Description
Enalapril and hydrochlorothiazide combination is used to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. Lowering blood pressure can reduce the risk of strokes and heart attacks.
Enalapril is an angiotensin converting enzyme (ACE) inhibitor. It works by blocking a substance in the body that causes the blood vessels to tighten. As a result, enalapril relaxes the blood vessels. This lowers blood pressure and increases the supply of blood and oxygen to the heart.
Hydrochlorothiazide is a thiazide diuretic (water pill). It reduces the amount of water in the body by increasing the flow of urine which helps lower the blood pressure.
This medicine is available only with your doctor's prescription.
This product is available in the following dosage forms:
- Tablet
Before Using
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Allergies
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Pediatric
Appropriate studies have not been performed on the relationship of age to the effects of enalapril and hydrochlorothiazide combination in the pediatric population. Safety and efficacy have not been established.
Geriatric
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of enalapril and hydrochlorothiazide combination in the elderly. However, elderly patients are more likely to have age-related kidney, liver, or heart problems, which may require caution and an adjustment in the dose for patients receiving enalapril and hydrochlorothiazide combination.
Breastfeeding
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Drug Interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Aliskiren
- Dofetilide
- Sacubitril
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acarbose
- Aceclofenac
- Acemetacin
- Acetyldigoxin
- Albiglutide
- Albuterol
- Allopurinol
- Alogliptin
- Alteplase, Recombinant
- Amiloride
- Amphetamine
- Amtolmetin Guacil
- Arsenic Trioxide
- Aspirin
- Azathioprine
- Azilsartan
- Azilsartan Medoxomil
- Benzhydrocodone
- Benzphetamine
- Bromfenac
- Bromocriptine
- Bufexamac
- Buprenorphine
- Canagliflozin
- Candesartan
- Canrenoate
- Cefepime
- Celecoxib
- Chlorpropamide
- Choline Salicylate
- Clonixin
- Codeine
- Cyclosporine
- Dapagliflozin
- Deslanoside
- Desmopressin
- Dexibuprofen
- Dexketoprofen
- Dextroamphetamine
- Diclofenac
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Aceclofenac
- Acemetacin
- Aminolevulinic Acid
- Amtolmetin Guacil
- Bepridil
- Bromfenac
- Bufexamac
- Bumetanide
- Bupivacaine
- Bupivacaine Liposome
- Capsaicin
- Carbamazepine
- Celecoxib
- Cholestyramine
- Choline Salicylate
- Clomipramine
- Clonixin
- Dexibuprofen
- Dexketoprofen
- Diclofenac
- Diflunisal
- Dipyrone
- Droxicam
- Ethacrynic Acid
- Etodolac
- Etofenamate
- Etoricoxib
- Etozolin
- Felbinac
- Fenoprofen
- Fepradinol
- Feprazone
- Floctafenine
- Flufenamic Acid
- Flurbiprofen
- Ginkgo
- Gold Sodium Thiomalate
- Gossypol
- Ibuprofen
- Indomethacin
Other Interactions
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Other Medical Problems
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
- Angioedema (swelling of the face, lips, tongue, throat, arms, or legs), history of—May increase the risk of this condition occurring again.
- Anuria (not able to pass urine) or
- Diabetic patients who are also taking aliskiren (Tekturna®) or
- Sulfa drug allergy (eg, sulfamethoxazole, Bactrim®, Septra®)—Should not be used in patients with these conditions.
- Asthma, history of—May increase likelihood of having an allergic reaction.
- Collagen vascular disease (an autoimmune disease) together with kidney disease—Increased risk of blood problems.
- Congestive heart failure, severe—Use may lead to kidney problems.
- Diabetes or
- Electrolyte imbalance (eg, low magnesium, potassium, or sodium in the blood) or
- Fluid imbalances (caused by dehydration, vomiting, or diarrhea) or
- Glaucoma, secondary angle closure or
- Gout or
- Heart or blood vessel disease (eg, aortic stenosis, hypertrophic cardiomyopathy) or
- Hypercalcemia (high calcium in the blood) or
- Hypercholesterolemia (high cholesterol in the blood) or
- Kidney disease or
- Liver disease or
- Myopia, acute (changes in the eyeball causing vision problems) or
- Systemic lupus erythematosus (SLE)—Use with caution. May make these conditions worse.
- Diabetes or
- Kidney problems—Increased risk of potassium levels in the body becoming too high. `
- Sympathectomy (nerve surgery)—The effects of enalapril and hydrochlorothiazide combination may be increased in patients who have had this surgery.
Proper Use
This medicine should not be the first medicine you use to treat your condition. It is meant to be used only after you have tried other medicines that have not worked or have caused unwanted side effects.
In addition to the use of this medicine, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium (salt). Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.
Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.
