Common questions about enalapril

Enalapril is a type of medicine called an ACE (angiotensin-converting enzyme) inhibitor.

Like other ACE inhibitors, it relaxes and widens your blood vessels. This lowers your blood pressure and makes it easier for your heart to pump blood around your body.

Enalapril starts to reduce your high blood pressure within a few hours, but it may take a few weeks to fully take effect.

If you're taking enalapril for heart failure, it may take weeks, even months, before you feel better.

If you're taking enalapril for high blood pressure, you may not have any symptoms. In this case, you may not feel any different when you take enalapril. This does not mean that the medicine is not working. It's important to keep taking it.

Enalapril is generally safe to take for a long time. In fact, it works best when you take it for a long time.

Taking enalapril for a long time can sometimes cause your kidneys to not work as well as they should. Your doctor will check how well your kidneys are working with regular blood tests.

Even if enalapril brings down your blood pressure successfully, it's best to carry on taking it. If you stop taking it, your blood pressure could go back up again.

If you need medicines to lower your blood pressure, you'll probably need them for the rest of your life.

Remember, by keeping your blood pressure low, you're protecting yourself against having a heart attack or stroke in the future.

There are several other ACE inhibitor medicines which work in the same way as enalapril. They include ramipril, lisinopril and perindopril.

Enalapril works as well as other ACE inhibitors when you take it to lower blood pressure and for heart failure. The side effects are also similar to those of other ACE inhibitors.

There are a few differences between enalapril and other ACE inhibitors:

• some ACE inhibitors are officially approved to be used after a heart attack to prevent further ones, but enalapril is not
• some ACE inhibitors are officially approved to be used in diabetic kidney disease, but enalapril is not

There are also lots of other types of blood pressure-lowering medicines:

• calcium channel blockers like amlodipine
• angiotensin receptor blockers like candesartan
• beta blockers like bisoprolol
• tablets which make you pee more (diuretics) like bendroflumethiazide

If you cannot take enalapril or other ACE inhibitor medicines because of side effects such as a dry cough, you may be able to switch to another blood pressure-lowering medicine. This will usually be a medicine called an angiotensin receptor blocker such as candesartan, irbesartan, losartan or valsartan.

Tell your doctor that you're taking enalapril if you're going to be put to sleep with a general anaesthetic for an operation or are going to have a major operation, such as a caesarean section, without a general anaesthetic.

Enalapril can reduce your blood pressure when it's used with an anaesthetic.

Your doctor may advise you to stop taking enalapril 24 hours before surgery.

Enalapril will not affect any type of contraception.

However, some types of hormonal methods of contraception, such as the combined pill and contraceptive patch, are not usually recommended if you have high blood pressure.

Talk to your doctor if you're taking or using a combined hormonal contraceptive.

If you have severe diarrhoea for more than 24 hours while taking enalapril, your contraceptive pills may not protect you from pregnancy.

If this happens, follow the instructions in the leaflet that comes with your contraceptive pills.

Find out more:

• What to do if you're sick or have diarrhoea when taking the combined pill
• What to do if you're sick or have diarrhoea when taking the progestogen-only pill

Enalapril can cause blurred vision and can make some people feel dizzy or weak.

Feeling dizzy is more likely to happen when you first start taking enalapril or after increasing your dose. It's best to stop driving, cycling and using tools or machinery during these times.

If this happens to you, do not drive a car, ride a bike, or use tools or machinery.

It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.

GOV.UK has more information on the law on drugs and driving

Enalapril lowers your blood pressure and drinking alcohol can increase its effects. This can make you feel dizzy or light-headed.

During the first few days of taking enalapril or after a dose increase, it's best to stop drinking alcohol until you see how the medicine affects you.

If you find enalapril makes you feel dizzy, it's best to stop drinking alcohol.

Do not use salt substitutes such as Lo-Salt. This is because they are high in potassium. When mixed with enalapril they may make the level of potassium in your blood too high.

There is nothing else you need to avoid while taking enalapril. Eating well can help if you have high blood pressure or heart failure.

You can boost the health of your heart by making some key lifestyle changes. These will also help if you have high blood pressure or heart failure.

• Quit smoking – smoking increases your heart rate and blood pressure. Quitting smoking brings down your blood pressure and relieves heart failure symptoms. Try to avoid secondhand smoke too.
• Cut down on alcohol – drinking too much alcohol raises blood pressure over time and also makes heart failure worse.
• Exercise – regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. It does not need to be too energetic, walking every day is enough.
• Eat well – aim to eat a diet that includes plenty of fruit and vegetables, wholegrains, fat-free or low-fat dairy products and lean proteins. It's a good idea to follow these tips for a lower salt diet too. Eating too much salt is the biggest cause of high blood pressure. The more salt you eat, the higher your blood pressure will be. Aim for no more than 6g of salt a day.
• Deal with stress – when you're anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse too. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help avoid stress.
• Vaccinations – if you have heart failure, it's recommended that you have the flu vaccine every year and the pneumococcal vaccine as recommended by your GP. Ask your doctor about these vaccinations. You can have them free on the NHS. Coronavirus (COVID-19) vaccination is recommended for most people. Make sure you've had all the doses that you are eligible for. Talk to your doctor if you think you might be in one of the at risk groups.