Buy Vasotec Online

What is Vasotec?

Vasotec (enalapril) is an ACE inhibitor. ACE stands for angiotensin converting enzyme.

Vasotec is used to treat high blood pressure (hypertension) and congestive heart failure.

Vasotec is also used to treat a disorder of the ventricles (the lower chambers of the heart that allow blood to flow out of the heart). This disorder can decrease the heart's ability to pump blood to the body.

Vasotec may also be used for purposes not listed in this medication guide.

Important information about Vasotec

Do not use Vasotec if you are pregnant. Stop using and tell your doctor right away if you become pregnant.

You should not use Vasotec if you have ever had angioedema.

If you have diabetes or kidney disease, you may not be able to take enalapril if you are taking medication that contains aliskiren. Tell your doctor about all medicines you use.

Vasotec can cause kidney problems. Call your doctor at once if you have swelling, rapid weight gain, little or no urinating, or if you feel short of breath.

Vasotec can affect your heart or your electrolyte levels. Call your doctor if you have chest pain, pounding heartbeats or fluttering in your chest, a slow heart rate or weak pulse, a tingly feeling, muscle weakness, or muscle tightness or contraction.

Before taking Vasotec

You should not use Vasotec if you have ever had angioedema, or if you are allergic to enalapril or to any other ACE inhibitor (benazepril, captopril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, trandolapril).

To make sure Vasotec is safe for you, tell your doctor if you have:

  • kidney disease (or if you are on dialysis);

  • liver disease;

  • heart disease or congestive heart failure (unless you are taking enalapril for this condition);

  • diabetes; or

  • a history of blood clot or stroke (including "mini-stroke").

FDA pregnancy category D. Do not use Vasotec if you are pregnant. Stop using this medication and tell your doctor right away if you become pregnant. Vasotec can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. Use effective birth control while taking this medication.

Enalapril can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using Vasotec.

How should I take Vasotec?

Take Vasotec exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Your doctor may occasionally change your dose to make sure you get the best results.

Vasotec can be taken with or without food.

You may have very low blood pressure while taking this medication. Call your doctor if you are sick with vomiting or diarrhea, or if you are sweating more than usual.

Your blood pressure will need to be checked often. Your kidney or liver function may also need to be tested.

If you need surgery, tell the surgeon ahead of time that you are using Vasotec. You may need to stop using the medicine for a short time.

If you are being treated for high blood pressure, keep using this medication even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Store Vasotec at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking Vasotec?

Avoid drinking alcohol. It can further lower your blood pressure and may increase some of the side effects of Vasotec.

Do not use salt substitutes or potassium supplements while taking Vasotec, unless your doctor has told you to.

Vasotec side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Vasotec: hives; severe stomach pain; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • a light-headed feeling, like you might pass out;

  • little or no urinating;

  • confusion, loss of appetite, vomiting, pain in your side or lower back;

  • swelling, rapid weight gain;

  • weakness, confusion, increased thirst, loss of appetite, vomiting, pounding heartbeats or fluttering in your chest;

  • fever, chills, body aches, flu symptoms;

  • pale skin, easy bruising or bleeding;

  • fast or uneven heartbeats;

  • high potassium (slow heart rate, weak pulse, muscle weakness, tingly feeling);

  • chest pain; or

  • jaundice (yellowing of the skin or eyes).

Common Vasotec side effects may include:

  • cough;

  • dry mouth, loss of taste sensation, loss of appetite;

  • dizziness, drowsiness, headache;

  • sleep problems (insomnia);

  • nausea, vomiting, diarrhea; or

  • mild skin itching or rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Vasotec?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with Vasotec, especially:

  • lithium;

  • a diuretic or "water pill";

  • gold injections to treat arthritis;

  • a potassium supplement such as Cytra, Epiklor, K-Lyte, K-Phos, Kaon, Klor-Con, or Polycitra; or

  • aspirin or NSAIDs (non-steroidal anti-inflammatory drugs)--ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.

This list is not complete. Other drugs may interact with Vasotec, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

For the Consumer

Applies to enalapril: oral tablet

Along with its needed effects, enalapril (the active ingredient contained in Vasotec) 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 while taking enalapril:

More common
  • Blurred vision
  • confusion
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • sweating
  • unusual tiredness or weakness
Less common
  • Chest pain
  • cough producing mucus
  • diarrhea
  • difficult or labored breathing
  • fainting
  • fever or chills
  • nausea
  • sneezing
  • sore throat
  • tightness in the chest
  • vomiting

Some side effects of enalapril 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:

More common
  • Dizziness
Less common
  • Lack or loss of strength
  • rash

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Applies to enalapril: compounding powder, intravenous solution, oral tablet

Cardiovascular

Cardiovascular side effects, such as hypotension in 2% to 15% and dizziness in 1% to 8% of patients, are more likely in patients with hypovolemia. Enalapril-induced hypotension is usually asymptomatic, but syncope has been reported in 1% of patients. Edema and chest pain have been reported in 3% and 5% of patients, respectively. Angioedema is rare, occurring in approximately 0.2% of patients, and may be due to the effect of enalapril (the active ingredient contained in Vasotec) on vasodilating kinins.