Remember that this medicine will not cure your high blood pressure but it does help control it. Therefore, you must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.
Swallow the tablet whole. Do not break, crush, or chew it. You may take this medicine with or without food.
Dosing
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage form (tablets):
- For high blood pressure:
- Adults—1 or 2 tablets taken as a single dose or two divided doses per day. Each tablet contains 10 milligrams (mg) enalapril and 25 mg hydrochlorothiazide.
- Children—Use and dose must be determined by your doctor.
- For high blood pressure:
Missed Dose
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Storage
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Precautions
It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.
Using this medicine while you are pregnant can harm your unborn baby, especially in your second or third trimester. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using this medicine, tell your doctor right away. You may need to stop using this medicine.
You should not use this medicine together with sacubitril. Do not use this medicine and sacubitril/valsartan (Entresto®) within 36 hours of each other.
This medicine may cause a serious type of allergic reaction, including anaphylaxis. This can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.
Call your doctor right away if you have severe stomach pain (with or without nausea or vomiting). This could be a symptom of a condition called intestinal angioedema.
Dizziness, lightheadedness, or fainting may also occur, especially when you get up suddenly from a lying or sitting position or if you have been taking a diuretic (water pill). . If you feel dizzy, lie down so you do not faint. Then sit for a few moments before standing to prevent the dizziness from returning. If you faint, stop using this medicine and call your doctor right away.
Check with your doctor right away if you become sick while taking this medicine, especially with severe or continuing nausea, vomiting, or diarrhea. These conditions may cause you to lose too much water or salt and may lead to low blood pressure. You can also lose water by sweating, so drink plenty of water during exercise or in hot weather.
This medicine may affect blood sugar levels. If you notice a change in the results of your blood or urine sugar tests, or if you have any questions, check with your doctor.
Check with your doctor if you have a fever, chills, or sore throat. These could be symptoms of an infection resulting from low white blood cells.
Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, or yellow eyes or skin. These could be symptoms of a serious liver problem.
Check with your doctor immediately if blurred vision, difficulty in reading, eye pain, or any other change in vision occurs during or after treatment. This could be a sign of a serious eye problem. Your doctor may want an eye doctor (ophthalmologist) to check your eyes.
Check with your doctor right away if you have bloody urine, a decrease in frequency or amount of urine, an increase in blood pressure, increased thirst, loss of appetite, lower back or side pain, nausea, swelling of the face, fingers, or lower legs, trouble breathing, unusual tiredness or weakness, vomiting, or weight gain. These could be symptoms of a serious kidney problem.
Hyperkalemia (high potassium in the blood) may occur while you are using this medicine. Check with your doctor right away if you have stomach pain, confusion, irregular heartbeat, nausea or vomiting, nervousness, numbness or tingling in the hands, feet, or lips, trouble breathing, or weakness or heaviness of the legs. Do not use medicines, supplements, or salt substitutes that contain potassium unless you have discussed this with your doctor.
This medicine may increase your risk of getting skin cancer (eg, non-melanoma skin cancer). Avoid sun exposure. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds. Talk to your doctor if you have concerns about this risk.
Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery.
This medicine may be less effective in black patients. Black patients also have an increased risk of swelling of the hands, arms, face, mouth, or throat. Talk with your doctor if you have concerns about this.
Alcohol, narcotic pain relievers, or sleeping pills may cause you to feel more lightheaded, dizzy, or faint when used with this medicine. Tell your doctor if you are drinking alcohol or using pain relievers or sleeping pills.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, and herbal or vitamin supplements.
Side Effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common
- Blurred vision
- chest pain, discomfort, or tightness
- chills
- cold sweats
- coma
- confusion
- decreased urine output
- diarrhea
- dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
- drowsiness
- dry mouth
- fainting
- fast, slow, or irregular heartbeat
- headache
- increased thirst
- irritability
- large, hive-like swelling on face, eyelids, lips, tongue, throat, hands, legs, feet, sex organs
- loss of appetite
- lower back or side pain
- muscle pain or cramps
- nausea or vomiting
- numbness or tingling in the hands, feet, or lips
- rapid breathing
- seizures
- sunken eyes
- sweating
- swelling of the face, ankles, or hands
- thirst
- trouble breathing
- unusual tiredness or weakness
- weak pulse
- wrinkled skin
Rare
- Persistent non-healing sore
- pink growth
- reddish patch or irritated area
- shiny bump
- white, yellow or waxy scar-like area
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
- Ankle, knee, or great toe joint pain
- cough
- decreased interest in sexual intercourse
- difficulty in moving
- inability to have or keep an erection
- itching skin
- joint stiffness or swelling
- lack or loss of strength
- loss in sexual ability, desire, drive, or performance
- pain in the joints
- trouble sleeping
- unable to sleep
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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