The pharmacokinetics of enalapril and enalaprilat in angiotensin-converting enzyme inhibitor naïve children with heart failure were adequately described by a combined model with absorption lag.

The results suggest that age, weight and renal function are clinically relevant covariates that should be considered when dosing enalapril in children with heart failure.

The newly identified covariate Ross score provides the scientific background to consider the severity of heart failure for the first dose of enalapril.