Enalapril is an antihypertensive agent belonging to the group of ACE inhibitors. The action of the drug is associated with an effect on the renin-angiotensin-aldosterone system. She takes part in the regulation of blood pressure.

A noticeable effect from the use of the drug can be obtained in about 2-4 hours, while the initial effect is achieved in about an hour. You can use the drug only as directed by a specialist.

Enalapril is available in tablet form. The active component of the product is enalapril. Each tablet may contain 5, 10 or 20 mg active substance.

Depending on the dosage, enalapril hl or enalapril h may be prescribed. Additional ingredients include gelatin, lactose monohydrate. In addition, the medicine contains magnesium carbonate and stearate, crospovidone.

The package contains 20-30 tablets. The drug should be stored at a temperature of 15-25 degrees for 3 years. After this time, it is prohibited to use the product. Many people are wondering how much enalapril costs. The price depends on the manufacturer and dosage. On average, the cost ranges from 20 to 100 rubles.

pharmachologic effect

Its activity is aimed at suppressing the action of angiotensin enzymes. This reduces the synthesis of aldosterone. Some people are wondering what kind of pressure enalapril is from. After its use, systolic and diastolic pressure decreases.

In addition, enalapril tablets help to dilate blood vessels and improve blood circulation in the region of the brain and kidneys. After prolonged use of the agent, a decrease in left ventricular hypertrophy can be seen. This helps to slow down or completely prevent heart failure.

Thanks to the use of the drug, the blood supply to the myocardium improves. In addition, the drug has a certain diuretic effect and reduces platelet aggregation.

The pressure decreases after about an hour, but the maximum effect can be seen after about 6 hours. It lasts for 24 hours. In some categories of patients, longer therapy is needed to achieve stable results. In such a situation, the drug is taken for several weeks.

If a person has heart failure, therapy lasts six months. Only in this case it will be possible to achieve tangible clinical results.

Pharmacokinetics

After taking the product, absorption is about 60%. About half of the drug binds to protein components. After taking the drug, a metabolite is formed, which is absorbed by the body. The drug is converted to enalaprilat, which is an active ACE inhibitor.

The drug can pass into breast milk and cross the placental barrier... The half-life of the drug takes 11 hours. Approximately 60% of the agent is excreted by the kidneys, 33% leaves the body during bowel movements. Peritoneal dialysis and hemodialysis allow you to completely remove the drug.

Indications

The drug is usually prescribed in such situations:

• Renovascular hypertension;
• Heart failure.

If a person has severe heart failure, the medicine is used to solve the following problems:

• Improved forecast;
• Slowing down the development of the disease;
• Reducing the number of hospitalizations.

The doctors' comments about enalapril indicate that it must be taken with caution in the development of liver failure, the appearance of stenosis of the renal arteries, in combination with immunosuppressants. The medicine is not recommended for diabetes mellitus and hyperkalemia. It is used very carefully when the body is weakened due to surgical interventions.

Side effects

Enalapril is able to provoke unwanted consequences for health:

1. The cardiovascular system can respond to drug use with a severe drop in pressure and orthostatic collapse. In rare cases, a person may experience chest pain or a heart attack - these complications are usually caused by an excessive decrease in pressure. There is a risk of arrhythmias, increased heart rate and pulmonary artery thromboembolism.
2. Disturbances in work nervous system can manifest as dizziness, weakness, headaches. A person may develop insomnia, depression, confusion. Often people complain of paresthesia, increased anxiety, drowsiness. When using the product in high dosage, there is a risk of developing nervousness.
3. The sensory organs sometimes react to taking the drug with the appearance of problems with the vestibular apparatus, impaired hearing and vision, and the occurrence of tinnitus.
4. Organ damage digestive system may be accompanied by a deterioration in appetite, dryness in oral cavity, dyspeptic symptoms. In some cases, intestinal obstruction, hepatitis, pancreatitis, jaundice develop. Some people complain of liver problems and impaired bile flow.
5. The respiratory system can react to the use of the drug with an unproductive cough, the development of bronchospasm, pharyngitis, shortness of breath. Some people develop interstitial pneumonitis or rhinorrhea.
6. The use of the drug can provoke allergies. It manifests itself in the form of skin rashes, angioedema of the face, dysphonia. Sometimes there is an itching sensation, vasculitis, urticaria and other disorders.
7. The urinary system reacts to the drug intake with impaired renal function and the development of proteinuria.

Overdose

An overdose of enalapril is accompanied by a strong decrease in blood pressure, including a state of collapse. Also, a person may develop a heart attack, acute circulatory disorders in the brain, or thromboembolism. Often, patients are faced with convulsive syndrome or a state of stupor.

To cope with the negative consequences, the patient needs to lie down. Moreover, the head should be located quite low. In mild cases, gastric lavage and internal use of saline are sufficient.

In difficult situations, measures are shown that will help stabilize the pressure. To do this, carry out intravenous administration 0.9% sodium chloride solution, as well as plasma substitutes. If necessary, angiotensin II should be given intravenously and hemodialysis should be performed.

Drug interactions

In order for enalapril to be exclusively beneficial, you need to strictly follow the instructions and remember about the interaction of the drug with other drugs:

1. The combination with anti-inflammatory drugs provokes a decrease in the hypotensive effect. A similar result is observed with excess salt intake with food.
2. When used with potassium-sparing diuretics, there is a risk of hyperkalemia.
3. The combination with lithium salts can slow down the elimination of this substance.
4. Enalapril can reduce the effectiveness of drugs containing theophylline.
5. Symptoms of a drop in pressure increase with the use of diuretics, beta-blockers, nitrates. Prazosin, hydralazine provoke similar results.
6. Reception of cytostatics, immunosuppressants and allopurinol leads to increased hematotoxicity.

special instructions

The drug is prescribed with caution to people with autoimmune pathologies, liver problems and diabetes mellitus. The same applies to complex types of arterial stenosis, hypertrophic cardiomyopathy, loss of salts and fluid.

If before this a person took saluretics and had chronic form heart failure, there is a risk of orthostatic hypotension. Therefore, before starting the use of enalapril, the loss of salts and liquid should be replenished.

With prolonged use of the drug, it is necessary to monitor the characteristics of the peripheral blood. Abrupt withdrawal of the drug does not lead to a sudden increase in pressure.

With surgical interventions during therapy with enalapril, there is a risk of hypotension. This condition is corrected by introducing the required volume of fluid. Before evaluating the work of the parathyroid glands, the use of the drug must be canceled.

When driving and others complex mechanisms you need to be careful. The drug can provoke dizziness. This is especially true when using the initial dose of the medication.

04/23/2014, Nika, 60 years old

Drugs taken: enalapril 5 mg

Conclusion ECG, ultrasound, other studies: Lion hypertrophy. ventricle. Rheumatism?? - not everything is clear to me.

Should I take enalapril continuously and constantly? Pressure - in the morning 140/90, in the evening - up to 160/105, sometimes 170/115. It happens occasionally 130/85, then I feel slight weakness, drowsiness, headache.

More articles on this topic:

1. The pressure dropped to 102/64. Can enalapril be taken?
2. How to take enalapril correctly?
3. Directory of drugs
4. Is your pain in chest hearty?
5. Do I need to constantly take something from the pressure?
6. Enalapril in enap and renitec preparations
7. Do I need to constantly take kapoten?

Diseases today of cardio-vascular system are among the main causes of mortality in the population.

Improper diet, excessive alcohol consumption and smoking - all this negatively affects the health of the heart and blood vessels. The most common disease in this area is hypertension.

Hypertensive patients, according to medical statistics, are up to 40% of the country's adult population. The article will focus on a drug that is designed to combat this problem. Enalapril, instructions for use, at what pressure to take - you can learn about all this by reading the material below.

Table of contents [Show]

Increases or decreases blood pressure?

This medicinal product contains the active ingredient of the same name, which is an inhibitor of the enzyme responsible for the increase in blood pressure. Enalapril gently reduces its concentration, which explains its therapeutic effect... Additionally, it dilates arteries and, to a lesser extent, veins, improving blood flow throughout the body.

At what pressure should I take?

Often from patients you can hear: "Enalapril - increases or decreases blood pressure?". Cardiologists say that Enalapril pressure pills, due to their ability to deactivate the corresponding enzyme, have a hypotonic effect. They lower well blood pressure with its increased rates.

Additionally, Enalapril dilates blood vessels from pressure, which helps to reduce the load on the left ventricle of the heart. That's why this drug prescribed to people with heart failure to compensate for it.

Enalapril tablets for high blood pressure are also shown in complex therapy kidney disease. Thanks to taking the pills, their blood circulation improves, the risk of their damage in diabetes mellitus of both types decreases.

Instructions for use

Enalapril, according to the instructions for use, is taken from pressure, available in the form of tablets with different dosages of the active substance (5, 10 and 20 mg.).

For different purposes of therapy, a specific volume of medication is prescribed. It also depends on the age and history of the patient.

Attention! You should not start taking the drug without consulting a specialist. It has a number of contraindications and is not applicable in some cases.

The tablets are taken regardless of food intake, with a sufficient amount of liquid.

We examined the properties of the drug Enalapril, at what pressure to take it, according to the instructions for use. But this drug, like any other, has side effects. These include:

• sharp or wavy pain in the chest or behind the left shoulder blade;
• a significant decrease in blood pressure in humans;
• irregular heart rate;
• migraines and dizziness.

It is also extremely rare, noted in the instructions for use, to demonstrate such side effects as:

• violation of the stool;
• increased patient anxiety;
• depressive conditions;
• a decrease in the level of hemoglobin in the blood;
• decrease in the absolute number of platelets;
• deterioration in kidney function;
• negative changes in urine tests.

Patients often taking Enalapril suffer from dry cough. It does not require treatment and disappears on its own after discontinuation of therapy.

The drug is not prescribed to pregnant women or nursing mothers. If there is an urgent need to take it, breastfeeding should be interrupted.

Care should be taken to use the drug, as noted in the instructions for use, if:

• you are on a salt-free diet;
• you are taking non-steroidal anti-inflammatory drugs in parallel;
• you have been diagnosed with any systemic disease connective tissue;
• you have high potassium levels in your blood;
• there is renal or hepatic impairment;
• there are ischemic disorders.

