Vasotec (Enalapril) for Heart Disease

Vasotec (enalapril) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to treat adults with symptomatic congestive heart failure. It is also used in certain people with a weakened heart who do not have symptoms.

How Vasotec Works and How It’s Taken

Vasotec is a type of medicine called angiotensin-converting enzyme (ACE) inhibitors.

It works by blocking an enzyme that helps make angiotensin II, a substance that tightens blood vessels. This helps blood vessels relax and lowers blood pressure. Vasotec also reduces a hormone called aldosterone, which helps the body hold on to salt and water. In people with heart failure, Vasotec can improve symptoms and help the heart pump blood more effectively.

Doctors prescribe Vasotec to treat adults with symptomatic congestive heart failure, a condition in which the heart cannot pump blood as well as it should and causes symptoms. It is also used in certain people whose heart’s main pumping chamber is weakened, even if they have no symptoms. In these people, Vasotec can lower the risk of developing heart failure symptoms and being hospitalized for heart failure.

Vasotec comes as a tablet taken by mouth. The dose depends on the heart condition being treated.

Typical Dosing for Heart Conditions

For adults with symptomatic heart failure, the recommended starting dose is 2.5 milligrams. The recommended dosing range is 2.5 to 20 milligrams twice daily.

For adults with asymptomatic left ventricular dysfunction, the starting dose used in the clinical study was 2.5 milligrams twice daily. The dose was gradually increased as tolerated to a target of 20 milligrams per day, divided into two doses.

This information is based on the prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Vasotec Side Effects

In clinical studies of Vasotec, the most common side effects occurred in about 1 percent to 8 percent of people with symptomatic heart failure. These include:

Dizziness
Hypotension (low blood pressure)
Cough
Syncope (fainting)
Diarrhea
Chest pain
Fatigue (feeling very tired)
Abdominal (stomach) pain
Asthenia (weakness or low energy)
Nausea
Vomiting

Serious Side Effects and Warnings

Vasotec can cause serious side effects that may require immediate medical attention. These include:

Angioedema — Sudden swelling of the face, lips, tongue, throat, or other areas that can affect breathing.
Intestinal angioedema — Swelling in the intestines can cause belly pain, with or without nausea or vomiting.
Severe low blood pressure — A large drop in blood pressure can cause fainting and in some high-risk people, may lead to heart attack or stroke.
Kidney problems, including acute kidney failure — A sudden worsening of kidney function can occur.
Neutropenia or agranulocytosis — Dangerously low white blood cell counts can raise infection risk.
Liver injury or liver failure — This may start with yellowing of the skin or eyes, called jaundice.
Serious allergic-type reactions — These anaphylactoid reactions can occur during venom desensitization treatment, certain types of dialysis, or LDL apheresis.
Fetal toxicity — Harm to a developing baby can occur if taken during pregnancy, especially in the second and third trimesters.

Vasotec has a boxed warning, the FDA’s strongest safety warning, for some of the serious risks mentioned above. A boxed warning does not mean the drug is unsafe for everyone or that everyone faces the same level of risk.

Get medical help right away if you think you are having a serious reaction.

What To Know Before Taking Vasotec

Tell your doctor if you have any allergies to enalapril or any ingredients in Vasotec.

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements.

Do not take Vasotec if you:

Have had angioedema (swelling under the skin) caused by an ACE inhibitor
Have hereditary or idiopathic angioedema (swelling that runs in families or has no known cause)
Are taking a neprilysin inhibitor, such as sacubitril. You must wait at least 36 hours when switching between Vasotec and sacubitril/valsartan
Have diabetes and are taking aliskiren

Vasotec is also FDA-approved to treat high blood pressure.

Vasotec can seriously harm a developing baby, especially during the second and third trimesters of pregnancy. Tell your doctor right away if you become pregnant. Vasotec should be stopped as soon as pregnancy is detected. Talk with your doctor if you are planning to become pregnant.

If you are breastfeeding, talk with your doctor. Enalapril can pass into breast milk, and you and your doctor may need to decide whether to stop breastfeeding or stop taking Vasotec.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Vasotec for heart conditions?

In a study of people with heart failure symptoms and reduced heart pumping ability, enalapril was linked to an 11 percent lower risk of death from any cause and a 30 percent reduction in hospital stays for heart failure over up to 55 months.

In another study of people with severe heart failure, 74 percent of those taking enalapril were alive after six months, compared with 56 percent taking a placebo (a pill with no active medication). After one year, survival rates were 64 percent with enalapril and 48 percent with placebo.

In people with a weakened heart who had no symptoms of heart failure, enalapril was linked to 32 percent fewer first hospital stays for heart failure and 32 percent fewer total hospital stays for heart failure over up to five years.

How long does Vasotec take to work for heart conditions?

Vasotec can begin lowering blood pressure within one hour of taking a dose, with the greatest reduction usually occurring within four to six hours. In some people, it may take several weeks to reach the best blood pressure response.

In studies of people with heart failure, changes in heart function and blood flow were seen after the first dose. However, it does not say exactly how long it takes for heart failure symptoms to improve.

What tests or monitoring are needed with Vasotec for heart disease?

People taking Vasotec for heart failure should have their kidney function checked. Blood pressure should also be monitored closely after the first dose and when doses are increased, especially in people at risk for low blood pressure.

Doctors may also check potassium levels in the blood because Vasotec can cause potassium to rise. In clinical studies, 3.8 percent of people with heart failure had high potassium levels.