Intestinal angioedema

Enalapril Maleate (ENALAPRIL MALEATE)

Warnings

Anaphylactoid and Possibly Related Reactions

Presumably because angiotensin-converting enzyme inhibitors affect the metabolism of eicosanoids and polypeptides, including endogenous bradykinin, patients receiving ACE inhibitors, including enalapril maleate, may be subject to a variety of adverse reactions, some of them serious. These reactions may include head and neck angioedema and intestinal angioedema.

Head and Neck Angioedema

Angioedema of the face, extremities, lips, tongue, glottis, and/or larynx has been reported in patients treated with ACE inhibitors, including enalapril maleate. This may occur at any time during treatment. In such cases, enalapril maleate should be promptly discontinued, and appropriate therapy and monitoring should be provided until complete and sustained resolution of signs and symptoms has occurred.

Intestinal Angioedema

Intestinal angioedema has been reported in patients treated with ACE inhibitors. These patients presented with abdominal pain, with or without nausea or vomiting, and in some cases, there was no prior history of facial angioedema. Intestinal angioedema should be included in the differential diagnosis of patients on ACE inhibitors presenting with abdominal pain.

Anaphylactoid Reactions During Desensitization

Two patients undergoing desensitizing treatment with hymenoptera venom while receiving ACE inhibitors sustained life-threatening anaphylactoid reactions. Anaphylactoid reactions have also been reported in patients dialyzed with high-flux membranes and treated concomitantly with an ACE inhibitor.

Hypotension

Excessive hypotension is rare in uncomplicated hypertensive patients treated with enalapril maleate alone. Patients with heart failure given enalapril maleate commonly have some reduction in blood pressure, especially with the first dose. Caution should be observed when initiating therapy, and patients at risk for excessive hypotension should be closely monitored.

Neutropenia/Agranulocytosis

Another ACE inhibitor, captopril, has been shown to cause agranulocytosis and bone marrow depression. Available data from clinical trials of enalapril are insufficient to show that enalapril does not cause agranulocytosis at similar rates. Periodic monitoring of white blood cell counts in patients with collagen vascular disease and renal disease should be considered.

Hepatic Failure

Rarely, ACE inhibitors have been associated with a syndrome that starts with cholestatic jaundice and progresses to fulminant hepatic necrosis, and sometimes death. Patients receiving ACE inhibitors who develop jaundice or marked elevations of hepatic enzymes should discontinue the ACE inhibitor and receive appropriate medical follow-up.

Fetal Toxicity

Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death. When pregnancy is detected, discontinue enalapril maleate as soon as possible. Appropriate management of maternal hypertension during pregnancy is important to optimize outcomes for both mother and fetus.

FAQ

1. What should I do if I experience symptoms of angioedema while taking enalapril maleate?

If you experience symptoms of angioedema such as swelling of the face, lips, tongue, or difficulty breathing, you should promptly discontinue enalapril maleate and seek medical attention. Antihistamines may be useful in relieving symptoms, but appropriate therapy and monitoring should be provided until complete resolution of symptoms.

2. Are there any specific precautions for pregnant women taking enalapril maleate?

Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy can result in fetal toxicity. If pregnancy is detected, enalapril maleate should be discontinued as soon as possible. Appropriate management of maternal hypertension during pregnancy is important to optimize outcomes for both mother and fetus.

3. What should I do if I miss a dose of enalapril maleate?

If you miss a dose of enalapril maleate, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.

Disclaimer: This content is for informational purposes only and should not be considered medical advice. Always consult with a healthcare professional before making any decisions about your health or medication.