All such phenomena should be reported to your doctor who prescribes this medicine for you.

Alcohol enhances the effect of the drug, as does the use of diuretics. This is noted in the instructions for use and should be taken into account if you are prescribed such therapy.

During treatment, you should regularly monitor blood pressure and blood counts, the state of the liver and kidneys.

At the beginning of therapy with Enalapril, you should stop driving a car, activities that require increased concentration. Since dizziness and dizziness may occur while taking the pills sharp deterioration well-being. It is permissible to return to a normal lifestyle after the selection of the final dosage of the medicine and its good tolerance for at least two weeks.

Hypertension symptoms

Dosage

Attention! All treatment regimens are selected strictly by your attending physician, taking into account the history and individual characteristics of the organism. All the diagrams below are of a general averaging nature.

They usually begin to take Enalapril at high pressure, 5 mg per day. If the drug is well tolerated by the patient, then after 10 days the dosage of Enalapril at high pressure can be doubled.

Often patients ask the question: “How to drink enalapril from high pressure with kidney disease? ":

• if the increase in blood pressure is caused by problems in the work of the human urinary system, then according to the standard scheme, the patient is prescribed 2.5 mg of the drug per day;
• with good portability daily dose can be increased to 20 mg.

In elderly people, it is customary to start taking the drug with 1.25 mg per day.

If necessary, according to the instructions for the use of Enalapril with increased pressure, you can drink up to 40 mg per day. If you accidentally take a larger dose of the medicine than prescribed in the instructions, you should immediately flush the stomach. An absorbent can be taken. If necessary, call an ambulance. An overdose of Enalapril is accompanied by convulsions of the patient, a sharp drop in blood pressure, collapse, lethargy, and blood clots.

How long does it take for Enalapril to reduce blood pressure?

If you are interested in the question, after what time Enalapril reduces blood pressure, then you can give an unambiguous answer. According to the instructions for use, one hour after administration, the maximum concentration of the active substance is in the blood plasma. It remains as such for the next 4–5 hours, then gradually decreases.

Thus, to the question of how quickly Enalapril reduces the pressure, you can accurately answer that the effect should be felt within an hour after taking the pill.

If a drug is prescribed to a patient for the first time, then the first three hours after taking it, he should be under the supervision of a doctor in order to avoid negative side effects.

Enalapril is characterized by an accumulating effect, that is, after two weeks of taking it will work better than in its first days.

What if the drug doesn't work?

In some cases, the drug may be ineffective. This is because the patient may have symptomatic hypertension. It is itself a symptom of some other disease. A decrease in blood pressure will be achieved if the primary cause is eliminated.

If Enalapril does not reduce blood pressure, then what to do in this case, the attending physician will tell you at an in-person consultation. As a rule, in this case, a combination therapy is prescribed using other types of drugs or complex drugs.

How long can the tablets be taken?

The question "how long can you take enalapril from pressure?" Enalapril, according to the instructions for use, has a vasoprotective and cardioprotective effect. It reduces the risk of developing myocardial infarction. Therefore, Enalapril must be taken for life.

Since the drug has a prolonged nature, its effect is not lost with prolonged use. If, nevertheless, there is an addiction to the active substance, then either the dosage of the agent should be increased, or it should be changed to one of the analogs.

Is it safe to drink at low blood pressure?

Often the question arises in patients "is it possible to drink enalapril at low pressure?" If you have persistent hypotension, then taking enalapril is contraindicated, as it will further reduce the performance.

If the pressure has decreased while taking Enalapril and you do not know whether to continue taking it, then it is advisable to cancel the pills for a while and consult with your doctor about a similar effect of therapy. Perhaps he will find it necessary to reduce the dosage taken.

If there are other side effects from taking the medicine that bother you, be sure to also contact your doctor.

Useful video

For more information on ACE inhibitors, see this video:

Conclusion

1. We reviewed the instructions for use of the drug enalapril, from what pressure it is applicable.
2. The drug has proven itself in persistent primary and secondary hypertension, heart failure.
3. Enalapril, like other ACE inhibitors, is taken continuously.

With changes in pressure indicators, drug therapy is required. Various synthetic and natural preparations are used for treatment. Enalapril - instructions for use, at what pressure does this drug help? What are the contraindications to consider?

Enalapril tablets - basic information

Enalapril is an effective and time-tested drug, belongs to ACE inhibitors, which are used to correct indicators of systolic and diastolic pressure. At what pressure is it used? The drug is used to treat high blood pressure, it is used alone or in combination with other drugs for hypertension and hypertension.

The medicine is produced in the form of tablets, with a dose of the active substance of 5, 10, 20 mg. The composition contains the active substance enalapril, auxiliary components that do not have any therapeutic effect.

The mechanism of action of the drug is based on the ability of enalapril to slow down the production of angiotensin, to reduce the amount of aldosterone. This relaxes the walls of blood vessels, normalizes blood flow in the cardiac and renal arteries, and prevents the development of heart failure and thrombosis.

Does enalapril raise or lower blood pressure? The drug effectively reduces systolic and diastolic pressure, while not causing a jump in heart rate readings.

What does the drug help from? With regular use, the ability to withstand loads increases, the manifestation of pathological changes in the left ventricle decreases, the load on the heart muscle is weakened, and it prevents the development of nephropathy in diabetics.

Drug analogues:

• Enam;
• Invoril;
• Myopril;
• Renitex;
• Enamp.

Enapharm N is a combined drug that contains not only enalapril, but diuretic components - this increases the antihypertensive property of the drug.

Enalapril is a budget drug, its price is 30–100 rubles. The cost is influenced by the country of origin - Russian medicines are the cheapest, while Serbian medicines have the highest price.

Important! Enalapril is a powerful drug that has many contraindications and side effects, so it can only be purchased at a pharmacy with a doctor's prescription.

Indications and contraindications

Before starting treatment, you must carefully read the instructions for use - it contains all the indications, contraindications, side reactions and signs of overdose.

Indications for use:

• any kind of hypertension and hypertension;
• chronic heart failure;
• nephropathy in insulin diabetics;
• pathological changes in the tissues of the left ventricle.

With angina pectoris and myocardial infarction, the drug is included in complex and restorative therapy.

Important! Enalapril acts slowly, so it is impractical to use it in a hypertensive crisis.

The drug is not prescribed during pregnancy, lactating women, persons under 18 years of age, people of advanced age. The drug is contraindicated in case of individual intolerance, porphyria. Care should be taken to take the medicine if there is a history of serious kidney pathologies, diseases that worsen the outflow of blood from the left ventricle.

Side effects

Enalapril does not belong to modern medicines, it was invented a long time ago, therefore, when taken, various side reactions often occur. But if the dosage is observed, the drug is well tolerated, negative consequences are rare.

Frequent adverse reactions:

• cough without phlegm, sometimes shortness of breath, pharyngitis;
• the drug can provoke diarrhea, intestinal obstruction;
• nausea, aversion to food, ulcer;
• pain in the region of the heart, bradycardia;
• deterioration in vision clarity;
• migraine, dizziness, fatigue.

Sometimes, against the background of prolonged use, depressive states develop, a rash appears, and the body temperature rises. All adverse reactions are reversible; when the drug is discontinued, they quickly pass.

In case of an overdose, collapse may occur against the background of a sharp decrease in pressure, heart attack, disorders in the brain of an ischemic nature, stupor and convulsions. When such symptoms appear, it is necessary to urgently rinse the stomach, lay the person down, raise his legs, call an ambulance.

Important! It is strictly forbidden to combine Enalapril and alcohol. Alcoholic beverages enhance the effect of the drug, which can cause the development of irreversible consequences, a sharp decrease in pressure below the permissible norm.

How to use

The drug is absorbed by 60%, the therapeutic effect appears after 2-4 weeks of regular intake. The maximum result is formed 7 hours after ingestion, lasts throughout the day.

Important! At the initial stage, severe dizziness may occur, the pressure sometimes drops sharply. Therefore, after taking the medicine, it is advisable to stay at home, not to do work that requires concentration.

The dosage of the drug depends on the disease, the age of the patient, the presence chronic diseases.

You can take the medicine once a day with or without food. It is better to drink the medicine in the morning, as it has a mild diuretic effect. With monotherapy, the initial dose is 5 mg, if the condition does not improve, then it is doubled after 7-14 days. With moderate hypertension, it is enough to take 10 mg of the drug per day. The maximum daily dose should not exceed 40 mg, while the medicine should be drunk in 2 divided doses.

If Enalapril Hexal is used as part of complex therapy for the treatment of heart failure, then the trial dose is 2.5 mg. It is increased by 2 times after 3-4 days, until the therapeutic effect becomes noticeable.

Enalapril FPO and Acri are taken at any time, 2.5–5 mg times every 24 hours. The maintenance dosage is no more than 20 mg, the safe maximum dose is 40 mg.

How long can you take Enalapril? Long-term drug treatment, in the absence of adverse reactions you can take it all your life.

Important! Before any surgical intervention, even dental, the doctor should be warned about treatment with ACE inhibitors.

Comparison of Enalapril with other analogues and substitutes

Many pharmaceutical companies produce various analogues of Enalapril. They differ in cost, composition, but the therapeutic effect is practically the same for all. The high price does not always guarantee the absence of side reactions.

Lisinopril or Enalapril - which is more effective? Lisinopril negatively affects male potency, a large dosage is required for a therapeutic effect. Enalapril is effective for ischemic disease, excreted by the liver and kidneys. Lisinopril - only by the kidneys.

Enalapril Hexal and Enalapril, is there a difference? Enalapril Hexal is produced by a German pharmaceutical company, Enalapril by a Russian one. The German counterpart is somewhat more expensive, but in terms of effectiveness, it is no better than the domestic drug.

Enap and Enalapril - what's the difference? Enap is a drug from Slovenia, it is produced in the form of tablets and solutions for injections. It costs several times more, but it works more effectively, side reactions are extremely rare.

Enalapril FPO and Enalapril - what's the difference? Both drugs are produced by domestic pharmaceutical companies, have the same effect, side effects. Slightly different in price, the maximum allowable dose of Enalapril FPO is 80 mg, in contrast to Enalapril.

