Enalaprilat solution as a means of emergency assistance in hypertension. From which the pills of Enalapril and their analogues are helped: indications and instructions for use, patient reviews with what pressure
Enalapril, instructions for the use of which contains complete data on the preparation, is an efficient and safe means.
The drug is released by the prescription.
According to the instructions for use, the Enalapril medicine is pills that have a white color and convex configuration. On one side of the tablet there is a risk. It allows you to easily and precisely split the disk in half.
Depending on the number of active substance, ENALAPRIL, the dosage of which is determined by the specialist, is divided into:
- Enalapril tablets 5 mg;
- Enalapril 10 mg (instructions for use contains a complete list of components);
- 20 mg.
Instructions Enalapril allocates two types of components:
- active substance;
- auxiliary components.
Table 1. Enalapril (the composition of the drug is given according to the instructions for use)
Active substance Enalapril |
|
| Enalapril Maleat | It has a vasodilant effect, leads to a decrease in pressure, has a pronounced cardioprotective effect with a prolonged application |
Auxiliary components |
|
| Milk sugar | Tableted Filler, is a source of energy |
| Magnesium Carbonate | Thickener, stabilizer, contribute to assimilation |
| Gelatin | Thickener |
| Crosspovidon | Allows you to keep shape, releases the active component |
| Stearinic acid | Stabilizer, preservative |
What anealapril tablets look like, from which they help, spelled out in instructions for use.
Mechanism of action
Many concerns the question of how much medicine acts. The drug ENALAPRIL reduces the pressure of approximately 15-40 minutes. The instructions for use reports that the largest amount of funds in the blood is found in 3-6 hours.
Table 2. Enalapril action mechanism
| Name | Effect | The use of Enalapril |
|---|---|---|
| Angiotensin | Special hormone, the type of which leads to a narrowing of the lumen of the vessels and stimulates the production of aldosterone | The process of turning into a "dangerous" form slows down, the release into blood is reduced. Arteries and veins are expanding, which leads to a decrease in pressure |
| Aldosterone | Increases pressure due to the narrowing of the lumen of vessels and increasing the volume of circulating blood | Synthesis and emissions decrease |
| Bradykin | Peptide with a vasodilant effect. Characterized by rapid decay | Debris time increases |
Thus, it is possible to conclude, for which ENALAPRIL and that is the result of its application. Thanks to the drug:
- vessels expand;
- blood pressure decreases;
- cardiac rhythm does not increase;
- muscle tissues of the heart are restored (in particular leads to the regression of hypertrophy), etc.
What helps?
For a full understanding of action, it is worth familiar with the information about what Enalapril is and from which the tool helps.
Tablets according to the instructions for use are prescribed at:
- regular increase in pressure for various reasons over 140-90 mm. mercury pillar;
- as pharmacological treatment a number of heart disease;
- to prevent the development of diseases of the heart / vessels caused by the fatal outcome.
Enalapril, the dose of which is determined on the basis of the diagnosis, is appointed exclusively by a specialist.
Indications for use
Establishing an accurate diagnosis is pledged successful treatment. Enalapril, the testimony for the use of which is prescribed in the instructions, recommended when:
- Arterial hypertension. Enalapril (the recipe can be obtained by a doctor) is effective in the primary form of the disease caused by the violation of the system regulating pressure. It is also assigned to secondary hypertension, which caused other pathologies. Instructions for use notes that it is effective with the renovascular form of hypertension.
- Essential hypertension. A special form of hypertension, a characteristic feature of which is to exhaust the renal depressor function.
- Chronic sh. Enalapril (instructions for use of the tablet recommends including comprehensive treatment) Effective with violations of the heart chambers.
- Conducting the prevention of CH and some forms.
A full-fledged source of information on what is an Enalapril pill, from which, and their application in what cases is recommended, is the instruction.
Annotation Enalapril does not stipulate with what pressure is optimally taken to take the drug. The drug must be drunk regularly, and not from the case of the case. Enalapril ( pharmacological group -), has a cardioprotective impact only under course appointment.
The most common causes of hypertension
Contraindications
Despite the safety of the medicine, according to the instructions for applying to some patients, it is forbidden to drink it. Enalapril, contraindications to which are quite extensive, is not recommended at:
- anaphylactic shock in history;
- arterial stenosis of the only / both kidney;
- overabiary of potassium in Oraganism:
- various forms of porphyria;
- allergies to components;
- together with Aliskeren;
- renal / liver failure, etc.
The entire list is indicated in the instructions for use.
Instructions for use
The release form of Enalapril, dosage, the time of action and features of the reception specified in the instructions for use. It also contains information on some categories of patients with additional restrictions:
- Children and teenagers. For this category of research, confirming the safety of the tools are absent. Up to 18 years old does not apply the drug.
- Elderly people. Treatment of patients 60-65 years requires special caution. The first reception is recommended in the hospital.
Drinking in the morning hours does not matter before or after meals. Enalapril 5 mg Instructions for use recommends Take in the initial stages of 1 tablet. In some cases, the dose is reduced to 2.5 mg (for the elderly, patients with concealments of the kidney, etc.). Average daily dose It is 10 or 20 mg (instructions for use involves a two-time reception).
For emergency pressure reduction, a means in ampoules is used. It is introduced 1.25 mg every 6 hours. After therapy with diuretics or with pronounced disorders, the kidney function of the dose decreases to 0.625 mg.
