Herten (Enalapril Maleate)

Herten (Enalapril Maleate) is indicated for several cardiovascular conditions where reduction of blood pressure or cardiac workload is desired.

• Hypertension (essential or secondary) requiring long‑term blood pressure control.
• Heart failure with reduced ejection fraction to improve symptoms and survival.
• Asymptomatic left ventricular dysfunction to delay progression to overt heart failure.
• Post‑myocardial infarction to reduce the risk of subsequent cardiovascular events.
• Diabetic nephropathy (off‑label) where ACE inhibition can slow renal decline.

• Enalapril is a prodrug that is converted to enalaprilat, a potent inhibitor of angiotensin‑converting enzyme (ACE). By blocking ACE, it prevents the conversion of angiotensin I to the vasoconstrictor angiotensin II, leading to vasodilation, reduced aldosterone secretion, and decreased sodium and water retention. The resulting decline in systemic vascular resistance and blood volume lowers arterial pressure and eases cardiac workload.

Like other ACE inhibitors, Herten may cause a range of adverse reactions, from mild and transient to rare but serious events.

Common

• Persistent dry cough.
• Dizziness or light‑headedness.
• Elevated blood potassium (hyperkalaemia).

Serious

• Angioedema involving the face, lips, tongue, or airway.
• Severe hypotension causing fainting.
• Acute kidney injury or rapid decline in renal function.

Before initiating Herten, clinicians should evaluate patient history and monitor specific parameters to minimize risk.

• Assess renal function and serum electrolytes prior to treatment and periodically thereafter.
• Use cautiously in patients with a history of angioedema or hereditary angioedema.
• Avoid in pregnancy; ACE inhibitors are contraindicated during the second and third trimesters.
• Monitor blood pressure closely during the first weeks to detect excessive hypotension.
• Adjust dose or discontinue if significant hyperkalaemia or worsening renal function occurs.
• Consider reduced dosing in elderly patients or those with low body weight.

Herten can interact with several medications, altering its efficacy or increasing the risk of adverse events.

Avoid

• Potassium‑sparing diuretics or supplements that may cause hyperkalaemia.
• Concomitant use of aliskiren in patients with diabetes or renal impairment.
• Other ACE inhibitors or angiotensin receptor blockers (dual blockade).

Use with caution

• Non‑steroidal anti‑inflammatory drugs (NSAIDs) that may reduce antihypertensive effect and affect renal function.
• Lithium, as ACE inhibition can increase lithium levels.
• Diuretics, especially thiazides, which may enhance hypotensive response.
• Certain antibiotics (e.g., trimethoprim‑sulfamethoxazole) that affect potassium balance.