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Enalapril and Its Adverse Effects: Managing Dry Cough, Hyperkalemia, and Angioedema Risks for Physicians

A middle-aged Hispanic patient with a mild cough consults a Hispanic doctor about the adverse effects of enalapril, an ACE inhibitor. The doctor, wearing a white coat and stethoscope, shows a diagram of the respiratory system on a tablet. On the desk, there are medical brochures about enalapril, highlighting dry cough, hyperkalemia, and the risk of angioedema. The office is modern, conveying trust and empathy.

Enalapril, an ACE inhibitor, is widely used in the treatment of hypertension and heart failure. However, its use can be associated with significant adverse effects, such as dry cough and angioedema. These side effects can impact patients' quality of life and, in some cases, necessitate discontinuation of treatment. In this article, we will explore how to manage these adverse effects and the available alternatives.

Diving into the Adverse Effects of Enalapril

Dry cough is one of the most common side effects associated with ACE inhibitors, including enalapril. This symptom is due to the accumulation of bradykinin, a peptide that is not adequately broken down due to ACE inhibition. Although dry cough is not dangerous, it can be bothersome and lead to treatment discontinuation in some patients. In these cases, considering a switch to an angiotensin receptor blocker (ARB) may be beneficial, as these medications do not affect bradykinin levels and, therefore, typically do not cause cough [1].

Angioedema is a less common but potentially serious adverse effect of enalapril. It is characterized by rapid swelling of the skin, mucous membranes, and subcutaneous tissues, and can be dangerous if it affects the airways. Although angioedema is more frequent with ACE inhibitors, it has also been reported with ARBs, albeit less frequently [2]. In cases of angioedema, it is crucial to discontinue enalapril immediately and consider therapeutic alternatives.

Conclusions

Managing the adverse effects of enalapril, such as dry cough and angioedema, is essential to ensure patient safety and well-being. Early identification of these effects and transitioning to alternative therapies, such as ARBs, can improve treatment adherence and patient quality of life. Additionally, it is important to educate patients about the signs and symptoms of these adverse effects so they can seek timely medical attention [3].

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Created 6/1/2025