In essence, this is another tradename drug. What is different from hexal:
- Different manufacturers. This tool produces the company "Hexal", located in Germany, and the second drug is the Russian firm. There is no one about what manufacturer is better not. Both brands have proven themselves from a positive side.
- Technologies. Funds are manufactured on various technical conditions and on different equipment.
- Structure. International name It is identical, since the manufacture of both means is used by Enalapril Maleat. However, manufacturers apply different auxiliary substances.
What is better, Enalapril or Hexal, it's hard to say. Pharmacodynamics and pharmacokinetics of both drugs are similar, so they are interchangeable.
Funds are analogues and have identical indications for use. Produced by various companies. The preparation of acry is manufactured in Russia by Akrichin.
The recipe of Enalapril in Latin is the same in both means, but the auxiliary substances are somewhat different. Before taking, it is recommended to familiarize yourself with the instructions for use.
The medicine is produced by the Moscow Pharmaceutical Enterprise "Obolensk". The composition and effect of drugs are identical. The FPO is similar when it starts to act, in what cases the reception is prohibited when it is necessary to drink tablets with caution. The usual pressure from pressure can be replaced by FPO without fears.
It is recommended at elevated pressure and heart failure. It differs exclusively with the list of additional substances. Refers to ACE inhibitors and can be used as within complex therapyand in monolation. It has identical side effects and recommendations for use.
Refers to comprehensive therapy drugs. Includes two active ingredients at once: an inhibitor of the ACE Enalapril Maleat and a diuretic hydrochlorothiazide. It is recommended in cases where the monolation does not help. Effectively reduces pressure even with pronounced arterial hypertension.
Available in 10 mg dosage. It is used as a means for reducing pressure, treatment and prevention of heart failure. Effectively reduces the number of hospitalizations when unstable angina, risk of death due to cardiovascular diseases.
Available in the form of a solution, which allows the use of the drug in emergency cases. Quickly reduces pressure at risk or hypertensive crisis. Used exclusively by the doctor ambulance or within the hospital. Uninterrupted injections may cause complications or patient death.
The manufacturer of the drug is the Indian company. The drug is available in a tablet form in a dosage of 2.5, 10, 20, as well as 5 mg (readings for use for all forms can be found in annotations).
The drug lowering the pressure contains 20 mg of the active substance. Acts 15 minutes after reception. The maximum concentration in the blood is found after 3-6 hours. With a properly selected dosage, the hypotensive effect is maintained within 24 hours. Before applying, it is recommended to familiarize yourself with the instructions for use.
Single therapeutic effect And similar composition allow us to be considered synonymous. They will be divided:
- Excipients. The ENAP includes several other components used to obtain the necessary consistency and physicochemical characteristics.
- Manufacturers. ENAP is produced in Slovakia and is different high levels protection against falsification.
- Price. ENAP is more expensive than analogue 2-3 times.
On a festive day or for a special occasion, some people want to have a sturdy drink. Patients are concerned about the compatibility of medication with alcohol, the consequences of which are not always predictable. According to the instructions for use:
- Alcohol provokes an excessive pressure drop. Coeming can cause low blood pressure. It can be dangerous to health and life.
- The drug with alcohol leads to an increase in the toxic effects of ethanol.
During pregnancy
Enalapril during pregnancy is very dangerous. It leads to a violation of the growth and development of the fetus. When pregnancy in the early deadlines, discovered after the assignment of the tools, it is worth the use of immediately. Women planning a conception that is carrying a child or nursing breasts is prohibited.
Side effects
Instructions for use describes a number of negative phenomena, which can be caused by taking tablets.
Table 3. Side Effects Enalapril
| The cardiovascular system | Pressure reduction, tachycardia, arrhythmia, myocardial infarction |
|---|---|
| Nervous system | Pain in the head, dizziness, sleep disorders and workability, irritability |
| Respiratory system | Dry cough, pneumonia, rhinitis, anaphylactic shock |
| Skin Covers | Swelling of quinque, urticaria, itching, burning, eczema |
| BCT organs | Vomiting, nausea, diarrhea, heartburn, skin yellowing |
| Sense organs | Specific anti-flavor, appearance of foreign sounds |
| Other | Increased sweating, decreased libido, impotence |
Does the potency affect?
Reducing sexual attraction is included in the list of possible side effects. However, if we talk about men, it is proved that aPF inhibitors Enhance the products of male hormones, improving potency. In any case, it does not mean the treatment of arterial hypertension does not make sense. That's why:
- in itself leads to impotence due to the narrowing of vessels and the lack of blood supply to the genital organs;
- also significantly increases the risk of sudden death.
Men S. arterial hypertension Not only the question of whether the drug affects the potency, but also the importance of the therapy. Without proper treatment, male strength will weaken, and the risk of death will be colossal.
Enalaxal, Enazil10, Enalacoid, Enalianoside 12, 5, Enalianoside 25, Enalianoside Mono, Enaloside Forte, Enam, Enap, Enap 20 HL, Enap L Combi, EnaPril, Enaren-n, Enarel, Enafril, Enzyx, Enzymes Duo, Enzymes Duo Forte
Recipe (international)
Rp: Tab. ENALAPRILI 0,01
D.T.D: №20 IN TAB.
S: 1 tab. 2 times a day
Recipe (Russia)
RP.: TAB. ENALAPRILI 10 MG.
