Q: Is it better to take Envas at night before going to bed or in the morning after breakfast?
A: Envas (Vasotec) can be taken at any time of day morning or night. It is important to take Envas at the same time every day consistently. Envas is in a group of drugs called angiotensin converting enzyme (ACE) inhibitors. Envas is used to treat high blood pressure (hypertension), congestive heart failure, kidney problems caused by diabetes, and to improve survival after a heart attack. The most common side effects of Envas are diarrhea, dizziness or lightheadedness when sitting up or standing, headache, nausea, persistent dry cough, tiredness, and vomiting. Burton Dunaway, PharmD
Important: if you experience any of the following potentially serious symptoms, stop taking Envas and contact your doctor for advice straightaway:
- Any difficulty breathing, or swelling of your face, mouth, tongue or throat. These are signs of an allergic reaction.
- Any yellowing of your skin or the whites of your eyes. These may be signs of a liver problem called jaundice, which is a rare side-effect.
- A severe skin rash.
If you experience any other symptoms which you think may be due to the tablets, speak with your doctor or pharmacist for further advice.
Before taking Envas,
- tell your doctor and pharmacist if you are allergic to Envas; other ACE inhibitors such as benazepril (Lotensin, in Lotrel), captopril (Capoten), fosinopril (Monopril), lisinopril (in Prinzide, in Zestoretic), moexipril (Univasc, in Uniretic), perindopril (Aceon), quinapril (Accupril, in Accuretic, in Quinaretic), ramipril (Altace), and trandolapril (Mavik, in Tarka); any other medications; or any ingredients in Envas tablets. Ask your pharmacist for a list of the ingredients.
- tell your doctor or pharmacist if you are taking valsartan and sacubitril (Entresto) or if you have stopped taking it within the last 36 hours. Your doctor will probably tell you not to take Envas, if you are also taking valsartan and sacubitril. Also, tell your doctor if you have diabetes and you are taking aliskiren (Tekturna, in Amturnide, in Tekamlo, in Tekturna HCT). Your doctor will probably tell you not to take Envas if you have diabetes and you are also taking aliskiren.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin (Indocin, Tivorbex); diuretics ('water pills'); lithium (Lithobid); and potassium supplements. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have or have ever had heart or kidney disease; lupus; scleroderma (a condition in which extra tissue grows on the skin and some organs); diabetes; or angioedema (a condition that causes difficulty swallowing or breathing and painful swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs).
- tell your doctor if you are breastfeeding.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking Envas.
- you should know that diarrhea, vomiting, not drinking enough fluids, and sweating a lot can cause a drop in blood pressure, which may cause lightheadedness and fainting.
Envas and Pregnancy
Envas may cause injury or death to a developing fetus, so don't use Envas if you are pregnant.
Tell your physician immediately if you are taking Envas and become pregnant.
Envas may cause several serious problems in pregnancy, some of which may result in the death of your baby.
It's also not recommended for use during breastfeeding.
Dosage Adjustment In Hypertensive Patients With Renal Impairment
The usual dose of Envas is recommended for patients with a creatinine clearance more than 30 mL/min (serum creatinine of up to approximately 3 mg/dL). For patients with creatinine clearance less than or equal to 30 mL/min (serum creatinine more than or equal to 3 mg/dL), the first dose is 2.5 mg once daily. The dosage may be titrated upward until blood pressure is controlled or to a maximum of 40 mg daily.
6. How to cope with s >
What to do about:
- dry, tickly cough - cough medicines don't usually help for coughs caused by Envas. Sometimes the cough will get better on its own if you keep taking Envas. Talk to your doctor if it carries on, bothers you or stops you from sleeping. Another medicine may suit you better. If your doctor recommends that you stop taking Envas, the cough may take a few days to a month to go away.
- feeling dizzy - if Envas makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you don't faint, then sit until you feel better. Don't drive or use tools or machines while you're feeling dizzy or shaky.
- headaches - make sure you rest and drink plenty of fluids. Don't drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if the headaches last longer than a week or are severe.
- diarrhoea - drink lots of fluids, such as water or squash, to avoid dehydration. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Don't take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
- itching or a mild rash - it may help to take an antihistamine which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you.
- blurred vision - avoid driving or using tools or machines while this is happening. If it lasts for more than a day or two speak to your doctor as they may need to change your treatment.
1. About Envas
Envas is a medicine used to reduce high blood pressure and to prevent or treat heart failure.
If you have high blood pressure, taking Envas will help prevent a future heart attack or stroke.
