Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For enalapril and felodipine combination, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to enalapril or felodipine, as well as to any other ACE inhibitor (benazepril, captopril, fosinopril, lisinopril, moexipril, quinapril, ramipril, or trandolapril). Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—Studies with this combination medicine have not been done in pregnant women. However, use of any of the ACE inhibitors during pregnancy, especially in the second and third trimesters (after the first 3 months), can cause low blood pressure, kidney failure, an underdeveloped skull, or even death in newborns. Felodipine can cause birth defects and problems with labor and delivery. Therefore, it is important that you check with your doctor immediately if you think that you may be pregnant . Be sure that you have discussed this with your doctor before taking this combination medicine.

Breast-feeding—Enalapril passes into breast milk. It is not known if felodipine passes into breast milk; however, felodipine passes into the milk of lactating rats. Use of this combination medicine is not recommended in women who are breast-feeding.

Children—Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of enalapril and felodipine in children with use in other age groups.

Older adults—Although this medicine has not been shown to cause different side effects or problems in older people than it does in younger adults, blood levels of the felodipine component may be increased in the elderly.

Racial differences—Black patients may be less sensitive to the blood pressure-lowering effects of this medicine. In addition, the risk of a serious allergic reaction involving swelling of the face, mouth, hands, or feet may be increased.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your health care professional know if you are taking any of the following:

• Carbamazepine (e.g., Tegretol) or
• Phenytoin (e.g., Dilantin) or
• Phenobarbital—Effects of felodipine may be greatly decreased

• Diuretics (water pills)—Effects on blood pressure may be increased

• Potassium-containing supplements or
• Salt substitutes that contain potassium—Use of these substances with ACE inhibitors may result in an unusually high potassium level in the blood, which can lead to irregular heart rhythm and other problems

Other medical problems—The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Bee-sting allergy treatments or
• Dialysis—Increased risk of serious allergic reaction occurring

• Dehydration—Lowering effects on blood pressure may be increased

• Diabetes mellitus (sugar diabetes)—Increased risk of potassium levels in the body becoming too high

• Heart attack or stroke or
• Heart or blood vessel disease or
• Hypotension (low blood pressure)—Further lowering of blood pressure may make problems resulting from these conditions worse

• Kidney disease or
• Liver disease—Effects may be increased because of slower removal from the body

• Previous reaction to any ACE inhibitor involving hoarseness; swelling of the face, mouth, hands, or feet; or sudden trouble in swallowing or breathing—Reaction is more likely to occur again

• Scleroderma or
• Systemic lupus erythematosus (SLE) (or history of)—Increased risk of blood problems caused by ACE inhibitors