S. 1 tablets 1 time per day
Recipentar Blank - 107-1 /
Active substance
ENALAPRIL)pharmachologic effect
Antihypertensive drug, the mechanism of action of which is associated with the oppression of the activity of an angiotensin-convertible enzyme, leading to a decrease in the formation of a vasoconducting factor - angiotensin-II and at the same time as activation of the formation of kinines and prostacyclin, possessing vasodilative action.
Analyanril refers to "prodrugs", after hydrolysis it in the body is formed by an Eanalaprilat, which inhibires said enzyme. Enalapril also has some diuretic effect associated with a moderate oppression of aldosterone synthesis. Along with a decrease in blood pressure, the drug reduces and post-loading on myocardium during heart failure, improves blood circulation in a small circle and respiratory function, lowers resistance to kidney vessels, which contributes to the normalization of blood exchange in them. The duration of the action of ENALAPRIL after one-time intake is about 24 hours.
Mode of application
For adults: Inside, regardless of the time of meals.
In treating hypertensive disease The initial dose of enalapril for adults is 0.01-0.02 g per day (one-time). In the future, the dose is selected individually for each patient (usually it is a dose of 0.02 g per day one-time). With moderate hypertension, it is enough to prescribe 0.01 g of the drug per day.
The maximum daily dose is 0.04.
With renovascular hypertension, Enalapril is prescribed in smaller doses. The initial dose is usually 5 mg per day. Then the dose is selected individually. The maximum daily dose is 20 mg (once a day)
In the heart failure, the ENALAPRIL is prescribed, starting from 0.0025 g, then the dose is gradually increased to 10-20 mg (1-2 times a day).
The duration of treatment depends on the effectiveness of therapy.
In all cases, with a too pronounced decrease in blood pressure, the dose of the drug is gradually reduced.
The drug is used both in monotherapy and in combination with other antihypertensive means.
Indications
Arterial hypertension (including renovascular), chronic heart failure (as part of combined therapy).
Essential hypertension.
Chronic heart failure (as part of combined therapy).
Prevention of clinically pronounced heart failure in patients with asymptomatic left ventricular dysfunction (as part of combined therapy).
Prevention of coronary ischemia in patients with left ventricle dysfunction in order to reduce the frequency of the development of myocardial infarction and reduce the frequency of hospitalizations about unstable angina.
Contraindications
Enalapril is contraindicated with increased sensitivity to an angiotensin-converting enzyme inhibitors.
The drug is not prescribed to children, during pregnancy.
Side effects
- From the side of the cardiovascular system:
excessive decrease in blood pressure, orthostatic collapse, rarely prudged pain, angina, myocardial infarction (usually related to a pronounced decline of blood pressure), extremely rare arrhythmias (atrial brady or tachycardia, atrial flications), heartbeat, thromboembolism of the branches of the pulmonary artery.
- from the side nervous system:
dizziness, headache, weakness, insomnia, anxiety, confusion, increased fatigue, drowsiness (2-3%), very rarely when using high doses - nervousness, depression, paresthesia.
- on the part of the senses:
violations of the vestibular apparatus, hearing impairment and vision, noise in the ears.
- from the digestive tract:
dry mouth, anorexia, dyspeptic disorders (nausea, diarrhea or constipation, vomiting, abdominal pain), intestinal obstruction, pancreatitis, violation of the function of the liver and berevel, hepatitis, jaundice.
- from the respiratory system:
unproductive dry cough, interstitial pneumonite, bronchospasm, shortness of breath, Rinorea, pharyngitis.
- Allergic reactions:
skin rash, itching, urticaria, angioedema edema, extremely rarely dysphony, polymorphic erythema, exfoliative dermatitis, Stephen-Johnson syndrome, toxic epidermal necroliza, pemphigus, photosensibilization, serozite, vasculitis, myosat, arthritium, arthritis, stomatitis.
Auxiliary substances: monohydrate lactose, magnesium carbonate, gelatin, crosspovidone, magnesium stearate.
10 pieces. - Blisters (2) - packs cardboard.
10 pieces. - Blisters (2) - packs cardboard.
ATTENTION!
Information on the page you will be viewed exclusively for informational purposes and does not promote self-treatment. The resource is intended to familiarize health officers with additional information about certain medicines, thereby increasing their level of professionalism. The use of the drug "" necessarily provides for advice with a specialist, as well as its recommendations for the method of application and dosage of the medicine you have chosen.
ATH code: C09AA02
Trade name: Enalapril International unpatient name: ENALAPRIL Release form: Tablets 5 mg, 10 mg and 20mg. Description: White tablets with a yellowish color tinge, flat-cylindrical, with a chamfer. Composition: one tablet contains: active substance - ENALAPRIL Maleata - 5 mg, 10 mg or 20 mg; Auxiliary substances: lactose monohydrate, starch 1500 (corn starch partially prevaitinized), corn starch, sodium hydrocarbonate, magnesium stearate. Pharmacotherapeutic Group: Means affecting the renin angiotensin system. An angiotensin surgery enzyme inhibitor.
Arterial hypertension various shapes and severity (including renovascular hypertension);
- heart failure of the I - III stage as part of complex therapy, including asymptomatic dysfunction of the left ventricle;
- Prevention of coronary ischemia in patients with left ventricle dysfunction.
Increased sensitivity to enalapril and other ACE inhibitors, a history of angioedema edema, porphyria, pregnancy, lactation period.
