Confusion over Enalapril

I downloaded the BETA excel file. While there are a lot of columns describing various aspects of each medication I did not find any column that showed the strength of each medication. The only column I could find that showed the strength included the name of the medication, the form and the units, in the Generic Name column of the RDP_category worksheet.

There is a need to have the strength all by itself so that calculations of the 'total daily dose' can be calculated. There are various medications that have been noted to be often prescribed at lower doses than what is recommended. If using clinical decision support rules to look at treatment targets and relate lab results to doses that are prescribed it is important to see the numeric dose rather than the full name of the medication.

Hello Marc,

We have notified the appropriate office within Health Canada about your concern. We will post their response on the forum once it is received.

Thank you for your patience.

Kind regards,

Jo-Anne

Hi Marc,
Our jurisdiction has similar issues. My understanding is that dosing is by the “Maleate”. Maleate appears as “sodium” in the tablet. So
Enalapril Maleate Enalapril Sodium
2.5mg = 2mg
5mg = 4mg
10mg = 8mg
20mg = 16mg
40mg = 32mg

But if you go to health Canada DPD, some manufacturer report by Maleate and some report by Sodium…. Leading to different strengths, but actually the same dose.
So Teva brand goes by sodium
ENALAPRIL SODIUM (ENALAPRIL MALEATE)
Strength = 2mg

But Apo Brand reports by Maleate –
ENALAPRIL MALEATE
Strength = 2.5mg

I believe they're all the same though.. it’s similar to doing a distance point in miles or kilometers. The distance is the same, the two points are the same.. just a different representation of the same thing. Not totally sure how we got there, but ultimately the only way to fix it is via Health Canada as you’ve stated.
The best part is, even though Teva is listed by DPD as sodium…. The product in the pharmacy goes by maleate I'm told.. pdf.hres.ca/dpd_pm/00065312.PDF... You don’t see an actual product that is labelled at 2mg, or 4mg… which is why it’s so confusing when it comes back that way through DIS systems. We’ve had this argument with our drug knowledge base provider before and they won’t change it… that’s how it comes from Health Canada so that’s how they represent it.
There needs to be greater scrutiny applied to how manufacturers submit their product information and consistency applied. I suspect all drug knowledge base vendors have the same issue. One way to help our clinicians decipher this more consistently is leveraging our medication value set, which incorporates the DPD, CCDD, and BC PDDF files to distinguish the brand, non-therapeutic product, and therapeutic moiety. You’re welcome to download the file, as it’s multi-jurisdictional minus the PIN listing which is BC specific (see link and download the BETA excel file-https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/health-information-standards/standards-catalogue/medication-value-set). Let us know if you want an unconstrained file that allows access to each file. Just email This email address is being protected from spambots. You need JavaScript enabled to view it.
Thanks

Hello,
We have recently received complaints/confusion from our clinical users regarding enalapril. We are aware that “Each tablet is made with 2.5 mg, 5 mg, 10 mg or 20 mg of enalapril maleate that appears as 2 mg, 4 mg, 8 mg or 16 mg of enalapril sodium in the tablets”.
Some DINs list the active ingredient as Enalapril Maleate with a strength of 2.5, 5, 10, or 20 mg.
Some DINs list the active ingredient as Enalapril Sodium with a strength of 2, 4, 8, or 16 mg.
Markings on tablets and labels on bottles typically use the 2.5, 5, 10, or 20 mg strengths.

The expectation from the clinical users is to have the active ingredient listed as Enalapril Maleate with a strength of 2.5, 5, 10, or 20 mg.

I was wondering if anyone else has encountered this issue, and if so how you have dealt with it.

Also wondering if someone from Health Canada could comment and if there is an opportunity to enhance the consistency of the information contained in the DPD.

Thanks,
Marc