Anapril/Anapril-S Dosage/Direction for Use

Recommended Doses & Mode of Administration: This drug can be given before, during, or after meals since food does not affect its absorption.
Adult Dosage: Hypertension: Initial dose is 5 mg orally once daily (no concurrent diuretic), 2.5 mg (if on existing diuretic). The dose should be titrated to give optimal blood pressure control. The usual maintenance dose is 10 to 40 daily as a single dose or two divided doses; maximum daily dose is 40 mg.
In some patients receiving once daily therapy, antihypertensive effects may diminish toward the end of a dosing interval. An increase in dosage or twice daily dosing should be considered.
Congestive Heart failure: Symptomatic Heart Failure: Initial dose is 2.5 once or twice daily. The usual maintenance dose is 2.5 to 20 mg twice daily; maximum dose is 40 mg daily in divided doses.
Asymptomatic Left Ventricular Dysfunction: Initial dose is 2.5 mg twice daily; maintenance dose is 2.5 to 10 mg twice daily; maximum dose is 20 mg daily in divided doses.
Because of the risk of severe hypotension, enalapril maleate therapy for heart failure should be initiated at low dose under close medical supervision. Carefully monitor hypotensive response to initial dose for the first 2 hours and until blood pressure stabilizes for at least 1 hour. To minimize the likelihood of hypotension, the existing diuretic doses should be reduced prior to adding angiotensin converting enzyme (ACE) inhibitor therapy if possible. Upward dose titration over a few days to weeks is recommended.
Uses in Special Population: Patients with Myocardial Infarction: Initial dose is 2.5 mg twice daily; maintenance dose is 2.5 - 10 mg twice daily; maximum dose is 20 mg daily.
Patients with Kidney Disease (Diabetic and Non-diabetic): Initial dose is 5 mg daily; maintenance dose is 5-20 mg daily; maximum dose is 20 mg daily.
Patients with Impaired Renal Function: Initial dose of 2.5 mg daily recommended for creatinine clearance 30 ml/min or less (serum creatinine 3 mg percent or greater). The dose should be titrated upward until blood pressure is controlled or a maximum of 40 mg daily is administered. (See Table 1.)

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Based on oral doses of 5-10 mg every 12 hours, the following dose adjustments are recommended. (See Table 2.)

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Patients with Hepatic Insufficiency: Since hepatic biotransformation is required for activation of enalapril, the presence of hepatic disease or hepatic congestion secondary to heart failure may impact this process and possibly result in reduced efficacy of the drug. However, dosing adjustment has not been suggested. It is possible that higher doses may have to be given in patients with impaired hepatic function.
Geriatric Patients with Hypertension: The dosage must be modified in response to the degree of renal impairment. (See Patients with Impaired Renal Function as previously mentioned.)
Pediatric Patients with Hypertension (6 months - 16 years old): Initial dose is 0.08 mg/kg (maximum 5 mg) once daily; maintenance dose is 0.08-0.58 mg/kg daily and maximum dose is 0.58 mg/kg (40 mg) daily.