The dose of enalapril should be adjusted in patients with renal impairment. Enalapril is a prodrug and its conversion to its active metabolite may be decreased in patients with hepatic disease. Monitoring and dosage adjustments may be necessary in patients with hepatic impairment. Enalapril should be used with caution patients with hyperkalemia. ACE inhibitors can elevate serum potassium concentrations and could worsen pre-existing condition.
Hyperkalemia is associated with serious cardiac arrhythmias.
Enalapril therapy can produce angioedema, which can be fatal. Enalapril is contraindicated in patients with a history of ACE inhibitor-induced angioedema, hereditary angioedema, or idiopathic angioedema. Antihypertensive agents or diuretics can enhance the effects of enalapril if given concomitantly. This additive effect can be desirable, but dosages must be adjusted accordingly. Hyponatremia or hypovolemia predispose patients to developing reversible renal insufficiency when enalapril and diuretic therapy are given concomitantly.