Enalapril — NZ Medication Guide
📋 Reviewed by a Registered Pharmacist NZ — This information is for general educational purposes only and does not replace professional medical advice. Always consult your doctor or pharmacist before starting, stopping, or changing any medication.
What is Enalapril?
Enalapril is an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure, heart failure, and to protect kidney function in certain conditions. This medication is commonly prescribed in New Zealand and is funded by Pharmac for hypertension and heart failure.
What is Enalapril Used For?
Enalapril is prescribed for hypertension, chronic heart failure, left ventricular dysfunction, and diabetic nephropathy. Like other ACE inhibitors, it is cardioprotective and renoprotective.
How Does Enalapril Work?
Enalapril is a prodrug converted in the liver to enalaprilat, its active form. Enalaprilat inhibits ACE, reducing the conversion of angiotensin I to angiotensin II — a potent vasoconstrictor. This lowers blood pressure, reduces cardiac preload and afterload, and protects the kidneys from pressure-mediated damage.
How to Take Enalapril
Taken once or twice daily, with or without food. Starting doses are low (2.5–5 mg) and titrated upward. Blood pressure, kidney function (creatinine, eGFR), and potassium levels must be monitored, especially when starting therapy or adjusting the dose.
Common Side Effects of Enalapril
- Persistent dry cough (very common — affects up to 20% of users)
- Dizziness or light-headedness (especially with first dose)
- Fatigue
- Headache
- Elevated potassium (hyperkalaemia)
Serious Side Effects — Seek Medical Attention
Contact your doctor or call 111 immediately if you experience any of the following:
- Angioedema — sudden swelling of the face, lips, tongue, or throat (rare but life-threatening — stop medicine and call 111)
- Severe hypotension (especially with first dose in dehydrated patients)
- Acute kidney injury
- Severe hyperkalaemia
Drug Interactions
Enalapril may interact with other medicines. Always inform your doctor and pharmacist of all medications, supplements, and herbal products you are taking. Key interactions include:
- Potassium supplements and potassium-sparing diuretics (spironolactone — risk of dangerous hyperkalaemia)
- NSAIDs (ibuprofen — reduce efficacy and increase risk of kidney injury)
- Lithium (ACE inhibitors raise lithium levels)
- ARBs and aliskiren (avoid dual blockade)
New Zealand Prescribing Information
Enalapril is funded by Pharmac and is available as 2.5 mg, 5 mg, 10 mg, and 20 mg tablets. It is one of the standard ACE inhibitors used in NZ for heart failure and hypertension. If the dry cough is intolerable, an angiotensin receptor blocker (ARB) such as losartan or candesartan may be substituted.
Frequently Asked Questions
Why do ACE inhibitors cause a cough?
ACE inhibitors block the breakdown of bradykinin, which accumulates in the lung and triggers irritation — causing a persistent dry cough in up to 20% of patients. If the cough is bothersome, speak to your doctor about switching to an ARB (such as losartan), which does not cause this side effect.
Can I take enalapril during pregnancy?
No. ACE inhibitors are contraindicated in pregnancy (especially the second and third trimesters) as they can cause severe fetal harm including renal failure and death. Use effective contraception and inform your doctor immediately if you become pregnant while taking enalapril.
⚠️ Disclaimer: This page is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or a qualified health provider with any questions you may have regarding a medical condition or medication. In New Zealand, medication availability and funding may vary — check with Pharmac or your pharmacist for the most current information.
Reviewed by a Registered Pharmacist NZ
References & Further Information
The following New Zealand and international resources were used to inform this page: