Enalapril

Pronunciation: en-AL-a-pril.

Generic name
enalapril
Brand names
Vasotec (United States, Canada), Innovace (United Kingdom), Renitec (European Union, Australia, New Zealand)
Drug class
Angiotensin-converting enzyme (ACE) inhibitor
Form
Tablet, 2.5 mg, 5 mg, 10 mg, or 20 mg depending on brand and market
Route
Oral
Legal status
Prescription-only in all markets reviewed.

Availability and supply rules vary by country

Trade names by country: United States · United Kingdom · Canada · Australia · New Zealand

Australia: Renitec / Renitec 20 (5) · Full directory

What enalapril is and how it works

Enalapril is a prescription medicine that blocks the angiotensin-converting enzyme (ACE), relaxing blood vessels and lowering blood pressure. It is used for high blood pressure, symptomatic heart failure, and to help prevent heart failure symptoms in people with reduced heart pumping function who do not yet have symptoms. (1) (2)

Enalapril carries a genuine boxed warning: it must be stopped as soon as pregnancy is detected, because ACE inhibitors can seriously harm or be fatal to a developing baby, especially later in pregnancy. It also carries real risks of a serious swelling reaction (angioedema), high blood potassium, low blood pressure, and a persistent dry cough -- always take it exactly as prescribed and tell your prescriber right away about any pregnancy, planned pregnancy, or new swelling of the face, lips, tongue, or throat.

Mechanism of action: how enalapril works

Enalapril is a prodrug hydrolysed to its active metabolite, enalaprilat, a non-sulfhydryl angiotensin-converting enzyme (ACE) inhibitor. By inhibiting ACE, it reduces conversion of angiotensin I to angiotensin II, lowering peripheral vascular resistance and blood pressure, and reducing aldosterone secretion. (1) (2)

What enalapril is used for

High blood pressure (hypertension)

Lowers high blood pressure, used alone or together with other medicines, especially thiazide diuretics. (1) (2)

Symptomatic heart failure

Used together with other heart failure treatments (such as diuretics and digitalis) to manage symptomatic congestive heart failure. (1) (2)

Preventing heart failure symptoms

Used in people with reduced heart pumping function (ejection fraction 35% or less) who do not yet have heart failure symptoms, to help prevent symptomatic heart failure from developing. (1) (2)

Before taking enalapril

Do not take / not appropriate for

  • Do not take enalapril if you are pregnant, especially in the second or third trimester -- it is contraindicated in later pregnancy. (all countries) (1) (2)
  • Do not take enalapril if you have ever had angioedema (a serious swelling reaction) from an ACE inhibitor, or if you have hereditary or idiopathic angioedema. (all countries) (1) (2)
  • Do not take enalapril together with sacubitril/valsartan, or within 36 hours of switching between the two. (United Kingdom, European Union) (2)
  • Do not take enalapril together with aliskiren if you have diabetes, or if you have kidney impairment. (all countries) (1) (2)

Tell your clinician about

  • Whether you are pregnant, planning to become pregnant, or breastfeeding.
  • Any history of angioedema, kidney disease, or a kidney transplant.
  • Any history of liver disease or low white blood cell counts.
  • All other medicines you take, especially diuretics, potassium supplements, potassium-sparing diuretics, lithium, NSAIDs, other blood-pressure medicines (especially ARBs or aliskiren), and trimethoprim.
  • Whether you are of Black African or Caribbean descent, since angioedema risk has been reported to be higher in this population.
  • Whether you are due to have surgery, a procedure requiring anaesthesia, or dialysis/desensitisation therapy.
(1) (2)

How to take enalapril

  • Take enalapril exactly as your prescriber directs, at around the same time each day.
  • Your dose is usually started low and increased gradually based on your blood pressure or heart failure symptoms.
  • Do not stop taking enalapril without talking to your prescriber, except that you should contact your prescriber immediately -- rather than stopping on your own without telling them -- if you become pregnant or think you might be pregnant, since prompt medical guidance is needed either way.
  • Tell your prescriber right away if you develop swelling of the face, lips, tongue, or throat, sudden stomach pain and swelling, or difficulty breathing or swallowing -- these can be signs of a serious reaction (angioedema) requiring emergency care.
(1) (2)

Procedures and treatment changes

Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4) (5) (6)

Missed dose

If you miss a dose, take it as soon as you remember unless it is almost time for your next dose, in which case skip the missed dose -- do not take a double dose. If you are unsure, ask your pharmacist or prescriber.

