Acetec Special Precautions

ACETEC should be used with caution for the simultaneous intake with potassium supplement or potassium sparing diuretics, all drugs which may increase the resistance of blood vessels.
For the patients with renal dysfunctions, the dosage must be reduced.
For the patients with liver dysfunction, the active metabolite of Enalapril becomes low and the dosage may be increased but there is no sufficient experience in these patients.
Neutropenia, thrombocytopenia, bone marrow depression and agranulocytosis have occurred rarely; a causal relationship can not be excluded.
ACETEC should not be recommended for children because there is no sufficient report of safety of the drug in children.
If increased BUN and creatinine concentration occur, reduction in dosage and/or withdrawal of the diuretic may be required. The possibility of renovascular hypertension should also be consider, especially in the presence of a solitary kidney, transplanted kidney, or bilateral renal artery stenosis.
Symptomatic hypotension is likely to occur in volume-depleted patients, patients with congestive heart failure. This is most likely to occur in those patients with more severe degrees of heart failure, as reflected by the use of high doses of loop diuretics, hyponatremia or functional renal impairment. In these patients, therapy should be started under medical supervision and the patients should be followed closely whenever the dose of ACETEC and/or diuretic is adjusted. Similar considerations may apply to patients with ischemic heart or cerebrovascular disease in whom an excessive fall in blood pressure could result in a myocardial infarction or cerebrovascular accident.
If hypotension occurs, place patients in supine position and, if necessary, give IV infusion of normal saline. A transient hypotensive response is not a contraindication to further doses, which can be given usually without difficulty once the blood pressure has increased after volume expansion. In some patients with heart failure who have normal or low blood pressure, additional lowering of systemic blood pressure may occur with ACETEC. This effect is anticipated and usually is not a reason to discontinue treatment. If hypotension becomes symptomatic, a reduction of dose and/or discontinuation of the diuretic and/or ACETEC may be necessary. No differences in blood pressure response or adverse effects have been noted in elderly patients receiving enalapril.
In patients undergoing major surgery or during anesthesia with agents that produce hypotension, enalapril will block angiotensin II formation secondary to compensatory renin release. If hypotension occurs and is considered to be due to this mechanism, it can be corrected by volume expansion.
Use in pregnancy: When used in pregnancy during the second and third trimesters ACE inhibitors can cause injury and even death to the developing fetus. When pregnancy is detected, this drug should be discontinued as soon as possible.
Use in lactation: Enalapril and enalaprilat are secreted in human milk in trace amounts. Cautions should be exercised if ACETEC is given to a nursing mother.