Comparing Enalapril and Lisinopril | Determining the best

Updated: 04/23/2021 15:11:06

Expert: Abramova Tsilya

The antihypertensive drugs Enalapril and Lisinopril do their job equally well. We've looked at the similarities and differences to find out which is better.

Comparison of the effectiveness of Lisinopril and Enalapril

The effectiveness of Lisinopril is quite similar to Enalapril - this means that the ability of the drug substance to provide the maximum possible effect is similar.
For example, if the therapeutic effect of Lisinopril is more pronounced, then using Enalapril even in large doses will not achieve this effect.

Also, the speed of therapy - an indicator of the speed of therapeutic action - is approximately the same for Lisinopril and Enalapril. And bioavailability, that is, the amount of a drug reaching its site of action in the body, is similar. The higher the bioavailability, the less it will be lost during absorption and use by the body.

General description of Enalapril

The antihypertensive drug Enalapril works due to the content of the substance of the same name, enalapril. It is an ACE inhibitor, which through certain mechanisms leads to inhibition of renin-angiotensin. The use of the drug provides a stable decrease in blood pressure without increasing heart rate.

Available in tablets of 2.5, 5, 10 and 20 mg. Manufacturer: Agio Pharmaceuticals, India. Also produced by Russian and Ukrainian companies.

The effect of the drug begins within a few hours after administration. The peak decrease in pressure is observed after 4 hours. Indicated for long-term use.

Research and effectiveness

Enalapril is on the WHO list of essential medicines. A number of studies show a positive effect of the drug on the prognosis of hypertension.

The results of ANBP2 make it clear that taking the drug reduces mortality and the risk of cardiovascular diseases much more effectively than diuretics. Enalapril significantly reduces the likelihood of complications of existing diseases. The study also showed the drug's ability to reduce the risk of death from heart attack in men.

Enalapril showed its effectiveness in patients with CHF in a double-blind study. With a 3-month course of taking the medication, an improvement in blood counts and elimination of the symptoms of the underlying disease were noted.

CONSENSUS Study

confirmed that the drug at a dose of 60 mg/day in combination with diuretics reduces the risk of death in heart failure.

Sources:

1. "Enalapril in the treatment of CHF." Difficult patient.
2. WHO Model List of Essential Medicines, 2009.

Contraindications

Not suitable for patients intolerant to enalapril.

Other contraindications to the medication:

1. a history of idiomatic Quincke's edema;
2. angioedema, which was observed when using drugs of this group;
3. stenosis of the arterial and mitral valve;
4. circulatory disorders;
5. previous kidney transplantation;
6. liver failure;
7. up to 12 years, pregnancy and lactation.

The product has many contraindications, so self-medication is unacceptable. The medicine should be prescribed by a doctor after all necessary diagnostic procedures have been carried out.

Side effects

The drug is well tolerated. The likelihood of side effects is related to the therapeutic effects of the substance. There are a number of conditions when the medicine is prescribed with caution.

Taking the drug often causes coughing. It is non-productive and stops after discontinuation of the drug. Some patients experience muscle spasms, dizziness, allergic manifestations, nausea, orthostatic hypertension, and diarrhea.

Dosage

The drug is taken orally regardless of food intake. When treating hypertension, adults consume 0.01-0.02 g per day. If the standard dosage is ineffective, it is changed taking into account the severity of the underlying disease. The maximum dosage per day is no more than 0.04 g.

For heart failure, the starting dosage is 0.0025 g. It can be increased to 10-20 mg up to 2 times a day. Enalapril can be used alone or in combination with other antihypertensive drugs. With a pronounced decrease in pressure, the dose changes.

Who is it suitable for?

The main indication for taking the tablets is arterial hypertension. The medicine is prescribed by the doctor. Enalapril is widely used for renovascular hypertension resistant to standard medications. The drug is also prescribed for congestive heart failure and ischemic myocardial disease. In some cases, it is prescribed for bronchospasm.

Comparison of the safety of Lisinopril and Enalapril

The safety of a drug includes many factors.

