Enalapril-Hydrochlorothiazide

Enalapril-Hydrochlorothiazide is a combination medication used to treat the symptoms of Hypertension (High Blood Pressure). 

• Enalapril-Hydrochlorothiazide is available under the following different brand names: Vaseretic

Common side effects of Enalapril-Hydrochlorothiazide include:

• Dizziness,
• Cough,
• Headache, and
• Nausea

Serious side effects of Enalapril-Hydrochlorothiazide include:

• Hives,
• Difficulty breathing,
• Swelling of the face, lips, tongue, or throat,
• Severe stomach pain,
• Fever,
• Sore throat,
• Burning in the eyes,
• Skin pain,
• Red or purple skin rash that spreads and causes blistering and peeling,
• Lightheadedness,
• Yellowing of the skin or eyes (jaundice),
• Blurred vision,
• Tunnel vision,
• Eye pain,
• Seeing halos around lights,
• Chills,
• Flu-like symptoms,
• Sore throat,
• Mouth sores,
• Leg cramps,
• Constipation,
• Muscle pain or weakness,
• Irregular heartbeats,
• Feeling jittery,
• Increased thirst or urination,
• Numbness or tingling,
• Loss of movement,
• Little or no urination,
• Swelling in your feet or ankles,
• Tiredness,
• Shortness of breath,
• Joint pain, and
• Skin rash on your cheeks or arms that worsens in sunlight

Rare side effects of Enalapril-Hydrochlorothiazide include:

• none 

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out.

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult dosage

Enalapril-Hydrochlorothiazide

• Tablet
  • 5 mg/12.5 mg
  • 10 mg/12.5 mg

Hypertension

Adult dosage

• 10-40 mg/12.5-50 mg (enalapril/HCTZ)/day orally once a day or divided every 12 hours.

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Enalapril-Hydrochlorothiazide has severe interactions with the following drugs:
  • aliskiren
  • protein a column
  • sacubitril/valsartan
• Enalapril-Hydrochlorothiazide has serious interactions with at least 49 other drugs.
• Enalapril-Hydrochlorothiazide has moderate interactions with at least 239 other drugs.
• Enalapril-Hydrochlorothiazide has minor interactions with at least 170 other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your healthcare professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

• Hypersensitivity to ACE inhibitors, thiazides, or sulfonamides
• ACE-inhibitor-induced angioedema, hereditary or idiopathic angioedema
• Coadministration of neprilysin inhibitors (. g, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hours of switching to or from sacubitril/valsartan
• Renal stenosis or anuria
  • Do not co-administer aliskiren in patients with diabetes

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Enalapril-Hydrochlorothiazide?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Enalapril-Hydrochlorothiazide?”

Cautions

• Begin combination therapy only after failed monotherapy
• Severe renal impairment, hepatic impairment
• Risk of hypotension, especially in CHF patients
• Dual blockade of the renin-angiotensin system with ARBs, ACE inhibitors, or aliskiren is associated with increased risk for hypotension, hyperkalemia, and renal function changes (including acute renal failure) compared to monotherapy
• Angioedema of the face, extremities, lips, tongue, glottis, and larynx has been reported in patients treated with angiotensin-converting enzyme inhibitors
• If laryngeal stridor or angioedema of the face, tongue, or glottis occurs discontinue therapy and institute appropriate therapy immediately
• Patients receiving coadministration of ACE inhibitor and mTOR (mammalian target of rapamycin) inhibitor (. g. temsirolimus, sirolimus, everolimus) therapy may be at increased risk for angioedema
• Intestinal angioedema has been reported in patients treated with ACE inhibitors
• Cholestatic jaundice may occur, which may progress to fulminant hepatic necrosis; discontinue
• Dry hacking nonproductive cough may occur within a few months of treatment; consider other causes of cough before discontinuation
• Hyperkalemia may occur with ACE inhibitors; risk factors include renal dysfunction, diabetes mellitus, and concomitant use of potassium-sparing diuretics and potassium supplements; use cautiously if at all with these agents
• Thiazide diuretics may cause hypokalemia, hypochloremic alkalosis, hypomagnesemia, and hyponatremia
• Hydrochlorothiazide may precipitate gout in patients with familial predisposition to gout or chronic renal failure
• Symptomatic hypotension with or without syncope can occur with ACE inhibitors; mostly observed in volume-depleted patients, correct volume depletion before initiation; monitor closely when initiating and increasing dosing
• Agranulocytosis, neutropenia, or leukopenia with myeloid hypoplasia reported with another ACE inhibitor; patients with renal impairment are at high risk; monitor CBC with a differential in these patients
• Photosensitization may occur; instruct patients to protect their skin from the sun and undergo regular skin cancer screening
• Hydrochlorothiazide may cause acute transient myopia and acute angle-closure glaucoma that may occur within hours of initiating therapy; discontinue therapy immediately in patients with acute decreases in visual acuity or ocular pain; additional treatment may be needed if uncontrolled intraocular pressure persists
• Use caution in patients with severe aortic stenosis; may reduce coronary perfusion resulting in ischemia
• Use hydrochlorothiazide with caution in patients with diabetes or at risk of diabetes; may see an increase in glucose
• Use caution in patients with collagen vascular disease, especially in patients with concomitant renal impairment
• Thiazide diuretics may decrease renal calcium excretion; consider avoiding use in patients with hypercalcemia
• Increased cholesterol and triglyceride levels were reported with thiazides; use caution in patients with moderate to high cholesterol concentrations
• Pathologic changes in parathyroid glands with hypercalcemia and hypophosphatemia reported with prolonged use; discontinue before testing for parathyroid function

Pregnancy and Lactation

• Use with caution if the benefits outweigh the risks. (1st trimester); Use in life-threatening emergencies when no safer drug is available during 2nd and 3rd trimesters.
• Lactation
  • Enters breast milk/not recommended