Overdose

Seek emergency medical attention if you think too much enalapril has been taken, especially with symptoms such as severe dizziness, fainting, or a very slow heartbeat, which can indicate dangerously low blood pressure. (1) (2)

Side effects

Side effects and their urgency vary; report severe, persistent, or concerning symptoms.

A dry, persistent, non-productive cough -- a well-known effect of all ACE inhibitors, which resolves after stopping the medicine.

What to notice: A dry, persistent, non-productive cough -- a well-known effect of all ACE inhibitors, which resolves after stopping the medicine.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1) (2)

Dizziness and headache.

What to notice: Dizziness and headache.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1) (2)

Low blood pressure, especially in heart failure or after the first dose.

What to notice: Low blood pressure, especially in heart failure or after the first dose.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1) (2)

Tiredness or weakness (fatigue).

What to notice: Tiredness or weakness (fatigue).

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)

Nausea and diarrhoea.

What to notice: Nausea and diarrhoea.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1) (2)

Fainting (syncope), especially in heart failure.

What to notice: Fainting (syncope), especially in heart failure.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)

Serious warnings

Angioedema (serious swelling reaction) — emergency

Symptoms: Swelling of the face, lips, tongue, throat, or arms/legs, or sudden stomach pain and swelling (intestinal angioedema), sometimes with difficulty breathing or swallowing.

Action: Seek emergency medical help immediately -- this reaction can be fatal if it affects the throat, and your care team will decide whether enalapril can ever be restarted afterward. This risk has been reported to be higher in Black patients. (1) (2)

Pregnancy — boxed_warning

Symptoms: Not applicable -- this is a proactive warning, not a symptom to watch for.

Action: Contact your prescriber immediately if you become pregnant or think you might be pregnant. Enalapril can cause serious injury or death to a developing baby, especially later in pregnancy, and your prescriber will need to change your treatment promptly. (1) (2)

High blood potassium (hyperkalaemia) — high caution

Symptoms: Muscle weakness, an irregular or slow heartbeat, or tingling sensations -- high potassium often has no symptoms and is found on a blood test.

Action: Contact your prescriber promptly and have blood tests checked as recommended, especially if you have kidney problems, take potassium supplements, or take potassium-sparing diuretics. (1) (2)

Very low blood pressure — high caution

Symptoms: Severe dizziness, light-headedness, or fainting, especially after the first dose or after a dose increase.

Action: Sit or lie down and contact your prescriber promptly; seek emergency care if you faint or cannot recover quickly. This is more likely if you are dehydrated, on diuretics, or being treated for heart failure. (1) (2)

Low white blood cell count (neutropenia) — high caution

Symptoms: Fever, sore throat, or infections that do not go away, which can be signs of a low white blood cell count.

Action: Contact your prescriber promptly for a blood test -- this rare effect has been reported with ACE inhibitors, more often in people with kidney problems or connective tissue disease. (1)

Kidney problems — high caution

Symptoms: A significant decrease in how much urine you pass, or swelling in your legs or ankles.

Action: Contact your prescriber promptly for tests -- enalapril can reduce kidney function, particularly in people whose kidney function already depends heavily on the renin-angiotensin system, or when combined with other blood-pressure medicines. (1) (2)

Liver problems — high caution

Symptoms: Yellowing of the skin or eyes (jaundice), dark urine, or unusual tiredness.

Action: Contact your prescriber promptly -- rare but serious liver injury has been reported with ACE inhibitors including enalapril. (1) (2)

Interactions

  • Potassium supplements, potassium-sparing diuretics, and salt substitutes can raise blood potassium to dangerous levels when combined with enalapril. (1) (2)
  • Other blood-pressure-lowering medicines, especially diuretics, angiotensin receptor blockers (ARBs), and aliskiren, can increase the risk of low blood pressure, high potassium, and reduced kidney function when combined with enalapril; combining with aliskiren is contraindicated in people with diabetes. (1) (2)
  • NSAID pain relievers can reduce enalapril's blood-pressure-lowering effect and increase the risk of kidney problems, especially in older adults or those who are dehydrated. (1) (2)
  • Lithium levels and toxicity risk can increase when combined with enalapril; more frequent monitoring of lithium levels is recommended. (1) (2)
  • Sacubitril/valsartan must not be combined with enalapril because of an increased angioedema risk. Trimethoprim can also increase the risk of high blood potassium. (2)