Captopril or Enalapril - which is more effective? These drugs belong to the same group, have a similar therapeutic effect - they improve the work of the heart muscle, normalize high blood pressure... But there are also some differences.

Captopril even with mild form hypertension should be taken 2-3 times a day, since its effect is shorter. Enalapril maintains optimal blood pressure for longer.

Captopril is effective in hypertensive crisis, Enalapril is not used as emergency... Captopril is more effective in heart failure, improves endurance, it can be used to prevent death from serious heart pathologies.

Lorista or Enalapril - which is better? Lorista - modern drug for the treatment of hypertension, chronic heart failure. It works effectively, has a minimum number of side reactions - there is no dry cough, male potency does not deteriorate with prolonged use. Lorista can be used in the treatment of persons over 60 years of age, patients with renal insufficiency without dosage adjustment.

Enalapril or Lozap - what's the difference? The drugs have the same effect, they need to be taken once a day, preferably at the same time. There are no particular differences in contraindications and side effects.

Enalapril and its analogues are an effective drug for lowering systolic and diastolic blood pressure. In the absence of adverse reactions, they can be taken for a long time, but only a doctor can prescribe the dose and duration of treatment. Any self-medication can lead to serious, irreversible consequences.

Read the official drug information Enalapril, instructions for use which includes general information and a treatment regimen. The text is provided for informational purposes only and cannot serve as a substitute for a doctor's consultation.

Enalapril is antihypertensive drug from the group of ACE inhibitors. It is considered "pro-Enalaprilm": during its hydrolysis, enalaprilat is created, which inhibits ACE. The principle of action of the drug is associated with a decrease in the formation of angiotensin II from angiotensin I, a decrease in the content of which leads to a direct decrease in the release of aldosterone. In this case, there is a decrease in the total peripheral vascular resistance, systolic and diastolic blood pressure, post - and preload on the myocardium.

Composition and form of release

10, 20, 30 or 50 tablets in polymer cans or plastic cases. 10 tablets in a blister strip of aluminum foil and polyvinyl chloride film. One can, a pencil case or 1, 2, 3, 5 or 50 blisters together with a leaflet in a secondary package.

The composition of the product

• Active substance: 10 mg enalapril maleate.
• Excipients: corn starch, gelatin, methylparaben, dibasic calcium phosphate, magnesium stearate, talc, erythrosine supra.

Enalapril - instructions for use in various dosage forms

According to the instructions, Enalapril is prescribed for adults for oral administration, regardless of food intake.

Enalapril: use in tablet form

The initial dose of Enalapril depends on the level of hypertension and is usually 2.5–5.0 mg once a day. As needed single dose the drug is increased to 20 mg 1-2 times a day. To maintain normal pressure, 10–20 mg of enalapril are prescribed per day. The maximum daily dose of Enalapril with good tolerability of the drug is no more than 40 mg per day in one or two doses. The dosage, frequency and duration of application of Enalapril are established by the doctor depending on the pathology and condition of the patient.

The use of Enalapril in chronic renal failure

In chronic renal failure, accumulation begins with a decrease in filtration of less than 10 ml / min. With a creatinine clearance (CC) of 80-30 ml / min, the dose of Enalapril is mostly 5-10 mg / day. , with CC up to 30-10 ml / min - 2.5-5 mg / day. , with CC less than 10 ml / min - 1.25–2.5 mg / day. only on dialysis days.

The duration of treatment is influenced by the effectiveness of therapy. With a strong 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 drugs.

Storage conditions for Enalapril

The instructions note that Enalapril is stored in a dry, darkened, hard-to-reach place for children when room temperature no more than 3 years.

Indications, contraindications, side effects of Enalapril

Indications for the use of Enalapril

The drug brand Enalapril is prescribed according to indications: arterial hypertension of any severity, including renovascular; chronic heart failure, left ventricular dysfunction; diabetic nephropathy.

Contraindications for the use of Enalapril

• With individual sensitivity to drugs-angiotensin-converting enzyme inhibitors,
• During pregnancy and during breastfeeding,
• In childhood
• With hereditary edema of Kivnke or angioedema in history,
• In case of impaired renal function, bilateral renal artery stenosis or renal artery stenosis of a single kidney,
• With stenosis of the aortic orifice,
• With hyperkalemia, azotemia, condition after kidney transplantation.

The drug Enalapril is not prescribed to patients on hemodialysis using dialysis membranes AN69, due to the risk of developing anaphylactoid reactions.

Enalapril: side effects

peripheral and central nervous system manifested by dizziness and headache, a feeling of fatigue, severe fatigue; infrequently, when used in significant doses, sleep disorders, nervousness, depression, imbalance, paresthesia, tinnitus occur.

Side effects of cardio-vascular system manifested in the form of orthostatic hypotension, fainting, palpitations, pain in the heart; infrequently, when used in significant doses, hot flashes appear.

Side effects digestive system after using the remedy, they are manifested by nausea; infrequently there is dry mouth, abdominal pain, vomiting, diarrhea, constipation, liver dysfunction, an increase in the activity of hepatic transaminases, an increase in the concentration of bilirubin in the blood, hepatitis, pancreatitis; very rarely when used in significant doses - glossitis.

Side effects hematopoietic system rarely manifest as neutropenia; in patients with autoimmune diseases in the form of agranulocytosis.

Side effects urinary system are rare in the form of impaired renal function and proteinuria.

Side effects respiratory system after using the remedy, they manifest themselves as a dry cough.

Side effects reproductive system are rare when used in significant doses in the form of impotence.

Dermatological reactions are rare, if the drug is used in high doses, hair loss may occur.

Allergic reactions: skin rash and Quincke's edema rarely appear.

Other manifestations: hyperkalemia and muscle cramps.

The use of Enalapril in the control of mechanisms

At the stage of selecting a certain dosage of Enalapril, it is necessary to refrain from driving and exercising. dangerous species activities that require an increased concentration of attention and a quick psychomotor reaction, since dizziness may occur, especially after the use of initial doses of an ACE inhibitor in patients receiving diuretics.

How long can you use Enalapril

According to the doctor's recommendation, the drug is used 1-2 times a day, regardless of food intake. Combined Enalapril preparations, which contain diuretics, are best used in the morning. The course of treatment with the drug is long, and with normal tolerance it can last throughout life.

The use of Enalapril during pregnancy

This drug is not indicated for use during pregnancy, if pregnancy has occurred, then the drug must be discontinued. Enalapril passes into breast milk. If necessary, its use during lactation should stop breastfeeding.

Enalapril: use for children

According to the instructions, the drug Enalapril is contraindicated in children under 18 years of age, since its effectiveness and safety have not been determined. If newborns or infants have been exposed to intrauterine exposure to ACE inhibitors, then it is necessary to carefully observe them for the timely detection of a pronounced decrease in blood pressure, oliguria, hyperkalemia and neurological disorders likely as a result of a decrease in renal and cerebral blood flow with a decrease in blood pressure caused by ACE inhibitors.

The therapeutic effects of Enalapril

Arteries expand more than veins, and there is no reflex increase in heart rate. The hypotensive effect is more pronounced with a significant level of plasma renin than with a normal or reduced level. Lowering blood pressure for therapeutic purposes does not affect cerebral circulation, blood supply in the vessels of the brain is retained for the right level even against the background of low blood pressure. Increases coronary and renal blood flow.

With prolonged use of Enalapril, hypertrophy of the left ventricle of the myocardium and myocytes of the walls of the arteries of a resistive type decreases, prevents an increase in heart failure and inhibits the development of left ventricular dilatation. Helps improve blood flow to the ischemic myocardium. Enalapril reduces platelet aggregation. Has some diuretic effect.

The period of onset of the hypotensive effect of Enalapril with internal use- 1 hour, the maximum result is achieved after 4-6 hours and lasts up to 24 hours. In some patients, in order to obtain an optimal blood pressure value, treatment is necessary for several weeks. With heart failure, a tangible clinical result is observed with prolonged use ─ more than 6 months.

Enalapril compatibility with acetylsalicylic acid and insulin

Acetylsalicylic acid in high doses reduces the antihypertensive properties of Enalapril. It is impossible to say with certainty whether acetylsalicylic acid reduces the therapeutic effect of the use of ACE inhibitors in patients with coronary artery disease and heart failure. The direction of this interaction depends on the course of the disease.

Acetylsalicylic acid, by inhibiting COX and prostaglandin synthesis, can provoke vasoconstriction, leading to a decrease in cardiac output and worsening of the condition of patients with heart failure receiving ACE inhibitors. According to the data, the simultaneous use of insulin, as well as other hypoglycemic agents and Enalapril can cause hypokalemia. This happens most often in the initial stages of therapy in patients with renal disease.

Enalapril compatibility with alcohol

In accordance with the instructions, drinking alcohol with Enalapril is not recommended, since alcohol increases the effect of the drug.

Enalapril's analogs: domestic and foreign

Analogs (synonyms) of the drug, which contain Enalapril as the main active ingredient, include the following drugs:

• Enap;
• Vasolapril;
• An analogue of Enalapril - Enam;
• Myopril;
• An analogue of Enalapril - Envas;
• Enalakor and others.

In addition, combined drugs are produced, for example, the Slovenian Enap H and Enap HL, the Russian Enapharm H and the like. In addition to Enalapril, these medicines contain the substance Hydrochlorothiazide, which has a diuretic effect, which increases the antihypertensive effect of the drug. Analogs of Enalapril, which have a similar effect, but a different chemical composition, include drugs such as Captopril, Lisinopril, Ramipril, Zofenopril, Perindopril, Trandolapril, Quinapril, Fozinopril.

Price for Enalapril

Check out the price of Enalapril in 2017 and cheap analogs. The cost of Enalapril in different pharmacies of even one network can differ significantly. But what is important is that the price difference between overseas and Russian counterparts remains practically unchanged.

Hypertension is one of the leading causes of death from cardiac diseases in almost all countries.

Regular intake of the antihypertensive drug Enalapril in a therapeutic dosage several times reduces the risk of complications from the cardiovascular system and sudden death.

