Enalapril vs Hydrochlorothiazide

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Introduction

For patients suffering from hypertension or heart conditions, certain drugs that manipulate the function of enzymes and hormones in the body can aid in stabilizing blood pressure and managing symptoms. Enalapril and Hydrochlorothiazide are two such medications frequently prescribed for these conditions. Both have a direct impact on different components within the cardiovascular system but contribute to reducing high blood pressure in patients. Enalapril is an Angiotensin-Converting Enzyme (ACE) inhibitor which works by relaxing blood vessels so that blood can flow more easily. On the other hand, Hydrochlorothiazide is classified as a 'water pill' (diuretic) that helps your body get rid of extra salt and water, primarily affecting fluid balance within the body.

What is Enalapril?

Enalapril (commonly known as Vasotec) was one of the first drugs from the ACE inhibitor class, which marked a major step forward in hypertension and heart failure treatment after diuretics. Enalapril was first approved by the FDA in 1985. This drug functions by inhibiting an enzyme that produces angiotensin II, a substance that narrows blood vessels and releases hormones causing your blood pressure to increase. It is often prescribed for treating high blood pressure, congestive heart failure, and other conditions related to an overactive renin-angiotensin system. Enalapril selectively suppresses angiotensin II with minimal influence on bradykinins leading it to have fewer side effects than other antihypertensive medications with broader actions.

On the other hand, Hydrochlorothiazide belongs to a class of drugs known as thiazide diuretics or "water pills," which help reduce fluid build-up in your body through increased urine production. It's commonly used for managing high blood pressure and fluid retention caused by various conditions such as heart disease. Comparing these two medications: while both are beneficial for hypertension management, their mechanism of action differs significantly; thus they're often used together rather than being considered interchangeable options.

What conditions is Enalapril approved to treat?

Enalapril is approved for the management of various heart-related conditions, including:

Hypertension, also known as high blood pressure
Symptomatic congestive heart failure
Asymptomatic left ventricular dysfunction (in combination with diuretics and digitalis)

How does Enalapril help with these illnesses?

Enalapril works to manage hypertension by reducing the amount of angiotensin II — a hormone that constricts blood vessels and releases another hormone called aldosterone, which causes sodium and water retention in the kidneys — thereby decreasing overall blood pressure. It does this by inhibiting an enzyme known as angiotensin converting enzyme (ACE), which is responsible for creating angiotensin II from its precursor, angiotensin I. Angiotensin II not only tightens the muscles surrounding your blood vessels but also increases the release of aldosterone leading to increased volume of circulating blood - both actions result in higher blood pressure. By lowering levels of angiotensin II with Enalapril, patients can reduce their high blood pressure and decrease their risk for associated health complications like heart attack or stroke.

On the other hand, Hydrochlorothiazide operates differently although it aims at achieving similar results – reduced hypertension. This medication belongs to a class of drugs called diuretics ("water pills") that work by causing your kidneys to get rid of unneeded water and salt through urine. The reduction in fluid volume consequently means lower cardiovascular load translating into decreased arterial pressure.

What is Hydrochlorothiazide?

Hydrochlorothiazide is a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention. It works by causing the kidneys to get rid of unneeded water and salt from the body into the urine, consequently lowering blood pressure. Hydrochlorothiazide was first approved by the FDA in 1959. As hydrochlorothiazide is not an ACE inhibitor like Enalapril, it does not block the action of a hormone known as angiotensin II to ultimately help relax and dilate blood vessels. This lack of interaction with angiotensin II means its side-effect profile also differs from ACE inhibitors, particularly in that it's less likely to cause coughing - a common side effect associated with ACE inhibitors such as Enalapril. The effects on sodium and water excretion brought about by hydrochlorothiazide can be beneficial for treating hypertension or edema (fluid retention), especially in patients who may have had insufficient responses to 'typical' ACE inhibitor drugs such as Enalapril.

What conditions is Hydrochlorothiazide approved to treat?

Hydrochlorothiazide is a diuretic medication, often referred to as a "water pill," that is approved by the FDA for several uses:

Hypertension (high blood pressure)
Edema (fluid retention) due to conditions such as congestive heart failure and cirrhosis
Nephrotic syndrome, which is kidney damage resulting in protein in the urine and swelling of body parts.

How does Hydrochlorothiazide help with these illnesses?

Hydrochlorothiazide is a diuretic, often referred to as a 'water pill', that helps your body get rid of excess salt and water by increasing the amount you urinate. It works on your kidneys by reducing the absorption of electrolytes such as sodium, which in turn increases urine output. This action reduces blood volume and lowers blood pressure, hence it's commonly used for managing hypertension or fluid retention caused by certain conditions like heart failure. While Enalapril primarily works through inhibiting an enzyme involved in narrowing blood vessels thereby relaxing them to lower blood pressure, Hydrochlorothiazide complements this effect with its unique mechanism of action. Consequently, Hydrochlorothiazide might be prescribed alone or along with other medications like Enalapril when more than one therapeutic approach is beneficial for treating high blood pressure.

