Enalaprilat
| Evidence Level: L5 | Predicted Indications: 1 |
Table of Contents
Enalaprilat: Primary hereditary glaucoma
One-Sentence Summary
Enalaprilat is an injectable ACE inhibitor originally used for hypertensive disorders and heart failure. The TxGNN model predicts it may be effective for primary hereditary glaucoma, but currently there are 0 clinical trials and 0 publications supporting this direction, so the prediction rests on the model score alone.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Not recorded in the local data |
| Predicted New Indication | Primary hereditary glaucoma |
| TxGNN Prediction Score | 0.9909 |
| Evidence Level | L5 |
| Canada Market Status | Marketed (marketed DINs: 1 of 1) |
| Number of DINs | 1 (marketed: 1) |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Detailed mechanism of action data is not available in the data compiled for this report. Based on general pharmacology, enalaprilat is the active diacid metabolite of enalapril and inhibits angiotensin-converting enzyme (ACE). This lowers angiotensin II production and is the basis for its blood-pressure-lowering effect in hypertension and heart failure.
A possible link to glaucoma is that ACE inhibition could reduce local ocular renin-angiotensin system activity. This might influence aqueous humor dynamics and intraocular pressure, or ocular blood flow and optic nerve perfusion. These ideas are hypotheses and have not been tested for this drug in primary hereditary glaucoma.
There are also significant reasons for caution. Primary hereditary glaucoma (for example, congenital or juvenile forms linked to genes such as MYOC or CYP1B1) is largely driven by developmental or structural defects in the outflow pathway. ACE inhibition is therefore unlikely to address the underlying cause. In addition, enalaprilat is given only intravenously, which makes chronic ocular use impractical without a new formulation or route. The connection is speculative and based only on the model score.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
Currently no related literature available.
Canada Market Information
| DIN | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| 02388499 | ENALAPRILAT INJECTION USP | Not specified | Not specified |
Safety Considerations
- Contraindications (knowledge graph, not label text): The TxGNN knowledge graph lists contraindication links to angioedema and related conditions: acquired angioedema, renin-angiotensin-aldosterone system-blocker-induced angioedema, non-histaminic angioedema, hereditary angioedema, and hereditary angioedema with C1 inhibitor deficiency.
- Drug Interactions: The interaction query found no drug-drug interactions. The only entry is its pharmacological target, angiotensin-converting enzyme (ACE), which is the intended mechanism of the drug rather than a drug-drug interaction.
Please refer to the package insert for the full set of warnings and contraindications.
Conclusion and Next Steps
Decision: Hold
Rationale: The prediction has no supporting clinical trials or publications (evidence level L5), and the proposed mechanism is speculative. Glaucoma of this type is mainly structural and developmental, and enalaprilat is available only as an intravenous injection, which is not suited to chronic ocular use. The knowledge graph also flags angioedema-related contraindications.
To proceed, the following is needed:
- Mechanism of action data (MOA) and a clearer mechanistic link to primary hereditary glaucoma
- Preclinical or literature evidence that ACE inhibition affects intraocular pressure or optic nerve outcomes in this condition
- Package insert warnings and contraindications from Health Canada for safety screening
- A feasible route or formulation (for example, topical ocular) and a route compatibility assessment
- Assessment of safety in patients with a history of angioedema, including hereditary forms
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.