An important role is played not only by the effectiveness of the drug itself, but also by its overall effect on the psychoemotional state of the patient.

Angiotensin-converting enzyme (ACE) inhibitors, which include Enalapril, rarely cause side complications and practically do not have a significant effect on the patient's usual lifestyle.

How does the drug fight high blood pressure?

The name of the protein compounds angiotensins comes from the Greek words angeon - vessel and tensio - tension... They are formed from β-globulin angiotensinogen, which is in the plasma part of the blood. Under the influence of renin, which is produced in kidney cells, angiotensinogen is converted to angiotensin I. However, it also has no effect on vascular tone.

But under the influence of another enzyme formed in the lung tissue, angiotensin-converting or angiotensin-converting (ACE - kinase II), angiotensin I passes into angiotensin II. It is one of the strongest endogenous (internal) factors that affect the tone of the vascular wall, and as a result, the level of systolic and diastolic blood pressure (BP).

ACE inhibitors also stimulate the synthesis of vasodilating bradykinin, inhibit the hypertensive activity of corticotropic and luteinizing hormones. Thanks to this, Enalapril has the following effect on the human body:

• Inhibition of the synthesis and secretion of aldosterone, a hormone of the adrenal cortex, which causes retention of fluid and sodium ions in the body, and potassium ions necessary for the normal functioning of the myocardium are excreted in urine.
• Weakening of reabsorption in the kidney tubules and a decrease in the production of antidiuretic hormone (arginine-vasopressin), which manifests itself in an additional mild diuretic effect.
• Long-term maintenance of the hypotensive effect by reducing the concentration of another vasoconstrictor factor, endothelin I.
• Influence on the vascular endothelium, which is especially important in old age, since during aging, deposits of collagen, elastin and calcium are formed on the walls of the arteries. Endothelial dysfunction is the first stage in the development of atherosclerosis, which begins even before the onset of atherosclerotic plaque formation. Enalapril increases the synthesis of nitric oxide and improves blood rheology, which, in turn, restores blood flow in the arteries.
• A decrease in the energy requirements of the myocardium, due to which the rhythm of contraction of muscle tissues is normalized, this feature of this drug explains its widespread use in such pathologies as ischemic disease (IHD), chronic heart failure, angina pectoris.
• Improving the "work" of the left ventricle, which primarily suffers in myocardial infarction, compliance with the doctor's recommendations regarding the dosage and duration of treatment reduces the pathological increase in the mass of the left ventricle of the heart.

In addition to acting on the cardiovascular system, Enalapril also has a protective effect on the kidneys. The fact is that in the pathogenesis of renal failure great importance plays the activation of the renin-angiotensin-aldosterone system.

The enzymes, proteins and other substances produced by it lead to collagen deposits and disruption of the functioning of the tubular system of the excretory organs. Knowing this mechanism, doctors prescribe Enalapril not only for nephropathies, but also for the treatment of renovascular hypertension, which is caused by a narrowing of the renal artery.

According to pharmacological classification ACE inhibitors, Enalapril belongs to class IIa prodrugs. It does not act "directly" on the body, but undergoes hydrolysis processes and is transformed into an active metabolite, enalaprilat, which directly affects the angiotensin-converting enzyme. And if Enalapril is prescribed in the form of tablets for the long-term treatment of hypertension, then a 0.125% solution of enalaprilat (in pharmacies you can buy Enap for injection) is used to relieve hypertensive crises.

The drug is rapidly, but not completely (approximately 60%), is absorbed into gastrointestinal tract regardless of food intake. The bioavailability of Enalapril is about 40%. The antihypertensive effect of the drug begins with the achievement of its maximum concentration in the blood, 1-4 hours after administration, the half-life and, accordingly, the action - up to 11 hours. More than half of the drug (up to 60%) is excreted by the kidneys in the form of enalaprilat and unchanged enalapril, part through the intestines.

Enalapril: indications for use, form of release, restrictions on use

Enalapril is produced by various domestic and foreign pharmaceutical corporations, sometimes the name of the company is reflected in trade name drug, for example, Enalapril Ajio manufactured by Ajio Pharmaceuticals, India.

The medicine is sold in packs of 20, 30 or 50 white tablets with 5, 10 or 20 mg of active ingredient. They can be biconvex or even with a horizontal line dividing the pill into two equal parts.

V chemical composition Enalapril has several amino acid residues. By physical properties the active substance is a white crystal-like powder, which practically does not dissolve in any solution, with the exception of alcohol.

Therefore, for the formation of tablets, auxiliary substances are added to it, such as lactose, magnesium compounds, gelatin, crospovidone.

Indications for the use of Enalapril are the following diseases:

• hypertension different etiology and the severity of the course;
• congestive heart failure;
• heart attack (only in combination with a number of other medicines);
• diabetic nephropathy (kidney pathology in diabetes mellitus);
• secondary hyperaldosteronism (an increase in the level of the adrenal cortex hormone aldosterone against the background of pathological activation of the renin - angiotensin - aldosterone system);
• Raynaud's disease (circulatory disorders in small arteries and arterioles of the upper and lower limbs);
• scleroderma (a systemic disease accompanied by an excessive accumulation of collagen in almost all tissues);
• prevention of complications, angina attacks, heart attacks in patients with an increase in the mass of the left ventricle of the heart.

In the foreign medical literature there is information that in patients with indications for the use of Enalapril, the frequency of symptoms of acute cardiac hypoxia, attacks of pain in the chest area, visits to a cardiologist for a worsening of the general condition decreased in comparison with other patients who were not prescribed this drug.

But you will have to look for another way to stabilize blood pressure in the presence of contraindications for the appointment of Enalapril.

These include:

• hypersensitivity, and not only to Enalapril, but also to other drugs from the class of angiotensin-converting enzyme inhibitors;
• if the person previously had Quincke's edema, including of unexplained etiology;
• pathological reaction to lactose;
• early and adolescence (up to 18 years).

In the drug Enalapril, indications for use require constant medical supervision in cases where there is:

• renal failure;
• narrowing of the lumen of the renal arteries or artery of only one "working" kidney;
• liver pathology;
• violation of blood flow in the blood vessels that feed the heart;
• rehabilitation period after kidney transplant surgery;
• systemic connective tissue pathologies;
• disorders of blood flow in the vessels of the brain.

Correction of the dose of Enalapril is necessary in the elderly (after 65-70 years), with endocrine disorders, an increase in the concentration of potassium in the blood, hyponatremia, in combination with other medicines intended for the treatment of coronary heart disease. To eliminate the risk of overdose, before prescribing the drug, check the condition of the patient's liver and kidneys.

Enalapril: instructions, dosage features

The drug in the form of ampoules is not available, therefore it is taken in the form of tablets, regardless of food and time of day.

The instruction for Enalapril provides for various treatment regimens, depending on the underlying disease:

• At arterial hypertension(including the renovascular "renal" type of pathology). The initial daily amount is 5 mg per day. Within 1-2 weeks, the doctor monitors the patient's condition and gradually increases the dosage. Usually it is up to 10-20 mg, divided into two doses throughout the day.
• With congestive chronic heart failure. Therapy begins with 2.5 mg per day, gradually (2.5-5 mg twice a week), this amount is brought to 15-20 mg per day (it is also possible to divide into two doses).

When treating with this drug, the following nuances must be taken into account:

• the daily amount of the drug Enalapril, the instruction does not recommend exceeding 40 mg (with renovascular hypertension - 20 mg). With a too pronounced decrease in blood pressure, it is reduced until the patient's condition is normalized;
• in patients over 65 years of age, the dosage is 1.25 mg per day;
• if the level of sodium ions in the blood is below normal (or the level of creatinine is above 0.14 mmol / l), the recommended daily amount of Enalapril in accordance with the instructions is 2.5 mg;
• in chronic renal failure with a reduced level of filtration, accumulation begins, in other words, the accumulation of Enalapril, which requires a dosage adjustment;
• before you start taking the medicine, you should stop the use of diuretics 2-3 days before;
• for patients with low systolic blood pressure (less than 110 mm Hg), treatment should be started with 1.25 mg per day, and the average maintenance amount of medication usually does not exceed 20 mg.

The drug Enalapril instruction allows you to use it both independently and in combination with other antihypertensive drugs. Usually the medicine is combined with diuretics. At the same time, a persistent antihypertensive effect is obtained against the background of a lower dosage of medications, which also reduces the risk of side complications.

So, in one of the studies when taking 2.5 mg of the diuretic indapamide, the symptoms of hypertension were arrested in the amount of enalapril 15.5 mg. Currently, studies are being carried out on the effect of joint administration of ACE inhibitors and mildronate on improving the condition of the vascular wall, which is important in the treatment of coronary heart disease against the background of atherosclerosis.

The antihypertensive effect of the combination of Enalapril with diuretics, calcium antagonists led to the creation of combination drugs, these are:

• Enap N and Enap HL, containing 10 mg of enalapril and 25 mg or 12.5 mg of the diuretic hydrochlorothiazide, respectively;
• Co-Renitek, 20 mg enalapril and 12.5 mg hydrochlorothiazide;
• Coripren, 10 mg of enalapril and calcium antagonist medicinidipine;
• Enzix Duo Forte is a set of 20 mg enalapril tablets and 2.5 mg indapamide tablets;
• Renipril, in terms of composition, is a complete analogue of Enap HL;
• Berlipril Plus, the dosage of active substances coincides with the medicine Enap N.

The method of using these drugs is not much different from the instructions for Enalapril. They are also taken once a day, usually 1 tablet. It is also worth paying attention to other names of this ACE inhibitor. These are Enalapril Hexal, Enalapril Akti, Enalapril FPO.

These preparations contain only Enalapril and are used in the same dosage as described above.

As indicated in the instructions, the use of Enalapril during pregnancy is contraindicated. This is due to the fact that the drug easily passes through the placenta and enters the fetal bloodstream, which can lead to irreversible pathologies. Therefore, with an unplanned conception against the background of treatment with Enalapril, doctors warn a woman about possible complications.

Also, the medicine is not recommended to be combined with breastfeeding, since the active component of the drug enters the milk and lasts for a day. It is clear that given the medication regimen, safe lactation is not possible.