How effective are both Enalapril and Hydrochlorothiazide?

Both enalapril and hydrochlorothiazide (HCTZ) have established histories of success in treating patients with hypertension, or high blood pressure. Enalapril is an angiotensin-converting enzyme (ACE) inhibitor that was first approved by the FDA in 1985, while HCTZ is a thiazide diuretic that has been used for decades.

Enalapril works primarily by inhibiting the formation of angiotensin II, a hormone that constricts blood vessels and increases blood pressure. By reducing the levels of this hormone, enalapril can help to relax and widen your blood vessels which makes it easier for your heart to pump blood around your body. It's usually prescribed as a treatment for high blood pressure but can also be used to treat some types of kidney disease and heart failure.

Hydrochlorothiazide acts on the kidneys to help the body eliminate sodium and water, reducing fluid volume and thus lowering blood pressure. This medication is typically one of the first options doctors prescribe because it's safe, effective, well-tolerated by patients and inexpensive.

A comparison study conducted between these two drugs indicated no significant difference in their ability to lower systolic or diastolic blood pressure after 12 weeks of treatment; however other studies suggest that ACE inhibitors like enalapril may be more beneficial than diuretics such as HCTZ due to added benefits like protection against stroke or coronary artery disease.

In terms of safety profiles both medications are generally well tolerated with side effects being mild in most cases but they differ somewhat: common side effects associated with enalapril include dizziness, lightheadedness due difficulty standing up from sitting position whereas HCTZ often leads electrolyte imbalances causing symptoms such as muscle cramps fatigue confusion among others.

abstract image of a researcher studying a bottle of drug.

At what dose is Enalapril typically prescribed?

Enalapril is typically prescribed in dosages ranging from 10-40 mg/day for the management of hypertension, while an initial dose may be as low as 2.5 mg for patients with congestive heart failure. For children and adolescents, the dosage will depend on body weight but generally starts at 0.08 mg/kg up to a maximum of 5mg per day. On the other hand, Hydrochlorothiazide doses usually range from 12.5-50 mg/day for treating high blood pressure or edema due to heart conditions or kidney problems. In either case, dosage can be adjusted after a few weeks depending on patient response and tolerance levels; however, it should not exceed the recommended maximum daily limit - which is 40 mg for Enalapril and 100mg for Hydrochlorothiazide.

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At what dose is Hydrochlorothiazide typically prescribed?

Hydrochlorothiazide treatment is typically initiated at a dose of 12.5-25 mg orally, once daily. Depending on the patient's response to medication and tolerability, this dosage can be increased up to a maximum of 50 mg per day, taken in one single dose in the morning. It should be noted that using too much hydrochlorothiazide can lead to electrolyte imbalances and dehydration, so it is crucial not to exceed the recommended dosage without first consulting with a healthcare professional. If after several weeks there appears to be no response or inadequate control over blood pressure or edema symptoms at the current dosage level, consultation with your doctor for possible alternatives or adjustments would be advisable.

What are the most common side effects for Enalapril?

Side effects of Enalapril can include:

Dizziness or lightheadedness, especially when standing up
Weakness or fatigue
Nausea and vomiting
Dry mouth
Abnormal taste sensation (metallic or salty taste)
Skin rash

On the other hand, Hydrochlorothiazide may cause:

Increased urination
Thirstiness due to loss of electrolytes and water from your body
Loss of appetite, nausea, stomach pain -Dizziness or lightheadedness upon standing up too quickly (orthostatic hypotension) -Low blood pressure (hypotension) -Gout attacks in people predisposed to it.

Remember that while these side effects are common, not everyone experiences them. Always consult with a healthcare provider if you experience any unusual symptoms.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Enalapril?

As with any medication, both Enalapril and Hydrochlorothiazide can potentially cause side effects. However, these are rare and usually not severe. In the unlikely event that they do occur, it is important to be aware of them:

Difficulty breathing or swallowing
Signs of a serious allergic reaction: rashes/hives, swollen face or throat
Lightheadedness as if about to faint (usually in the first few days after starting the drug)
Rapid weight loss due to decreased appetite and nausea
Decreased sodium levels - symptoms include headache, confusion, slurred speech, severe weakness or dizziness.
Severe skin reactions like blisters or peeling skin.

With Hydrochlorothiazide specifically:

Changes in vision such as blurred sight; eye pain; seeing halos around lights;
Fainting spells accompanied by rapid heart rate; shortness of breath.

It's noteworthy that Enalapril might lead sometimes to kidney problems while Hydrochlorothiazide could affect liver function. If you encounter unusual fatigue/weakness with yellowing eyes/skin (jaundice), dark urine or severe stomach/abdominal pain get medical help right away. Always remember that your doctor has prescribed this medication because he/she judged that its benefits outweigh potential risks for you personally.

What are the most common side effects for Hydrochlorothiazide?

