Drug interactions
Enalapril + Protein a column
Severity: Contraindicated
Enalapril and Protein a column: contraindicated interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Patients taking ACE inhibitors who undergo immunoadsorption with a protein A column have had severe anaphylactoid reactions with flushing, hypotension, and dyspnea. Bradykinin accumulation is thought to be responsible.
What this interaction means in plain words
Enalapril and Protein a column are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two.
Why it happens
ACE inhibition reduces bradykinin breakdown, and column-activated bradykinin generation leads to anaphylactoid reactions.
What to do
Stop enalapril well before the procedure (labeling suggests about 72 hours) and use an alternative antihypertensive. Consider a different apheresis membrane if the ACE inhibitor cannot be stopped.
What to ask your pharmacist
- Is there an alternative to one of these two medicines for me?
- If both are essential, who is monitoring me and how often?
- Which symptoms mean I should stop and seek help straight away?
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Other interactions of Enalapril
- Aliskiren + Enalapril Contraindicated
- Enalapril + Sacubitril / valsartan Contraindicated
- Enalapril + Sacubitril-valsartan Contraindicated
- Amifostine + Enalapril Major
- Amiloride + Enalapril Major
- Amlodipine-hydrochlorothiazide-valsartan + Enalapril Major
Frequently asked questions
Can I take Enalapril with Protein a column?
MediHelp rates the interaction as contraindicated. Enalapril and Protein a column are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two. Patients taking ACE inhibitors who undergo immunoadsorption with a protein A column have had severe anaphylactoid reactions with flushing, hypotension, and dyspnea. Bradykinin accumulation is thought to be responsible.
How serious is the interaction between Enalapril and Protein a column?
MediHelp rates it contraindicated, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Stop enalapril well before the procedure (labeling suggests about 72 hours) and use an alternative antihypertensive. Consider a different apheresis membrane if the ACE inhibitor cannot be stopped.
What other medicines interact with Enalapril?
MediHelp also lists interactions of Enalapril with, for example, Aliskiren, Sacubitril / valsartan, Sacubitril-valsartan. The full list is on the Enalapril page.
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