Guideline Summary: Enalapril Dosing and Safety Based on Cited Evidence

Heart‑Failure Dosing Recommendations

• The 2006 Canadian heart‑failure guideline recommends a target dose of 10 mg twice daily of enalapril for chronic heart‑failure patients, based on large randomized trials; higher doses may be required in some individuals. 1

Contraindications to Dose Escalation

• An enalapril dose increase should be avoided when a patient’s systolic blood pressure is below 80 mm Hg. 2

Intravenous Enalaprilat in Hypertensive Emergencies

• For acute hypertensive crises, the recommended initial intravenous enalaprilat dose is 1.25 mg administered over 5 minutes. 2
• Subsequent intravenous enalaprilat doses may be titrated up to 5 mg every 6 hours as needed to achieve the blood‑pressure goal. 2
• Intravenous enalaprilat is contraindicated in patients with severe aortic stenosis or bilateral renal‑artery stenosis. 2