Enalapril

Managing hypertension to prevent serious complications

Enalapril is particularly well-suited for individuals focused on managing hypertension to prevent serious complications. Research and clinical experience suggest meaningful benefits in this area when used as part of a comprehensive treatment approach.

Treating heart failure and improving survival rates

Enalapril is particularly well-suited for individuals focused on treating heart failure and improving survival rates. Research and clinical experience suggest meaningful benefits in this area when used as part of a comprehensive treatment approach.

Protecting organs from damage caused by high blood pressure

Enalapril is particularly well-suited for individuals focused on protecting organs from damage caused by high blood pressure. Research and clinical experience suggest meaningful benefits in this area when used as part of a comprehensive treatment approach.

Dry cough

Annoying but harmless persistent cough from increased bradykinin in airways. Affects 15-20% of ACE inhibitor users. Usually appears within days of starting but can develop weeks later. Worsens when lying flat.

Management: Sip water frequently to coat throat. Use sugar-free lozenges (honey or zinc help). Try dextromethorphan cough suppressant if severe. Avoid ACE irritants like spicy food. Sleep with head elevated on extra pillow. If intolerable after 2-4 weeks, switch to ARB (e.g., losartan) which doesn't cause this effect.

Dizziness

Orthostatic hypotension—blood pressure dropping too rapidly on standing, especially from lying/sitting position. Most common in first 1-2 weeks or after dose increases. More likely if dehydrated or on diuretics.

Management: Rise slowly from bed or chair—sit up for 30 seconds before standing. Stay well-hydrated (drink 2-3 liters water daily unless restricted). Avoid sudden position changes or standing for long periods. Eat small salty snacks if approved by provider. Compression stockings help. Symptoms usually resolve within 2-3 weeks as body adjusts.

Fatigue

Mild tiredness that often improves as your body adjusts. Results from lower blood pressure reducing cardiac workload—a sign the drug is working. Usually most noticeable in first 1-2 weeks and gradually improves.

Management: Gradual increase in activity level helps build tolerance. Small frequent meals prevent energy crashes. Ensure adequate sleep (7-9 hours). Check iron and B12 levels as deficiency worsens fatigue. Avoid sudden exertion before body adapts. Caffeine in moderation is acceptable. Fatigue typically resolves by week 3-4.

Hyperkalemia

ACE inhibitors reduce aldosterone, causing kidneys to retain potassium. Risk increases with kidney disease or concurrent potassium-sparing diuretics. Potassium typically rises 0.3-0.5 mEq/L. Dangerous only if becomes severe (>5.5 mEq/L).

Management: Get baseline potassium test before starting; recheck at 1 week, 4 weeks, then every 3-6 months. Avoid potassium supplements and salt substitutes (KCl). Limit high-K foods moderately (bananas, oranges, leafy greens less frequent). NSAIDs increase K retention—use sparingly. If level rises above 5.5, notify provider immediately—may need to reduce dose or add diuretic.

Angioedema

Rare but serious swelling of face, lips, tongue, or throat from elevated bradykinin in tissue. Can occur hours to weeks after starting. More common in African ancestry and smokers. Affects <1% of users but requires immediate action.

Management: This is a MEDICAL EMERGENCY—go to ER immediately if swelling affects breathing or throat. Milder facial/lip swelling: stop enalapril immediately, do not restart. Emergency room will give IV diphenhydramine and corticosteroids. Switch to ARB (losartan) or other antihypertensive class. Never rechallenge with ACE inhibitors.