Anapril

Anapril is a blood pressure medication containing Enalapril Maleate, an ACE Inhibitor (Angiotensin-Converting Enzyme Inhibitor). First approved by the US FDA in 1985 for treating hypertension, heart failure, and asymptomatic left ventricular dysfunction.

Enalapril is a prodrug — after ingestion, the liver converts it into the active form Enalaprilat, which inhibits the ACE enzyme. This prevents formation of Angiotensin II (a potent vasoconstrictor), causing blood vessels to relax and blood pressure to fall. It also reduces Aldosterone secretion, decreasing fluid and salt retention — particularly beneficial for heart failure patients.

Anapril is available in two strengths: 5 mg for starting treatment and 20 mg for target dosing in hypertension and heart failure.

Hypertension (high blood pressure): A first-line antihypertensive per ACC/AHA guidelines. Used alone or combined with diuretics. Reduces the risk of stroke, heart attack, and kidney failure.

Heart failure: High-level evidence from CONSENSUS and SOLVD trials proves Enalapril reduces mortality in heart failure. A major meta-analysis of 47,662 patients confirmed ACE Inhibitors reduce all-cause mortality by 11% and cardiovascular mortality by 14%.

Asymptomatic left ventricular dysfunction: Slows progression to symptomatic heart failure.

Diabetic kidney protection (off-label): Enalapril helps prevent diabetic nephropathy, even in patients with normal blood pressure.

Hypertension: Start with 1 tablet (5 mg) once daily. The doctor may increase to 10–40 mg per day, given once or twice daily.

Heart failure: Start low (2.5 mg) and gradually increase to a target of 20 mg per day, divided into two doses.

Kidney disease / elderly patients: Start lower than usual, adjust slowly, and monitor kidney function and potassium levels regularly.

Take with or without food — the key is consistent timing each day. If you miss a dose, take it as soon as you remember unless it's nearly time for the next one. Never double up.

Important: Never stop on your own — sudden withdrawal may cause dangerous blood pressure rebound.

Common side effects:

• Dry cough — the signature ACE Inhibitor side effect, caused by Bradykinin accumulation. Affects about 5–10% of users. Not dangerous but can be bothersome. If intolerable, your doctor may switch to an ARB.
• Dizziness, headache — especially when first starting
• Fatigue

Uncommon side effects:

• Nausea, diarrhoea
• Altered taste
• Hyperkalaemia (high potassium) — requires blood monitoring

Warning signs — seek immediate medical attention:

• Angioedema — swelling of face, lips, tongue, or throat causing difficulty breathing. Rare but a medical emergency.
• Severe hypotension (fainting, severe dizziness)
• Acute kidney function decline

Do not use:

• Allergy to Enalapril or any ACE Inhibitor
• History of Angioedema from ACE Inhibitors
• Pregnancy — especially 2nd and 3rd trimesters; can cause serious foetal harm
• Bilateral renal artery stenosis
• Within 36 hours of Sacubitril/Valsartan (Entresto)

Use with caution:

• Kidney disease — dose adjustment required; monitor creatinine and potassium regularly
• Starting alongside diuretics — risk of severe first-dose hypotension
• Avoid potassium supplements and salt substitutes
• Breastfeeding — consult your doctor
• Avoid alcohol — enhances blood pressure lowering, increasing fainting risk

Anapril (Enalapril — ACE Inhibitor) vs. Amlopine (Amlodipine — CCB): Amlopine doesn't cause dry cough and lowers BP more effectively as monotherapy in Asian patients. However, Anapril offers superior heart and kidney protection, particularly for patients with diabetes or heart failure. The two are often prescribed together as a standard combination.

Anapril (ACE Inhibitor) vs. Loranta (Losartan — ARB): Both act on the RAAS system, but ARBs rarely cause dry cough. However, a large meta-analysis (47,662 patients) found that ACE Inhibitors reduce mortality in heart failure by 11%, while ARBs do not show a significant reduction. ACE Inhibitors are therefore recommended as first-choice for heart failure patients.

Anapril vs. Enaril (Enalapril — different manufacturer): Identical active ingredient (Enalapril), same price (145 THB). Different manufacturers — Anapril by Berlin Pharmaceutical, Enaril by another manufacturer. Both Thai FDA-registered.

Commonly combined (your doctor may prescribe together):

• Diuretics (e.g. Hydrochlorothiazide) — FDA-approved fixed-dose combination with Enalapril; response rate exceeds 90%
• Calcium Channel Blockers (e.g. Amlodipine) — standard combination, may reduce Amlodipine-related ankle swelling

Medications to avoid or use with caution:

• NSAIDs (e.g. Ibuprofen, Naproxen) — reduce Anapril's effectiveness and increase kidney risk
• Potassium supplements / salt substitutes — risk of dangerous hyperkalaemia
• ARBs (e.g. Losartan) — never combine ACE Inhibitor + ARB; increases kidney failure and hyperkalaemia risk
• Sacubitril/Valsartan (Entresto) — stop Anapril at least 36 hours before starting
• Lithium — Enalapril increases Lithium blood levels; close monitoring required

Enalapril is absorbed from the gut and converted to active Enalaprilat in the liver. Effects begin within 1 hour of taking a dose. Peak blood levels occur at 3–4 hours. Blood pressure-lowering effects last 12–24 hours depending on dose.

For lower doses, twice-daily dosing may be needed. Higher doses may allow once-daily dosing. The drug is primarily excreted by the kidneys, requiring dose adjustment in kidney disease.

Full blood pressure control takes 2–4 weeks of continuous use. Don't stop early because you haven't seen immediate results.

Anapril is a pharmacist-dispensed medication. You can order online from Intimo Life.

Can I buy Anapril online?

Yes. Order through Intimo Life — select the product, consult with a licensed pharmacist online, and receive your medication at home. No need to visit a hospital.

Do I need a prescription?

A doctor's prescription is not required, but the medication must be dispensed by a licensed pharmacist. At Intimo Life, our pharmacist will review your health history, current medications, and blood pressure readings to confirm suitability.

How does Intimo Life ship orders?

We deliver nationwide in Thailand with discreet packaging — no product names on the outside.