Predisposing risk factors for hypotension after enalapril administration are decreased intravascular volume (angiotensin-dependency), hyponatremia, and concurrent use of a diuretic agent.

Nervous system

Nervous system side effects have included headache (3% to 20%). Other nervous system complaints, such as vertigo, fatigue, peripheral paresthesias, and insomnia have been reported in 0.1% to 5% of patients.

Renal

Renal side effects of new or worsened renal insufficiency, presenting as an increased serum creatinine, uric acid, and potassium has occurred in approximately 4% of patients, particularly in patients with "high angiotensin states" (congestive heart failure, edema, renal artery stenosis, or chronic renal failure).

Enalapril, like other angiotensin converting enzyme inhibitors, may decrease serum aldosterone levels, resulting in mild to moderate hyperkalemia. Diuretic use and advanced age increase the risk of renal impairment. Enalapril reduced the risk of renal impairment compared to placebo in diabetic patients. The concomitant use of beta blockers with enalapril has been shown to be renoprotective.

Enalapril may worsen renal insufficiency, especially if the patient is hypovolemic or hypotensive.

Patients with underlying congestive heart failure are predisposed to renal side effects associated with enalapril.

Hepatic

Rare case reports of enalapril-associated hepatitis, where liver function tests rose despite resolution of congestive heart failure, are reported.

A 54-year-old woman with hypertension developed asymptomatic abnormal liver function tests associated with eosinophilia and relatively normal abdominal ultrasonography seven weeks after beginning enalapril (the active ingredient contained in Vasotec) An extensive work-up revealed no evidence of infection; liver biopsy revealed cellular degeneration, portal eosinophilic and mononuclear infiltration, and centrilobular necrosis. The signs and symptoms of hepatitis resolved upon discontinuation of enalapril.

An 80-year-old woman with hypertension and mild heart failure developed hepatomegaly and icterus accompanied by increased conjugated bilirubin, alkaline phosphatase, and aspartate aminotransferase thirty days after beginning enalapril treatment. The patient had not been taking any other medications or herbal products. Tests for hemochromatosis, Wilson's disease, and alpha-1 antitrypsin deficiency returned with normal results. Serology for hepatitis A, B, C and autoimmune screen were negative. Other infectious causes were ruled out. Twenty days after admission, the patient developed grade III encephalopathy and severe coagulation disorders and died 30 days after admission.

In patients with liver dysfunction, frequent monitoring of liver function tests during enalapril administration is recommended.

Hepatic side effects associated with the use of enalapril or other ACE inhibitors have included a rare syndrome that begins with cholestatic jaundice and progresses to fulminant hepatic necrosis and (sometimes) death. Experts recommend discontinuation of therapy with this drug if jaundice or markedly elevated hepatic serum enzymes develop. Both cholestatic jaundice and centrilobular necrosis have been described.

Hypersensitivity

Late-onset enalapril-induced angioedema (more than three months) is reported in at least one patient who had taken enalapril (the active ingredient contained in Vasotec) without incident for three years. Patients with intestinal angioedema generally present with abdominal pain (with or without nausea or vomiting) and in some cases there was no prior history of facial angioedema, and C-1 esterase levels were normal. These symptoms resolve after stopping the ACE inhibitor.

Hypersensitivity reactions to enalapril, as with some other angiotensin converting enzyme (ACE) inhibitors, may be life-threatening. Angioedema of the face, extremities, lips, tongue, glottis and/or pharynx have been reported rarely in patients receiving ACE inhibitors. Obstructive laryngeal and glossal angioedema due to enalapril is a rare, but potentially fatal reaction. In addition, intestinal angioedema has been reported in patients treated with ACE inhibitors. It is recommended that any patient with dyspnea, dysphagia, or significant facial angioedema stop therapy immediately and avoid ACE inhibitor therapy in general. Enalapril is not recommended for patients with a history of idiopathic angioedema.

Other hypersensitivity reactions including photosensitivity in 0.1%, or urticaria in 0.3% of patients have been reported. A single case of Henoch-Schonlein purpura has also been reported.

Respiratory

Rare case reports of asthma associated with some angiotensin converting enzyme inhibitors suggest that these drugs seem to play a role in the genesis and metabolism of bronchodilatory mediators. For this reason, some experts recommend cautious use of enalapril (the active ingredient contained in Vasotec) in patients with preexisting asthma.

A retrospective study has revealed a significantly higher incidence of discontinuation of angiotensin converting enzyme (ACE) inhibitor therapy due to cough among black patients compared with non-black patients (9.6% vs. 2.4%).

Several agents have been studied for treating cough with ACE inhibitors. No long term trials exist to allow a definitive treatment option. Cromolyn has the most data showing some benefit. Other agents studied include baclofen, theophylline, sulindac, and benzonatate.

Respiratory side effects have included a dry, nonproductive cough which can be a problem for 1% to 5% of patients. Some patients with enalapril-induced cough have demonstrated new bronchial hyperactivity. Less common respiratory system side effects have included rhinorrhea, which is thought to be due to the effect of enalapril on vasodilating kinins. In addition, ACE inhibitors have been associated with exacerbation of obstructive sleep apnea symptoms due to ACEI-induced upper airway inflammation.