At the same time, with Lisinopril it is quite similar to Enalapril. It is important where the drug is metabolized: drugs are excreted from the body either unchanged or in the form of products of their biochemical transformations. Metabolism occurs spontaneously, but most often involves major organs such as the liver, kidneys, lungs, skin, brain and others. When assessing the metabolism of Lisinopril, as well as Enalapril, we look at which organ is the metabolizing organ and how critical the effect on it is.

The risk-benefit ratio is when the prescription of a drug is undesirable, but justified under certain conditions and circumstances, with the obligatory observance of caution in use. At the same time, Lisinopril does not have any risks when used, just like Enalapril.

Also, when calculating safety, it is taken into account whether only allergic reactions occur or possible dysfunction of the main organs. In other matters, as well as the reversibility of the consequences of using Lisinopril and Enalapril.

What are angiotensin-converting enzyme inhibitors?

Mentioned above is the mysterious enzyme ACE, the effect of which on blood vessels affects blood pressure. ACE, or angiotensin-converting enzyme, is indeed the most important enzyme that affects the RAAS (renin-angiotensin-aldosterone system), which in turn is “responsible” for blood pressure in the body.

Excessive activity of this system leads to pathological narrowing of blood vessels, which is manifested by an increase in blood pressure. Therefore, substances that can somewhat weaken the activity of the RAAS system by influencing the angiotensin-converting enzyme are called ACE inhibitors. Are all ACE blockers the same, are there any differences and which is better?

Types of ACE inhibitors

In modern therapeutic practice, 3rd generation ACE inhibitors are used, which may vary:

• pharmacokinetic properties (duration of action, features of excretion from the body, presence of an active metabolite);
• chemical structure.

The presence of a structure that interacts with the active center of ACE allows us to divide existing inhibitors into types:

• with the presence of a sulfhydryl group - these include Zofenopril, Pivalopril, Captopril;
• with the presence of a phosphoryl (phosphinyl) group - Fosinopril;
• with the presence of a carboxyl group - Perindopril, Ramipril, Lisinopril, Enalapril.

As we can see, both drugs of interest to us belong to the same variety, in the formula of which there is a carboxyl group. Its presence in the active substance, unlike the sulfhydryl group, does not provoke skin rashes, sleep disturbances and many other side effects. In addition, the presence of a carboxyl group affects the duration of action of the drug (18–24 hours). What is the difference between Lisinopril and Enalapril, which is better?

Classification of ACE inhibitors by physicochemical properties

Comparison of addiction between Lisinopril and Enalapril

Like safety, addiction also involves many factors that must be considered when evaluating a drug.

So, the totality of the values ​​of such parameters as “syndrome o” in Lisinopril is quite similar to the similar values ​​in Enalapril. Withdrawal syndrome is a pathological condition that occurs after the cessation of intake of addictive or dependent substances into the body. And resistance is understood as initial immunity to a drug; in this it differs from addiction, when immunity to a drug develops over a certain period of time. The presence of resistance can only be stated if an attempt has been made to increase the dose of the drug to the maximum possible. At the same time, Lisinopril has a fairly low incidence of “syndrome”, just like Enalapril.

Indications for use

Let's take a closer look at the indications for use of the drugs in question.

Enalapril is used for:

• arterial hypertension (including renovascular);
• chronic failure.

Lisinopril is prescribed for:

• renovascular and essential hypertension (monotherapy and in combination);
• acute myocardial infarction (first day);
• chronic heart failure;
• diabetic nephropathy.

What's better? As you can see, the range of actions of Lisinopril is much wider than the scope of use of Enalapril.

Comparison of side effects of Lisinopril and Enalapril

Side effects or adverse events are any adverse medical event that occurs in a subject after administration of a drug.

Lisinopril has almost the same level of adverse events as Enalapril. They both have few side effects. This implies that the frequency of their occurrence is low, that is, the indicator of how many cases of an undesirable effect of treatment are possible and registered is low. The undesirable effect on the body, the strength of influence and the toxic effect of Lisinopril are similar to Enalapril: how quickly the body recovers after taking it and whether it recovers at all.

Which drug is better

Enalapril is used to treat various types of hypertension, including renovascular. It is also effective in heart failure. Its low price allows for long-term treatment without interrupting the course. However, the cost of the two drugs differs slightly.

