Korandil (Enalapril Maleate)

• Enalapril is an ACE inhibitor used in the management of cardiovascular conditions that involve the renin‑angiotensin system.
• Hypertension: lowers elevated blood pressure, reducing the risk of stroke and heart attack in adult patients.
• Heart failure: improves cardiac output and symptoms by decreasing afterload and fluid retention in patients with reduced ejection fraction.
• Post‑myocardial infarction left ventricular dysfunction: helps prevent remodeling and further decline of heart function after an MI.
• Diabetic nephropathy: slows progression of kidney damage by reducing intraglomerular pressure in patients with type 2 diabetes.

• Enalapril is a prodrug that is converted to enalaprilat, a potent inhibitor of the 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, thereby lowering blood pressure and easing cardiac workload. The effect is dose‑dependent and persists as long as the drug is present in the circulation.

Enalapril may be associated with a range of adverse reactions, varying from mild to serious.

Common Side Effects

• Cough: persistent dry cough affecting up to 10% of patients.
• Dizziness: light‑headedness, especially after the first dose or dose increase.
• Headache: mild to moderate headache.
• Fatigue: general tiredness or reduced energy.
• Hypotension: low blood pressure, particularly after standing.

Serious or Rare Side Effects

• Angioedema: swelling of face, lips, tongue or airway requiring immediate medical attention.
• Neutropenia: marked reduction in white blood cells that can increase infection risk.
• Severe renal impairment: sudden rise in serum creatinine indicating kidney dysfunction.

When prescribing Enalapril, clinicians should observe several safety considerations to minimize risks.

• Blood pressure monitoring: check systolic and diastolic values after initiation and dose changes.
• Renal function assessment: evaluate serum creatinine and eGFR before treatment and periodically.
• Electrolyte balance: monitor potassium levels, especially when combined with potassium‑sparing agents.
• History of angioedema: avoid use in patients who have previously experienced angioedema.
• Pregnancy and lactation: use only if clearly needed, after risk‑benefit evaluation.
• Store at room temperature: keep tablets in the original container, protect from moisture and direct sunlight.

Enalapril can interact with several medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Aliskiren: concurrent use may increase risk of renal dysfunction and hyperkalemia.
• Lithium: Enalapril can raise lithium concentrations, leading to toxicity.
• Potassium‑sparing diuretics (e.g., spironolactone): may cause dangerous hyperkalemia.

Moderate Interactions (Monitor Closely)

• Loop or thiazide diuretics: combined effect may produce excessive hypotension.
• Non‑steroidal anti‑inflammatory drugs (NSAIDs): can blunt antihypertensive effect and affect renal function.
• Other antihypertensives (e.g., beta‑blockers): additive blood pressure lowering may require dose adjustment.