Enalapril-Hydrochlorothiazide

• This drug can cause serious (possibly fatal) harm to an unborn baby if used during pregnancy. It is important to prevent pregnancy while taking this medication.
• Consult your medical provider for more details and to discuss the use of reliable forms of birth control while taking this medication.
• If you are planning pregnancy, become pregnant or think you may be pregnant, contact your medical provider right away.

• This medication is used to treat high blood pressure (hypertension).
• Lowering high blood pressure helps prevent strokes, heart attacks and kidney problems.

• This product contains 2 medications—Enalapril and Hydrochlorothiazide:

  • Enalapril belongs to a class of drugs known as ACE inhibitors. It works by relaxing blood vessels so that blood can flow through the body more easily.
  • Hydrochlorothiazide is a "water pill" (diuretic) and causes your body to get rid of extra salt and water. This effect may increase the amount of urine you make when you first start the medication. It also helps to relax the blood vessels so that blood can flow through the body more easily.

• Take this medication by mouth with or without food as directed by your medical provider, usually once daily. If you take this product too close to bedtime, you may need to wake up to urinate. It is best to take this medication at least 4 hours before your bedtime. Consult your medical provider or pharmacist if you have questions about your dosing schedule.
• If you are also taking Cholestyramine or Colestipol, take Enalapril/Hydrochlorothiazide at least 4 hours before or at least 4 to 6 hours after either of those drugs.
• Dosage is based on your medical condition and response to treatment.
• Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day.
• It may take several weeks before you get the full benefit of this medication. Keep taking this medication even if you feel well. Most people with high blood pressure do not feel sick.
• Tell your medical provider if your condition does not improve or if it worsens—for example, your routine blood pressure readings remain high or increase.

• Dizziness, lightheadedness or tiredness may occur as your body adjusts to the medication. Dry cough may also occur. If any of these effects continue or get worse, tell your medical provider or pharmacist right away.
• Angioedema is a potential side effect. Symptoms include swelling of the lips, tongue, throat or neck. This is not considered an allergic reaction and can occur any time during treatment. This swelling can compromise the airway and be life threatening. Black patients and patients with a personal or family history of angioedema are at higher risk. If you believe you may be at higher risk, discuss alternative treatment options with your medical provider.
• In rare cases, some people, especially those who already have severe heart disease, may develop worsening chest pain, a heart attack, stroke, blood clots or arrhythmias after starting this medication or increasing the dose. Get medical help right away if you experience chest pain, jaw/left arm pain, shortness of breath or unusual sweating, weakness or difficulty speaking.
• Remember that this medication has been prescribed because your medical provider has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not experience serious side effects.

• This product may cause dehydration and electrolyte imbalance. Tell your medical provider right away if you have any symptoms of dehydration or electrolyte imbalance, including:

  • Extreme thirst
  • Very dry mouth
  • Muscle cramps or weakness
  • Fast, slow or irregular heartbeat
  • Confusion

• Tell your medical provider right away if you experience any serious side effects, including:

  • Toe or joint pain
  • Irregular heartbeat
  • Decrease in vision
  • Eye pain
  • Symptoms of a high potassium blood level, such as muscle weakness or slow/irregular heartbeat
  • Easy bruising or bleeding
  • Signs of kidney problems, like change in amount of urine

• In rare cases, this drug may cause serious and possibly fatal liver problems. Tell your medical provider right away if you notice any of the following rare but very serious side effects:

  • Nausea or vomiting that doesn't stop
  • Yellowing eyes or skin
  • Dark urine
  • Severe stomach or abdominal pain

• A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including:

  • Rash
  • Itching or swelling, especially of the face/tongue/throat
  • Severe dizziness
  • Trouble breathing

• This is not a complete list of possible side effects. If you notice other effects not listed above, request a callback for medical advice. You may also report side effects to the FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

• Before taking this product, tell your medical provider or pharmacist if you are allergic to either Enalapril or Hydrochlorothiazide, other ACE inhibitors (such as Captopril and Lisinopril), other thiazides (such as Chlorothiazide) or if you have any other allergies. 
• This product may contain inactive ingredients, which can cause allergic reactions or other problems. Go to your patient dashboard and request a medical provider callback for more details.

