Enalapril for severe heart failure in infancy.

Frenneaux, Michael; Stewart, Ralph; Newman, Chris; Hallidie-Smith, K A

doi:10.1136/adc.64.2.219

Cited by 40 publications

(21 citation statements)

References 11 publications

(3 reference statements)

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“…enalapril. Other adverse effects included hyperkalemia (>5 mmol/ Frenneaux et al [66] reported one neonate with myocarditis who L) in four patients, three of whom were receiving simultaneous was treated with enalapril and developed hypotension; the patient spironolactone. Hyperkalemia was quickly normalized by disconlater died of intractable heart failure.…”

Section: Renal Effects 42 Hypotensionmentioning

confidence: 96%

“…Frenneaux et al [66] treated six infants with a large ventricular inhibitors in chronic heart failure result not only from hemodyseptal defect and heart failure with enalapril, with clinical imnamic effects, but from the prevention of harmful myocardial and provement noted in all patients. The mean weight of the patients vascular remodeling resulting from the renin-angiotensin-aldosterincreased from 3.3 to 3.6kg after 2 weeks of treatment with one system.…”

Section: Ace Inhibitors Suggesting That the Beneficial Effects Of Acementioning

confidence: 97%

“…In the Frenneaux et al [66] study of eight infants with severe heart failure who Ohuchi et al [76] studied ten patients with postoperative Fontan received enalapril therapy, one infant could not tolerate enalapril circulation, who were treated with ACE inhibitors for >6 months. After treatment with ACE inhibition, no significant change in because of hypotension.…”

Section: Postoperative Fontan Circulationmentioning

confidence: 99%

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ACE Inhibitors in Pediatric Patients with Heart Failure

Momma

2006

Pediatric Drugs

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This article reviews reports of ACE inhibitor use in pediatric heart failure and summarizes the present implications for clinical practice. Captopril, enalapril, and cilazapril are orally active ACE inhibitors, and widely used in pediatric cardiology, although more than ten other ACE inhibitors have been applied clinically in adults. Effects of ACE inhibitors on the renin-angiotensin-aldosterone system in pediatric patients are similar to those in adults. ACE inhibitors lower aortic pressure and systemic vascular resistance, do not affect pulmonary vascular resistance significantly, and lower left atrial and right atrial pressures in pediatric patients with heart failure. In infants with a large ventricular septal defect and pulmonary hypertension, ACE inhibitors decrease left-to-right shunt in those infants with elevated systemic vascular resistance. ACE inhibitors induce a small increase in left ventricular ejection fraction, left ventricular fractional shortening, and systemic blood flow in children with left ventricular dysfunction, mitral regurgitation, and aortic regurgitation. These beneficial effects usually persist long term without the development of tolerance. Therapeutic trials of ACE inhibitors have been reported in children with heart failure and divergent hemodynamics, including myocardial dysfunction, left-to-right shunt, such as large ventricular septal defect and pulmonary hypertension, aortic or mitral regurgitation, and Fontan circulation. Hypotension and renal failure usually occur within 5 days after starting ACE inhibition or increasing the dose and, in most cases, recovery is seen after reduction or cessation of the drug. With all ACE inhibitors, smaller doses are administered initially to prevent excessive hypotension, and doses are increased gradually to the target dose. Captopril is administered orally, usually every 8 hours. Daily doses range from 0.3 to 1.5 mg/kg in children. Enalapril is administered orally, once or twice a day, and daily doses range from 0.1 to 0.5 mg/kg. Enalaprilat is administered intravenously, one to three times a day, in doses ranging from 0.01 to 0.05 mg/kg/dose. For the treatment of chronic heart failure in children, ACE inhibitors are essential along with other medications including diuretics, digoxin, and beta-blockers (beta-adrenoceptor antagonists).

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Section: Renal Effects 42 Hypotensionmentioning

confidence: 96%

Section: Ace Inhibitors Suggesting That the Beneficial Effects Of Acementioning

confidence: 97%

Section: Postoperative Fontan Circulationmentioning

confidence: 99%

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ACE Inhibitors in Pediatric Patients with Heart Failure

Momma

2006

Pediatric Drugs

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“…However, its use in pediatrics has been poorly evaluated for this indication (Eronen et al, 1991;Frenneaux et al, 1989;Lloyd et al, 1989;Rheuban et al, 1990).…”

Section: Introductionmentioning

confidence: 99%

Inhibition of angiotensin converting enzyme with enalapril maleate in infants with congestive heart failure.

Dutertre

Autret

et al. 1993

Brit J Clinical Pharma

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We studied the inhibition of angiotensin converting enzyme (ACE) in eight infants with congestive heart failure (CHF) poorly controlled with digoxin and diuretics, treated orally with 0.25 mg kg-1 enalapril maleate once a day. Baseline ACE activities were compared between these infants and control children without CHF or ACE inhibitor. Except for one infant who vomited, inhibition of ACE activity was 75.5 ± 12.2%, 75.5 ± 10.5% and 51.7 ± 12.2%, at 4, 12 and 24 h after drug intake respectively. There was no correlation between postnatal age and inhibition of ACE activity. In infants with CHF, mean baseline ACE activity was significantly higher than in control infants (36.4 ± 7.2 mu ml-1 vs 26.9 ± 6.9 mu ml-, P < 0.05). These results were very similar to those seen in adults.

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“…A few non-randomised studies have demonstrated haemodynamic improvement with angiotensin-converting enzyme inhibitors (ACEIs) in paediatric patients, such that ACEIs have gained widespread acceptance for use with diuretics 1–3. Initiation of captopril requires inpatient monitoring due to hypotension and impairment of renal function.…”

mentioning

confidence: 99%