Lisinopril is most often prescribed for essential hypertension. It can be used as a stand-alone product. It is also prescribed on the first day after a heart attack to normalize the condition.

Both drugs cause a persistent decrease in blood pressure. The choice of drug is determined by the active ingredient, its possible side effects and contraindications. The medicine should be prescribed by a doctor after examination.

Comparison of ease of use of Lisinopril and Enalapril

This includes dose selection taking into account various conditions and frequency of doses. At the same time, it is important not to forget about the release form of the drug; it is also important to take it into account when making an assessment.

The ease of use of Lisinopril is approximately the same as Enalapril. However, they are not convenient enough to use.

The drug ratings were compiled by experienced pharmacists who studied international research. The report is generated automatically.

Last update date: 2020-12-04 13:42:31

General description of Lisinopril

The antihypertensive drug Lisinopril contains lisinopril dihydrate. This is a long-acting inhibitor. Used to treat hypertension and prevent consequences. Its peculiarity is the possibility of use in patients with obesity.

Available in tablets of 5, 10 and 20 mg. Manufacturer – Avant, Ukraine.

The drug reduces the formation of angiotensin and suppresses aldosterone. Increases tolerance to physical activity, reduces blood pressure, dilates arteries, reduces preload in CHF.

Long-term use of the drug leads to a decrease in hypertrophy of the heart muscle and arteries. Treatment leads to improved blood circulation in ischemic disorders. Prolongs the life of patients with chronic heart failure.

It begins to act within an hour, maintaining the result for a day. The effect for hypertension is observed within 1-2 days from the start of administration. A stable result is observed after 4-8 weeks.

Research and effectiveness

Lisinopril is a well-studied ACE inhibitor, the mechanism of action of which is based on reducing angiotensin synthesis and suppressing the activity of the renin-angiotensin system.

In a comparative analysis of the effectiveness of Enalapril and Lisinopril, both drugs showed a persistent decrease in blood pressure, but the effect of the latter was more pronounced. Tolerability of drugs is no different. At the same time, Lisinopril acts for a longer time.

The risk of side effects from using the drug depends on the duration of treatment. The most common symptom is a dry cough, occurring in 4-18% of patients.

Lisinopril is the reference ACE inhibitor. Its high effectiveness has been proven in diseases such as arterial hypertension and diabetes. It can be widely used in the treatment of these diseases.

Source:

“The use of Lisinopril for arterial hypertension,” Difficult Patient, 2006.

Contraindications

Lisinopril is contraindicated if a hypersensitivity reaction to the components in the composition has previously been observed. The drug is not prescribed for narrowing of the aorta, cerebrovascular pathologies, or coronary artery disease.

Other contraindications to the use of the drug:

1. hematopoietic disorders;
2. connective tissue pathologies;
3. hypoglycemia;
4. narrowing of the renal artery;
5. up to 18 years of age and in old age.

During pregnancy, Lisinopril is not prescribed, since there is no data on its toxic and mutagenic effects on the embryo. In case of treatment during lactation, breastfeeding is temporarily stopped.

Side effects

In rare cases, patients experience attacks of hypotension. There is a risk of arrhythmia, angina, dizziness, tachycardia. Some patients note increased fatigue, hand tremors, and decreased appetite. Possible taste disturbance.

Possible side effects from different systems and organs:

1. CNS – lability, confusion;
2. CVS - severe decrease in blood pressure, angina pectoris, rapid heartbeat;
3. Gastrointestinal tract - dry mucous membranes, hepatitis, pancreatitis, dyspepsia;
4. allergic manifestations - swelling of the lips, face, tongue, rash, fever;
5. others – vasculitis, increased urea levels, asthenia.

In case of overdose, a pronounced decrease in blood pressure occurs. At the same time, dry mucous membranes, drowsiness, constipation, anxiety, and irritability are observed. When the dosage is increased with the development of undesirable symptoms, symptomatic therapy is carried out. Vasopressors are prescribed and blood pressure is monitored.

A strong decrease in blood pressure while taking ACE inhibitors is often associated with taking diuretics, which reduce circulating blood volume. This effect can also be caused by diarrhea, vomiting, and restriction in the diet of table salt.

