Vasotec® is the brand name of the widely prescribed generic drug enalapril maleate. It is used to treat high blood pressure, heart failure, and occasionally asymptomatic left ventricular dysfunction. When determining the appropriate initial Vasotec® dosage regimen for a patient, it is important to consider factors like his or her age, condition, kidney health, liver function and other medications, as these factors may necessitate adjustments.
Adult patients suffering from high blood pressure should receive an initial Vasotec® dosage of 5 mg once per day under supervision, with adjustments to the dosage made according to their response. The effective therapeutic range for most patients is between 10 and 40 mg per day in a single dose. It should be given in two divided doses for patients who experience blood pressure spikes at the end of the dosing interval.
Most candidates for therapy with Vasotec® will be receiving treatment with diuretics, which must be discontinued for at least two days before Vasotec® can be given. Patients who cannot safely cease treatment with diuretics may instead be given an initial Vasotec® dosage of 2.5 mg while being closely monitored for symptoms of low blood pressure. The initial Vasotec® dosage for non-neonatal pediatric patients with normal kidney function is significantly lower at just 0.08 mg per 2.2 lbs (1 kg) of body weight up to a maximum of 5 mg or 0.58 mg per 2.2 lbs (1 kg).
When the patient is suffering from a moderate to severe reduction in kidney function in addition to hypertension, the initial dose must be reduced. Patients with a creatine clearance of less than 30 ml per minute should receive only 2.5 mg of Vasotec® initially. Dialysis patients should receive the same dose on days that they undergo dialysis, while the dose on non-dialysis days should be adjusted according to their response.
Patients suffering from heart failure may be given Vasotec® in addition to standard treatment with digitalis and diuretics. While the initial recommended adult dosage is 2.5 mg daily, it should be carefully increased as tolerated over days or weeks up to a maximum of 40 mg per day in two divided doses. Patients should be monitored for a period of at least two hours after dosage increases to ensure that they do not suffer from serious low blood pressure, while their use of diuretics should be gradually eliminated if possible.
The use of Vasotec® to treat heart failure in patients suffering from reduced kidney function is acceptable, but must be monitored carefully initially. Those with levels of serum creatinine less than 1.6 mg/dl or serum sodium less than 130 mEg/L should start with a daily dose of 2.5 mg under close supervision. Adjustments to Vasotec® dosage should be performed cautiously in no less than four day intervals up to a maximum of 40 mg per day.