With caution to apply with primary hyperaldosteroneism, bilateral stenosis of renal arteries, stenosis of the artery of the only kidney, hyperkalemia, condition after the kidney transplantation; aortal stenosis, mitral stenosis (with impaired hemodynamics), idiopathic hypertrophic subaartal stenosis, systemic diseases connective tissue, ischemic Disease Hearts, cerebrovascular diseases, diabetes, renal failure (proteinurium more than 1 g / day), liver failure, in patients who comply with a diet with a salt restriction or hemodialysis, while receiving with immunosuppressants and saluretics, in older people (over 65 years old ).
The simultaneous use of inhibitors of angiotensin gluttering enzyme or ATII receptor blockers with alicarer in patients with diabetes or moderate / severe renal failure (SCF less than 60 ml / min / 1.73 m2) is contraindicated.
Inside, regardless of meals.
Arterial hypertension
The initial dose at a light degree of arterial hypertension (AG) is 5 mg 1 time per day. With other degrees of hypertension, the initial dose is 10 mg 1 time per day. In the absence of the effect, the dosage of the drug increases by 5 mg with an interval of 1 week. Supporting dose - 20 mg 1 time per day. The dose should not exceed 40 mg per day.
Renovascular hypertension
Therapy begins with a lower initial dose - 2.5 mg. The dose is selected according to the needs of the patient. Maximum daily dose - 40 mg of enalapril with daily reception.
Concomitant treatment of arterial hypertension diuretics
After the first admission of Enalapril, arterial hypotension can develop. The drug is recommended to assign with caution. Diuretics treatment should be discontinued 2-3 days before the start of treatment with Enalapril. If possible, the initial dose of ENALAPRIL should be reduced (up to 5 mg or less) to determine the initial effect of the drug.
Heart failure / asymptomatic left ventricle dysfunction
The initial dose of enalapril in patients with chronic heart failure is 2.5 mg per day, the purpose of the drug should be carried out under careful medical control to establish the initial effect of the drug. Enalapril can be used in conjunction with diuretics and, when necessary, with heart glycosides. The dose should be raised with an interval of 1 week by 5 mg to a conventional supporting daily dose of 20 mg, which is assigned once or divided into two receptions depending on the patient tolerability. Selection of doses should be carried out within 2-4 weeks.
Application in pediatrics
Experience in the use of enalapril in children with arterial hypertension in clinical studies limited. For children who can swallow tablets, the dose should be selected individually, depending on the patient's condition and on the degree of decline arterial pressure. The recommended initial dose is 2.5 mg for patients with body weight from 20 to< 50 кг и 5 мг для пациентов с массой тела > 50 kg. Enalapril takes 1 time per day.
Structure
each tablet contains: active substance Enalapril Maleat - 10.0 mg; auxiliary components: Collideon 25 (Pisidone), lactose, corn starch, Aerosil 200 (silicon colloidal dioxide), magnesium stearate, Punchy 4 R (E-124), orange yellow (E-110).
Description
Round, yellowish pink tablets, with risky on one side and with a linen of faults on the other side, interspersed.
pharmachologic effect
ACE inhibitor is a hypotensive agent. An angiotensin II is suppressing the formation of angiotensin I II and eliminates its vasoconstrictor effect. The drug gradually reduces blood pressure, without causing changes in the frequency of heart abbreviations and a minute volume of blood. Reduces the total peripheral resistance of vessels, reduces post capacity. It also reduces preload, reduces pressure in the right atrium and a small circulation circle. The drug reduces left ventricular hypertrophy. The drug reduces the tone of the hidden gloming arterioles, thereby improving intraccurous hemodynamics, and prevents the development of diabetic nephropathy.
The time of the hypotensive effect during oral administration is 1 h, it reaches a maximum after 4-6 hours and is preserved up to 24 hours. In some patients, therapy has been necessary for several weeks to achieve an optimal level of blood pressure. In chronic heart failure, a noticeable clinical effect is observed with long-term treatment - 6 months or more.
Pharmacokinetics
After receiving, about 60% of the enalapril is absorbed from gastrointestinal tract. Metabolized in the liver with the formation of active metabolite - enalaprilalate. The maximum concentration of enalaprilalate in serum is achieved after 3-4 hours after reception.
Communication with plasma proteins Enalaprilalate - 50-60%. The maximum concentration in the blood plasma of ENALAPRIL is achieved after 1 h, enalaprilalate - 3-4 hours. Enalaprilat easily passes through histohematic barriers, excluding the GEB, a small amount penetrates through the placenta and in breast milk. The half-life of Enalaprilalate - 11h. It is removed mainly by the kidneys - 60% (20% - in the form of enalapril and 40% - in the form of enalaprilalate), through the intestines - 33% (6% - in the form of enalapril and 27% - in the form of enalaprilate). Removed during hemodialysis (speed
62 ml / min) and peritoneal dialysis.
4 days after the start of receiving the drug, the half-life of enalaprilalate stabilizes and is 11h.
Excreted by the kidneys.
Indications for use
Treatment of arterial hypertension;
Treatment of clinically pronounced heart failure;
Prevention of clinically pronounced heart failure in patients with asymptomatic dysfunction of the left ventricle (fraction of emissions ≤ 35%).
Contraindications
Hypersensitivity to Enalapril and other ACE inhibitors, angioedema edema in history, pregnancy (especially the second and third pregnancy trimesters) , lactation, childhood Up to 18 years (safety and efficacy are not defined).