Treatment with Enalapril lasts more than one month, and during this period, patients often need other drugs. However, not all medications are combined with ACE inhibitors.

• Antihypertensive drugs... There is a mutual reinforcement of the action, which requires a reduction in dosage.
• Loop diuretics... One of the side effects of Enalapril is an increase in the level of potassium in the blood, this is especially often observed with concomitant renal failure, diabetes. Certain diuretics (Spironolactone or Triamterene) remove excess potassium from the body.
• Drugs to lower blood sugar... Enalapril enhances their action, which is fraught with the risk of hypoglycemia. This combination requires a blood glucose test for the first four weeks of treatment.
• Medicines containing lithium... ACE inhibitors delay the excretion of lithium by the kidneys, which leads to an increase in their concentration in the body.
• Medicines affecting the functioning of the central nervous system(antidepressants, drugs for general anesthesia, antipsychotics). There is a possibility that your blood pressure drops too much.
• Sympathomimetics(Isoprenaline, Izadrin, Astmopent), non-steroidal anti-inflammatory drugs(NSAIDs) reduce the hypotensive effect of Enalapril.
• Cytostatics and other immunosuppressants when combined with ACE inhibitors can cause a strong decrease in the level of leukocytes in the blood.
• Antacids, affect the degree of absorption of Enalapril from the digestive tract.

Other drugs do not significantly affect the use of Enalapril in dosage according to the instructions. In the course of treatment, regular monitoring of clinical indicators of the general and biochemical analysis blood. In home therapy, the patient is asked to independently measure blood pressure twice a day and record these indicators in a special journal.

Enalapril is an antihypertensive substance that belongs to the category of ACE inhibitors. The mechanism of its work is based on the effect on a special system - the renin-angiotensin-aldosterone system. It is she who helps to regulate pressure. To get the results you want, you need to know how to take enalapril.

Composition

Forms of issue

The medicine is produced in the form of tablets. The active ingredient is the substance of the same name. 1 tablet contains 5, 10 or 20 mg of the active ingredient. Depending on the amount of active ingredient, the doctor may prescribe substances marked with h or hl.

Also, enalapril from pressure contains additional components - lactose monohydrate, magnesium stearate, gelatin. The medicine includes crospovidone, sodium and magnesium carbonate.

The price of enalapril is determined depending on the company that produces it and the volume of the active substance. On average, the cost ranges from 20-100 rubles.

Description of the drug

Enalapril tablets are an antihypertensive agent. The principle of the drug is based on a decrease in the activity of angiotensin. This helps to reduce the production of aldosterone. Many people wonder what enalapril helps from. The substance reduces different types of pressure - both systolic and diastolic.

Also, the drug helps to dilate blood vessels and normalizes blood circulation. The drug has a particularly strong effect on the brain and kidneys. After prolonged use of the substance, left ventricular hypertrophy decreases. Due to this, the course of heart failure is improved or the occurrence of this condition is completely prevented.

The use of a medication leads to an improvement in blood flow to the myocardium. Also, the drug has a diuretic effect and helps to reduce platelet adhesion.

After consuming the substance, the pressure drops after about 1 hour. The limiting effect is achieved after 6 hours and is present for 1 day. Sometimes, longer treatment is required to achieve lasting results. In such a situation, the medicine has to be taken for several weeks.

In the presence of heart failure, treatment continues for 6 months. Only then can you get noticeable results.

Indications

Key indications for the use of enalapril include the following:

• Hypertension, including renovascular hypertension;
• Heart failure of a chronic nature - the medicine is part of the complex treatment;
• Prevention of severe heart failure with asymptomatic left ventricular disease;
• Prevention of coronary ischemia in patients with left ventricular damage - due to this, the risk of heart attack is reduced and the number of hospitalizations associated with an unstable form of angina pectoris decreases.

The medicine should be taken regardless of food. If this substance is the only remedy for hypertension, it is used at an initial dosage of 5 mg. Instructions for the use of tablets enalapril recommends drinking them once a day.

If there is no result, after a couple of weeks the amount of the medicine should be increased. In this situation, it is recommended to take 10 mg of the drug. After using the initial dose, the person should be under the supervision of specialists for 2 hours. Then, for another 1 hour, you need to monitor the condition, waiting for the pressure to return to normal.

If necessary and normal tolerance of the substance, the amount can be increased to 40 mg. This volume is recommended to be consumed 1 or 2 times. After a couple of weeks, supportive therapy can be started. The dosage of enalapril can be from 10 to 40 mg.

With an unexpressed degree of pathology, the volume of the substance is on average 10 mg. But the maximum dosage of the drug cannot be more than 40 mg.

If it is necessary to treat with enalapril in a few days, you should stop using diuretics. If difficulties arise with this, the initial dosage of the drug is 2.5 mg per day.

When a person develops hyponatremia or an increase in creatinine content to 0.14 mmol / l or more, 2.5 mg of the drug is used. This must be done once a day. When a renovascular form of the disease is detected, the initial volume is 2.5-5 mg. Subsequently, you can take no more than 20 mg.

Features of taking the medicine

With heart failure, which is characterized by chronic course, first prescribed the use of 2.5 mg of the drug once. Subsequently, the amount is increased by 2.5-5 mg. It is recommended to do this in 3-4 days. To prescribe the required amount, you should focus on the body's reactions. The maximum volume is 40 mg.

With a systolic pressure of up to 110 mm Hg. Art. at the beginning of therapy, take 1.25 mg. The volume is adjusted for 2-4 weeks. If necessary, this period is reduced. The maintenance amount is 5-20 mg. It can be consumed in 1-2 doses.

Elderly people often experience significant drops in blood pressure. In this case, the substance lasts longer. This is due to the slowdown in the rate of its elimination. Therefore, the limiting initial volume is 1.25 mg.

In case of availability chronic insufficiency renal accumulation of the substance is achieved at a filtration rate of 10 ml / min. With a creatinine clearance of 80-30 ml / min, a volume of 5-10 mg is recommended. If this parameter is 30-10 ml / min, the dose must be adjusted. It should be at the level of 2.5-5 mg. With a clearance of up to 10 ml / min, the dosage is reduced to 1.25-2.5 mg during hemodialysis.

The choice of the duration of therapy is influenced by the dynamics of the development of pathology. With a clear decrease in pressure, the volume of the drug is gradually reduced. For hypertension, enalapril may be the only medicine or is combined with other substances.

Contraindications

Instructions for the use of enalapril include the following restrictions:

• History of Quincke's edema;
• Lactation;
• Allergy to the active ingredient, its metabolites and additional ingredients;
• Porphyria.

Side effects

In some situations, the substance causes negative reactions. Side effects of enalapril include the following:

1. When the nervous system is damaged, headaches, excessive fatigue, and dizziness occur. Occasionally, with the consumption of higher dosages of the substance, depressive conditions, sleep problems, and nervousness are possible. There is also a risk of tinnitus, balance problems or paresthesias.
2. With damage to the heart and blood vessels, fainting, orthostatic hypotension. Sometimes there are pains in the heart and palpitations are felt. Occasionally, when a substance is taken in a high dosage, hot flashes appear.
3. With damage to the digestive system, nausea occurs. Sometimes there may be vomiting, problems with stools, dry mouth, pain in the abdomen. There is also a risk of an increase in the activity of liver transaminases, the appearance of hepatitis or pancreatitis. There is also a risk of liver problems and an increase in bilirubin levels. Glossitis is very rare.
4. With damage to the urinary organs, proteinuria develops and the kidneys are disrupted.
5. On the part of the hematopoietic system, neutropenia occurs in rare situations. People with autoimmune pathologies are likely to develop agranulocytosis.
6. If the respiratory system is affected, there is a threat of dry cough.
7. The reproductive system can react to the use of the drug with the appearance of impotence. However, this violation occurs extremely rarely when the substance is consumed in large quantities.
8. Allergy occurs very rarely and is accompanied by rashes or angioedema.
9. Dermatological reactions manifest as hair loss. However, this is extremely rare and is usually associated with the use of a high dosage of the drug.
10. Occasionally, the drug provokes an increase in potassium content and the appearance of muscle cramps.

Interaction features

Eating food does not affect the absorption of the medicine. Enalapril is able to potentiate the hypotensive activity of beta-blockers, prazosin, nitrates. The same applies to the use of hydralazine, methyldopa, potassium ion antagonists. When combined with non-steroidal anti-inflammatory drugs, the effectiveness of enalapril decreases.

If you combine the substance with potassium preparations or potassium-sparing diuretics, there is a possibility of hyperkalemia. Also, enalapril leads to a decrease in lithium clearance, a decrease in the half-life of theophylline. The use of cimetidine causes an increase in the half-life of enalapril.

The risk of hypotension increases when the drug is combined with anesthetic substances. The same effect appears when combined with alcohol.

Overdose

Spasm

With excessive use of the drug, there is a risk of a serious drop in blood pressure. In severe cases, even collapse occurs. There is also a risk of acute problems with cerebral circulation, heart attack or thromboembolism. Seizures or stupor may occur.

To eliminate the negative consequences of an overdose, you must lie down. The head should be placed fairly low. In simple situations, it is enough to rinse the stomach and inject the salt solution inside.

In advanced situations, measures are required to stabilize the pressure. For this purpose, plasma substitutes are used and a 0.9% sodium chloride solution is administered intravenously. If necessary, hemodialysis is performed or angiotensin II is used by intravenous administration.

Analogs

In some situations, the need arises for the use of other substances. To analogs of enalapril with the same active ingredient relate:

There are combination medications that also include a diuretic component -. Due to this, the hypotensive activity of the substance increases.

Analogs to substances with a similar effect include the following:

Hungary Germany India Macedonia / Russia Republic of Belarus Republic of Macedonia Russia Serbia Serbia and Montenegro Serbia / Russia Yugoslavia

Product group

Cardiovascular drugs

Antihypertensive combined remedy(angiotensin converting enzyme (ACE) inhibitor + diuretic).

