Hydrochlorothiazide and enalapril

Hydrochlorothiazide is a type of water pill called a thiazide diuretic, and enalapril is a medicine known as an ACE inhibitor, which stands for angiotensin converting enzyme.

Hydrochlorothiazide and enalapril is a combination medicine used to treat high blood pressure.

Hydrochlorothiazide and enalapril may also be used for other reasons not mentioned in this medication guide.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may change your dose from time to time. Use the medicine exactly as directed.

Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking hydrochlorothiazide and enalapril. This can lead to very low blood pressure, electrolyte disorders, or kidney failure.

Your blood pressure will need to be checked often. Your kidney function may also need to be checked. Your blood and urine may be tested if you have been vomiting or are dehydrated.

If you need surgery, tell the surgeon in advance that you are using hydrochlorothiazide and enalapril.

Keep using hydrochlorothiazide and enalapril as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Store at room temperature away from moisture, heat, and light. Keep the tablets in their original container, along with the packet or canister of moisture-absorbing preservative.

Do not use if you are pregnant. If you become pregnant, stop taking hydrochlorothiazide and enalapril and tell your doctor right away.

You should not use this medicine if you are unable to urinate, if you have ever had angioedema, or if you are allergic to sulfa drugs or any ACE inhibitor. Do not take hydrochlorothiazide and enalapril within 36 hours before or after taking medicine that contains sacubitril (such as Entresto).

If you have diabetes, do not use hydrochlorothiazide and enalapril together with any medication that contains aliskiren (a blood pressure medicine).

You should not use this medicine if you are allergic to hydrochlorothiazide or enalapril, or if:

• you are unable to urinate;
• you have ever had angioedema;
• you recently took a heart medicine called sacubitril;
• you are allergic to sulfa drugs; or
• you are allergic to any ACE inhibitor (benazepril, captopril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, trandolapril).

Do not take hydrochlorothiazide and enalapril within 36 hours before or after taking medicine that contains sacubitril (such as Entresto).

If you have diabetes, do not use hydrochlorothiazide and enalapril together with any medication that contains aliskiren (a blood pressure medicine).

You may also need to avoid taking hydrochlorothiazide and enalapril with aliskiren if you have kidney disease.

Tell your doctor if you have ever had:

• asthma or allergies;
• kidney disease (or if you are on dialysis);
• cirrhosis or other liver disease;
• glaucoma;
• congestive heart failure;
• gout;
• an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);
• lupus;
• if you are allergic to penicillin; or
• if you are on a low salt diet.

Do not use if you are pregnant. If you become pregnant, stop taking this medicine and tell your doctor right away. Enalapril can cause injury or death to the unborn baby if you take the medicine during your second or third trimester.

You should not breastfeed while you are using this medicine.

Get emergency medical help if you have signs of an allergic reaction (hives, severe stomach pain, difficulty breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

You may be more likely to have an allergic reaction if you are African-American.

Hydrochlorothiazide and enalapril may cause serious side effects. Call your doctor right away if you have:

• a light-headed feeling, as if you might pass out;
• jaundice (yellowing of the skin or eyes);
• blurred vision, tunnel vision, eye pain, or seeing halos around lights;
• fever, chills, flu-like symptoms, sore throat, mouth sores;
• signs of an electrolyte imbalance—leg cramps, constipation, muscle pain or weakness, irregular heartbeats, feeling jittery, increased thirst or urination, numbness or tingling, loss of movement;
• kidney problems—little or no urination, swelling in your feet or ankles, feeling tired or short of breath; or
• new or worsening symptoms of lupus—joint pain, and a skin rash on your cheeks or arms that worsens in sunlight.

Common side effects of hydrochlorothiazide and enalapril may include:

• dizziness;
• cough;
• headache; or
• nausea.

This is not a complete list of side effects, and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Usual Adult Dose for Hypertension:

Enalapril 5 to 10 mg-Hydrochlorothiazide 12.5 to 25 mg orally once a dayMaximum dose: Enalapril 20 mg-Hydrochlorothiazide 50 mg per dayComments: Hydrochlorothiazide may be increased after 2 to 3 weeks.Use: Treatment of hypertension only after failure to achieve the desired effect with monotherapy or the titrated components.

Take the medicine as soon as you can, but if it is nearly time for your next dose, skip the missed dose. Do not take two doses at the same time.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include increased thirst, feeling light-headed, or fainting.

Do not use potassium supplements or salt substitutes, unless your doctor has told you to.

Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids. Follow your doctor's instructions about the type and amount of liquids you should drink.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

Drinking alcohol may increase certain side effects of hydrochlorothiazide and enalapril.

Tell your doctor about all your current medicines. Many drugs can affect hydrochlorothiazide and enalapril, especially:

• other blood pressure medications, including another diuretic or "water pill";
• digoxin;
• lithium;
• cancer medicine;
• gold injections to treat arthritis;
• insulin or oral diabetes medicine;
• a muscle relaxer;
• medicine to prevent organ transplant rejection--cyclosporine, everolimus, sirolimus, tacrolimus; or
• NSAIDs (nonsteroidal anti-inflammatory drugs)--aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.

This list is not complete, and many other drugs may affect hydrochlorothiazide and enalapril. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.