a maximum of 40 mg daily. [See table below.] 1 See WARNINGS, Anaphylactoid Reactions during membrane exposure. 2 Dosage on nondialysis days should be adjusted depending on the blood pressure response. Heart Failure Enalapril maleate is indicated for the treatment of symptomatic heart failure, usually in combination with diuretics and digitalis.
The appearance of hypotension after the initial dose of enalapril maleate does not preclude subsequent careful dose titration with the drug, following effective management of the hypotension. Dosage Adjustment in Patients with Heart Failure and Renal Impairment or Hyponatremia In patients with heart failure who have hyponatremia (serum sodium less than 130 mEq/L) or with serum creatinine greater than 1.6 mg/dL, therapy should be initiated at 2.5 mg daily under close medical supervision (see DOSAGE AND ADMINISTRATION, Heart Failure, WARNINGS and PRECAUTIONS, Drug Interactions ).
The dose may be increased to 2.5 mg b.i.d., then 5 mg b.i.d. and higher as needed, usually at intervals of four days or more if at the time of dosage adjustment there is not excessive hypotension or significant deterioration of renal function. The maximum daily dose is 40 mg. Pediatric Hypertensive Patients The usual recommended starting dose is 0.08 mg/kg (up to 5 mg) once daily.
| Renal Status | Creatinine Clearance mL/min | Initial Dose mg/day |
| Normal Renal Function | >80 mL/min | 5 mg |
| Mild Impairment | ≤80 >30 mL/min | 5 mg |
| Moderate to Severe Impairment | ≤30 mL/min | 2.5 mg |
| Dialysis Patients 1 | - | 2.5 mg on dialysisdays 2 |
Preparation and administration
Preparation of Suspension (for 200 mL of a 1.0 mg/mL suspension) Add 50 mL of sodium citrate and citric acid oral solution, USP to a polyethylene terephthalate (PET) bottle containing ten 20 mg enalapril maleate tablets and shake for at least 2 minutes. Let concentrate stand for 60 minutes. Following the 60-minute hold time, shake the concentrate for an additional minute.