Forms of issue

• 10 - blisters (2) - packs of cardboard 10 - blisters (2) - packs of cardboard. 10 - contour cell packs (1) - cardboard packs. 10 - contour cell packs (2) - cardboard packs. 10 - contoured cell packs (3) - cardboard packs. 10 - contour cell packs (1) - cardboard packs. 10 - contour cell packs (2) - cardboard packs. 10 - contoured cell packs (3) - cardboard packs. 10 - contour cell packs (2) - cardboard packs 10 - contour cell packs (2) - cardboard packs. 10 - contour cell packs (2) - cardboard packs. 10 - contour cell packs (2) - cardboard packs. 10 - contour cell packs (2) - cardboard packs. 10 - contoured cell packs (3) - cardboard packs. 10 - contoured cell packs / polymer coated paper / PVC / (2) - 10 packs of cardboard. - blisters (2) - packs of cardboard 10 pcs. - blisters (5) - cardboard packs. 10 pieces. - blisters Al / Al (2) - packs of cardboard 10 pcs. - blisters Al / Al (2) - packs of cardboard. 20 tabs per pack 30 tabs per pack 20 tablets, 20 tablets per pack 12.5 mg tablets + 20 mg 20 tablets per pack 20 tablets pack 28 tablets enalapril maleate 10 mg 10 pcs. - contour cell packaging (2) - cardboard packs.

Description of the dosage form

• white round flat tablets with beveled edges, scored on one side and smooth on the other, round, biconvex tablets from white to white with a yellowish honeycomb. white round flat tabs with a line on one side and smooth on the other Tablets Tablets Tablets 10 mg: round, biconvex tablets of red-brown color with light and dark blotches on the surface and on the cross-section. tablets, white with a yellowish tinge, flat-cylindrical, with a bevel. White tablets. White tablets, round, biconvex, scored. White tablets, round, biconvex, scored on one side. White tablets, round, biconvex, scored on one side. The tablets are red-brown in color with individual impregnations, round, biconvex, with a risk. Tablets are round, biconvex from light pink to pink in color with light and dark blotches on the surface and in cross section. Tablets are light orange in color with individual impregnations, round, biconvex, scored.

pharmachologic effect

Combined drug, the action of which is due to the properties of the components that make up its composition. Enalapril, an ACE inhibitor, is a prodrug: as a result of its hydrolysis, enalaprilat is formed, which inhibits ACE. Hydrochlorothiazide is a thiazide diuretic. Acts at the level of the distal renal tubules, increasing the excretion of sodium and chlorine ions. At the beginning of treatment with hydrochlorothiazide, the volume of fluid in the vessels decreases as a result of increased excretion of sodium and fluid, which leads to a decrease in blood pressure and a decrease in cardiac output. Due to hyponatremia and a decrease in fluid in the body, the RAAS is activated. The reactive increase in the concentration of angiotensin II partially limits the decrease in blood pressure. With continued therapy, the hypotensive effect of hydrochlorothiazide is based on a decrease in the systemic vascular resistance. The activation of the renin-angiotensin-aldosterone system results in metabolic effects on the electrolyte balance of the blood, uric acid, glucose and lipids, which partially neutralizes the effectiveness of antihypertensive treatment. Despite an effective decrease in blood pressure, thiazide diuretics do not reduce structural changes in the heart and blood vessels. Enalapril enhances the antihypertensive effect: inhibits the RAAS, i.e. production of angiotensin II and its effects. Additionally, it reduces the production of aldosterone and enhances the action of bradykinin and the release of prostaglandins. Because it often has its own diuretic effect, which can enhance the action of hydrochlorothiazide. Enalapril reduces pre- and afterload, which unloads the left ventricle, reduces regression of hypertrophy and collagen proliferation, and prevents damage to myocardial cells. As a result, the heart rhythm slows down and the load on the heart decreases (in chronic heart failure), the coronary blood flow improves and the oxygen consumption of cardiomyocytes decreases. Thus, the sensitivity of the heart to ischemia decreases, and the number of dangerous ventricular arrhythmias also decreases. Has a beneficial effect on cerebral blood flow in patients with arterial hypertension and chronic cardiovascular disease. Prevents the development of glomerulosclerosis, maintains and improves renal function and slows down the course of chronic kidney disease, even in those patients who have not yet developed arterial hypertension. It is known that the antihypertensive effect of ACE inhibitors is higher in patients with hyponatremia, hypovolemia and increased level serum renin, while the effect of hydrochlorothiazide does not depend on serum renin. Therefore, the simultaneous administration of enalapril and hydrochlorothiazide has an additional antihypertensive effect. In addition, enalapril prevents or attenuates the metabolic effects of diuretic therapy and has a beneficial effect on structural changes in the heart and blood vessels. The simultaneous appointment of an ACE inhibitor and hydrochlorothiazide is used when each drug alone is not effective enough or monotherapy is carried out using maximum doses the drug, which increases the incidence of undesirable effects. This combination allows you to obtain a better therapeutic effect with lower doses of enalapril and hydrochlorothiazide and to reduce the development of unwanted effects. The antihypertensive effect of the combination usually lasts for 24 hours.

Pharmacokinetics

Enalapril Absorption Enalapril is rapidly absorbed from the gastrointestinal tract. The suction volume is 60%. Food does not affect the absorption of enalapril. Tmax is 1 hour. Tmax of enalaprilat in serum is 3-6 hours. Distribution Enalaprilat penetrates into most body tissues, mainly into the lungs, kidneys and blood vessels... Plasma protein binding 50-60%. Enalapril and enalaprilat penetrate the placental barrier, are excreted in breast milk. Metabolism In the liver, enalapril is hydrolyzed to an active metabolite - enalaprilat, which is a carrier of the pharmacological effect and does not undergo further metabolism. Excretion Excretion is a combination of glomerular filtration and tubular secretion. Renal clearance of enalapril and enalaprilat is 0.005 ml / s (18 l / h) and 0.00225-0.00264 ml / s (8.1-9.5 l / h), respectively. It is withdrawn in several stages. With the appointment of multiple doses of enalapril T1 / 2 of enalaprilat from the blood serum is approximately 11 hours. Enalapril is excreted in the urine - 60% and feces - 33%, mainly in the form of enalaprilat. Enalaprilat is 100% excreted in the urine. Enalaprilat is removed from the bloodstream by hemodialysis or peritoneal dialysis. Hemodialysis clearance of enalaprilat 0.63-1.03 ml / s (38-62 ml / min). The serum concentration of enalaprilat after 4 hours of hemodialysis decreases by 45-57%. Pharmacokinetics in special clinical situations In patients with reduced renal function, excretion is slowed down, which requires a dosage change in accordance with renal function, especially in patients with severe renal failure. In patients with hepatic impairment, the metabolism of enalapril can be slowed down without damaging its pharmacodynamic effect. In patients with heart failure, absorption and metabolism of enalaprilat slows down, and Vd also decreases. Since these patients may have renal failure, the excretion of enalapril may be slowed down in them. In elderly patients, the pharmacokinetics of enalapril may change to a greater extent due to concomitant diseases than the elderly. Hydrochlorothiazide Absorption Hydrochlorothiazide is absorbed mainly in duodenum and proximal small intestine... Absorption is 70% and increases by 10% when taken with food. Tmax is 1.5-5 hours. V distribution is about 3 l / kg. Plasma protein binding - 40%. The drug accumulates in erythrocytes, the mechanism of accumulation is unknown. Penetrates the placental barrier and accumulates in the amniotic fluid. The serum concentration of hydrochlorothiazide in the umbilical vein blood is practically the same as in the maternal blood. The concentration in the amniotic fluid is 19 times higher than that in the serum from the umbilical vein. Hydrochlorothiazide level in breast milk very low. Hydrochlorothiazide was not detected in the serum of infants whose mothers took hydrochlorothiazide during breastfeeding.

Special conditions

Care must be taken when prescribing Enalapril to patients with reduced BCC (as a result of diuretic therapy, with restriction of salt intake, hemodialysis, diarrhea and vomiting) - the risk of a sudden and pronounced decrease in blood pressure is increased after using even the initial dose of an ACE inhibitor. Transient arterial hypotension is not a contraindication for continuing treatment with the drug after stabilization of blood pressure. In case of repeated pronounced decrease in blood pressure, the dose should be reduced or the drug should be discontinued. The use of highly permeable dialysis membranes increases the risk of developing an anaphylactic reaction. Correction of the dosage regimen on days free from dialysis should be carried out depending on the level of blood pressure. Before and during treatment with ACE inhibitors, periodic monitoring of blood pressure, blood parameters (hemoglobin, potassium, creatinine, urea, liver enzyme activity), and protein in the urine is necessary. Patients with severe heart failure, ischemic heart disease and cerebrovascular disease should be closely monitored, in whom a sharp decrease in blood pressure can lead to myocardial infarction, stroke, or renal impairment. Abrupt withdrawal of treatment does not lead to withdrawal syndrome (a sharp rise in blood pressure). For newborns and infants who have been exposed to intrauterine exposure to ACE inhibitors, it is recommended to closely monitor for the timely detection of a pronounced decrease in blood pressure, oliguria, hyperkalemia and neurological disorders possible due to a decrease in renal and cerebral blood flow with a decrease in blood pressure caused by ACE inhibitors. With oliguria, it is necessary to maintain blood pressure and renal perfusion by introducing appropriate fluids and vasoconstrictors. In the presence of renal failure, it is possible to reduce the excretion of the active metabolite, leading to an increase in its concentration in the blood plasma. These patients may require lower doses of the drug. In patients with arterial hypertension and unilateral or bilateral stenosis of the renal arteries, an increase in the content of urea and creatinine in the blood serum is possible. In such patients, it is necessary to monitor renal function during the first few weeks of therapy. It may be necessary to reduce the dosage of the drug. The ratio of risk and potential benefit should be taken into account when prescribing Enalapril to patients with coronary and cerebrovascular insufficiency, due to the danger of increased ischemia with excessive arterial hypotension. The drug should be administered with caution to patients with diabetes mellitus due to the risk of developing hyperkalemia. Patients with a history of indications of angioedema may have an increased risk of developing angioedema during treatment with Enalapril. Patients with severe autoimmune diseases, such as systemic lupus erythematosus or scleroderma, have an increased risk of neutropenia or agranulocytosis while taking Enalapril. It is recommended to exercise caution when prescribing Enalapril for the treatment of chronic heart failure in patients receiving cardiac glycosides and / or diuretics. Before examining the functions of the parathyroid glands, the drug should be canceled. Alcohol enhances the hypotensive effect of the drug. Before surgery (including dentistry), the surgeon / anesthetist should be warned about the use of ACE inhibitors. Influence on the ability to drive vehicles and control mechanisms At the beginning of treatment, until the end of the dose selection period, it is necessary to refrain from driving vehicles and engaging in potentially hazardous activities that require increased concentration of attention and speed of psychomotor reactions, since dizziness is possible, especially after the initial dose of the inhibitor ACE in patients taking diuretics. Overdose Symptoms: a pronounced decrease in blood pressure up to the development of collapse, myocardial infarction, acute cerebrovascular accident or thromboembolic complications, convulsions, stupor. Treatment: the patient is transferred to horizontal position with a low headboard. In mild cases, gastric lavage and ingestion of saline are indicated, in more severe cases, measures aimed at stabilizing blood pressure: intravenous administration of saline, plasma substitutes, if necessary, administration of angiotensin II, hemodialysis (the rate of elimination of enalaprilat averages 62 ml / min ).