Pregnancy, breastfeeding, kidney/liver function, age

Pregnancy

Enalapril carries a boxed warning and must be discontinued as soon as pregnancy is detected -- it is contraindicated in the second and third trimesters, because of a genuine risk of serious injury or death to the developing baby. Contact your prescriber immediately if you become pregnant or are planning a pregnancy, so an alternative treatment can be arranged promptly. (1) (2) (3) (4) (5) (6)

Breastfeeding

Enalapril passes into breast milk in small amounts; use in nursing mothers is generally not recommended, especially soon after birth -- discuss with your prescriber. (1) (2) (3) (4) (5) (6)

Children

Not recommended in neonates; use in other paediatric patients depends on kidney function and requires specialist guidance, per the sources reviewed for this dossier. (1) (2) (3) (4) (5) (6)

Elderly

Older adults are usually started on a lower dose with more gradual titration, since higher drug levels and greater sensitivity to blood-pressure-lowering effects are more likely. (1) (2) (3) (4) (5) (6)

Hepatic_impairment

Discuss with your prescriber if you have liver problems -- rare but serious liver injury has been reported with ACE inhibitors. (1) (2) (3) (4) (5) (6)

Renal_impairment

Requires a reduced starting dose, adjusted according to kidney function; closely monitored, especially at treatment initiation and in severe impairment or after a kidney transplant. (1) (2) (3) (4) (5) (6)

Monitoring

Before starting

  • Pregnancy status in anyone who could become pregnant
  • Baseline kidney function and blood potassium
  • Baseline blood pressure
  • Review of other medicines, especially diuretics, potassium-affecting medicines, and other blood-pressure medicines

During treatment

  • Kidney function and blood potassium checked periodically, especially after starting or increasing the dose.
  • Blood pressure monitored, particularly after the first dose and any dose increase.
  • Prompt reporting of any swelling of the face, lips, tongue, throat, or stomach, or any signs of pregnancy.
(1) (2)

Storage

Store at controlled room temperature, in the original packaging, out of reach of children.

Study the drug class: ACE inhibitors

Professional information

Clinician-facing context only, sourced from the current US FDA Vasotec prescribing information and current UK emc Innovace SmPC; verify against the current full local label before prescribing.

United States

Indication: Hypertension / heart failure / asymptomatic left ventricular dysfunction

Dose summary: Hypertension: initial 5 mg once daily (2.5 mg if on diuretics), usual range 10-40 mg daily. Heart failure: initial 2.5 mg daily, range 2.5-20 mg twice daily, maximum 40 mg daily in divided doses. Renal impairment (GFR <=30 mL/min): start 2.5 mg daily.

Renal context: GFR <=30 mL/min: initiate at 2.5 mg daily with careful titration and monitoring. (1)

United Kingdom / European Union / Australia / New Zealand

Indication: Hypertension, heart failure, prevention of symptomatic heart failure

Dose summary: Hypertension: initial 5-20 mg daily, maintenance typically 20 mg daily (maximum 40 mg). Heart failure: start 2.5 mg under medical supervision, titrate to 20 mg maintenance over 2-4 weeks (maximum 40 mg in divided doses).

Renal context: Dose adjustment required for CrCl <80 mL/min; contraindicated in severe renal impairment or kidney transplant per the UK SmPC reviewed. (2)

Mechanism of action

Hepatic guidance

Rare cases of a syndrome starting with cholestatic jaundice and progressing to fulminant hepatic necrosis have been reported with ACE inhibitors including enalapril; clinicians typically make the decision to discontinue enalapril promptly when marked liver enzyme elevations or jaundice develop, and patients should contact their prescriber right away about any such symptoms rather than stopping the medicine unilaterally.

Overdose note

Hypotension is the most likely manifestation of overdose; manage with normal saline infusion and supportive care. Haemodialysis and peritoneal dialysis are effective for removing enalaprilat. (1) (2)

Frequently asked questions

Does enalapril have a boxed warning?