With Hydrochlorothiazide, potential side effects may comprise:

Increased urination
Dizziness or lightheadedness (especially upon standing up)
Thirst and dry mouth
Nausea, stomach upset or pain
Muscle weakness or cramps due to electrolyte imbalance
Unusual weight loss
Rash or other skin reactions
Headache, blurry vision Some people might also experience a slower heartbeat. Less common but more serious side effects can include confusion, unusual fatigue or weakness suggesting anemia. It's essential for patients on this medication to maintain regular check-ups with their healthcare provider.

Are there any potential serious side effects for Hydrochlorothiazide?

Hydrochlorothiazide, while generally well-tolerated, can also cause some serious side effects in rare instances. Such symptoms may include:

Allergic reactions such as skin rash, itching or hives, swelling of the face or hands
Breathing problems and difficulty swallowing
Unusual bleeding or bruising
Confusion accompanied by abnormal mood swings
Blurred vision and eye pain
Fast or irregular heartbeat; increased thirst; muscle cramps
Dry mouth with feelings of excessive sleepiness If any of these side effects occur when taking hydrochlorothiazide, it is crucial to seek immediate medical attention.

Contraindications for Enalapril and Hydrochlorothiazide?

Both Enalapril and Hydrochlorothiazide, like many other hypertension medications, may cause certain side effects such as dizziness or lightheadedness. If you notice a significant increase in these symptoms, seek immediate medical attention.

Neither Enalapril nor Hydrochlorothiazide should be taken if you are taking lithium for bipolar disorder due to the risk of lithium toxicity. Always inform your physician about all the medications and supplements that you are currently taking; Lithium will require careful monitoring when used concurrently with either Enalapril or Hydrochlorothiazide to avoid harmful interactions.

Additionally, patients with diabetes who take medication to control blood sugar need to be cautious while on these drugs because they can affect blood sugar levels. Regular monitoring of blood glucose is recommended for such individuals.

Pregnant women or those planning pregnancy should not use enalapril as it can harm the fetus particularly during the second and third trimesters.

How much do Enalapril and Hydrochlorothiazide cost?

For the brand name versions of these drugs:

The price for 30 tablets of Enalapril (10 mg) averages around $100, which works out to approximately $3.33/day.
The price for 30 tablets of Hydrochlorothiazide (25 mg), on the other hand, is about $90 or around $3/day.

Hence, if you are taking a typical dose, then brand-name Hydrochlorothiazide tends to be slightly less expensive on a per-day treatment basis than Enalapril. However, cost should not be a primary consideration in determining which of these drugs is right for you.

Regarding their generic versions:

Generic Enalapril (10 mg tablets) can be found in packs ranging from 15 up to several hundred capsules with costs starting from approximately $0.40/day but can go higher depending upon your dosage and where it's purchased.
Generic Hydrochlorothiazide (25 mg) usually comes in similar pack sizes as well; its daily cost starts at about $0.20 and may increase based on dosage and purchasing location.

Therefore, both generic options offer significant savings compared to their branded equivalents.

Popularity of Enalapril and Hydrochlorothiazide

Enalapril, available under the brand name Vasotec among others, was prescribed to about 7.2 million people in the US in 2020. Enalapril accounted for just over 18% of ACE inhibitor prescriptions in the US. It is commonly used for treating high blood pressure and heart failure and has been generally stable in prevalence since 2013.

Hydrochlorothiazide (HCTZ), including brand versions such as Microzide, was prescribed to a staggering number of around 42 million people in the USA during that same year. In the US, HCTZ accounts for nearly half of thiazide diuretic prescriptions and a significant portion of overall antihypertensive drug prescriptions. The prevalence of hydrochlorothiazide has been approximately steady over last decade.

Conclusion

Both enalapril and hydrochlorothiazide have long-standing records of usage in patients with hypertension, and are backed by numerous clinical studies indicating that they effectively lower blood pressure. In some cases, the drugs may be combined to enhance their effectiveness; this is subject to careful consideration by a physician due to potential interactions. Enalapril is an ACE inhibitor that works primarily on renin-angiotensin system to reduce blood pressure while hydrochlorothiazide is a diuretic (water pill) that helps your body get rid of excess salt and water.

Enalapril is often considered as a first-line treatment option for hypertension, whereas hydrochlorothiazide would usually be considered as an adjuvant therapy (addition) or used when patients cannot tolerate ACE inhibitors due to side effects like persistent cough or angioedema.

Both medications are available in generic form which represents significant cost savings especially for patients who must pay out of pocket. Both enalapril and hydrochlorothiazide may require an adjustment period, meaning full-blood-pressure-lowering effects may not occur immediately after starting these medicines.

The side effect profile varies between the two drugs: enalapril can cause dizziness, lightheadedness or dry cough while common side effects with hydrochlorothiazide include frequent urination, dehydration symptoms such as thirst and muscle cramps. For both drugs, patients should monitor their blood pressure regularly when starting treatment and seek medical help immediately if they notice any severe unusual symptoms.