Apo-Enalapril Dosage/Direction for Use





Full Prescribing Info
Dosage/Direction for Use
The absorption of APO-ENALAPRIL (enalapril maleate) is not affected by food.
Dosage must be individualized.
Hypertension: Initiation of therapy requires consideration of recent antihypertensive drug treatment, the extent of blood pressure elevation and salt restriction: the dosage of other antihypertensive agnts being used with APO-ENALAPRIL may been to be adjusted.
The recommended initial dose in patients not on diuretics is 5 mg once a day. Dosage should be adjusted according to blood pressure response. The usual dosage range is 10 to 40 mg per day administered in a single dose or two divided doses. In some patients treated once daily, the antihypertensive effect may diminish toward the end of the dosing interval. In such patients an increase in dosage or twice daily administration should be considered. If blood pressure is not controlled, a diuretic may be added.
The maximum daily dose is 40 mg. Raising the dose above the level is not recommended because of the possibility of increased adverse reactions.
Symptomatic hypotension occasionally may occur following the initial dose of enalapril and is more likely in patients who are currently being treated with a diuretic. The diuretic should, if possible, be discontinued for two to three days before beginning therapy with APO-ENALAPRIL to reduce the likelihood of hypotension (See Warnings).
If the diuretic cannot be discontinued, an initial dose of 2.5 mg should be used to determine whether excessive hypotension occurs.
To date there is insufficient experience with enalapril in the treatment of accelerated or malignant hypertension, APO-ENALAPRIL, therefore, is not recommended in such situations.
Dosage in the Elderly (over 65 years): The starting dose should be 2.5 mg. Some elderly patients may be more responsive to enalapril than younger patients.
Dosage Adjustment in Renal impairment: The doses should be reduced in patients with hypertension according to the following guidelines: See Table 3.

Click on icon to see table/diagram/image

Congestive Heart Failure: APO-ENALAPRIL is to be used in conjunction with diuretics and digitalis. Therapy must be initiated under close medical supervision, usually in a hospital. Blood pressure and renal function should be monitored, both before and during treatment with APO-ENALAPRIL, because severe hypotension and, more rarely, consequent renal failure have been reported (See Warnings and Precautions).
Initiation of therapy requires consideration of recent diuretic therapy and the possibility or severe salt/volume depletion. If possible, the dose of diuretic should be reduced before beginning treatment.
The recommended initial dose is 2.5 mg once a day.
In the absence of, or after effective management of symptomatic hypotension the dose should be increased gradually, depending on the patient's response, to the usual maintenance (10-20 mg), given in a single dose or in two divided doses. The dose titration may be performed over a two to four week period, or more rapidly if indicated by the presence of residual signs and symptoms of heart failure.
The maximum daily dose is 40 mg.
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