Yes. Enalapril's current US FDA label carries a boxed warning for fetal toxicity: ACE inhibitors like enalapril can cause serious injury or death to a developing baby, especially in the second and third trimesters, and must be stopped as soon as pregnancy is detected. Contact your prescriber immediately if you become pregnant or think you might be pregnant. (1)

Why do I have a persistent dry cough on enalapril?

A persistent, non-productive dry cough is a well-known effect of all ACE inhibitors, including enalapril. It is not dangerous but can be bothersome; it resolves after stopping the medicine. Discuss with your prescriber if it troubles you -- they can decide whether an alternative medicine is appropriate. (1) (2)

Is enalapril sold under the same brand name everywhere?

No. It is sold as Vasotec in the United States and Canada, as Innovace in the United Kingdom, and as Renitec in the European Union, Australia, and New Zealand. Generic enalapril is also widely available. (1) (2) (5)

What is the mechanism of action of enalapril?

Enalapril is a prodrug hydrolysed to its active metabolite, enalaprilat, a non-sulfhydryl angiotensin-converting enzyme (ACE) inhibitor. By inhibiting ACE, it reduces conversion of angiotensin I to angiotensin II, lowering peripheral vascular resistance and blood pressure, and reducing aldosterone secretion. (1) (2)

What is the generic name of Enalapril?

The generic name is enalapril. It is sold under brand names including Vasotec (United States, Canada), Innovace (United Kingdom), Renitec (European Union, Australia, New Zealand). (1) (2)

What class of drug is enalapril?

Enalapril is classed as: Angiotensin-converting enzyme (ACE) inhibitor. (1) (2)

References

  1. VASOTEC (enalapril maleate) tablets -- full prescribing informationU.S. Food and Drug Administration / DailyMed (NIH), full prescribing information · United States · accessed 2026-07-30 · source 1
  2. Innovace 2.5 mg Tablets (enalapril maleate) -- Summary of Product Characteristicselectronic medicines compendium (emc), United Kingdom -- Organon Pharma (UK) Limited · United Kingdom · accessed 2026-07-30 · source 2
  3. Renitec (and associated names, INN: enalapril) -- Article 30 referral, summary information and SPC harmonisationEuropean Medicines Agency (EMA) -- Article 30 referral · European Union · accessed 2026-07-30 · source 3
  4. VASOTEC (enalapril maleate/enalapril tablets) -- Product MonographHealth Canada product monograph · Canada · accessed 2026-07-30 · source 4
  5. RENITEC enalapril maleate 10 mg / RENITEC 20 enalapril maleate 20 mg tablet blister pack -- ARTG entries 10521 / 10515Therapeutic Goods Administration (TGA), Australia · Australia · accessed 2026-07-30 · source 5
  6. RENITEC (enalapril maleate) 5 mg / 10 mg / 20 mg tablets -- New Zealand Data SheetMedsafe (New Zealand regulator) · New Zealand · accessed 2026-07-30 · source 6

Brand names by country

Single-ingredient enalapril names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.

Priority countries

United States

  • Vasotec2.5 mg, 20 mg, 10 mg, 5 mg · bausch health us llc
  • Epaned1 mg/mL · azurity pharmaceuticals, inc.

United Kingdom

  • Innovace (2)MHRA licensed emc smpc confirmed · 2.5 mg, 5 mg, 10 mg, 20 mg · Organon Pharma (UK) Limited

Canada

  • VASOTEC

Australia

  • Renitec / Renitec 20 (5)TGA ARTG registered 1991 · 10 mg, 20 mg · Organon Pharma Pty Ltd (previously Merck Sharp & Dohme (Australia) Pty Ltd)

New Zealand

  • Renitec (6)Medsafe data sheet confirmed · 5 mg, 10 mg, 20 mg · not independently confirmed beyond data-sheet existence in this pass
View brands in additional countries.

European Union

Renitec (and generics) (3)

This page provides general reference information about enalapril and is not a substitute for advice from the prescriber managing your treatment. All dosing and treatment decisions, including starting, changing, or stopping this medicine, should be made with your prescriber.

Related medicines

Related conditions