Check with the doctor or pharmacist before taking the medicine if: the patient has a heart problem.
The patient has a condition involving the blood vessels in the brain.
The patient has a blood problem such as low or lack of white blood cells (neutropenia/agranulocytosis), low blood platelet count (thrombocytopenia) or a decreased number of red blood cells (anaemia).
The patient has a liver problem.
The patient has a kidney problem (including kidney transplantation). These may lead to higher levels of potassium in the blood which can be serious. The doctor may need to adjust the dose of Enalapril Actavis Tablets or monitor the blood level of potassium.
The patient is having dialysis.
The patient has been very sick (excessive vomiting) or had bad diarrhoea recently.
The patient is on a salt-restricted diet, are taking potassium supplements, potassium-sparing agents, or potassium-containing salt substitutes.
The patient is over 70 years of age.
The patient has diabetes: Monitor the blood for low blood glucose levels, especially during the first month of treatment. The level of potassium in the blood can also be higher.
The patient has ever had an allergic reaction with swelling of the face, lips, tongue or throat with difficulty in swallowing or breathing. Be aware that black patients are at increased risk of these types of reactions to ACE inhibitors.
The patient has low blood pressure (the patient may notice this as faintness or dizziness, especially when standing).
The patient has collagen vascular disease (e.g. lupus erthematosus, rheumatoid arthritis or scleroderma), are on therapy that suppresses the immune system, are taking the drugs allopurinol or procainamide, or any combinations of these.
The patient thinks she is (or might become) pregnant: Enalapril Actavis Tablets is not recommended in early pregnancy, and must not be taken if she is more than 3 months pregnant, as it may cause serious harm to the baby if used at that stage (see Use in Pregnancy & Lactation).
The patient is breast-feeding or about to start breast-feeding (see Use in Pregnancy & Lactation): She should be aware that Enalapril Actavis Tablets lowers the blood pressure in black patients less effectively than in non-black patients.
If not sure if any of these applies, talk to the doctor or pharmacist before taking Enalapril Actavis Tablets.
Dual blockade of the renin-angiotensin-aldosterone system (RAAS): There is evidence that the concomitant use of ACE-inhibitors, angiotensin II receptor blockers or aliskiren increases the risk of hypotension, hyperkalaemia and decreased renal function (including acute renal failure). Dual blockade of RAAS through the combined use of ACE-inhibitors, angiotensin II receptor blockers or aliskiren is therefore not recommended.
If dual blockade therapy is considered absolutely necessary, this should only occur under specialist supervision and subject to frequent close monitoring of renal function, electrolytes and blood pressure.
ACE-inhibitors and angiotensin II receptor blockers should not be used concomitantly in patients with diabetic nephropathy.
If the patient is about to have a procedure: If the patient is about to have any of the following, tell the doctor that he/she is taking Enalapril Actavis Tablets: Any surgery or receive anaesthetics (even at the dentist); a treatment to remove cholesterol from the blood called 'LDL apheresis'; a desensitisation treatment, to lower the effect of an allergy to bee or wasp stings.
Important information about some of the ingredients of Enalapril Actavis Tablets: Enalapril Actavis Tablets contains lactose, which is a type of sugar. If the patient has been told by the doctor that he/she has intolerance to some sugars, talk to the doctor before taking this medicine.
Driving and using machinery: The patient may feel dizzy or sleepy while taking Enalapril Actavis Tablets. If this happens, do not drive or use any tools or machines.