Last update March 7, 2021

Enalapril

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

Enalapril is an angiotensin converting enzyme (ACE) inhibitor used in the treatment of high blood pressure and heart failure.
Oral administration every 12-24 hours.

It is excreted in breastmilk in clinically insignificant amounts (Anderson 2018, Serrano 2015, Rush 1991, Redman 1990, Kirsten 1998, Huttunen 1989) and no problems have been observed in infants whose mothers were taking it (Anderson 2018, Rush 1991, Huttunen 1989 ), nor problems in the establishment of breastfeeding (Bach 1995).

It use is authorized in small infants and, off-label, in neonates. (FDA 2018, Kirsten 1998)

Due to its possible renal toxicity in preterm infants, it is preferable to avoid its use during the neonatal period in the case of prematurity. (Serrano 2015).

Expert authors and medical associations such as the American Academy of Pediatrics consider it to be a drug which is usually compatible with breastfeeding (Ghelfi 2021, Serrano 2015, Rowe 2013, Dennis 2012, Ghanem 2008, AAP 2001, Kirsten 1998).

The protective role of breastfeeding against maternal hypertension has been proven (Park 2018).

Alternatives

We do not have alternatives for Enalapril since it is relatively safe.

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

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Other names

Enalapril is also known as


Enalapril in other languages or writings:

Group

Enalapril belongs to this group or family:

Tradenames

Main tradenames from several countries containing Enalapril in its composition:

List of 46 tradenames

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 60 %
Molecular weight 492 daltons
Protein Binding 60 %
VD 1.7 l/Kg
pKa 3.67 -
Tmax 1.5 hours
T½ 11 hours
M/P ratio 0.8 -
Theoretical Dose 0.0009 mg/Kg/d
Relative Dose 0.56 %
Ped.Relat.Dose 0.18 - 0.9 %

References

  1. Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consulted on March 17, 2022 Full text (link to original source)
  2. Ghelfi AM, Ferretti MV, Staffieri GJ. Tratamiento farmacológico de la hipertensión arterial no severa durante el embarazo, el posparto y la lactancia. [Pharmacological treatment of non-severe hypertension during pregnancy, postpartum and breastfeeding]. Hipertens Riesgo Vasc. 2021 Feb 22. pii: S1889-1837(21)00013-1. Abstract
  3. FDA. Enalapril. Drug Summary. 2018 Full text (in our servers)
  4. Anderson PO. Treating Hypertension During Breastfeeding. Breastfeed Med. 2018 Abstract
  5. Park S, Choi NK. Breastfeeding and Maternal Hypertension. Am J Hypertens. 2018 Abstract
  6. AEMPS. Enalapril. Ficha técnica. 2018 Full text (in our servers)
  7. Kearney L, Wright P, Fhadil S, Thomas M. Postpartum Cardiomyopathy and Considerations for Breastfeeding. Card Fail Rev. 2018 Abstract Full text (link to original source) Full text (in our servers)
  8. Malachias MV, Figueiredo CE, Sass N, Antonello IC, Torloni MR, Bortolotto MRF L. 7th Brazilian Guideline of Arterial Hypertension: Chapter 9 - Arterial Hypertension in pregnancy Arq Bras Cardiol. 2016 Abstract Full text (link to original source) Full text (in our servers)
  9. Serrano Aguayo P, García de Quirós Muñoz JM, Bretón Lesmes I, Cózar León MV. Tratamiento de enfermedades endocrinológicas durante la lactancia. [Endocrinologic diseases management during breastfeeding.] Med Clin (Barc). 2015 Jan 20;144(2):73-9. Abstract
  10. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. Tenth edition (acces on line) 2015
  11. Dennis AT. Management of pre-eclampsia: issues for anaesthetists. Anaesthesia. 2012 Sep;67(9):1009-20. Abstract Full text (link to original source) Full text (in our servers)
  12. Ghanem FA, Movahed A. Use of antihypertensive drugs during pregnancy and lactation. Cardiovasc Ther. 2008 Abstract Full text (link to original source) Full text (in our servers)
  13. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Abstract Full text (link to original source) Full text (in our servers)
  14. Kirsten R, Nelson K, Kirsten D, Heintz B. Clinical pharmacokinetics of vasodilators. Part II. Clin Pharmacokinet. 1998 Abstract
  15. Bach N. [Enalapril treatment of a pre-eclamptic woman]. Ugeskr Laeger. 1995 Abstract
  16. Rush JE, Snyder DL, Barrish A, Hichens M. Comment on Huttunen K, Grönhagen-Riska C and Fyhrquist F, 1989. Enalapril treatment of a nursing mother with slightly impaired renal function. Clin Nephrol 31: 278. Clin Nephrol. 1991 Abstract
  17. Redman CW, Kelly JG, Cooper WD. The excretion of enalapril and enalaprilat in human breast milk. Eur J Clin Pharmacol. 1990 Abstract
  18. Huttunen K, Grönhagen-Riska C, Fyhrquist F. Enalapril treatment of a nursing with slightly impaired renal function. Clin Nephrol. 1989 Abstract

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