Renal failure: creatinine clearance less than 10 ml / min (for a given dosage form).
The simultaneous use of inhibitors of angiotensin glossy enzyme or ATP receptor blockers with alicarer in patients with diabetes or moderate / severe renal failure (SCF< 60 мл/мин/1,73 м 2) противопоказано.
C care: Reduced kidney function, liver, simultaneously with immunosuppressants, with double-sided stenosis of renal arteries.
Pregnancy and lactation period
Pregnancy
Except when it is impossible to replace the IAPF to another alternative therapy, patients planning pregnancy should be transferred to antihypertensive drug therapy, in which security profile for pregnant women is well-studied. When pregnancy occurs, the reception of the ACE inhibitor must be terminated immediately, and other antihypertensive therapy is prescribed if necessary.
The use of ACE inhibitors is contraindicated in the second and third trimesters of pregnancy.
When using ACE inhibitors in the second and third trimesters of pregnancy, a manifestation of fetotoxic action was established (violation of the function of the kidneys, oligohydramniosis, delay in the ossification of the bones of the skull) and neonatal toxicity ( renal failure, hypotension, hypercalemia). In the event that the reception of the ACE inhibitor was carried out from the second trimester of pregnancy, the ultrasound of the kidney function and the bones of the skull are recommended. In newborns whose mothers took the ACE inhibitors, it is necessary to carefully monitor blood pressure to prevent the possible development of the hypotension.
Lactation
At the time of treatment, breastfeeding should be stopped.
Enalapril in very low concentrations penetrates breast milk. Although the concentrations created can be viewed as clinically insignificant, the use of this drug during breastfeeding period is not recommended in the case of premature newborns, as well as in the first few weeks after birth due to the estimated risk of adverse effects on the cardiovascular system and kidneys, as well as Insufficient clinical experience.
When feeding a child older use data medicines Perhaps if therapy is considered as the child necessary for the mother and the condition of the child controlled from the point of view of the possible development of any adverse reactions.
Method of application and dose
The drug should be taken at the same time of the day (regardless of meals), drinking a small amount of fluid.
The dosing mode is set individually depending on the state of the patient.
In the treatment of arterial hypertension The drug is prescribed in the initial dose of 5 mg / day (in this case it is recommended to use dosage form Enalapril - 5 mg tablets). After receiving the initial dose, patients must be under medical supervision for 2 hours and an additional 1 hour until the hell stabilizes. The dose correction is carried out depending on the clinical effect achieved. Usually, the supporting daily dose is from 10-20 mg, in exceptional cases - up to 40 mg in 1 or 2 reception. In the case of prescribing to patients, at the same time receiving diuretics, treatment with a diuretic must be stopped in 2 - 3 days before the appointment of Enalapril. The initial dose for patients who received diuretics is 2.5 mg 1 time / day. When the initial dose of the drug is 2.5 mg it is recommended to use the dosage form of Enalapril - Tablets
2.5 mg.
With asymptomatic dysfunction of the left ventricle The recommended initial dose of the drug is 2.5 mg 2 times / day, in this case it is recommended to use the dosage form of the Enalapril - Tablets 2.5 mg. Depending on the patient's condition, a dose correction is possible. The average supporting dose is 10 mg 2 times / day.
In chronic heart failurethe recommended initial dose of the drug is 2.5 mg 1 time / day, in this case it is recommended to use the dosage form of Enalapril - 2.5 mg tablets. Increase the dose of the drug should be gradually until the maximum clinical effect is achieved; On average, the optimal dose is required 2 to 4 weeks. The average supporting dose is 2.5 - 10 mg 1 time / day, the daily maximum supporting dose is 40 mg (divided into 2 receptions).
In the treatment of arterial hypertension for kidney disease The dosing mode is set depending on the severity of the abnormalities of the kidney function or from creatinine clearance values. The initial dose of the drug should be gradually increased until a satisfactory clinical effect is achieved. With Creatinine clearance, 80-30 ml / min dose is usually 5-10 mg / day, creatinine clearance is 30-10 ml / min - 2.5 - 5 mg / day (in the case of a prescription 2.5 mg it is recommended to use the drug shape of Enalapril - Tablets 2.5 mg).
The duration of treatment depends on the effectiveness of therapy. With too pronounced decrease in blood pressure, the dose of the drug is gradually reduced.
Patients with impaired kidney function
Dosage in renal failure
The interval between enalapril intakes and / or reduced dose should be increased.
Enalapril is removed during dialysis. Dosage on days without dialysis should be adjusted depending on blood pressure.
If you need to receive the drug at a dose of 2.5 mg or 5 mg, it is recommended to use the dosage form of Enalapril - a tablet 2.5 mg or 5 mg.
Elderly patients
The dose should be selected, taking into account the patient's kidney function.
Children with arterial hypertension over the age of 6
The experience of clinical use of Enalapril in children with arterial hypertension is limited.
Children who can swallow pills, the dose should be prescribed individually, in accordance with the patient's condition, the response to the treatment and mass of the patient's body.
The recommended initial dose is 2.5 mg for patients with a body weight from 20 to 50 kg (it is recommended to use the dosage form of Enalapril - tablets 2.5 mg) and 5 mg for patients with body weight ≥ 50 kg (it is recommended to use the dosage form of Enalapril - Tablets 5 mg). Enalapril takes 1 time per day. The dosage should be adjusted depending on the needs to maximum 20 mg per day for patients with a body weight from 20 to 50 kg and 40 mg for patients with body weight ≥ 50 kg.
