RENOTEC
Clinical safety rating: caution
Comprehensive clinical and safety monograph for RENOTEC (RENOTEC).
Renotec is a direct renin inhibitor that binds to the active site of renin, inhibiting the conversion of angiotensinogen to angiotensin I, thereby reducing angiotensin II levels and lowering blood pressure.
| Metabolism | Primarily hepatic via CYP3A4; minor contributions from CYP2C19 and CYP2D6. Metabolites are inactive. |
| Excretion | Approximately 70% of the dose is excreted in urine as unchanged drug, and 20-30% via feces as metabolites; less than 5% is excreted unchanged in feces. |
| Half-life | Terminal elimination half-life is 12-15 hours; clinical context: supports once-daily dosing; half-life may be prolonged in renal impairment (creatinine clearance <30 mL/min). |
| Protein binding | Approximately 95% bound to plasma proteins, mainly albumin and alpha-1-acid glycoprotein. |
| Volume of Distribution | Volume of distribution is 0.2-0.3 L/kg, indicating moderate distribution into tissues; clinical meaning: limited extravascular distribution, predominantly in central compartment. |
| Bioavailability | Oral bioavailability is 40-50% due to first-pass metabolism; food does not significantly affect absorption. |
| Onset of Action | Oral: peak plasma concentration at 2-4 hours; clinical effect (blood pressure reduction) begins within 1-2 hours. |
| Duration of Action | Duration of antihypertensive effect is approximately 24 hours, allowing once-daily dosing; maximal effect may persist for 24-48 hours after discontinuation. |
| Molecular Weight | 585.6 |
Enalapril 5-40 mg orally once or twice daily; initial dose 5 mg once daily, titrate based on response.
| Dosage form | INJECTABLE |
| Renal impairment | GFR 30-60 mL/min: reduce dose to 50%; GFR <30 mL/min: initial dose 2.5 mg daily; hemodialysis: 2.5 mg on dialysis days. |
| Liver impairment | Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 50%; Child-Pugh C: contraindicated. |
| Pediatric use | Children (1-16 years): 0.08 mg/kg up to 5 mg once daily; maximum 0.58 mg/kg or 40 mg daily. |
| Geriatric use | Initial dose 2.5 mg daily; monitor renal function and serum potassium; titrate slowly. |
| 1st trimester | Contraindicated due to risk of fetal hypotension, oligohydramnios, and renal dysfunction. |
| 2nd trimester | Contraindicated due to risk of fetal hypotension, oligohydramnios, and renal dysfunction. |
| 3rd trimester | Contraindicated due to risk of fetal hypotension, oligohydramnios, and renal dysfunction. |
Clinical note
Comprehensive clinical and safety monograph for RENOTEC (RENOTEC).
| Placental transfer | Crosses placenta; documented in human studies. |
| Breastfeeding | Excreted in breast milk in small amounts; potential for hypotension in the infant. Use with caution, monitor infant for adverse effects. |
| Lactation Rating |
■ FDA Black Box Warning
No FDA boxed warning.
| Serious Effects |
History of angioedema related to previous ACE inhibitor therapyPregnancyBilateral renal artery stenosisHypersensitivity to the drug or any of its excipients
| Precautions | Hypotension in volume-depleted patients, Hyperkalemia, especially in patients with renal impairment or on potassium-sparing diuretics, Renal impairment: Monitor serum creatinine and potassium, Angioedema: Discontinue immediately if occurs, Fetal toxicity: Avoid in pregnancy; discontinue if pregnancy is detected |
| Food/Dietary | Avoid high-potassium foods (e.g., bananas, oranges, potatoes, spinach, avocado) in large amounts. Do not use salt substitutes containing potassium chloride. Grapefruit juice has no significant interaction. Alcohol may potentiate hypotensive effects. |
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| L3 (Moderately Safe) |
| Teratogenic Risk | First trimester: Increased risk of congenital malformations, particularly cardiovascular and CNS defects. Second and third trimesters: Oligohydramnios, fetal renal dysfunction, skull ossification delay, and neonatal hypotension. |
| Fetal Monitoring | Serial fetal ultrasound for oligohydramnios and renal function; maternal blood pressure weekly; fetal heart rate monitoring; periodic renal function tests (serum creatinine, BUN) and electrolytes. |
| Fertility Effects | No known direct effects on fertility; however, underlying condition may impact reproductive function. |
| Clinical Pearls | Renotec (enalapril) is an ACE inhibitor. Monitor renal function and potassium levels, especially in patients with renal impairment or on potassium-sparing diuretics. First-dose hypotension may occur; start with low dose in volume-depleted patients. Angioedema is rare but requires immediate discontinuation. Use with caution in bilateral renal artery stenosis. Avoid in pregnancy (category D). |
| Patient Advice | Take exactly as prescribed, usually once daily. Do not stop without consulting your doctor. · Report any swelling of face, lips, tongue, or difficulty breathing immediately. · Avoid potassium supplements or salt substitutes containing potassium unless directed. · May cause dizziness, especially after first dose; rise slowly from sitting or lying down. · Use effective contraception; not recommended during pregnancy. · Stay well-hydrated but do not overhydrate; avoid dehydration from sweating or diarrhea. |