How does this medication work? What will it do for me?
This is a combination product that contains 2 medications used to lower high blood pressure. Enalapril belongs to a class of medications called ACE inhibitors and helps lower blood pressure by decreasing the workload on the heart. Hydrochlorothiazide is a diuretic (also called a water pill) that helps control blood pressure by getting rid of excess salt and water.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
Each rust, oval-shaped, scored tablet, with "MSD 720" on one side, contains enalapril maleate 10 mg and hydrochlorothiazide 25 mg. Nonmedicinal ingredients: cornstarch, lactose, magnesium stearate, pregelatinized starch, red ferric oxide, and sodium bicarbonate.
How should I use this medication?
The recommended dose ranges from 1 to 2 tablets once daily of enalapril 10 mg - hydrochlorothiazide 25 mg. Before starting the combination product, you should be started on the individual components of this medication. Once the desired dose of each medication is determined to achieve optimal effect on blood pressure, the combination product can be substituted if possible. Enalapril - hydrochlorthiazide may be taken with or without food. Try to take it at the same time each day.
Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature, protect it from moisture, and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not take this medication if you:
- are allergic to enalapril, hydrochlorothiazide, or any ingredients of this medication
- are allergic to sulfa medications
- are pregnant
- are breast-feeding
- cannot pass urine (also known as anuria)
- have had angioedema (a serious allergic reaction that causes the area around the throat and tongue to swell) after taking any other medication from the class of medications known as ACE inhibitors (e.g., lisinopril, ramipril, captopril)
- have been diagnosed with hereditary angioedema
- have galactose intolerance (a rare hereditary condition)
- have diabetes or kidney disease and are taking aliskiren
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- abdominal pain
- cough (dry, persistent)
- difficulty sleeping
- erectile dysfunction (impotence)
- increased sensitivity of skin to sunlight (skin rash, itching, redness or other discoloration of skin or severe sunburn after exposure to sunlight)
- loss of appetite
- loss of taste
- unusual tiredness or fatigue
Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- dizziness, lightheadedness, or fainting (signs of low blood pressure)
- rapid, irregular heartbeat
- joint pain (e.g., toe pain may be a sign of gout)
- lower back or side pain
- muscle cramps
- signs of anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)
- signs of bleeding (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don’t stop bleeding)
- signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
- signs of kidney problems (e.g., decreased urination, nausea, vomiting, swelling of legs or hands, fatigue)
- signs of liver problems such as abdominal pain, nausea or vomiting, itching of skin, yellow eyes or skin
- signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)
- signs of too much or too little potassium in the body
- dry mouth
- increased thirst
- irregular heartbeat
- mood or mental changes
- muscle cramps or pain
- numbness or tingling in hands, feet, or lips
- weak pulse
- weakness or heaviness of legs
- skin rash (with or without itching), fever, or joint pain
- stomach pain (severe) with nausea and vomiting
- swelling of hands, ankles, or feet
- symptoms of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)
- tingling or burning sensation
Stop taking the medication and seek immediate medical attention if any of the following occur:
- chest pain
- symptoms of a serious allergic reaction, including angioedema (e.g., hives; swelling of the face, mouth, hands, or feet; and difficulty breathing)
- severe skin rash, including skin blistering and peeling (possibly with headache, fever, coughing, or aching before the rash begins)
- symptoms of increased pressure in the eyes (e.g., decreased or blurred vision, eye pain, red eye, swelling of the eye)
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
HEALTH CANADA ADVISORY
February 4, 2014
Health Canada has issued new restrictions concerning the use of enalapril. To read the full Health Canada Advisory, visit Health Canada's web site at www.hc-sc.gc.ca.
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Allergic reaction: Some people who are allergic to sulfonamide medications also experience allergic reactions to hydrochlorothiazide. Before you take this medication, tell your doctor about any previous adverse reactions you have had to medications, especially to sulfonamide antibiotics or diabetes medications. Contact your doctor at once if you experience signs of an allergic reaction, such as skin rash, itching, difficulty breathing, or swelling of the face and throat.
Angioedema: Angioedema (a serious allergic reaction that causes the area around the throat and tongue to swell) may occur with ACE inhibitors, including this medication, although uncommonly. If you experience swelling of the face, tongue, or throat, you should stop taking this medication at once and get immediate medical attention.
People who have had angioedema caused by other substances may be at increased risk of angioedema while receiving an ACE inhibitor such as contained in this medication.
Blood disorders: In rare cases, a low white blood cell count has been reported by people taking this medication. Your doctor may occasionally monitor your level of white blood cells by performing blood tests. Low white blood cell levels may increase your risk for infection. If you notice any signs of infection (e.g., fever, sore throat), contact your doctor as soon as possible.
Cholesterol: An increase in cholesterol and triglyceride levels may occur when taking hydrochlorothiazide. Your doctor will monitor you for these changes while you are taking this medication.
Cough: People taking enalapril may develop a dry, persistent cough that usually disappears only after stopping or lowering their dose of enalapril. Inform your doctor of any cough that does not seem to be related to a usual cause.
Diabetes: This medication may make it more difficult for people who have diabetes to control their blood sugar. If you have diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. An adjustment to doses of antidiabetic medications may be required.
Fluid and electrolyte balance: The levels of electrolytes such as potassium, sodium, magnesium, and chloride can be reduced by the use of hydrochlorothiazide. Your doctor will periodically check to see whether these are in balance, and a potassium supplement may be necessary. Warning signs or symptoms of fluid and electrolyte imbalance include:
- dry mouth
- low blood pressure
- muscle pains or cramps
- muscular fatigue
- nausea and vomiting
- racing heartbeat
Gout: Hydrochlorothiazide may increase the level of uric acid in the body. If you have a history of gout, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you develop painful, warm, and swollen joints, contact your doctor.
Glaucoma: Rarely, hydrochlorothiazide can cause an increase in the pressure in the eyes (glaucoma). If you experience decreased sharpness of vision or eye pain shortly after starting to take this medication, contact your doctor immediately. This may be more likely to happen to people who have previously had sulfonamide or penicillin allergies.
Kidneys: This medication may affect kidney function for certain people. Let your doctor know if you notice any decrease in urine output or increased swelling of the lower limbs, which suggests an accumulation of fluid due to decreased urination.
Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, which may cause side effects. This medication can also worsen liver function. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication. If you notice any signs of liver problems (e.g., abdominal pain, itching of skin, or yellow eyes or skin, loss of appetite, vomiting), contact your doctor immediately.
Low blood pressure: Occasionally, blood pressure drops too low after taking enalapril. This usually happens after the first or second dose or when the dose is increased. It is more likely to occur if you take water pills, have a salt-restricted diet, are on dialysis, are sweating excessively and not drinking enough fluids, or are suffering from diarrhea or vomiting. If low blood pressure causes you to faint or feel lightheaded, contact a doctor.
Lupus: Hydrochlorothiazide can cause the symptoms of systemic lupus erythematosus (SLE) to worsen. If you have SLE, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Surgery: It is important that your physician and anesthesiologist know that you are taking this medication before you undergo any surgical procedures requiring general anesthesia.
Pregnancy: ACE inhibitors should not be taken by pregnant women. If you become pregnant while taking this medication, stop taking this medication at once and contact your doctor immediately.
Breast-feeding: These medications pass into breast milk. If you are a breast-feeding mother and are taking enalapril and hydrochlorothiazide, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of using this medication have not been established for children. Its use by them is not recommended.
What other drugs could interact with this medication?
There may be an interaction between enalapril - hydrochlorothiazide and any of the following:
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.
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