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Pronunciation:

(e NAL a pril & hye droe klor oh THYE a zide)

U.S. Brand Names:

Vaseretic®

Synonyms:

Hydrochlorothiazide and Enalapril

Generic Available:

Yes

Canadian Brand Names:

Vaseretic®

Use:

Treatment of hypertension

Pregnancy Risk Factor:

C/D (2nd and 3rd trimesters)

Pregnancy Implications:

See individual agents.

Lactation:

Enters breast milk (both ingredients)/compatible

Adverse Reactions:

See individual agents.

Drug Interactions:

Enalapril: Substrate of CYP3A4 (major)

Also see individual agents.

Pharmacodynamics/Kinetics:

See individual agents.

Dosage:

Oral: Dose is individualized

Patient Education:

See individual agents. Pregnancy precaution: Inform prescriber if you are or intend to become pregnant.

Cardiovascular Considerations:

Combination therapy for the treatment of hypertension should be individualized for each patient. Potential advantages for enalapril and hydrochlorothiazide combination therapy may include improved compliance and synergistic reductions in blood pressure with an accompanied reduction in side effects. ACE inhibitors and thiazides are also standard therapy for left ventricular systolic dysfunction. See Special Cardiac Considerations for individual agents.

Dental Health: Effects on Dental Treatment:

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

No information available to require special precautions

Mental Health: Effects on Mental Status:

May cause drowsiness and dizziness; rarely may cause insomnia, confusion, and depression

Mental Health: Effects on Psychiatric Treatment:

May rarely cause agranulocytosis; use caution with clozapine and carbamazepine; may decrease lithium clearance resulting in an increase in serum lithium levels and potential lithium toxicity; monitor serum lithium levels

Dosage Forms:

Tablet:

5-12.5: Enalapril maleate 5 mg and hydrochlorothiazide 12.5 mg

10-25: Enalapril maleate 10 mg and hydrochlorothiazide 25 mg

International Brand Names:

Vaseretic® (CA)

References

Chobanian AV, Bakris GL, Black HR, et al, "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report,"JAMA, 2003, 289(19):2560-71.

"Consensus Recommendations for the Management of Chronic Heart Failure. On Behalf of the Membership of the Advisory Council to Improve Outcomes Nationwide in Heart Failure,"Am J Cardiol, 1999, 83(2A):1A-38A.

"Guidelines for the Evaluation and Management of Heart Failure. Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Evaluation and Management of Heart Failure),"Circulation, 1995, 92(9):2764-84.

Kaplan NM and Sever PS, "Combination Therapy: A Key to Comprehensive Patient Care,"Am J Hypertens, 1997, 10(7 Pt 2):127S.

Moser M and Black HR, "The Role of Combination Therapy in the Treatment of Hypertension,"Am J Hypertens, 1998, 11(6 Pt 2):73S-8S, 95S-100S.

Packer M, Poole-Wilson PA, Armstrong PW, et al, "Comparative Effects of Low and High Doses of the Angiotensin-Converting Enzyme Inhibitor, Lisinopril, on Morbidity and Mortality in Chronic Heart Failure,"Circulation, 1999, 100(23):2312-8.

Pfeffer MA, Greaves SC, Arnold JM, et al, "Early Versus Delayed Angiotensin-Converting Enzyme Inhibition Therapy in Acute Myocardial Infarction. The Healing and Early Afterload Reducing Therapy Trial,"Circulation, 1997, 95(12):2643-51.

Ryan TJ, Anderson JL, Antman EM, et al, "ACC/AHA Guidelines for the Management of Patients With Acute Myocardial Infarction. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction),"J Am Coll Cardiol, 1996, 28(5):1328-428.

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