Consequences of angiotensin-converting enzyme inhibitor overdose

Overdose with angiotensin-converting enzyme (ACE) inhibitors is still a relatively underreported phenomenon. We report here a case of an unintentional overdose of enalapril (100 mg) together with other medications. The patient experienced no adverse consequences. Pharmacokinetic evaluation revealed a t 1/2 for enalaprilat (prodrug) of seven hours and for enalapril at 36 hours. Based on this case report as well as others, guidelines for assessment and treatment of these patients are proposed. Management of hypotension is the primary therapeutic intervention.