Attempted Suicide with Enalapril

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Abstract
To the Editor: Enalapril (MK-421; ethyl ester of N-[(S)-1-(ethoxycarbonyl)-3-phenylpropyl]-L-alanyl-L-proline) is a long-acting inhibitor of angiotensin-converting enzyme that is used in the treatment of hypertension.1 The drug appears to be safe in the usual doses. However, we recently saw a patient who attempted to commit suicide by ingesting large doses of enalapril and warfarin.The patient was a 56-year-old woman who had had a mitral-valve replacement and had congestive cardiac failure since 1982. Enalapril (5 mg) was added to her drug regimen of spironolactone (100 mg daily), furosemide (80 mg twice daily), warfarin (2 mg daily), and digoxin (0.125 mg daily). . . .