Composition

• 1 tab. enalapril maleate 10 mg Excipients: lactose monohydrate 124.6 mg, corn starch 21.4 mg, talc 6 mg, sodium bicarbonate 5.1 mg, magnesium stearate 1.7 mg, iron dye red oxide 1.2 mg. 1 tab. enalapril maleate 20 mg Excipients: lactose monohydrate 117.8 mg, corn starch 13.9 mg, talc 6 mg, sodium bicarbonate 10.2 mg, magnesium stearate 1.7 mg, iron dye red oxide 0.1 mg, iron dye yellow oxide 0.3 mg. 1 tab. enalapril maleate 5 mg 1 tab. enalapril maleate 10 mg 1 tab. enalapril maleate 10 mg hydrochlorothiazide 25 mg 1 tab. enalapril maleate 20 mg 1 tab. enalapril maleate 20 mg Excipients: lactose monohydrate 117.8 mg, corn starch 13.9 mg, talc 6 mg, sodium bicarbonate 10.2 mg, magnesium stearate 1.7 mg, iron dye red oxide 0.1 mg, iron dye yellow oxide 0.3 mg. 1 tab. enalapril maleate 20 mg Excipients: lactose monohydrate, magnesium carbonate, gelatin, crospovidone, magnesium stearate. 1 tab. enalapril maleate 5 mg 1 tab. enalapril maleate 5 mg Excipients: lactose monohydrate 129.8 mg, corn starch 22.4 mg, talc 6 mg, sodium bicarbonate 2.6 mg, hyprolose 2.5 mg, magnesium stearate 1.7 mg. 1 tablet contains the active substance: Enalapril maleate - 5.0 mg Excipients: Lactose, calcium hydrogen phosphate, microcrystalline cellulose, starch, magnesium stearate, talc, sodium carboxymethyl starch, colloidal silicon dioxide. 1 tablet contains: active ingredient - enalapril maleate 10 mg; excipients: lactose monohydrate, povidone, potato starch, talc, magnesium stearate. 1 tablet contains: active ingredient - enalapril maleate 5 mg; excipients: lactose monohydrate, povidone, potato starch, talc, magnesium stearate. 1 tablet contains: active substance: enalapril maleate 10 mg; excipients: microcrystalline cellulose 68 mg, pregelatinized corn starch 30 mg, talc 3.00 mg, colloidal silicon dioxide 1.00 mg, magnesium stearate 1.00 mg, iron oxide red - / 2.00 mg / 0.10 mg. 1 tablet contains: active substance: enalapril maleate 20 mg; excipients: microcrystalline cellulose 70 mg, corn starch andrejelatinized 43 mg, talc 4.10 mg, colloidal silicon dioxide 1.40 mg, magnesium stearate 1.40 mg, iron oxide red 0.10 mg. 1 tablet contains: active substance: enalapril maleate 5 mg; excipients: microcrystalline cellulose 73. 00 mg, pregelatinized corn starch 30.00 mg, talc 3.00 m, colloidal silicon dioxide 1.00 mg g, magnesium stearate 1.00 iron oxide red - 2.00 mg hydrochlorothiazide - 12.5 mg and enalapril maleate - 20.0 mg hydrochlorothiazide 12.5 mg enalapril maleate 10 mg Excipients: lactose monohydrate 24.5 mg, potato starch 10 mg, microcrystalline cellulose 35 mg, povidone 2 mg, sodium bicarbonate 2 mg, sodium carboxymethyl starch (sodium starch glycolate) 2 mg, talc 1 mg, magnesium stearate 1 mg. hydrochlorothiazide 12.5 mg enalapril maleate 20 mg Excipients: lactose monohydrate 18.5 mg, potato starch 10 mg, microcrystalline cellulose 31 mg, povidone 2 mg, sodium bicarbonate 2 mg, sodium carboxymethyl starch (sodium starch glycolate) 2 mg, talcum powder magnesium stearate 1 mg. hydrochlorothiazide 12.5mg, enalapril 10mg; Auxiliary substances: lactose, MCC, povidone, croscarmellose sodium, colloidal silicon dioxide Hydrochlorothiazide 25mg; Enalapril 10mg; Auxiliary substances: lactose monohydrate, potato starch, MCC, povidone, sodium bicarbonate, sodium carboxymethyl starch, talc, magnesium stearate Hydrochlorothiazide 25mg; Enalapril 10mg; Auxiliary substances: lactose, MCC, povidone, croscarmellose sodium, colloidal silicon dioxide, magnesium stearate, enalapril 10 mg; Auxiliary substances: lactose monohydrate; magnesium carbonate; gelatin; crospovidone; magnesium stearate enalapril 10 mg; Auxiliary substances: potato starch, calcium stearate, lactose, povidone enalapril 10 mg; Auxiliary substances: lactose monohydrate; magnesium carbonate; gelatin; crospovidone; magnesium stearate Enalapril 10mg; Auxiliary substances: lactose, potato starch, sugar, gelatin, calcium stearate, Enalapril 10MG; Auxiliary substances: lactose, potato starch, talc, calcium stearate, enalapril hyprolose 20 mg; Auxiliary substances: potato starch, calcium stearate, lactose, povidone enalapril 20 mg; Auxiliary substances: lactose monohydrate; magnesium carbonate; gelatin; crospovidone; magnesium stearate enalapril 30 mg; Auxiliary substances: potato starch, calcium stearate, lactose, povidone enalapril 5 mg; Auxiliary substances: lactose monohydrate; magnesium carbonate; gelatin; crospovidone; magnesium stearate enalapril maleanate 5mg; Auxiliary substances: lactose monohydrate; magnesium carbonate; gelatin; crospovidone; magnesium stearate enalapril maleate 10 mg Excipients: sodium bicarbonate, lactose monohydrate, corn starch, talc, magnesium stearate, iron oxide red. enalapril maleate 10 mg hydrochlorothiazide 25 mg Auxiliary substances: lactose monohydrate; magnesium carbonate; gelatin; crospovidone; magnesium stearate enalapril maleate 10 mg; Excipients: potato starch, calcium stearate, lactose, povidone enalapril maleate 20 mg Excipients: sodium bicarbonate, lactose monohydrate, corn starch, talc, magnesium stearate, iron oxide red, iron oxide yellow enalapril maleate 5 mg : potato starch, calcium stearate, lactose, povidone enalapril maleate 5 mg Excipients: sodium bicarbonate, lactose monohydrate, corn starch, talc, hyprolose, magnesium stearate. enalapril maleate 10 mg Excipients: potato starch, lactose (milk sugar), low molecular weight povidone, calcium stearate

Enalapril indications for use

• Arterial hypertension (including renovascular), chronic heart failure (as part of combination therapy). Essential hypertension. Chronic heart failure (as part of combination therapy). Prevention of the development of clinically severe heart failure in patients with asymptomatic left ventricular dysfunction (as part of combination therapy). Prevention of coronary ischemia in patients with left ventricular dysfunction in order to reduce the incidence of myocardial infarction and reduce the incidence of hospitalizations for unstable angina.

Enalapril contraindications

• Hypersensitivity to enalapril and other ACE inhibitors, a history of angioedema associated with treatment with ACE inhibitors, porphyria, pregnancy, lactation, age up to 18 years (efficacy and safety have not been established). Use with caution in primary hyperaldosteronism, bilateral renal artery stenosis, stenosis of the artery of a single kidney, hyperkalemia, condition after kidney transplantation; aortic stenosis, mitral stenosis (with hemodynamic disturbances), idiopathic hypertrophic subaortic stenosis, systemic connective tissue diseases, ischemic heart disease, cerebrovascular diseases, diabetes mellitus, renal failure (proteinuria more than 1 g / day), liver failure, in patients on a diet with salt restriction or those on hemodialysis, while taking it with immunosuppressants and saluretics, in the elderly (over 65 years old).

