Trade Names:Lexxel- Extended-release tablets enalapril maleate 5 mg/felodipine 2.5 mg- Extended-release tablets enalapril maleate 5 mg/felodipine 5 mg
The 2 components have complementary antihypertensive actions. Enalapril suppresses the renin-angiotension-aldosterone system. Felodipine dihydropyridine calcium channel blocker produces peripheral vasodilation.
Not indicated for initial treatment of hypertension.
History of angioedema.
PO 1 tablet every day for patients whose BP is not adequately controlled with felodipine or enalapril monotherapy. If inadequate BP control persists beyond 1 to 2 wk, increase to 2 tablets/day.
Store tablets at controlled room temperature (59° to 86°F). Protect from moisture and light.
Enalapril may increase risk of hypersensitivity.Antacids
Enalapril bioavailability may be decreased. Separate administration times by 1 to 2 h.Barbiturates
Effects of felodipine may be decreased.Capsaicin
Enalapril-induced cough may be exacerbated.Carbamazepine
Plasma levels of felodipine may be decreased, reducing effect.CYP3A4 inhibitors (eg, erythromycin)
Increased effect of felodipine.Diuretics
Excessive reduction in BP may occur.Food
Effects of felodipine may increase if given with grapefruit juice.Hydantoins
Serum felodipine levels may be decreased, reducing effects.Indomethacin
Hypotensive effects may be reduced, especially in low-renin or volume-dependent hypertensive patients.Lithium
Increased lithium levels and symptoms of lithium toxicity may occur.Phenothiazine
Enalapril may increase pharmacological effect of phenothiazines.Potassium preparations, potassium-sparing diuretics
Enalapril may increase serum potassium levels.Rifampin
Pharmacologic effects of enalapril may be decreased.
None well documented.
Peripheral edema (4%); angina; arrhythmias; AV block; chest pain; hypotension; MI; orthostatic hypotension; palpitation; syncope; tachycardia; vasculitis.
Headache (10%); dizziness (4%); asthenia, fatigue (2%); anxiety; insomnia; irritability; lightheadedness; nervousness; paresthesias; psychiatric disturbances; somnolence; vertigo.
Flushing (2%); pruritus; rash.
Abdominal discomfort; constipation; cramps; diarrhea; dry mouth; dyspepsia; flatulence; nausea; thirst; vomiting.
Micturition disorders; sexual difficulties; UTI.
Agranulocytosis; decreased hemoglobin and hematocrit; eosinophilia; epistaxis; neutropenia; pancytopenia; thrombocytopenia.
Cough (2%); bronchitis; dyspnea; nasal or chest congestion; pharyngitis; respiratory infections; rhinitis; shortness of breath; sinusitis; sneezing; wheezing.
Arthralgia; arthritis; fever; gingival hyperplasia; hyperkalemia; muscle cramps; myalgia; pain; inflammation.
When used in pregnancy during the second and third trimesters, ACE inhibitors can cause injury and even death to the developing fetus. When pregnancy is detected, discontinue therapy as soon as possible.
Category C (first trimester); Category D (second and third trimesters).
Secreted into breast milk.
Safety and efficacy have not been determined.
May have greater hypotensive effects and increased risk of peripheral edema with higher doses.
Reduce dose and give less frequently. Dose reduction or discontinuation may be necessary. Monitor renal function during first few weeks of therapy and adjust dosage.
Use with caution in patients with hepatic function impairment or reduced hepatic blood flow.
Angioedema may occur; use is contraindicated in patients with history of angioedema.
Use with caution.
Use felodipine with caution. Transient hypotension may occur.
Chronic dry cough may occur during treatment; higher incidence in women.
Neutropenia and agranulocytosis have occurred; risk appears greater with renal dysfunction and collagen vascular disease; monitor WBC counts frequently.
During major surgery or anesthesia, with agents that produce hypotension, enalapril may block angiotensin II formation secondary to compensatory renin release. If hypotension occurs and is considered to be caused by this mechanism, it can be corrected by volume expansion.
Abrupt withdrawal of calcium channel blockers may cause increased frequency and duration of angina. Taper dose gradually.