Enalapril and Hydrochlorothiazide

Enalapril and hydrochlorothiazide is a prescription medication used to treat high blood pressure. It is a single product containing 2 medications: enalapril and hydrochlorothiazide. Enalapril belongs to a group of drugs called angiotensin-converting enzyme (ACE) inhibitors. Enalapril works by blocking the ACE enzyme, which helps blood vessels to relax and lowers blood pressure. Hydrochlorothiazide belongs to a group of drugs called thiazide diuretics, which work by stopping reabsorption of salt into your body. This prevents fluid from building up in the body.

This medication comes in tablet form. It is given once or twice daily, with or without food.

Common side effects of enalapril and hydrochlorothiazide include dizziness, tiredness (fatigue), and headache. Do not drive or operate heavy machinery until you know how this medication affects you. 

Enalapril and hydrochlorothiazide is a prescription medication used to treat high blood pressure.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information. 

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The dose your doctor recommends may be based on the following:

• your blood pressure
• previous medications used and the doses tried
• how you respond to this medication
• your other medical conditions

The dosing of enalapril and hydrochlorothiazide is based off its two components: enalapril and hydrochlorothiazide. The usual dosage range of enalapril is 10 to 40 mg per day given as a single or two divided doses. The usual dosage range of hydrochlorothiazide is 12.5 to 50 mg daily. The maximum dose is 40 mg/day of enalapril and 50 mg/day of hydrochlorothiazide.

WARNING: FETAL TOXICITY

• When pregnancy is detected, discontinue enalapril and hydrochlorothiazide as soon as possible.
• Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.

Serious side effects have been reported with enalapril and hydrochlorothiazide or its ingredients including the following:

• Narrowing of a heart valve and heart muscle thickening (aortic stenosis/hypertrophic cardiomyopathy)
• Allergic reactions. Tell your healthcare provider right away if you have some or all of the following symptoms:
• • swelling of the face, limbs, lips, tongue, throat
  • difficulty breathing
  • stomach (abdominal) pain (intestinal angioedema) with or without nausea or vomiting
• Excessive low blood pressure. Tell your healthcare provider if you continue to experience light headedness. 
• Liver damage.
• Lowered white blood cell count (neutropenia/agranulocytosis) increasing the risk of infections
• A condition in which close objects appear clearly, but far ones don't (myopia) or a buildup of pressure in the eye that can cause blindness (glaucoma). Tell your healthcare provider right away if you experience ​visual changes or eye pain.
• Harm to an unborn baby (fetal toxicity). Do not take enalapril and hydrochlorothiazide if you are pregnant or will become pregnant.
• Imbalances in the levels of salts and fluids in your body (electrolyte and fluid imbalance). Tell your healthcare provider right away if you have some or all of the following symptoms:
  • dry mouth
  • thirst
  • weakness
  • drowsiness
  • restlessness
  • muscle pains or cramps
  • low blood pressure
  • low output of urine
  • fast heart rate
  • nausea
  • vomiting

Enalapril and hydrochlorothiazide can cause drowsiness. Do not drive or operate heavy machinery until you know how this medication affects you.

Do not take enalapril and hydrochlorothiazide if you:

• are allergic to enalapril and hydrochlorothiazide or to any of its ingredients or to other sulfonamide-derived drugs
• kidneys are unable to produce urine (anuric)
• history of a type of swelling that affects deeper layers in your skin, often around your eyes and lips (angioedema)
• are a diabetic patient taking aliskiren (Tekturna)

Serious side effects have been reported with enalapril and hydrochlorothiazide. See the "Enalapril and hydrochlorothiazide Precautions" section. 

Common side effects of enalapril and hydrochlorothiazide include the following:

• dizziness
• headache
• tiredness (fatigue)
• cough
• muscle cramps
• nausea
• abnormal physical weakness or lack of energy (asthenia)
• low blood pressure upon standing (orthostatic effects)
• cannot get or keep an erection (impotence)
• diarrhea

This is not a complete list of enalapril and hydrochlorothiazide side effects. Ask your doctor or pharmacist for more information. 

Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088. 

Tell your doctor about all the medicines you take including prescription and nonprescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you are taking:

• ACE inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), quinapril (Accupril), and ramipril (Altace)
• angiotensin receptor II blockers such as azilsartan (Edarbi), candesartan (Atacand), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis, Twynsta), and valsartan (Diovan)
• direct renin inhibitors (DRIs) like aliskiren (Tekturna)
• diuretics like furosemide (Lasix), hydrochlorothiazide (Microzide, HCTZ), spironolactone (Aldactone), and triamterene (trade name Dyrenium)
• nonsteroidal anti-inflammatory drugs (NSAIDS) such as naproxen (Aleve) and ibuprofen (Advil)
• potassium supplements or potassium-containing salt substitutes
• lithium (Lithobid)
• injectable gold (sodium aurothiomalate)
• alcohol, a class of drugs called barbiturates, or a type of pain medications called narcotics
• diabetic medications
• cholestyramine (Questran) and colestipol (Colestid)
• medicines that provide relief for inflamed areas of the body (corticosteroids) such as methylprednisolone (Medrol) and dexamethasone (Decadron)
• substances that raise blood pressure (pressor amines) such as norepinephrine (Levophed)
• medicines that relax skeletal muscles such as cyclobenzaprine (Flexeril) and carisoprodol (Soma)

Do not drink alcohol while taking this medication.

This is not a complete list of enalapril and hydrochlorothiazide drug interactions. Ask your doctor or pharmacist for more information. 

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Enalapril and hydrochlorothiazide falls into category D. When pregnancy is detected, discontinue enalapril and hydrochlorothiazide as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and death to the unborn baby.

Tell your doctor is you are breastfeeding or plan to breastfeed. 

Enalapril and hydrochlorothiazide has been detected in human breast milk. Because of the possibility for adverse reactions in nursing infants from enalapril and hydrochlorothiazide, a choice should be made whether to stop nursing or to stop use of this medication. The importance of the drug to the mother should be considered.