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Enalapril vs Monopril
Introduction
Patients diagnosed with hypertension or other heart conditions often require medication that can aid in controlling blood pressure and preventing heart failure. Enalapril and Monopril are two such medications commonly prescribed for these purposes. They both belong to a class of drugs known as angiotensin-converting enzyme (ACE) inhibitors which work by relaxing the blood vessels, thus lowering blood pressure and improving the efficiency of the heart. Enalapril is well-known in this category, acting effectively to decrease chemicals that tighten the blood vessels so blood flows smoothly. On contrast, Monopril - also an ACE inhibitor - serves similar functions but has fosinopril sodium as its main component which might be more suitable for certain patients based on their medical history and tolerance levels.
Enalapril vs Monopril Side By Side
| Attribute | Vasotec | Monopril |
|---|---|---|
| Brand Name | Vasotec | Monopril |
| Contraindications | Should not be taken with ARBs or other ACE inhibitors. Not recommended during pregnancy and breastfeeding. | Should not be taken with ARBs or other ACE inhibitors. Not recommended during pregnancy and breastfeeding. |
| Cost | For brand name: around $20 for 30 tablets of 10 mg. Generic: starting as low as about $0.12/day to $0.50/day. | For brand name: approximately $70 for 30 tablets of 20 mg. Generic: generally remains below or close to a dollar per day. |
| Generic Name | Enalapril | Fosinopril |
| Most Serious Side Effect | Severe allergic reactions, signs of kidney problems, high potassium levels, liver problems. | Signs of an allergic reaction, lightheadedness leading to fainting spells, high potassium levels, liver problems, kidney problems. |
| Severe Drug Interactions | Medicines known as angiotensin II receptor blockers (ARBs) or other ACE inhibitors. | Medicines known as angiotensin II receptor blockers (ARBs) or other ACE inhibitors. |
| Typical Dose | 5–40 mg/day for hypertension, starting dosage of 5 mg/day. | 10-20 mg/day initially, can be increased to 40 mg/day, maximum up to 80 mg/day divided into two doses. |
What is Enalapril?
Enalapril (commonly known as Vasotec) was one of the first drugs in a class known as angiotensin-converting enzyme inhibitors, or ACE inhibitors, which marked a significant advancement from the previous generation of blood pressure medications. Enalapril was first approved by the FDA in 1985. It works by blocking an enzyme in your body that narrows your blood vessels and releases hormones that can raise your blood pressure. This allows for more effective control of hypertension and alleviation of heart failure symptoms. Compared to Fosinopril (generic name for Monopril), another drug from the same class, Enalapril has fewer side effects due to its selective action on angiotensin-converting enzymes with only minor influence on other bodily systems.
What conditions is Enalapril approved to treat?
Enalapril is approved for the treatment of several cardiovascular conditions:
- Hypertension, also known as high blood pressure
- Symptomatic heart failure
- Asymptomatic left ventricular dysfunction
How does Enalapril help with these illnesses?
Enalapril manages hypertension and heart failure by increasing the amount of angiotensin II converting enzyme (ACE) inhibitors in the body. It does this by blocking ACE, which is involved in narrowing blood vessels and releasing hormones that can raise blood pressure, so levels can be maintained lower for longer periods of time. Angiotensin II is a peptide hormone that plays an important role in vasoconstriction and maintaining blood pressure, amongst other things. Individuals with hypertension or heart failure oftentimes have relatively higher levels of angiotensin II. Therefore, by increasing ACE inhibitors through Enalapril use, it can limit the negative effects of high blood pressure and help patients manage their condition and stabilize their cardiovascular health.
What is Monopril?
Monopril, also known by its generic name fosinopril, is an angiotensin-converting enzyme inhibitor (ACE inhibitor) used in the treatment of hypertension and some types of chronic heart failure. By preventing the conversion of angiotensin I to angiotensin II (a potent vasoconstrictor), it effectively decreases blood pressure while also reducing strain on the heart. Monopril was approved by the FDA in 1991.
Unlike enalapril which is a pro-drug that must be metabolized to its active form enalaprilat for therapeutic effects, fosinopril itself is active without needing additional metabolism. This means patients may experience benefits quicker with Monopril compared to Enalapril.
While all ACE inhibitors can cause dry cough as a side effect due to their action on bradykinins, this side effect has been reported less frequently with fosinopril than with other drugs in its class such as enalapril. Moreover, monotherapy using Monopril could provide effective control over high blood pressure especially among patients who aren't responding adequately enough to “typical” hypertension treatments.
What conditions is Monopril approved to treat?
Monopril, an ACE inhibitor, is approved for the treatment of:
- Hypertension (high blood pressure)
- Heart failure
It can be used alone or in combination with other medications to manage these conditions. Monopril works by relaxing blood vessels so that blood can flow more easily, effectively helping to lower high blood pressure and reduce the risk of stroke or heart attack.
How does Monopril help with these illnesses?
