Enalapril

The Basics

What is Enalapril?

Used alone or in combination to treat high blood pressure.

Brand names for Enalapril

Vasotec

How Enalapril is classified

Antihypertensive Agents, Angiotensin-Converting Enzyme Inhibitors, ACE Inhibitors, ACEIs

Enalapril During Pregnancy

Enalapril pregnancy category

Category D

Note that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.

What we know about taking Enalapril while pregnant

Use of drugs that act on the renin-angiotensin system during the second and thirdtrimesters of pregnancy reduces fetal renal function and increases fetal andneonatal morbidity and death. Resulting oligohydramnios can be associated withfetal lung hypoplasia and skeletal deformations. Potential neonatal adverseeffects include skull hypoplasia, anuria, hypotension, renal failure, and death.When pregnancy is detected, discontinue Vasotec as soon as possible. Theseadverse outcomes are usually associated with use of these drugs in the second andthird trimester of pregnancy. Most epidemiologic studies examining fetalabnormalities after exposure to antihypertensive use in the first trimester have notdistinguished drugs affecting the renin-angiotensin system from otherantihypertensive agents. Appropriate management of maternal hypertensionDuring pregnancy is important to optimize outcomes for both mother and fetus.In the unusual case that there is no appropriate alternative to therapy with drugsaffecting the renin-angiotensin system for a particular patient, apprise the motherof the potential risk to the fetus. Perform serial ultrasound examinations to assessthe intra-amniotic environment. If oligohydramnios is observed, discontinueVasotec, unless it is considered lifesaving for the mother. Fetal testing may beappropriate, based on the week of pregnancy. Patients and physicians should beaware, however, that oligohydramnios may not appear until after the fetus hassustained irreversible injury. Closely observe infants with histories of in uteroexposure to Vasotec for hypotension, oliguria, and hyperkalemia. [seePrecautions, Pediatric Use]. No teratogenic effects of enalapril were seen in studies of pregnant rats and rabbits. On a body surface area basis, the doses used were 57 times and 12 times,respectively, the maximum recommended human daily dose (MRHDD).

Taking Enalapril While Breastfeeding

What are recommendations for lactation if you're taking Enalapril?

Because of the low levels of enalapril in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants.

Maternal / infant drug levels

Because of the low levels of enalapril in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants.

Possible effects of Enalapril on milk supply

In 15 postmenopausal hypertensive women (prior lactation status not stated), serum prolactin levels were decreased by 22% compared to placebo after enalapril 20 mg once daily for 15 days.[4] The maternal prolactin level in a mother with established lactation may not affect her ability to breastfeed.

A woman with pre-eclampsia was treated was started at term with oral enalapril 10 mg daily. Her milk came in on day 3 postpartum and she had no difficulties with nursing during 5 weeks of observation.[5]

Possible alternatives to Enalapril

Benazepril, Captopril, Quinapril.