Pharmacokinetics of enalapril and lisinopril in subjects with normal and impaired hepatic function

The pharmacokinetic and pharmacodynamic profiles of two angiotensin-converting enzyme (ACE) inhibitors, enalapril (a prodrug) and lisinopril (directly acting), were compared in eight patients with hepatic cirrhosis and 10 healthy controls. The pharmacokinetics of both drugs were affected in patients with hepatic cirrhosis. The percentage urinary recovery of the parent (inactive) drug enalapril was higher in patients with cirrhosis than controls. Serum concentrations of both drugs showed considerable variation in cirrhotic patients, but the variance ratio between patients with cirrhosis and controls was greater for enalapril than lisinopril. Peak serum concentrations of both ACE inhibitors were higher in patients with cirrhosis than in controls, which may be due to increased drug absorption. The time to peak drug concentration was longer for lisinopril than enalapril.