Monopril, like enalapril, is an ACE inhibitor used to treat high blood pressure and heart failure by inhibiting the angiotensin-converting enzyme in the body. This action reduces levels of angiotensin II, a hormone that can constrict blood vessels and increase blood pressure. Monopril's ability to relax and widen the blood vessels helps decrease resistance, lower blood volume, and reduce workload on the heart. Moreover, it slows down or prevents a chemical process called hypertrophy which makes your heart muscle cells larger than normal as a reaction to increased stress on your heart such as hypertension. While both drugs are similar in function, some patients respond better or experience fewer side effects with Monopril compared to Enalapril.
How effective are both Enalapril and Monopril?
Both Enalapril and Fosinopril (Monopril) are established ACE inhibitors, commonly prescribed for hypertension and heart failure. They were approved by the FDA within a few years of each other in the 1980s and act on similar biochemical pathways to exert their effects. The effectiveness of Enalapril and Fosinopril was directly studied in a double-blind clinical trial in 1992; both drugs demonstrated comparable efficacy in managing symptoms of hypertension with broadly consistent safety profiles.
A meta-analysis review published in 2005 showed that Enalapril is effective at reducing blood pressure from the first week of treatment onwards, has an acceptable side effect profile compared to many other antihypertensives, and is well tolerated even among elderly populations. This same study also reports that Enalapril became one of the most widely prescribed ACE inhibitors around the world due to its proven history and effectiveness against hypertension. The dose showing optimal efficacy is typically thought to be between 10-40 mg/day depending on individual patient conditions.
A more recent systematic review conducted in 2016 suggested that Fosinopril displays similar effectiveness when compared to placebo or other common antihypertensive treatments for controlling high blood pressure levels. Even though Fosinopril isn't usually considered a first-line treatment option like Enalapril might be, it's still often prescribed as part of combination therapy alongside diuretics or calcium channel blockers where needed. Notably, while data confirming its efficacy as standalone treatment may not be as abundant as for enalapril, there's no compelling evidence suggesting any significant difference between these two medications regarding their ability to control high blood pressure effectively.
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At what dose is Enalapril typically prescribed?
Oral dosages of Enalapril for hypertension treatment range from 5–40 mg/day, but studies have shown that a starting dosage of 5 mg/day is usually sufficient for most individuals. Children's dosage should be determined by the child's weight and typically starts at 0.08 mg/kg up to 5mg a day. In both adults and children, if there is no response after several weeks, the dosage can be gradually increased. However, it's crucial not to exceed a maximum daily dose of 40 mg.
On the other hand, Monopril (Fosinopril) used in treating hypertension usually starts with an oral dose ranging from 10-40mg once daily. The starting dose for heart failure patients or those over age 65 may start as low as 10mg per day. If necessary after several weeks without achieving desired blood pressure control or symptom relief, the doctor may increase your dosage carefully monitoring any side effects you might experience during this process.
At what dose is Monopril typically prescribed?
Monopril treatment is usually initiated at a dosage of 10-20 mg/day. The dose can then be increased to 40 mg/day, divided into two doses, spaced 12 hours apart. If necessary, the maximum dose may reach up to 80 mg/day divided into two equal doses of 40mg and spaced approximately an interval of about half a day apart. This maximum amount might need to be explored if there's no significant response to the treatment at the dosage level of 40 mg/day after several weeks.
What are the most common side effects for Enalapril?
Common side effects of Enalapril may include:
- Dizzy spells or light-headedness, especially when standing up from a lying/sitting position
- Fatigue/weakness
- Coughing (dry, non-productive)
- Nausea and/or vomiting
- Diarrhea or constipation
- Headache
- Rash and itching
- Abdominal pain (digestive discomfort)
On the other hand, Monopril can cause some similar but also unique side effects in comparison to Enalapril. These might include:
- Fatigue/general weakness
- Constipation or diarrhea
- Upper respiratory tract infections like sinusitis or pharyngitis
- Dry coughing
- Light-headedness/dizziness upon changing positions swiftly.
Remember to always consult your healthcare provider for any alarming symptoms while taking these medications.
Are there any potential serious side effects for Enalapril?
While Enalapril and Monopril are both angiotensin-converting enzyme (ACE) inhibitors used to treat high blood pressure, they may cause different side effects. Here are some potential side effects of Enalapril:
- Severe allergic reactions: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, or trouble breathing.
- Light-headedness as a result of low blood pressure
- Signs of kidney problems such as change in the amount of urine
- Symptoms related to high potassium levels in the body - muscle weakness, slow/irregular heartbeat
- Liver problems – yellowing eyes or skin, dark urine, abdominal pain
- Persistent sore throat or fever
In rare cases:
- Fainting and decreased sexual ability have been reported
If you experience any serious side effect while using Enalapril, it's crucial that you seek immediate medical attention.
What are the most common side effects for Monopril?
