Enalaprilat
| Evidence Level: L5 | Predicted Indications: 1 |
Table of Contents
Enalaprilat: From Hypertension and Heart Failure to Primary Hereditary Glaucoma
One-Sentence Summary
Enalaprilat is an injectable ACE inhibitor (the active form of enalapril), originally used to treat hypertension and heart failure. The TxGNN model predicts it may be effective for primary hereditary glaucoma, but at present there are 0 clinical trials and 0 publications supporting this direction, so the prediction rests on the computational score alone.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Hypertensive disorder, hypertension, congestive heart failure, heart failure (the licence record contains no approved indication text) |
| Predicted New Indication | Primary hereditary glaucoma |
| TxGNN Prediction Score | 0.9909 |
| Evidence Level | L5 |
| India Market Status | Listed in a compiled Indian medicine price dataset (1 of 1) – CDSCO approval status is not included in this data |
| Number of Listed Products | 1 (valid: 1) |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Currently, detailed mechanism of action data is not available from the data compiled for this report. Based on known information, enalaprilat is the active diacid metabolite of enalapril and an angiotensin-converting enzyme (ACE) inhibitor. Its efficacy in hypertension and heart failure is established, and it may mechanistically be applicable to glaucoma through the renin-angiotensin system.
A plausible but unproven link is the local renin-angiotensin system in the eye, which is expressed in the ciliary body and trabecular meshwork. In theory, ACE inhibition could lower intraocular pressure by altering aqueous humor dynamics or by improving ocular perfusion. This remains hypothetical.
There are important caveats. Primary hereditary glaucoma (for example, congenital or juvenile forms) is typically driven by structural developmental defects of the anterior chamber angle or by mutations in genes such as MYOC, CYP1B1 and FOXC1. These pathways are not clearly modulated by ACE inhibition. In addition, enalaprilat is available only as an intravenous injection, which makes it impractical for a chronic eye condition. The high TxGNN score is a computational prediction with no clinical validation.
India Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| 72883 | Envas Injection (Cadila Pharmaceuticals Ltd) | Ampoule of 1 ml injection | Not stated in the available record |
Safety Considerations
- Contraindications (from the knowledge graph, not label text): The drug-disease contraindication links in the TxGNN knowledge graph include angioedema, acquired angioedema, renin-angiotensin-aldosterone system-blocker-induced angioedema, non-histaminic angioedema, hereditary angioedema, and hereditary angioedema with C1 inhibitor deficiency.
- Drug Interactions: The only recorded item is pharmacological, not a drug-drug interaction: enalaprilat’s target is angiotensin-converting enzyme (ACE), which is its intended mechanism.
Please refer to the package insert for other safety information, such as warnings.
Conclusion and Next Steps
Decision: Hold
Rationale: The only support is a high computational prediction score. No clinical trials or publications were found, the mechanistic link to hereditary glaucoma is speculative, and the intravenous-only formulation does not suit a chronic ocular indication.
To proceed, the following is needed:
- Package insert warnings and contraindications for Envas Injection, to allow safety screening
- Detailed mechanism of action data (for example, from DrugBank)
- Preclinical or clinical evidence that ACE inhibition lowers intraocular pressure or benefits hereditary glaucoma
- An assessment of route and formulation feasibility (for example, topical or other ocular delivery)
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.