ACE Inhibitor
Enalapril: Drug Interactions
Enalapril is an ACE inhibitor that lowers blood pressure, reduces cardiac workload, and provides kidney protection in hypertension, heart failure, and diabetic nephropathy.
ACE inhibitors have critical interactions with drugs that raise potassium or affect renal function.
Major Interactions — Avoid or Monitor Closely
- ⚠Aliskiren (in diabetics or renal impairment) — dual RAAS blockade increases risk of hypotension, hyperkalemia, renal failure; contraindicated
- ⚠ARBs combined with ACE inhibitors — dual RAAS blockade; increased adverse events without additional BP benefit; avoid combination
- ⚠Potassium-sparing diuretics (spironolactone, amiloride) — additive hyperkalemia; careful monitoring required
Moderate Interactions — Use With Caution
- •NSAIDs (ibuprofen, naproxen) — reduce antihypertensive effect; increase risk of acute kidney injury and hyperkalemia
- •Potassium supplements — additive hyperkalemia; monitor serum potassium
- •Lithium — ACE inhibitors reduce lithium clearance, increasing lithium toxicity risk
- •Ciclosporin / tacrolimus — additive nephrotoxicity and hyperkalemia
- •Insulin and oral hypoglycaemics — ACE inhibitors may enhance hypoglycaemic effect; monitor blood glucose
- •TMP-SMX (trimethoprim) — trimethoprim blocks renal potassium excretion; hyperkalemia risk
Food & Drink Interactions
- •High-potassium foods (bananas, citrus, potatoes) — potentiate hyperkalemia risk, especially in CKD
- •Salt substitutes containing potassium chloride — increased hyperkalemia risk
- •Alcohol — additive hypotensive effect
Monitoring Requirements
Renal function (eGFR, creatinine) and electrolytes (potassium) within 1–2 weeks of starting or dose change; blood pressure; first-dose hypotension especially in volume-depleted patients
Conditions Treated with Enalapril
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