Enalapril Pediatric Dose — Cardiovascular (ACE Inhibitor)
Enalapril is an oral angiotensin-converting enzyme (ACE) inhibitor that lowers systemic vascular resistance by blocking the conversion of angiotensin I to angiotensin II. It is used in pediatric patients primarily for the management of hypertension and heart failure, including cases associated with congenital heart disease or cardiomyopathy. As a prodrug, enalapril is hydrolyzed to its active form, enalaprilat, following gastrointestinal absorption.
Pediatric Dosing
- Initial dose: 0.1 mg/kg/day PO, divided every 12–24 hours
- Maximum pediatric dose: 0.5 mg/kg/day, not to exceed 40 mg/day
- Adult dose (reference): 10–40 mg/day PO once daily or divided BID
Titrate gradually based on clinical response and tolerability. For a 20 kg child: initial dose = 20 × 0.1 mg/kg/day = 2 mg/day, which may be given as 1 mg every 12 hours. The maximum dose for this child would be 20 × 0.5 mg/kg/day = 10 mg/day.
Indications and Clinical Context
Enalapril is indicated in pediatric patients for the treatment of hypertension and as an adjunct in the management of chronic heart failure and ventricular dysfunction. ACE inhibitors reduce afterload and preload, improving cardiac output in patients with dilated cardiomyopathy or post-surgical congenital heart disease. Enalapril is among the preferred oral agents in this class for children due to available dosing data and formulation flexibility.
Guidelines from major pediatric cardiology and nephrology societies support ACE inhibitor use in children with proteinuric renal disease and left ventricular dysfunction, making enalapril a commonly encountered agent in both PICU and outpatient cardiovascular settings. Consult institutional protocol for disease-specific titration targets.
Administration and Monitoring
Enalapril is administered orally and may be compounded into a suspension for younger patients or those unable to swallow tablets. Initiate at the lowest recommended dose and titrate every 1–2 weeks as tolerated. Monitor blood pressure closely after each dose increase to detect symptomatic hypotension, particularly in volume-depleted patients or those on concomitant diuretics.
- Route: Oral (PO) only per this dosing reference
- Key monitoring parameters: Blood pressure, serum potassium, serum creatinine/BUN, and signs of angioedema
- Contraindications: History of ACE inhibitor–associated angioedema, bilateral renal artery stenosis, concurrent use with aliskiren in patients with diabetes or renal impairment, and pregnancy
- Adverse effects: Hypotension (especially first-dose), hyperkalemia, renal function deterioration, and dry cough
Disclaimer: This article is an educational reference summarizing standard pediatric dosing values. It is not a substitute for clinical judgment. Always verify doses against institutional protocols, the current edition of authoritative references (e.g., Lexicomp, Harriet Lane Handbook, PALS guidelines), the patient’s accurate weight, and any patient-specific factors (renal/hepatic function, allergies, comedications) before administration.