Side effect"Type \u003d" Checkbox "\u003e
Side effect
Listed bellow side effects presented in accordance with the following gradations of the frequency of their occurrence: very often (\u003e 1/10); Often (\u003e 1/100,<1/10); нечасто (>1/1000, <1/100); редко (>1/10000, <1/1000); очень редко (<1/10000) (включая отдельные сообщения), неизвестная частота (по имеющимся данным определить частоту встречаемости не представляется возможным).
From the side of the blood:rarely - anemia (including aplastic and hemolytic), neutropenia, reduced hemoglobin, reduced hematocrit, thrombocytopenia, agranulocytosis, inhibition of bone marrow, pancytopenia, lymphadenopathy, autoimmune diseases.
From the endocrine system:unknown - the syndrome of the violation of the adg secretion.
Metabolic disorders:infrequently - hypoglycemia.
From the nervous system and psyche:often - depression, headache; Rarely - confusion of consciousness, drowsiness, insomnia, nervousness, paresthesia, vertigo, sleep disorders, abnormal dreams.
From the authorities of the vision:very often - blurredness.
From the side of the cardiovascular system:very often - dizziness; Often - hypotension (including orthostatic hypotension), syncope, sore pain, rhythm disorders, angina, tachycardia; Rarely - orthostatic hypotension, tachycardia, myocardial infarction or stroke (perhaps as a result of excessive pressure reduction in high risk patients), Rhino phenomenon.
From the respiratory system:very often - cough; Often - shortness of breath; Rarely - Rinorea, sore throat and hoarseness, bronchospasm / asthma, pulmonary infiltrates, rhinitis, allergic alveolit \u200b\u200b/ eosinophilic pneumonia.
From the digestive tract:very often - nausea; Often - diarrhea, abdominal pain, change in taste; Rarely - intestinal obstruction, pancreatitis, vomiting, dyspepsia, constipation, anorexia, stomach irritation, dry mouth, peptic ulcers, stomatitis / aphthous ulcers, glossitis; Very rarely - an angioedema intestinal swelling.
From the digestive system:rarely - liver failure, hepatitis hepatocellular or cholestatic, hepatitis, including necrosis, cholestasis (including jaundice).
From the side of the skin and subcutaneous fabrics:often - rash, hypersensitivity / angioemical swelling of the face, limbs, lips, language, voice gap and / or larynx; infrequently increased sweating, itching, urticaria, alopecia; Rarely - multiple erythema, Stevens-Johnson syndrome, exfoliative dermatitis, toxic epidermal necroliz, pemphigus, erythrodermia.
The development of a complex symptom complex, which included some or all of such manifestations as: fever, serozite, vasculitis, myalgia / myozit, arthritium / arthritis, positive antinuclear antibody test, Eosinophilia and leukocytosis. How side effects may occur rash, photosensitization and other skin reactions.
From the urinary system:infrequently - impaired kidney function, renal failure, proteinuria; Rarely - Oliguria.
From the reproductive system:infrequently impotence; Rarely - gynecomastia.
General violations:very often - asthenia; Often - fatigue; Infrequently - muscle cramps, riding, ringing in the ears, a feeling of discomfort, fever.
Changes in laboratory indicators:often - hypercalemia, improving the level of creatinine in blood serum; Rarely - an increase in blood urea levels, hyponatremia, an increase in liver enzymes, serum bilirubin.
Overdose
People's overdose data are limited. The most characteristic features of overdose registered today are pronounced arterial hypotension, which starts about 6 hours after receiving a tablet, simultaneously with the blockade of the renin-angiotensin system, a stupor. Symptoms associated with an overdose of ACE inhibitors may include circulatory shock, electrolyte disorders, renal failure, hyperventilation, tachycardia, heartbeat, bradycardia, dizziness, anxiety and cough.
Recommended treatment in overdose is intravenous infusion of the physiological solution. In the occurrence of the patient's hypotension, they laid horizontally with raised legs. The possibility of infusion of angiotensin II and / or catecholamines intravenously should be considered. If the drug was adopted recently, it should be taken to take measures to eliminate the enalapril of Maleate (for example, vomiting, washing the stomach, the introduction of sorbents and sodium sulfate). Enalapril can be removed from a total circulation with hemodialysis. With stable therapy, bradycardia shows the use of pacemakers. It is necessary to constantly monitor the main life functions concentration in the blood serum of electrolytes and creatinine.
Interaction with other medicines
With simultaneous appointment with potassium-saving diuretics or potassium drugs, hypercalemia is possible. With simultaneous use with diuretics, beta, adrenobloclars, methyldop, nitrates, calcium channels, hydralazine, prazosin is possible to enhance hypotensive action. With simultaneous use with the NSAID (including with acetylsalicylic acid), it is possible to reduce the effect of enalapril and raising the risk of developing the renal function. With simultaneous use with ethanol, as well as funds for general anesthesia increase the risk of arterial hypotension. Enalapril weakens the effect of drugs containing theophylline. With simultaneous use with lithium preparations, lithium removal slows down and its action is enhanced. With simultaneous use with cimetidine, the half-life of Enalapril is extended.
Double blockade of Renin-angiotensin-allydosterone system
Based on the available data, the Dual Blockade of Raas with the use of IAPF, BRA II or alianic can not be recommended to any patient, especially patients with diabetic nephropathy.