• Before using this medication, tell your medical provider or pharmacist your medical history, especially of:

  • An allergy to sulfonamides ("sulfa") because there may be cross-reactivity between the two classes of drugs
  • A history of an allergic reaction that included swelling of the face/lips/tongue/throat (angioedema)
  • Aortic stenosis
  • Blood filtering procedures, such as LDL apheresis and dialysis
  • Dehydration
  • Glaucoma or other vision issues
  • Gout
  • High cholesterol/triglycerides
  • Hypertrophic cardiomyopathy
  • Kidney disease, like renal artery stenosis
  • Liver disease
  • Lupus
  • Parathyroid disease or history of elevated calcium levels
  • Porphyria
  • Untreated salt imbalances, such as high calcium, high or low potassium or low magnesium
  • Skin cancer
• This drug may make you dizzy, which can be exacerbated by alcohol or marijuana (cannabis). Do not drive, use machinery or do anything that requires alertness until you can do it safely. Limit alcoholic beverages. Talk to your medical provider if you are using marijuana.
• To lower your risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.
• To help prevent dizziness, drink plenty of fluids while taking this medication unless directed otherwise by your medical provider. Too much sweating, diarrhea or vomiting may cause you to feel lightheaded. Report prolonged diarrhea or vomiting to your medical provider.
• Although Enalapril may be used to prevent kidney problems or treat people who have kidney problems, it may also cause or worsen serious kidney problems in rare cases. Your medical provider will check your kidney function while you are taking Enalapril. Tell your medical provider right away if you have any signs of kidney problems, such as a change in amount of urine.
• Before having surgery, tell your doctor or dentist about all the products you use, including prescription drugs, nonprescription drugs and herbal products.
• This medication may make you more sensitive to the sun. It may also increase your risk for skin cancer, especially if you take it for a long time. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your medical provider right away if you get sunburned, have skin blisters/redness or notice new or changed moles/skin lesions.
• This product may affect your potassium levels. Before using potassium supplements or salt substitutes that contain potassium, consult your medical provider or pharmacist.
• If you have diabetes, this product may affect your blood sugar. Check your blood sugar regularly as directed and share the results with your medical provider. Tell your medical provider right away if you have symptoms of high blood sugar such as increased thirst/urination or signs of low blood sugar like sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness or tingling hands/feet. Your medical provider may need to adjust your diabetes medication, exercise program or diet.
• Older adults may be more sensitive to the side effects of this drug, especially dizziness and change in the amount of urine (kidney problems).
• Tell your medical provider if you are pregnant or plan to become pregnant. You should not become pregnant while using Enalapril/Hydrochlorothiazide, as this medication may harm an unborn baby. If you become pregnant, talk to your OB/GYN right away about the risks and benefits of this medication (see also “Warnings to be aware of” section).
• This product passes into breast milk, but it is unlikely to harm a nursing infant. Consult your OB/GYN before breastfeeding.

• Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. 
• Keep a list of all the products you use—including prescription/nonprescription drugs and herbal products—and share it with your medical provider and pharmacist. 
• Do not start, stop or change the dosage of any medicines without your medical provider's approval.

• Some products that may interact with this drug are:

  • Aliskiren
  • Allopurinol
  • Certain drugs that weaken the immune system or increase the risk of infection, such as Everolimus or Sirolimus
  • Dofetilide
  • Drugs that may increase the level of potassium in the blood (such as ARBs including Losartan/Valsartan, antibiotics such as Bactrim or birth control pills containing Drospirenone)
  • Lithium, Duloxetine and some other antipsychotic medications
  • Multivitamins and vitamin D supplements
  • Licorice
  • Sacubitril
  • Some diabetes medications
  • Some cardiac medications
  • Steroids
• A very serious reaction may occur if you are getting injections for bee/wasp sting allergy (desensitization) and are also taking Enalapril/Hydrochlorothiazide. Make sure all your medical providers know which medicines you are using.
• Some products have ingredients that could raise your blood pressure or worsen your heart failure. Tell your pharmacist what products you are using, and ask how to use them safely—especially cough-and-cold products, diet aids or NSAIDs such as Ibuprofen and Naproxen.
• This medication may interfere with certain lab tests—including parathyroid, protein-bound iodide, tyramine and phentolamine tests—possibly causing false test results. Make sure lab personnel and all your medical providers know you use this drug.

• Do not share this medication with others.
• Talk with your medical provider about making changes to your lifestyle that may help this medication work better, such as stress reduction programs, exercise and dietary changes.
• Lab and/or medical tests—such as kidney/liver function, blood mineral levels like potassium and skin exams—should be done while you are taking this medication. Keep all medical and lab appointments. Consult your medical provider for more details.
• Have your blood pressure checked regularly while taking this medication. Learn how to check your own blood pressure at home, and share the results with your medical provider.

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

• Store at room temperature away from light and moisture. Do not store in the bathroom.
• Keep all medications away from children and pets.
• Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details.