In rare cases, there is a possibility of acute kidney failure, myalgia, and fever. During pregnancy, while taking the drug, there is a risk of kidney pathology in the unborn child.

Dosage

The initial dose of Lisinopril is 10 mg per day for 1 dose. If the effect is insufficient, the dose is increased to 20-80 mg/day. For CHF, treatment begins with 2.2 mg. The maintenance dose is 5-20 mg r/s.

If the water-electrolyte balance is disturbed, the dosage does not exceed 5 mg. For maximum effect, it is recommended to take the medicine at the same time every day.

Who is it suitable for?

Lisinopril is indicated for patients with different types of arterial hypertension. It is prescribed in the complex therapy of CHF.

Patient reviews

Dmitry, 65 years old, Orel: “A few months ago I suffered a stroke. The doctor prescribed Lisinopril for the treatment of hypertension. My blood pressure quickly returned to normal, but I have difficulty coping with such a side effect as a dry cough, which bothers me both day and night.”

Alena, 33 years old, Samara: “Many years ago they gave me a disability because... I suffer from severe asthma. Recently my blood pressure began to rise even more. I tried all sorts of medications, but only Enalapril helped. Thanks to him, my blood pressure normalized and it became much easier to breathe.”

In patients taking Lisinopril, blood pressure quickly returns to normal, so the drug is more effective.

Release forms and price

Enalapril is produced both in Russia and abroad, so there is some variation in prices for tablets:

• 5 mg, 20 pcs. – 7-75 rub.;
• 5 mg, 28 pieces – 79 rubles;
• 10 mg, 20 pcs. – 19-100 rub.;
• 10 mg, 28 pieces – 52 rubles;
• 10 mg, 50 pieces – 167 rubles;
• 20 mg, 20 pcs. – 23-85 rub.;
• 20 mg, 28 pieces – 7 rubles;
• 20 mg, 50 pieces – 200 rub.

Lisinopril tablets are also produced by different pharmaceutical companies, and its cost varies over a fairly wide range:

• 5 mg, 30 pieces – 35-160 rubles;
• 10 mg, pcs. – 59-121 rubles;
• 30 pieces – 35-160 rubles;
• 60 pieces – 197 rubles;
• 20 mg, 20 pcs. – 43-178 rub.;
• 30 pcs. – 181-229 rubles;
• 50 pieces – 172 rubles.

What is more effective according to doctors?

To find out the opinion of doctors, the authors of our site specifically conducted a survey among cardiologists, gastroenterologists, pulmonologists and other specialists. Reviews from doctors on the question of which is more effective - Lisinopril or Enalapril - make you think.

1. Some believe that Enalapril has a greater evidence base in the treatment of chronic heart failure.
2. Others summarize that the disadvantage of both drugs is the need for constant and high doses in order to achieve a therapeutic effect.
3. One cardiologist notes that only 10% of his patients observed a more or less tolerable effect from taking these ACE inhibitors.
4. When asked why most elderly patients prefer to maintain normal blood pressure with Enalapril or Lisinopril, there is only one answer - it’s all about the cheapness of these tablets (as patients joke, “we don’t care about fat today - we drink cheap Aprils...”).
5. As for side effects, the opinion of pulmonologists is interesting. They report increased cases of severe, difficult-to-control cough while taking ACE inhibitors. As one cardiologist confirmed, every second of his patients coughs in response to the use of Lisinopril or Enalapril.

So, doctors also find it difficult to answer the question of which is stronger - Enalapril or Lisinopril, and which is better.

Adverse reactions

For the drugs Enalapril and Lisinopril, the instructions state similar adverse reactions. There have been no comparative studies on this issue yet and we cannot say unambiguously which product has a higher safety profile.

The most common side symptoms:

1. anemia;
2. hypoglycemia – decreased sugar levels;
3. headache, dizziness;
4. sleep disorders;
5. rapid heartbeat and cardiac arrhythmia;
6. cough;
7. nausea;
8. stool disorders;
9. increased fatigue;
10. allergic reactions.

Often, ACE inhibitors lead to a significant decrease in blood pressure - and then you need to reconsider the dosage and regimen of the drug.