Enalapril (Paediatric Heart Failure / Hypertension)

How it works

Its active metabolite enalaprilat inhibits angiotensin-converting enzyme, reducing angiotensin II formation and aldosterone secretion, producing vasodilatation and reduced fluid retention.

Prescribing in practice

• First-dose hypotension can be pronounced in children who are volume-depleted, on diuretics or have heart failure, so initiate cautiously, often with the first dose given under supervision.
• It can cause hyperkalaemia and deterioration in renal function, particularly with renal artery stenosis or concomitant potassium-sparing agents, and is contraindicated in pregnancy.
• Start low and titrate using a children's formulary, reducing the dose in renal impairment.

Monitoring

Monitor blood pressure, renal function and serum potassium before and during treatment, particularly after initiation and dose changes.

Counselling the patient

• A dry persistent cough or dizziness on standing can occur; report them to the team.
• Avoid over-the-counter anti-inflammatory medicines unless advised and keep well hydrated.
• Adolescents who could become pregnant must seek advice promptly as this medicine is unsafe in pregnancy.

Evidence & guidelines

ACE inhibitors including enalapril are well established for paediatric hypertension and heart failure, with use guided by specialist recommendations and the SPC.