In patients with diabetes or moderate / severe renal failure (SCF<60мл/мин/1,73 м 2) одновременное применение Алискирена с иАПФ или БРА II противопоказано.
In some cases, when the Joint Application of the IAPF and Sconce II is absolutely shown, it is necessary to carefully monitor the specialist and the mandatory monitoring of the function of the kidneys, water and electrolyte balance, blood pressure.
Gold preparations
Single reports on nitrite-shaped reactions are obtained (symptoms include redness of the face, nausea, vomiting and hypotension) in patients receiving injectable gold drugs (sodium ahuroyatomalat) and ACE inhibitors, including enalapril.
Antidiabetic means
Epidemiological studies suggest that the simultaneous use of ACE inhibitors and antidiabetic preparations (insulin, antidiabetic drugs for intake) can lead to a noticeable reduction in blood sugar levels with risk of hypoglycemia. This phenomenon with the greatest probability may appear in patients with damage to the kidneys during the first weeks of combination treatment.
Tricyclic antidepressants / neuroleptics / anesthetics / narcotic drugs
The simultaneous use of some anesthetics, tricyclic antidepressants and neuroleptics with ACE inhibitors can lead to an additional decrease in blood pressure.
Analapril. During the treatment period, the content of potassium in serum should also be monitored. Arterial hypotension is more often developing against the background of hypovolemia, restrictions on the consumption of salt, with hemodialysis, against the background of diarrhea or vomiting during surgical operations or anesthesia using compounds causing arterial hypotension.
In cases where the hypotension takes persistently, a dose and / or stop treating diuretic and / or enalapril.
In patients with bilateral stenosis of the kidney arteries or stenosis of the arteries of the only kidney, arterial hypotension, developing after the start of treatment enalapril, It may lead to a deterioration in the function of the kidneys, an increase in the content of urea and creatinine in serum.
When appointing enalaprilaA rare cases of angioedema edema are described (more often in the non-Patients of the Negroid race). In such cases, it is necessary to immediately cease treatment and establish a permanent monitoring of the patient until the symptoms are completely disappeared. Antihistamines in this case have a positive effect. In the development of choking against the background of edema, the epinephrine solution (adrenaline) is subcutaneously, 0.1% (0.3-0.5 ml) and / or take measures to ensure the loss of respiratory tract.
In rare cases, the reception of ACE inhibitors against the background of hyposensibilization by allergens of refilled or dialysis using high bandwidth membranes (for example, AN69) causes severe anaphyactic reactions. In such patients, the use of antihypertensive tools of another class is recommended.
There are reports on the occurrence of reversible unproductive cough in the treatment of ACE inhibitors.
In patients who received enalapril Within 48 weeks, there is an increase in serum potassium in 0.02 MEKV / l. In the treatment of enalapril, the content of potassium in serum should be monitored.
Form release
10 tablets in contour cell packaging. 3 contour packages along with the instructions for use are placed in a pack of cardboard.
Storage conditions
In the place protected from moisture at a temperature not higher than 25ºС.
Keep out of the reach of children.
Shelf life
3 years. Do not use the expiration date specified on the package.
Content
Elanopryl will help with increasing pressure, problems with blood circulation, pain in the heart of the drug indicates its effect relative to blood plasma platelets. Tablets are used for the prevention and therapy of cardiac, renal failure in adults. Familiarize yourself with their detailed instructions for use in order to achieve the desired effect during treatment.
Tablets Enalapril
According to the pharmacological classification, Tablets from the pressure of Enalapril refer to the group of ACE inhibitors (angiotensin-sparing enzyme). They affect the renin angiotensive system, have a positive effect under therapy of cardiovascular diseases. Their active substance is an Enalapril Maleat, which in the body turns into a metabolite, stimulating the production of hormones and the hydraulic effect.
Structure
Enalapril is available only in tablet form. Tablets have a round shape, yellow-pink color, risk and fracture line, permissible inclusions. Detailed:
Pharmacokinetics drug
The drug is considered a prodrug, an active metabolite of enalaprilat is produced from it in the body. The mechanism of work includes inhibiting the activity of ACE, which reduces the transformation rate of the substance to a component that has a pronounced vasoconstrictor and stimulating the production of aldosterone in the adrenal cortex. Due to the decrease in angiotensin concentration, aldosterone is reduced.
This vasodilatory drug reduces post-load, preload (pressure in pulmonary capillaries) and resistance in kidney vessels. Enalapril increases the redundant load. In the presence of chronic heart failure, the drug reduces the degree of its progression, the risk of ischemia and the development of attacks of myocardial infarction.
After entering inside the medicine is absorbed from the stomach. At the absorption speed does not affect meals. Metabolism occurs in the liver by hydrolysis, binds to plasma proteins by 55%. The half-life is 11 hours, rises with renal failure. More than half of the dose are excreted by the kidneys, the remainder of the intestine. With intravenous introduction, 100% of the drug is derived from the urine.
From what isnepril pills
Instructions for use of Tablets Enalapril talks about the following indications for their use:
- arterial hypertension, including renovascular type;
- chronic heart failure, angina;
- essential hypertension;
- prevention of development of severe heart failure;
- preventing the development of coronary ischemia during left ventricle dysfunction.
