依那普利
Enalapril
Enalapril maleate / Enalaprilat
別名: Enacard · Vasotec · Glioten · Lotrial · Pres · Renitec · Reniten · Xanef · Enalapril maleate · Enalaprilat · MK-421 · MK-422 · Enalaprilic acid
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
經審核的 v13 劑量證據
結構化劑量計算證據Adjunctive therapy for heart failure (extra-label) — Dilated cardiomyopathy
- q24-48h
NA
必須一併考量的臨床脈絡 (3)
- Adjunctive therapy for heart failure (extra-label):
- ■ This medicine is usually well tolerated but vomiting and diarrhea can occur. It may be given with or without food. If your animal vomits, stops eating, or acts sick after getting enalapril on an empty stomach, give with food or a small treat to see if this helps. If vomiting continues, contact your veterinarian.
- Enalapril tablets should be stored at temperatures less than 30°C (86°F) in tight containers. Enalapril solution should be stored under refrigeration at 2°C to 8°C (36°F-46°F) in tightly closed containers; avoid freezing or excessive heat. Enalapril solution may be stored at room temperature (20°C-25°C [68°F-77°F]) but must be discarded after 60 days.
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
概覽
依那普利 (Enalapril) 是獸醫學中廣泛使用的血管收縮素轉化酶 (ACE) 抑制劑。它作為一種平衡的血管擴張劑，能同時降低前負荷與後負荷，是治療犬貓充血性心臟衰竭 (CHF) 的基石，常與匹莫苯丹 (Pimobendan) 和呋塞米 (Furosemide) 併用。
除了心血管方面的應用，依那普利還具有極高的腎臟保護特性。透過降低腎絲球出球小動脈的阻力，它能有效降低腎絲球內壓及蛋白尿，使其成為慢性腎病 (CKD) 和蛋白質流失性腎病 (PLN) 的標準輔助療法。
臨床要點： 依那普利是一種前驅藥 (Prodrug)，需要透過肝臟生物轉化為其活性代謝物依那普利拉 (Enalaprilat)。在患有嚴重肝功能障礙的病患中，此轉化過程可能受損，應考慮替代療法。由於它主要經由腎臟排泄，在有明顯腎功能不全的病患中通常需要調整劑量。
作用機轉
Enalapril is a prodrug converted in the liver to the active compound enalaprilat. Enalaprilat competitively binds to and inhibits Angiotensin-Converting Enzyme (ACE).
- RAAS Inhibition: Prevents the conversion of inactive Angiotensin-I → active Angiotensin-II (a potent vasoconstrictor).
- Vasodilation: Decreased Angiotensin-II leads to reduced total peripheral resistance, pulmonary vascular resistance, and blood pressure (↓ afterload and preload).
- Aldosterone Reduction: Lower Angiotensin-II levels reduce the secretion of aldosterone from the adrenal cortex, leading to decreased sodium and water retention, while mildly increasing potassium retention.
- Renal Hemodynamics: Preferentially dilates the efferent arteriole of the glomerulus. This reduces intraglomerular hydrostatic pressure, thereby decreasing the filtration of proteins into the urine (anti-proteinuric effect) and slowing the progression of glomerular disease.
安全性與警告
禁忌症
- Hypersensitivity to ACE inhibitors
- Pregnancy (Category C in first trimester, Category D in second/third trimesters due to fetal kidney developmental risks)
不良反應
- Anorexia
- Vomiting
- Diarrhea
- Weakness
- Hypotension
- Renal dysfunction
- Hyperkalemia
- Lethargy (especially in cats)
- Inappetence
注意事項
Use with caution and close supervision in patients with renal insufficiency (doses may need to be reduced). Use cautiously in patients with hyponatremia or sodium depletion, coronary or cerebrovascular insufficiency, preexisting hematologic abnormalities, or a collagen vascular disease (e.g., SLE). Patients with severe CHF should be monitored very closely upon initiation of therapy for acute hypotension or acute kidney injury. Safe use during nursing cannot be assumed as it is excreted into milk.
藥物交互作用
Possible increased risk for hypoglycemia; enhanced monitoring recommended
Potential for increased hypotensive effects; furosemide doses may need reduction (by 25-50%) when adding enalapril
Increased hyperkalemic effects; enhanced monitoring of serum potassium recommended
Potential for increased hypotensive effect
Increased serum lithium levels possible; increased monitoring required
May reduce the anti-hypertensive or positive hemodynamic effects of enalapril; may increase risk for reduced renal function
Increased risk for hyperkalemia
監測
- Clinical signs of CHF (respiratory rate/effort, exercise tolerance)
- Serum electrolytes (especially potassium)
- Renal panel (creatinine, BUN)
- Urine protein (UPC ratio)
- CBC with differential (periodic)
- Blood pressure (especially if treating hypertension or if clinical signs of hypotension arise)
藥物動力學
半衰期
吸收
In humans, enalapril is well absorbed after oral administration (approx 60% bioavailable), but enalaprilat is not.
分佈
Distributed poorly into the CNS. Crosses the placenta and is distributed into milk in trace amounts.
代謝
Enalapril is a prodrug converted in the liver to the active compound enalaprilat.
排除
In dogs, approximately 95% of enalaprilat is cleared via renal routes. Reduced renal function can impact elimination rates.
過量
In dogs, a dose of 200 mg/kg was lethal, but 100 mg/kg was not.
- Primary Concern: Severe hypotension.
- Treatment: Supportive treatment with volume expansion using normal saline is recommended to correct blood pressure.
- Monitoring: Because of the drug's long duration of action, prolonged monitoring and treatment may be required.
- Decontamination: Recent overdoses should be managed by using gut emptying protocols when warranted.
可用產品
劑型
- Tablets
- Injection (Enalaprilat for IV use)
- Oral suspension (compounded)
獸醫用
- Enalapril Maleate Tablets: 1 mg, 2.5 mg, 5 mg, 10 mg, & 20 mg (Enacard)
人用標示
- Enalapril Maleate Tablets: 2.5 mg, 5 mg, 10 mg & 20 mg (Vasotec, generic)
- Enalaprilat Injection: equivalent to 1.25 mg/mL in 1 mL & 2 mL vials (generic)
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Commercially available tablets should be stored at temperatures less than 30°C in tight containers. Enalaprilat injection should be stored at <30°C; after dilution with D5W, normal saline, or D5 in lactated Ringer's, it is stable for up to 24 hours at room temperature. Compounded oral suspensions should be protected from light.
飼主須知
依那普利可用於幫助您的寵物心臟更輕鬆地泵血，或保護牠們的腎臟減少蛋白質流失。
- 給藥方式： 可與食物一起或空腹給予。如果您的寵物在空腹服藥後嘔吐，請嘗試與少量零食或餐點一起餵食。
- 持續用藥很重要： 未經獸醫師同意，請勿突然停止或減少劑量，因為這可能導致心臟或腎臟疾病突然惡化。
- 注意事項： 如果嘔吐或腹瀉持續存在或變得嚴重，請聯繫您的獸醫師。
- 低血壓的跡象： 觀察是否有虛弱、嗜睡、步態不穩或昏厥的現象。如果出現這些情況，請立即聯繫獸醫師，因為可能需要調整劑量。
- 監測： 在服用此藥物期間，您的獸醫師需要定期檢查寵物的血液數值（腎功能和鉀離子）以及血壓。
VetSheet 藥物參考供合格獸醫專業人員作臨床決策輔助之用，不能取代專業判斷或廠商最新仿單。