Why the study?
Adult enalapril data cannot be automatically extrapolated to children because disposition, efficacy, and safety vary across the paediatric continuum.
Does enalapril have adequate pharmacokinetic, efficacy, and safety data to support its use in children with hypertension, heart failure, and chronic kidney diseases?
Does enalapril have adequate pharmacokinetic, efficacy, and safety data to support its use in children with hypertension, heart failure, and chronic kidney diseases?
Current evidence on the pharmacokinetics, efficacy, and safety of enalapril in children is limited and inadequate, highlighting the need for further research, particularly in young children and those with heart failure.
Enalapril dosing in children warrants caution without age-specific PK guidance; leaves open confirmation of developmental effects.
Enalapril is an angiotensin-converting enzyme (ACE) inhibitor that is used for the treatment of (paediatric) hypertension, heart failure and chronic kidney diseases. Because its disposition, efficacy and safety differs across the paediatric continuum, data from adults cannot be automatically extrapolated to children. This review highlights paediatric enalapril pharmacokinetic data and demonstrates that these are inadequate to support with certainty an age-related effect on enalapril/enalaprilat pharmacokinetics. In addition, our review shows that evidence to support effective and safe prescribing of enalapril in children is limited, especially in young children and heart failure patients; studies in these groups are either absent or show conflicting results. We provide explanations for observed differences between age groups and indications, and describe areas for future research.
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Smeets et al. (2020) studied this question.
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