This medicine is only available on prescription. It comes as tablets. It also comes as a liquid for people who find it hard to swallow tablets but your pharmacist will have to order this for you.
Envas is also available mixed with another blood pressure medicine called hydrocholorothiazide.
In trials in patients treated with digitalis and diuretics, treatment with Envas resulted in decreased systemic vascular resistance, blood pressure, pulmonary capillary wedge pressure and heart size, and increased cardiac output and exercise tolerance. Heart rate was unchanged or slightly reduced, and mean ejection fraction was unchanged or increased. There was a beneficial effect on severity of heart failure as measured by the New York Heart Association (NYHA) classification and on symptoms of dyspnea and fatigue. Hemodynamic effects were observed after the first dose and appeared to be maintained in uncontrolled studies lasting as long as four months. Effects on exercise tolerance, heart size, and severity and symptoms of heart failure were observed in placebo-controlled studies lasting from eight weeks to over one year.
Warnings for other groups
For pregnant women: This drug can have a negative impact on the development of a fetus. Envas should only be used during pregnancy in serious cases where it’s needed to treat a dangerous condition in the mother.
Talk to your doctor if you’re pregnant or planning to become pregnant. Ask your doctor to tell you about the specific harm that may be done to the fetus. This drug should only be used if the potential risk to the fetus is acceptable given the drug’s potential benefit.
For women who are breastfeeding: Envas may pass into breast milk and may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.
For seniors: Older adults may process drugs more slowly. A normal adult dose may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dose or a different schedule.
For children: Envas shouldn’t be used to treat high blood pressure in infants and children with severe kidney disease. The use of this medication to treat heart failure or asymptomatic left ventricular dysfunction hasn’t been studied in children. This drug shouldn’t be used to treat these conditions in people younger than 18 years.
This dosage information is for Envas oral tablet. All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:
- your age
- the condition being treated
- how severe your condition is
- other medical conditions you have
- how you react to the first dose
Envas and Envasat have been detected in human breast milk. Because of the potential for serious adverse reactions in nursing infants from Envas, a decision should be made whether to discontinue nursing or to discontinue VASOTEC, taking into account the importance of the drug to the mother.
Pregnancy and Lactation
Use Envas with caution during the first trimester of pregnancy if benefits outweigh risks. Animal studies show risk and human studies are not available or neither animal nor human studies were done.
UDuring the second and third trimesters of pregnancy, use Envas only in LIFE-THREATENING emergencies when no safer drug is available. There is positive evidence of human fetal risk. Envas and similar drugs have been associated with fetal injury that includes low blood pressure (hypotension), neonatal skull hypoplasia, anuria, reversible and irreversible renal failure, and death.
UEnvas enters breast milk. It is not recommended for use while breastfeeding. The American Academy of Pediatrics (AAP) Committee states Envas is "compatible with nursing". Consult your doctor.
Dry hacking nonproductive cough may occur within few months of treatment; consider other causes of cough prior to discontinuation.
See "What Are Side Effects Associated with Using Envas?”
Taking lithium with Envas may increase the lithium levels in your body. This may make you have more side effects.
Using injectable gold with Envas may increase your risk of a nitritoid reaction. Nitritoid reactions affect the constriction or dilation of your blood vessels. Symptoms include:
- warmth and reddening of your face and cheeks (flushing)
- low blood pressure
One of the side effects of Envas is dizziness, so don’t drive if it makes you dizzy.
Envas can also worsen kidney problems in people who already have kidney disease.
Discuss your medical history with your doctor to determine if you are allergic to Envas, or other ACE inhibitors. Inactive ingredients can cause allergic reactions.
Can Envas cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the more common ones associated with Envas. The best place to find a full list of the side-effects which can be associated with your medicine, is from the manufacturer's printed information leaflet supplied with the medicine. Alternatively, you can find an example of a manufacturer's information leaflet in the reference section below. Speak with your doctor or pharmacist if any of the following continue or become troublesome.
2. Key facts
- Envas lowers your blood pressure and makes it easier for your heart to pump blood around your body.
- Your first dose of Envas may make you feel dizzy, so it's best to take it at bedtime. After that, if you don't feel dizzy, you can take it at any time of day.
- Some people get a dry, irritating cough with Envas.
- If you get severe diarrhoea or vomiting from a stomach bug or illness, tell your doctor. You may need to stop taking Envas for a while until you feel better.
- Drinking alcohol with Envas can make you feel dizzy or light-eaded.
- Envas is also called by the brand name Innovace. When it's mixed with hydrochlorothiazide, its brand name is Innozide.