High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.

Enalapril belongs to a group of medicines called ACE inhibitors which block the action of a chemical in the body called angiotensin converting enzyme (ACE). Normally, ACE produces another chemical, angiotensin. Thus enalapril reduces the amount of angiotensin in the blood.

Angiotensin has two actions. Firstly it acts on blood vessels to make them narrow and secondly it acts on the kidney to produce less urine. As enalapril stops the production of angiotensin, these actions are reversed. Therefore more urine is produced by the kidneys, which results in less fluid in the blood vessels. The blood vessels also widen. The overall effect of this is a drop in blood pressure and a decrease in the workload of the heart.

Hydrochlorothiazide is known as a thiazide diuretic. Thiazide diuretics act in the kidney to remove water from the blood into the urine, by causing an increase in the removal of salts such as potassium and sodium from the blood. This removal of salts causes water to be drawn out of the blood and into the kidneys, where it is then excreted in the urine.

Removing water from the blood decreases the volume of fluid circulating through the blood vessels. The drop in fluid volume results in a drop in the pressure of the fluid within the blood vessels, which helps to lower high blood pressure. It also decreases the effort required by the heart to pump blood around the body.

The combination of these two medicines is particularly useful in treating high blood pressure.

ADULTS
The doctor will adjust your dosage until your blood pressure is in the desired range. If you are taking the 5 milligrams enalapril/12.5 milligrams hydrochlorothiazide combination, the maximum daily dosage is 4 tablets. For the 10/25 combination, the maximum is 2 tablets.

CHILDREN
The safety and effectiveness of Generic Vaseretic in children have not been established.

OLDER ADULTS
Your doctor will prescribe Generic Vaseretic cautiously, starting with small doses.

If you miss a Generic Vaseretic dose
Take the missed Generic Vaseretic dose as soon as you remember.
If it is time for the next Generic Vaseretic dose, skip the missed one and go back to the regular schedule.
Never take two doses of Generic Vaseretic at the same time.

Generic Vaseretic Overdose
Generic Vaseretic taken in excess can cause symptoms of overdose. If you suspect an overdose, seek medical attention immediately.

Symptoms of a Generic Vaseretic overdose may include:

• dehydration,
• low blood pressure

Generic Vaseretic Storage instructions

• Keep Generic Vaseretic out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause Generic Vaseretic to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Generic Vaseretic Preparations:
Tablets
Enalapril maleate 10mg + Hydrochlorothiazide 12.5mg
Enalapril maleate 10mg + Hydrochlorothiazide 25mg
Enalapril maleate 5mg + Hydrochlorothiazide 12.5mg

Generic Vaseretic if taken together with potassium sparing diuretics, potassium supplements or potassium containing salt substitutes there is an increased risk of raised blood potassium level (hyperkalaemia). These should only be used with frequent monitoring of blood potassium levels.

Generic Vaseretic when taken together with medicines that decrease blood pressure there is an increased risk of a large drop in blood pressure.

Generic Vaseretic reduces the ability of the body to remove the medicine lithium, which may give rise to adverse effects.

Generic Vaseretic when taken together with other medicines which can cause low blood potassium level (hypokalaemia) e.g. corticosteroids, carbenoxolone or beta-agonist bronchodilators such as salbutamol, there may be an increased risk of developing hypokalaemia.

Generic Vaseretic may raise blood glucose levels and therefore reduce the effectiveness of antidiabetic medicines. Dose adjustments of the antidiabetic may be required.

Generic Vaseretic precautions if you are pregnant or breastfeeding
Generic Vaseretic should not be used during pregnancy as it may be harmful to the unborn baby. Seek medical advice from your doctor.

Significant amounts of Generic Vaseretic may pass into breast milk. Generic Vaseretic should not be used by breastfeeding mothers. Discuss this with your doctor.

Special warnings about Generic Vaseretic
It is recommended that salt (electrolyte) levels in the blood should be monitored while taking Generic Vaseretic.

If you experience any of the following symptoms while taking Generic Vaseretic you should inform your doctor promptly, so that the amount of fluids and salts in your body can be checked:

• thirst,
• lethargy,
• confusion,
• weakness,
• drowsiness,
• muscle cramps,
• scanty production of urine,
• abnormal heart rhythm,
• seizures,
• nausea and vomiting.

As diuretics cause your kidneys to produce more urine, you may prefer to take Generic Vaseretic in the morning rather than before going to bed, as this will reduce the likelihood of you needing to get up in the night to visit the toilet. Seek further advice from your doctor or pharmacist.

If you should require local or general anaesthesia, it is important that you inform your anaesthetist you are taking Generic Vaseretic.

Why Generic Vaseretic should not be prescribed?
If you are sensitive to or have ever had an allergic reaction to enalapril or hydrochlorothiazide, or similar drugs, or if you are sensitive to other sulfa drugs, you should not take Generic Vaseretic.
If you have a history of angioedema (swelling of face, extremities, and throat) or inability to urinate, you should not take Generic Vaseretic.

More common side effects of Generic Vaseretic may include:

• cough,
• diarrhea,
• dizziness,
• drop in blood pressure upon standing up,
• fatigue,
• headache,
• impotence,
• low potassium levels (leading to symptoms such as dry mouth, excessive thirst, weak or irregular heartbeat, muscle pain or cramps),
• muscle cramps,
• nausea,
• rash,
• tingling or pins and needles, and
• weakness.

Less common side effects of Generic Vaseretic may include:

• abdominal pain,
• abnormal dreams,
• abnormal skin sensations such as numbness, prickling, or burning,
• allergic reactions,
• arthritis,
• back pain,
• black stools,
• blisters,
• blood clots in lungs,
• blurred vision,
• bronchitis,
• chest pain,
• confusion,
• conjunctivitis,
• constipation,
• decrease in sex drive,
• depression,
• disturbances in heart rhythm,
• dry eyes,
• dry mouth,
• excessive sweating,
• fainting,
• fluid in lungs,
• flushing,
• gas,
• gout,
• heart attack,
• hepatitis,
• hives,
• hoarseness,
• inability to sleep,
• indigestion,
• inflammation of mouth and tongue,
• inflammation of the pancreas,
• itching,
• joint pain,
• kidney failure,
• liver failure,
• loss of appetite,
• loss of coordination,
• loss of hair,
• low blood pressure,
• muscle cramps,
• nervousness,
• rapid heartbeat,
• rash,
• restlessness,
• ringing in ears,
• runny nose,
• sensitivity to light,
• shortness of breath,
• sleepiness,
• sore throat,
• stroke,
• tearing,
• urinary tract infection,
• vomiting, and
• yellow eyes and skin