How to take Enalapril
According to the instructions, tablets are accepted into or used to prepare intravenous solution. In the oral use of Enalapril, the initial dose is considered 2.5-5 mg times / day, an average dose of 10-20 mg / day, divided into two receptions. With intravenous input, the dosage is practiced at 1.25 mg every 6 hours. To detect hypotension during dehydration and sodium deficiency, the dose is 625 mg, with inadequate response repeated in an hour.
The maximum daily dose during oral administration is 80 mg of enalapril.Dosage correction is made by a doctor, according to the instructions, and depends on the type of disease:
|
Disease |
Initial dose, mg |
Reception mode, times / day |
Medium dose, mg |
Reception mode, times / day |
Notes |
|
Arterial hypertension |
10-20, can reach up to 40 |
For therapy with diuretics, stop treating them in 2-3 days, the initial dose decreases to 2.5 mg |
|||
|
Left ventricle dysfunction leaking asymptomatic |
A dose adjustment can be made depending on the patient's condition. |
||||
|
Cardiac insufficiency flowing chronically |
The increase in dosage is made after 2-4 weeks, 40 mg is considered the maximum supporting dose, divided into two receptions |
||||
|
Arterial hypertension against kidney disease |
Removed during dialysis |
||||
|
Patients with body weight 20-50 kg |
|||||
|
Patients with body weight more than 50 kg |
special instructions
In the instructions of Enalapril, it is said about the special guidelines for the use of the drug, which is useful to know the patients:
- Caution is allowed to treat the means of patients with severe aortic stenosis, with loss of liquids and salts, the drug reduces cardiomyopathy hypertrophy.
- Long therapy requires periodic blood control.
- In operations during treatment with the drug it is possible to develop a hypotension, which is adjusted by the introduction of fluid.
- In the study of the parathyroid gland therapy, medicine is canceled.
- The drug affects the velocity of psychomotor reactions and the concentration of attention, so caution is required when driven by transport and mechanisms.
Enalapril during pregnancy
The instructions say that the use of enalapril during pregnancy is contraindicated. If it came, it is worth it to stop the reception of the drug, except in cases where it is impossible to replace the therapy with an alternative option. When taking medication in the second and third trimesters, fetotoxic effects and neonatal toxicity were recorded.
If the use of Enalapril failed to cancel, the ultrasound of the fetus is required. According to the reviews of mothers taking the drug during the launch of the child, blood pressure is controlled in newborns. During lactation, the active substance penetrates into milk, so breastfeeding must be stopped. It threatens negative influence on the kidneys and heart.
Medicinal interaction
In the application instructions are indicated features of the drug interaction of Enalapril with other medicines:
- immunosuppressants increase the risk of leukopenia;
- potassium diuretics, potassium preparations lead to the development of hypercalemia;
- opioid analgesics, thiazide and loop diuretics enhance antihypertensive effects;
- acetylsalicylic acid reduces the antihypertensive effect, and beta-adrenoblays and nitrates increase it;
- non-steroidal anti-inflammatory remedies reduce the effectiveness of enalapril;
- the simultaneous use of insulin leads to hypoglycemia;
- the medication weakens the effect of theophylline;
- the combination with lithium preparations increases the concentration of lithium in the blood serum, intoxication occurs;
- ethanol enhances the risk of arterial hypotension.
Side effects
The instructions for use describes the following possible side effects from enalapril:
- dizziness, headaches, feeling fatigue;
- sleep disorder, depression, noise in the ears;
- hypotension, fainting, rapid heartbeat, blood tides to face;
- nausea, dry mouth, vomiting, diarrhea, constipation;
- hepatitis, glossitis, neutropenia;
- dry cough, impotence, hair loss;
- muscular cramps.
Overdose
According to the instructions for use, the symptoms of the analopril overdose are the reduction of pressure, the development of collapse, heart attack.The patient feels tachycardia, dizziness, feeling of fear. The therapy includes washing the stomach, consumption of activated carbon. With severe poisoning, an intravenous administration of saline (0.9% sodium chloride), hemodialysis with high-strength membranes.
Contraindications
The instructions indicate on the following contraindications in which the use of Enalapril is prohibited:
- angioedema edema in history;
- bilateral stenosis of the renal blood flow or the artery of the only kidney;
- a combination with alianized diabetic diabetics;
- renal impairment;
- pregnancy, lactation;
- age up to 18 years;
- increased sensitivity to components or other ACE inhibitors.
Terms for sale and storage
The medication is released from pharmacies according to the recipe, stored in a dry place without access light and away from children at temperatures up to 25 degrees for three years.
Analogs
According to the active substance and the pharmacological effect rendered to the pharmacological effect, the following analogs of Enalapril in tablets manufactured by Russian and foreign pharmaceutical factories:
- ENAP;
- Renietec;
- Berlipril;
- Lotry;
- Dienef;
- EnaPren;
- Non-drive;
- Renatital;
- Xanef;
- ENAPRIN;
- Vasotek;
- Renithic;
- Caldine;
- EDNIT;
- Envas.
Price of Enalaprila
You can buy a drug through pharmacies or the Internet, having a recipe on your hands. The cost will depend on the number of tablets in the package and the accepted trade allowance. Exemplary prices of Enalapril in Moscow are as follows:
|
A variety of tablets |
Manufacturer |
Internet price, rubles |
Pharmacy price, rubles |
|
10 mg 20 pcs. |
|||
|
10 mg 20 pcs. |
Switzerland |
||
|
Switzerland |
|||
|
20 mg 20 pcs. |
Switzerland |
||
|
10 mg 50 pcs. |
Switzerland |
Video
