Hypace Special Precautions

Hypotension [systolic blood pressure (SBP) <90 mmHg]: More likely to occur if a patient has been volume-depleted eg, by diuretic therapy, dietary salt restriction, dialysis, diarrhea or vomiting. Patients with severe degrees of heart failure, as reflected by the use of high doses of loop diuretics, hyponatremia or functional renal impairment should be closely supervised so that the doses of diuretic and/or enalapril maleate be adjusted. If hypotension occurs, the patient should be placed in the supine position and, if necessary, should receive IV infusion of normal saline.
Impaired Renal Function: Acute renal failure, usually reversible after discontinuation of use. Patients with renal insufficiency may require reduced and/or less frequent doses.
Hypersensitivity/Angioneurotic Edema: Rarely reported, but in such cases, Hypace-therapy should be discontinued promptly and appropriate monitoring should be instituted to ensure complete resolution of symptoms prior to discharging the patient. In instances where swelling has been confined in the lips and the face, the conditions generally resolved without treatment, although antihistamines are useful in relieving the symptoms.
Angioneurotic edema associated with laryngeal edema may be fatal. Where there is involvement of the tongue, glottis or larynx, appropriate therapy eg, SC epinephrine solution 1:1000 (0.3-0.5 mL) should be administered promptly.
Anaphylactoid Reactions During Hymenoptera Desensitization: Rarely reported, but in such case can be avoided by temporarily withholding ACE inhibitor therapy prior to each desensitization.
Hemodialysis Patients: Anaphylactoid reactions have been reported in patients dialyzed with high-flux membranes and treated concomitantly with ACE inhibitor. Consideration should be given to these patients to use a different type of dialysis membrane or a different class of antihypertensive agent.
Cough: Characteristically, it is nonproductive, persistent and resolves after discontinuation of therapy.
Surgery/Anesthesia: If hypotension occurs and is considered to be due to enalapril's blockade of angiotensin II formation secondary to compensatory renin release, it can be corrected by volume expansion.