Hematologic

Rare, reversible cases of agranulocytosis associated with enalapril (the active ingredient contained in Vasotec) and other angiotensin converting enzyme (ACE) inhibitors have been reported. ACE inhibitors have been used to treat post renal transplant erythrocytosis. Data have shown that they may decrease circulating erythropoietin levels in these patients.

Hematologic side effects are extremely rare. Discontinuation of enalapril due to anemia has been reported in less than 0.1% of patients. Rare cases of neutropenia and agranulocytosis have been reported.

Gastrointestinal

A 56-year-old woman with hypertension and diabetes developed acute abdominal pain, nausea, and vomiting associated upper abdominal tenderness, hyperamylasemia, hyperlipasemia, and normal upper abdominal ultrasonography within 24 hours of starting enalapril (the active ingredient contained in Vasotec) The signs and symptoms of pancreatitis resolved over the next several days once the drug was discontinued. No rechallenge was performed.

A 65-year-old woman was diagnosed with acute pancreatitis by ultrasonography, CT scan, and serum amylase level of 980 units/L. The patient had been receiving enalapril, HCTZ, and amiloride for one year. The pancreatitis resolved over 7 days. The patient upon rechallenge with enalapril developed severe upper abdominal pain, vomiting, and hypotension. CT scan showed intrapancreatic necrosis and peripancreatic fluid. Four weeks later a CT scan showed three pseudocysts that took 4 months to resolve. The author of the report concluded that rechallenging patients who develop acute pancreatitis while on enalapril is not recommended.

Gastrointestinal side effects are unusual. Nausea, vomiting, or diarrhea has each been reported in less than 3% of patients. Dysgeusia is rare, occurring in less than 0.5% of patients. Rare cases of pancreatitis and acute small bowel mucosal edema associated with enalapril have been reported.

Dermatologic

Dermatologic side effects reported most commonly include a pruritic, maculopapular eruption on the upper trunk and arms, in approximately 1.5% of patients. (Only 0.4% of patients have discontinued therapy due to rash.) Rare dermatologic side effects have included alopecia, photosensitive lichenoid eruptions, erythema with vasculitis, bullous pemphigoid, pemphigus foliaceous and toxic pustuloderma.

A 52-year-old Korean woman with hypertension experienced a generalized, erythematous, scaly rash associated with a positive Nikolsky sign and biopsy results consistent with pemphigus foliaceous within three weeks after beginning enalapril. Direct immunofluorescence revealed intercellular IgG deposition. The pemphigus remained active at least 12 months after enalapril was discontinued.

A 35-year-old woman with hypertension developed alopecia during enalapril therapy, which resolved upon discontinuation of the drug, and recurred upon rechallenge.

A 77-year-old man with heart failure developed a generalized morbilliform rash after starting enalapril. Biopsy was consistent with toxic pustuloderma.

Psychiatric

A 52-year-old woman with hypertension and a history of depression associated with the use of beta-blockers, developed fatigue, malaise, and clinical signs and symptoms of depression, including suicidal ideation, within five weeks after starting enalapril (the active ingredient contained in Vasotec) The depression gradually resolved with substitution of a thiazide diuretic and a low sodium diet. Rechallenge resulted in recurrent depression.

A 41-year-old man with hypertension became agitated, anxious, depressed, and unable to sleep four weeks after starting enalapril. The psychosis resolved when enalapril was stopped, and recurred upon rechallenge.

Psychiatric problems associated with enalapril have been rarely reported, and include depression and acute psychosis.

Endocrine

Endocrinologic side effects have included the syndrome of inappropriate ADH secretion and gynecomastia (rare). Limited data have shown that the use of ACE inhibitors is an independent risk factor for the development of hypoglycemia in some diabetic patients.

A 69-year-old woman with diabetes mellitus and hypertension developed symptomatic hyponatremia associated with decreased plasma and increased urine osmolalities, normal thyroid and basal cortisol studies, and a positive water load test four months after beginning enalapril. The syndrome resolved upon discontinuation of enalapril, and recurred upon rechallenge.

Musculoskeletal

Musculoskeletal complaints have included severe arthralgias and myalgias which have rarely been associated with some ACE inhibitors, including enalapril (the active ingredient contained in Vasotec)

A 76-year-old woman with hypertension, on enalapril monotherapy for three weeks, developed progressive myalgias, asthenia, morning stiffness, and weakness associated with no abnormal laboratory values. Due to the absence of other apparent causes, enalapril was discontinued, and the patient's myalgias disappeared. In at least one other case, rechallenge resulted in recurrent symptoms.

Immunologic

Immunologic side effects have been reported in a limited study of nine elderly patients, three of whom developed a positive fluorescent antinuclear antibody test during six weeks of enalapril (the active ingredient contained in Vasotec) therapy.

Genitourinary

Genitourinary side effects rarely reported include vulvovaginal pruritus, dysuria, and incontinence, and have been associated with the use of enalapril (the active ingredient contained in Vasotec) in an elderly patient.