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Indications:

is indicated for the treatment of hypertension. is effective alone or in combination with other antihypertensive agents, especially thiazide-type diuretics. is indicated for the treatment of symptomatic congestive heart failure, usually in combination with diuretics and digitalis. In these patients ENALAPRIL improves symptoms, increases survival, and decreases the frequency of hospitalization . Asymptomatic Left Ventricular Dysfunction In clinically stable asymptomatic patients with left ventricular dysfunction (ejection fraction ≤ 35 percent), ENALAPRIL decreases the rate of development of overt heart failure and decreases the incidence of hospitalization for heart failure.

Contraindications:

contraindicated in patients who are hypersensitive to this product and in patients with a history of angioedema related to previous treatment with an angiotensin converting enzyme inhibitor and in patients with hereditary or idiopathic angioedema.

Adverse reactions:

Body As A Whole: Anaphylactoid reactions Cardiovascular: Cardiac arrest; myocardial infarction or cerebrovascular accident, possibly secondary to excessive hypotension in high risk patients pulmonary embolism and infarction; pulmonary edema; rhythm disturbances including atrial tachycardia and bradycardia; atrial fibrillation; palpitation, Raynaud’s phenomenon. Digestive: Ileus, pancreatitis, hepatic failure, hepatitis ,melena, anorexia, dyspepsia, constipation, glossitis, stomatitis, dry mouth. Hematologic: Rare cases of neutropenia, thrombocytopenia and bone marrow depression. Musculoskeletal: Muscle cramps. Nervous/Psychiatric: Depression, confusion, ataxia, somnolence, insomnia, nervousness, peripheral neuropathy (e.g., paresthesia, dysesthesia), dream abnormality. Respiratory: Bronchospasm, rhinorrhea, sore throat and hoarseness, asthma, upper respiratory infection, pulmonary infiltrates, eosinophilic pneumonitis. Skin: Exfoliative dermatitis, toxic epidermal necrolysis, Stevens-Johnson syndrome, pemphigus, herpes zoster, erythema multiforme, urticaria, pruritus, alopecia, flushing, diaphoresis, photosensitivity. Special Senses: Blurred vision, taste alteration, anosmia, tinnitus, conjunctivitis, dry eyes, tearing. Urogenital:Renal failure, oliguria, renal dysfunction, flank pain, gynecomastia, impotence. Miscellaneous: A symptom complex has been reported which may include some or all of the following: a positive ANA, an elevated erythrocyte sedimentation rate, arthralgia/arthritis, myalgia/myositis, fever, serositis, vasculitis, leukocytosis, eosinophilia, photosensitivity, rash and other dermatologic manifestations. Angioedema: Angioedema has been reported in patients receiving ENALAPRIL, with an incidence higher in black than in non-black patients. Angioedema associated with laryngeal edema may be fatal. If angioedema of the face, extremities, lips, tongue, glottis and/or larynx occurs, treatment should be discontinued and appropriate therapy instituted immediately. Fetal/Neonatal Morbidity and Mortality Cough. Pediatric Patients The adverse experience profile for pediatric patients appears to be similar to that seen in adult patients. Clinical Laboratory Test Findings Serum Electrolytes: Hyperkalemia, hyponatremia. INCREASE IN Creatinine, Blood Urea Nitrogen Hematology Small decreases in hemoglobin and hematocrit occur frequently in either hypertension or congestive heart failure patients treated with ENALAPRIL but are rarely of clinical importance unless another cause of anemia coexists. Liver Function Tests Elevations of liver enzymes and/or serum bilirubin have occurred

Interactions:

* gold injections to treat arthritis; *lithium (Lithobid, Eskalith); *a potassium supplement such as K-Dur, Klor-Con; *salt substitutes that contain potassium; *aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Motrin, Advil), diclofenac (Voltaren), etodolac (Lodine), indomethacin (Indocin), ketoprofen (Orudis), naproxen (Aleve, Naprosyn), and others; or *a diuretic (water pill).

Warnings:

*kidney disease (or if you are on dialysis); *liver disease; *heart disease or congestive heart failure; *diabetes; or *a connective tissue disease such as Marfan syndrome, Sjogren’s syndrome, lupus, scleroderma, or rheumatoid arthritis. FDA pregnancy category D. Do not use this medication without telling your doctor if you are pregnant or planning a pregnancy. Enalapril could cause birth defects in the baby if you take the medication during pregnancy. Use an effective form of birth control. Stop using this medication and tell your doctor right away if you become pregnant during treatment. Enalapril can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

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Consultants Corner

Dr. Faisal Dibsi

Dr. Faisal Dibsi Specialist of Otolaryngology - Head and Neck Surgery

Dr. Samer Al-Jneidy

Dr. Samer Al-Jneidy Pediatrician

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