Korandil (Enalapril Maleate)

Enalapril is an ACE inhibitor that acts on the renin‑angiotensin‑aldosterone system to manage cardiovascular conditions.

• Hypertension: lowers systemic blood pressure and reduces risk of stroke and heart attack.
• Heart failure: improves cardiac output and decreases symptoms of fluid overload.
• Post‑myocardial infarction left ventricular dysfunction: helps prevent remodeling and further cardiac events.

• Enalapril is converted in the body to enalaprilat, which binds to the active site of angiotensin‑converting enzyme (ACE). This inhibition blocks the conversion of angiotensin I to the potent vasoconstrictor angiotensin II, leading to vasodilation, reduced aldosterone secretion, decreased sodium and water retention, and ultimately lower arterial pressure.

Enalapril may cause a range of adverse reactions, from mild to severe.

Common Side Effects

• Cough: dry, persistent throat irritation.
• Dizziness: especially upon standing.
• Headache: mild to moderate intensity.
• Fatigue: general feeling of tiredness.
• Hyperkalemia: elevated blood potassium levels.
• Renal function changes: modest increase in serum creatinine.

Serious or Rare Side Effects

• Angioedema: swelling of face, lips, tongue, or airway.
• Severe hypotension: marked drop in blood pressure.
• Acute kidney injury: rapid decline in renal function.
• Hepatotoxicity: abnormal liver enzymes.
• Neutropenia: low white blood cell count.
• Stevens‑Johnson syndrome: severe skin reactions.

Before initiating therapy, consider patient‑specific factors and monitor appropriately.

• Pregnancy: contraindicated in the second and third trimesters due to fetal toxicity.
• Renal impairment: adjust dose and monitor creatinine and electrolytes.
• Hyperkalemia risk: avoid concurrent potassium‑sparing diuretics or supplements.
• Hypotension: caution in patients with volume depletion or on diuretics.
• Drug-specific monitoring: regular blood pressure and renal function checks.
• Store at ambient temperature: keep below 25 °C, retain in original packaging, protect from moisture and direct sunlight.

Enalapril can interact with several drug classes, affecting efficacy or safety.

Major Interactions (Avoid)

• Aliskiren: combined use in diabetes or renal impairment may increase risk of renal dysfunction.
• Lithium: may increase lithium levels, leading to toxicity.
• Potassium‑sparing diuretics or supplements: can precipitate severe hyperkalemia.

Moderate Interactions (Monitor Closely)

• Non‑steroidal anti‑inflammatory drugs (NSAIDs): may blunt antihypertensive effect and impair renal function.
• Diuretics: may cause additive hypotensive effect, especially during initiation.
• Antihyperglycemics: may enhance hypoglycemic response.
• Rifampin: may reduce enalapril plasma concentrations.
• Certain antibiotics (e.g., trimethoprim): can increase potassium levels.