Heart failure

Active Ingredient: Enalapril

Indication for Enalapril

Population group: only minors (0 - 18 years old)
Therapeutic intent: Curative procedure

Enalapril maleate is indicated for the treatment of heart failure in children from birth to less than 18 years.

For this indication, competent medicine agencies globally authorize below treatments:

0.01-0.04 mg/kg single initial dose followed 8 hours later by 0.15-0.3 mg/kg per day in one or two divided doses

For:

Dosage regimens

Oral, between 0.01 milligrams enalapril per kilogram of body weight and 0.04 milligrams enalapril per kilogram of body weight, one dose, over the duration of 8 hours. Afterwards, oral, between 0.15 milligrams enalapril per kilogram of body weight and 0.3 milligrams enalapril per kilogram of body weight, divided 1 to 2 times daily.

Detailed description

Starting/test dose

0.01 to 0.04 mg/kg (max 2 mg) as a single initial dose.

  • Before giving a test dose, blood pressure (BP) and renal function should be checked. If the BP is below the 5th percentile or creatinine is above normal limit for age, then enalapril should not be given.
  • Test dose should be at the lower end of the range for less stable patients and in infants <30 days of age.
  • Blood pressure should be monitored at intervals for 1–2 hours after the initial dose. If systolic BP is below the 5th percentile enalapril should be stopped and appropriate clinical care given.

Target/maintenance dose

0.15 to 0.3 mg/kg (max 20 mg) per day in one or two divided doses 8 hours after test dose. The dose should be individualised according to blood pressure, serum creatinine and potassium response.

  • If systolic blood pressure (SBP) is greater than or equal to the 5th percentile and serum creatinine is no more than 1.5 × baseline, consider enalapril dose up-titration.
  • If SBP is below the 5th percentile and serum creatinine is more than 2 × baseline, enalapril should be stopped.
  • If systolic blood pressure is below the 5th percentile and serum creatinine is between 1.5 and 2 × baseline, enalapril dose should be titrated down.
  • If SBP is above the 5th percentile and serum creatinine is more than 2 × baseline, enalapril dose should be titrated down.
  • If systolic blood pressure is greater than or equal to the 5th percentile and serum creatinine is between 1.5 to 2 × baseline the enalapril should be continued at the same dose.

At any stage if potassium ≥5.5 mmol/l pause enalapril treatment. Once hyperkalaemia has resolved, restart enalapril on the same or a lower dose level. If hyperkalaemia recurs, repeat the above and restart at a lower level. If potassium is repeatedly above 5.5 mmol/l, despite multiple dose decreases, discontinue enalapril.

If a dose is missed the next dose should be given as usual. Do not give a double dose to make up for a forgotten dose.

Dosage considerations

It can be taken with or without meals.

Active ingredient

Enalapril

Enalapril is hydrolysed via hepatic CES 1 to the active metabolite enalaprilat, which acts as an ACE inhibitor. ACE is a peptidyl dipeptidase which catalyses the conversion of angiotensin I to the vasoconstrictor substance angiotensin II and hence inhibition of ACE results in decreased plasma angiotensin II. This also leads to increased plasma renin activity and decreased aldosterone secretion. The mechanism of action of enalapril is therefore primarily via the suppression of the RAAS. However, ACE is identical to kininase II, and so enalapril may also exert its effects by blocking the degradation of bradykinin, a potent vasodepressor peptide.

Read more about Enalapril

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