Enalapril: uses, side effects and cautions

Enalapril is used to manage high blood pressure and heart failure. As an ACE inhibitor it makes blood vessels relax and widen, which helps lower blood pressure. It is available on prescription; Innovace is a brand the NHS lists.

Enalapril comes as tablets, a liquid and orodispersible tablets. Swallow ordinary tablets with water; if you have the liquid, use the syringe supplied for an accurate measure; orodispersible tablets go under the tongue or inside the cheek and are left to dissolve fully.

The NHS says a doctor may prescribe a low dose to start with and increase it gradually over a few weeks. Try to take it at the same time each day. You can eat as normal.

Some people take it for several years or longer, and it matters to keep taking it for as long as your doctor prescribes. You may need regular blood tests or other checks.

If you forget a dose, skip it and take the next at the usual time. Never double up. An extra dose can occasionally be dangerous, so call NHS 111 if you take too much.

Tell the prescriber if you have had an allergic reaction to enalapril or another ACE inhibitor, have angioedema, or have kidney or liver problems. These are the exclusions the NHS lists.

Dizziness, especially on standing quickly, is commonly reported, along with blurred vision, a dry cough, headaches, altered taste, chest pain, breathlessness, nausea, vomiting and diarrhoea. If you feel dizzy or drowsy, do not drive, cycle or use machinery until it has passed.

Rare serious effects are anaphylaxis, kidney failure with blood in the urine, angioedema with swelling of the lips, tongue or face, blood cell changes, and liver problems with itching or yellow skin. Call NHS 111 if you think you may be having a serious effect; breathing difficulty or throat swelling needs 999.

Because the liquid and the dissolving tablets are measured or handled differently from ordinary tablets, check which form you have been given and read the instructions that come with that form. If your pharmacy changes the form or the manufacturer, ask whether anything about taking it changes.

Keep a note of the blood tests you have had and when the next one is due, as the NHS says regular checks may be needed. If you are ill with sickness or diarrhoea and cannot keep fluids down, mention that you take enalapril when you seek advice, since dehydration can affect blood pressure and the kidneys.

Named medicines include furosemide, aciclovir, amitriptyline, cefalexin, lithium, ibuprofen and aspirin, plus other blood pressure and heart medicines. The NHS says this is not the full list.

Alcohol can add to low blood pressure, so keep it modest.

Enalapril is not usually used in pregnancy because it can affect how the baby develops, and a safer alternative will be recommended. The NHS says enalapril can often be used while breastfeeding, but it is best to check because small amounts pass into breast milk. That is why it can be the ACE inhibitor of choice when a nursing parent needs one.

Lisinopril, ramipril and perindopril are other ACE inhibitors, and angiotensin receptor blockers such as losartan and candesartan are alternatives. Side effects can be reported via the Yellow Card scheme.