Monopril, like Enalapril, is a medication used to treat high blood pressure and heart failure. However, Monopril may cause some distinct side effects including:
- Dry cough
- Dizziness or lightheadedness due to a drop in blood pressure
- Headache
- Fatigue or weakness
- Nausea or stomach pain
- Rash or itching skin
- Changes in taste sensation The more serious but rare side effects can include fainting, symptoms of high potassium levels (such as muscle weakness, slow/irregular heartbeat), signs of infection like fever and sore throat. These are not all the potential side effects of Monopril. Always consult your healthcare professional if you experience any unusual symptoms after taking this medication.
Are there any potential serious side effects for Monopril?
While Monopril is generally well-tolerated, it can occasionally lead to serious side effects. If you are taking this medication, be aware of the following potential symptoms:
- Signs of an allergic reaction such as hives; difficulty breathing; swelling in your face or throat
- Lightheadedness leading to fainting spells
- Symptoms indicative of high potassium levels like slow heart rate, weak pulse, muscle weakness
- Signs of liver problems including nausea, upper stomach pain, itching, tired feeling and loss of appetite
- Jaundice (yellowing of skin or eyes)
- Kidney problems resulting in little or no urination
If you notice any changes in health while on Monopril it's vital that you consult with a healthcare professional immediately.
Contraindications for Enalapril and Monopril?
Both Enalapril and Monopril, like all ACE inhibitors used for blood pressure control and heart failure management, might cause symptoms such as dizziness or lightheadedness due to a drop in blood pressure. If you notice these symptoms worsening or if you experience fainting spells, please seek immediate medical attention.
Neither Enalapril nor Monopril should be taken if you are using medicines known as angiotensin II receptor blockers (ARBs) or other ACE inhibitors. Always inform your physician about any medications you're taking; ARBs will require discontinuation before starting treatment with either Enalapril or Monopril to prevent dangerous interactions. Also remember that these drugs are not recommended during pregnancy and breastfeeding due to the potential risk of harm to the fetus or newborn.
How much do Enalapril and Monopril cost?
For the brand name versions of these drugs:
- The price for 30 tablets of Enalapril (10 mg) averages around $20, which works out to about $0.66/day.
- The price for 30 tablets of Monopril (20 mg) is more expensive, at approximately $70, working out to roughly $2.33/day.
Hence, if you are on a higher dosage range for Enalapril (i.e., 40 mg/day), then brand-name Monopril can be less costly on a per-day treatment basis depending upon your specific dose and the offers available in your location. However, remember that cost should not be the primary factor when determining which drug is right for you.
For generic versions of Enalapril and Monopril (Fosinopil), costs are significantly lower:
- Generic Enalapril comes in packs ranging from 15 up to hundreds of capsules with prices starting as low as about $0.12/day and typically not exceeding about $0.50/day.
- Generic Fosinopil is also available in larger quantities but tends to be slightly more expensive than enalapril; however, its cost generally remains below or close to a dollar per day. As always with medication choices, it’s important to consult your healthcare provider before making any changes based on pricing information alone.
Popularity of Enalapril and Monopril
Enalapril, in generic form as well as under brand names such as Vasotec, was estimated to have been prescribed to about 7 million people in the US in 2020. Enalapril accounted for just over 16% of ACE inhibitor prescriptions in the US. However, it is one of the most common ACE inhibitors (a class of drugs used primarily for treating high blood pressure and heart failure). The prevalence of enalapril has been approximately steady over the last decade.
Fosinopril, marketed under brand name Monopril among others, was prescribed to an estimated 1 million people in the USA in 2020. In comparison with enalapril's popularity within its drug class, fosinopril accounts for a smaller market share - constituting around just under 4% of overall ACE inhibitor prescriptions. The use of fosinopril has been steadily decreasing since peaking around a decade ago.
Conclusion
Both Enalapril and Monopril (Fosinopril) have long-standing records of usage in patients with hypertension, heart failure and kidney problems associated with diabetes. They are backed by numerous clinical studies indicating their effectiveness over placebo treatments. Both drugs belong to the class of angiotensin-converting enzyme (ACE) inhibitors which work by relaxing blood vessels so that blood can flow more easily.
Enalapril is a commonly prescribed first-line treatment for hypertension, while Monopril might be considered if enalapril doesn't provide adequate control or isn't well tolerated due to side effects.
Both medications are available in generic form, representing significant cost savings especially for patients who must pay out of pocket. The onset of action for both drugs may take several weeks; thus patience is required before expecting noticeable improvements.
The side effect profile is similar between the two drugs, generally being well-tolerated but they can occasionally cause dry cough, dizziness or light-headedness due to lowering of blood pressure too much. Rarely some serious side effects like angioedema (swelling under your skin), hyperkalemia (high levels potassium in your blood), and kidney problems could occur. For both medications, it's important patients monitor their bodies' reactions closely when starting treatment and seek medical help immediately if they notice any severe unusual symptoms.
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Refrences
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