Enalapril dosage

• 10 mg 10 mg + 25 mg 12.5 mg + 10 mg 12.5 mg + 20 mg 2.5 mg 2.5 mg, 5 mg, 10 mg, 20 mg 20 mg 25 mg + 10 mg 5 mg 5 mg, 10 mg, 20 mg

Enalapril side effects

• Side effects are classified according to the WHO recommendation in accordance with the frequency of their occurrence: very often - at least 10%; often - not less than 1%, but less than 10%; infrequently - not less than 0.1%, but less than 1%; rarely - not less than 0.01%, but less than 0.1%; very rarely - less than 0.01%, including individual messages. From the hematopoietic and lymphatic system: infrequently - anemia (including aplastic and hemolytic); rarely - neutropenia, decreased hemoglobin and hematocrit, thrombocytopenia, agranulocytosis, inhibition of bone marrow hematopoiesis, pancytopenia, lymphadenopathy, autoimmune diseases... Violations of its side of metabolism and nutrition: infrequently - hypoglycemia. From the side of the central nervous system: very often - dizziness; often -headache, depression; infrequently - confusion, insomnia, hyperexcitability, paresthesia, vertigo; rarely - unusual dreams, sleep disturbances. From the senses: infrequently - tinnitus; rarely - blurred vision. From the side of the cardiovascular system: often - a marked decrease in blood pressure, fainting, chest pain, heart rhythm disturbances, angina pectoris, tachycardia; infrequently - a feeling of palpitations, orthostatic hypotension, myocardial infarction or cerebrovascular accident (possibly caused by a sharp decrease in blood pressure in high-risk patients); rarely - Raynaud's syndrome. From the respiratory system: very often - cough, often shortness of breath, infrequently rhinorrhea. sore throat and hoarseness, bronchospasm, / bronchial asthma, infiltrates in the lungs, rhinitis, allergic alveolitis / eosinophilic pneumonia. From the digestive system: very often - nausea; often - diarrhea, abdominal pain, change in taste; infrequently - intestinal obstruction, pancreatitis, vomiting, dyspepsia, constipation, anorexia, dryness of the oral mucosa. peptic ulcer; rarely - somatitis / aphthous ulcers, glossitis; very rarely - intestinal angioedema. From the liver and biliary tract: rarely - liver failure, hepatitis (hepatocellular or cholestatic), including hepatic necrosis, cholestasis (including jaundice). On the part of the skin and subcutaneous tissues: often - hypersensitivity reactions / angioedema of the face, extremities, lips, tongue, vocal folds and / or larynx, skin rash; infrequently - increased sweating, itchy skin, urticaria, alopecia; rarely - exudative erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis. exfoliative dermatitis, pemphigus, erythroderma. A symptom complex has been reported, which may be accompanied by some and / or all of the listed symptoms: fever, scrositis, vasculitis, myalgia / myositis, arthralgia / arthritis, increased antinuclear antibody titer, increased erythrocyte sedimentation rate, eosinophilia and leukocytosis. Skin rash, photosensitivity, or other skin manifestations may occur. From the side of the kidneys and urinary tract: infrequently - impaired renal function, acute renal failure, proteinuria; rarely oliguria. On the part of the genitals and mammary gland: infrequently - impotence; rarely, gynecomastia. Laboratory indicators: often - hyperkalemia, increased serum creatinine concentration; infrequently - hyloatremia, hyperuricemia; rarely - increased activity of "liver" enzymes, hyperbilirubinemia. Others: very often - asthenia; often - increased fatigue; infrequently - muscle cramps, flushing of the face, general malaise, fever. In rare cases, with the simultaneous use of ACE inhibitors (including enalapril) and intravenous (iv) administration of gold preparations (sodium aurothiomalate), a symptom complex has been described, including facial redness, nausea, vomiting, and arterial hypotension. With the use of ACE inhibitors, rare cases of the development of a syndrome of inappropriate secretion of aitidiuretic hormone have been reported. Adverse events that were observed during the post-marketing use of enalapril (causal relationship has not been established): urinary tract infection, upper respiratory tract, bronchitis, cardiac arrest, atrial fibrillation, herpes zoster, melena, ataxia, branch thromboembolism pulmonary artery and lung infarction, hemolytic anemia, including cases of hemolysis in patients with glucose-6-phosphate dehydrogenase deficiency.

Drug interactions

Calcium-sparing diuretics and potassium supplements. The simultaneous use of enalapril and potassium-sparing diuretics (such as spironolactone, eplerenone, triamterene, amiloride), potassium preparations or potassium-containing substitutes for food salt, as well as the use of other drugs that increase the level of potassium in the blood plasma (for example, heparin) can lead to a significant increase in the level potassium in blood plasma. If it is necessary to use enalapril with the above drugs, regular monitoring of the potassium content in the blood plasma should be carried out. Diuretics (thiazide and "loop"). The use of diuretics in high doses can lead to hypovolemia (due to a decrease in the BCC), and the addition of enalapril to therapy can lead to a pronounced decrease in blood pressure. The excessive antihypertensive effect of enalapril can be reduced either by discontinuing the diuretic, or by increasing the BCC or the use of table salt, as well as by reducing the dose of enalapril. Other antihypertensive drugs. The simultaneous use of enalapril and beta-blockers, alpha-blockers, gaiiglioblocking agents, methyldones, nitroglycerin and other nitrates or blockers of "slow" calcium channels can further reduce blood pressure. Lithium. With the simultaneous use of enalapril with lithium preparations - slowing down the excretion of lithium (increasing the cardiotoxic and neurotoxic effects of lithium). If necessary, the use of this combination should regularly monitor the concentration of lithium in the blood plasma. Tricyclic antidepressants, antipsychotics (antipsychotics), drugs for general anesthesia enhance the antihypertensive effect and increase the risk of orthostatic hypotension (additive effect). Non-steroidal anti-inflammatory drugs. The simultaneous use of non-steroidal anti-inflammatory drugs (NG1VP) (incl. selective inhibitors cyclooxygenase-2 (COX-2)) can weaken the antihypertensive effect of antihypertensive drugs. Thus, the antihypertensive effect of angiotensin II receptor antagonists or ACE inhibitors may be attenuated by NSAIDs, including COX-2 inhibitors. NSAIDs and ACE inhibitors have an additive effect on increasing serum potassium levels, which can lead to impaired renal function, especially in patients with impaired nighttime function. This effect is reversible. With simultaneous use in patients with impaired night function, caution should be exercised. Gold preparations. With the simultaneous use of ACE inhibitors and gold preparations (sodium aurothiomalate) intravenously, a symptom complex is described, including flushing of the skin of the face, nausea, vomiting and arterial hypotension. Sympathomimetics may reduce the antihypertensive effect of ACE inhibitors. Oral hypoglycemic agents and insulin. Epidemiological studies suggest that the simultaneous use of ACE inhibitors and hypoglycemic agents may lead to hypoglycemia. Most often, hypoglycemia develops in the first weeks of therapy in patients with impaired renal function. Long lasting and controlled clinical researches enalapril does not confirm these data and does not limit the use of enalapril in patients with diabetes mellitus. However, such patients should be monitored regularly. Ethanol may enhance the antihypertensive effect of ACE inhibitors. Acetylsalicylic acid, thrombolytics and beta-blockers. Enalapril can be used simultaneously with acetylsalicylic acid (as an antiplatelet agent), thrombolytics and beta-blockers. Allopuriol, cytostatics and immunosuppressants. Concomitant use with ACE inhibitors may increase the risk of developing leukopenia. Cyclosporine. Concomitant use with ACE inhibitors may increase the risk of developing hyperkalemia. Antacids may decrease the bioavailability of ACE inhibitors. Enalapril weakens the action drugs containing theophylline. There was no clinically significant pharmacokinetic interaction with hydrochlorothiazide, furosemide, digoxin, timolol, methyldopa, warfarin, indomethacin, sulindac and cimetidine. Double blockade of the renin-angiotensin-aldosterone system (RAAS) with the use of angiotensin II receptor antagonists, ACE inhibitors or aliskiren (direct renin inhibitor) is associated with an increased risk of arterial hypotension, syncope, hyperkalemia and renal dysfunction (including acute renal failure) compared to monotherapy. Regular monitoring of blood pressure, renal function and blood electrolytes is required in patients taking Enalapril and other drugs that affect the RAAS. can be reduced lyoo by abolishing diureticr, lyoo by increasing 01 (K z endapril. st, meldone, nitroglycerin and other nitrates or blockers of "slow" calcium channels can further reduce blood pressure. Lithium. With the simultaneous use of enalapril with lithium preparations - slowing down elimination of lithium (enhancement of the cardiotoxic and neurotoxic effects of lithium) .If necessary, the use of this combination should regularly monitor the concentration of lithium in the blood plasma.Tricyclic antidepressants, antipsychotics (antipsychotics), drugs for general anesthesia enhance the antihypertensive effect and increase the risk of orthostatic hypotension ( additive effect). Non-steroidal anti-inflammatory drugs. The simultaneous use of non-steroidal anti-inflammatory drugs (NG1VP) (including selective inhibitors of cyclooxygenase-2 (COX-2)) can weaken the antihypertensive effect of antihypertensive drugs. Thus, antihyper the tensile effect of angiotensin II receptor antagonists or ACE inhibitors can be attenuated by NSAIDs, including COX-2 inhibitors. NSAIDs and ACE inhibitors have an additive effect on increasing serum potassium levels, which can lead to impaired renal function, especially in patients with impaired nighttime function. This effect is reversible. With simultaneous use in patients with impaired night function, caution should be exercised. Gold preparations. With the simultaneous use of ACE inhibitors and gold preparations (sodium aurogiomalat) intravenously, symptom complex has been described, including flushing of the skin of the face, nausea, vomiting and arterial hypotension. Sympathomimetics may reduce the antihypertensive effect of ACE inhibitors. Oral hypoglycemic agents and insulin. Epidemiological studies suggest that the simultaneous use of ACE inhibitors and hypoglycemic agents may lead to hypoglycemia. Most often, hypoglycemia develops in the first weeks of therapy in patients with impaired renal function. Long-term and controlled clinical studies of enalapril ns confirm these data and do not limit the use of enalapril in patients

Overdose

Symptoms: a pronounced decrease in blood pressure, up to the development of collapse, myocardial infarction, acute cerebrovascular accident or thromboembolic complications, imbalance in water and electrolyte balance, renal failure, rapid breathing, tachycardia, palpitations, bradycardia, dizziness, anxiety, feeling of fear cough, stupor. The concentration of enalaprilat in blood plasma is 100-200 times higher than after the use of therapeutic doses was observed after oral administration of 300 mg and 440 mg of enalapril, respectively. Treatment: the patient is placed in a horizontal position with a low headboard. In mild cases, gastric lavage and ingestion of activated charcoal are indicated, in more serious cases, measures aimed at normalizing blood pressure: intravenous administration of 0.9% sodium chloride solution, plasma substitutes, if necessary, intravenous administration of catecholamines, hemodialysis (speed elimination of enalaprilat - 62 ml / min). Patients with therapy-resistant bradycardia are indicated for driver positioning.

Storage conditions

• store in a dry place
• keep away from children
• store in a dark place

Information provided by the State Register of Medicines.

Synonyms

• Berlipril, Vasopren, Renitek, Ednit, Enap, Enam, Envas