The use of high permeability dialysis membranes increases the risk of developing an anaphylactic reaction. Correction of the dosing regimen on days free from dialysis should be performed depending on the level of blood pressure.
Before and during treatment with ACE inhibitors, periodic monitoring of blood pressure, blood counts (hemoglobin, potassium, creatinine, urea, activity of "liver" enzymes) and protein in the urine is necessary.
It should be carefully monitored for patients with severe heart failure,ischemic heart disease and cerebrovascular diseases, in which a sharp decrease in blood pressure can lead to myocardial infarction, stroke, or renal dysfunction.
Sudden abolition of treatment does not lead to the syndrome of "withdrawal" (a sharp rise in blood pressure).
For newborns and infants who have undergone intrauterine exposure to ACE inhibitors, careful monitoring is recommended to timely detect a marked decrease in blood pressure, oliguria, hyperkalemia and neurological disorders, possibly due to a decrease in renal and cerebral blood flow with a decrease in blood pressure caused by ACE inhibitors. In oliguria it is necessary to maintain BP and renal perfusion by introducing appropriate fluids and vasoconstrictors. In the presence of renal failure, it is possible to reduce the excretion of the active metabolite, leading to an increase in its concentration in the blood plasma. Such patients may require the administration of smaller doses of the drug.
In patients with hypertension and unilateral or bilateral stenosis of the renal arteries, an increase in urea and creatinine in the blood serum is possible.
These patients need to monitor kidney function during the first few weeks of therapy. You may need to reduce the dosage of the drug.
Consideration should be given to the relationship between risk and potential benefit in the appointment of enalapril to patients with coronary and cerebrovascular insufficiency, due to the risk of increased ischemia in cases of excessive arterial hypotension.
The drug should be administered with caution to patients with diabetes because of the risk of developing hyperkalemia.
Patients with a history of anginaurotic edema may have an increased risk of developing angioedema while enalapril is being treated.
In patients with severe autoimmune diseases, for example, systemic lupus erythematosus or scleroderma, the risk of developing neutropenia or agranulocytosis is increased with Enalapril.
Caution is advised when administering Enalapril for the therapy of chronic heart failure in patients receiving cardiac glycosides and / or diuretics.
Before the study of parathyroid function enalapril should be canceled. Alcohol enhances the hypotensive effect of the drug.
At the beginning of the treatment, before the completion of the dose selection period, it is necessary to refrain from driving vehicles and practicing potentially dangerous activities that require an increased concentration of attention and speed of psychomotor reactions, since dizziness is possible, especially after the initial dose of an ACE inhibitor in patients taking diuretics.
Before surgery (including dentistry), it is necessary to alert the surgeon / anesthesiologist about the use of ACE inhibitors.