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.

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.

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 are good at lowering blood pressure when it is elevated.

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

High blood pressure pills 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, is available in the form of tablets with various dosages 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 or behind the left scapula;
• 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, that such side effects, how:

• 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 intake of diuretics. This is noted in the instructions for use and should be taken into account if you are prescribed such therapy.

Data should be monitored regularly during treatment. blood pressure and blood counts, liver and kidney status.

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 medication 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 use of Enalapril when high blood 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, an ambulance team should be called. 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, an hour after administration, the maximum concentration of the active substance is found 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. 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.

Can i drink at low blood pressure?

Often the question arises in patients "is it possible to drink enalapril at low pressure?" If you have a constant, 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 medication that bother you, be sure to also contact your doctor.

Useful video

For more information, 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.

INN: Enalapril

Manufacturer: Borisov plant of medical preparations JSC

Anatomical-therapeutic-chemical classification: Enalapril

Registration number in the RK: No. RK-LS-5 No. 019608

Registration period: 28.01.2013 - 28.01.2018

Instructions

Tradename

Enalapril

International non-proprietary name

Enalapril

Dosage form

5 mg and 10 mg tablets

Composition

One tablet contains

active substance- enalapril maleate 5 mg or 10 mg,

Excipients: lactose monohydrate, povidone, potato starch, talc, magnesium stearate.

Description

Tablets are white or white with a yellowish sheen, flat-cylindrical, with a score and a chamfer.

Farmakotherapeutic group

Drugs affecting the renin-angiotensin system. Angiotensin-angiotensin-converting enzyme (ACE). ACE inhibitors. Enalapril.

ATX code С09АА02

Pharmacological properties

Pharmacokinetics

After oral administration, about 60% of the drug is absorbed, food does not affect the absorption of enalapril. After taking a dose of 10 mg, the time to reach the maximum concentration in the blood plasma is 1 hour, and its level is 200-400 ng / ml. After absorption, it undergoes presystemic metabolism in the liver with the formation of active enalaprilat. Enalaprilat easily passes through the histohematogenous barriers (excluding the blood-brain barrier), crosses the placenta and is found in fetal tissues. The half-life of enalapril is 2 hours. After a dose of 20 mg, the maximum concentration of enalaprilat in the blood plasma is 70-100 ng / ml and is reached after 3-4 hours. The therapeutic concentration of enalaprilat in the blood plasma is 10-100 ng / ml. It binds to plasma proteins by 50%. The half-life of enalaprilat is 8-11 hours. 60% of the dose taken (20% as enalapril and 40% as enalaprilat) is eliminated in the urine and 33% through the intestines (6% as enalapril and 27% as enalaprilat). Within 24 hours, about 90% of the dose taken is eliminated. In severe chronic renal failure (creatine clearance less than 30 ml / min), the elimination of enalaprilat slows down, and its plasma level increases 13 times, drug accumulation occurs when creatine clearance is less than 10 ml / min. Removed by hemodialysis and peritoneal dialysis.

Pharmacodynamics

Enalapril has a hypotensive, vasodilating and cardioprotective effect.

Enalapril inhibits the activity of the angiotensin-converting enzyme (ACE). As a result, the formation of angiotensin II decreases, the secretion of aldosterone is stimulated. It prevents the breakdown of bradykinin and enhances its vasodilating effect on the B2-type bradykinin receptors.

As a result of the use of enalapril in the blood plasma, the level of vasoconstrictor hormones decreases; the level of bradykinin, prostaglandin E2 and prostacyclin, endothelial relaxing factor and atrial natriuritic peptide increases.

Enalapril causes vasodilation and lowers blood pressure. With the introduction of enalapril, the hypotensive effect develops 1 hour after administration, reaches a maximum by 6 hours and lasts about 24 hours. Enalapril slows down the development of hypertrophy and fibrosis of the arterial wall. Thanks to vasodilating action enalapril reduces total peripheral vascular resistance (myocardial afterload), pulmonary capillary wedge pressure (myocardial preload), pulmonary vascular resistance, increases cardiac output... With prolonged use, it reduces the severity of myocardial hypertrophy, prevents the progression of heart failure and slows down the development of left ventricular dilation (cardioprotective effect).

Indications for use

Arterial hypertension

Chronic heart failure (as part of combination therapy)

Prevention of symptomatic heart failure in patients with asymptomatic left ventricular dysfunction (left ventricular ejection fraction< 35 %)

Method of administration and dosage

Administered orally, regardless of food intake. In patients with high activity of the renin-angiotensin-aldosterone system (for example, renovascular hypertension, salt deficiency and / or dehydration, cardiac decompensation or severe form arterial hypertension) there may be a sharp drop in blood pressure after taking the first dose. In this connection, the first dose is better taken at bedtime in the supine position.

With arterial hypertension adults are prescribed an initial dose of 5 mg once a day. If there is no effect after 1-2 weeks, the dose is increased by 5 mg. With good tolerance, the dose can be increased to 20 mg / day in 1 dose. 2-3 weeks after taking enalapril at the maximum dose, they switch to maintenance therapy at a dose of 10-20 mg / day. The maximum daily maintenance dose of enalapril is 40 mg / day (in 2 divided doses).

In the case of diuretic use, diuretic treatment should be discontinued 2-3 days before enalapril is prescribed, or enalapril should be started at a dose of 2.5 mg / day, slowly increasing the dose by 2.5 mg / week until the optimal effect is achieved.

When the concentration of Na + in the blood serum is less than 130 mmol / l or the level of creatinine in the blood serum is more than 0.14 mmol / l, the initial dose of enalapril is 2.5 mg / day.

With renovascular and renal hypertension the initial dose is 2.5-5 mg once a day, the maintenance dose is 10 mg once a day. The maximum daily dose is 20 mg in 2 divided doses.

At chronic heart failure an initial dose of 2.5 mg once with a gradual increase by 2.5-5 mg every 3-4 days to the maximum tolerable (depending on the level of blood pressure), but not more than 20 mg / day. The average maintenance dose is 5-20 mg / day. The next dose increase is carried out with a stable systolic blood pressure of more than 90 mm Hg. Art. In patients with low systolic blood pressure (less than 110 mm Hg), as well as in the elderly, treatment begins with a dose of 1.25 mg / day.

For asymptomatic left ventricular dysfunction apply 2.5 mg 2 times a day. The dose is increased by 2.5 mg every week to the optimally tolerated, but not more than 20 mg / day in 2 divided doses.

In patients with impaired renal function the initial dose of enalapril with creatinine clearance (CC) 80-30 ml / min is 5-10 mg / day, with CC 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 depends on the severity of the effect of the drug; in case of excessive hypotension, the dose of enalapril must be reduced.

Side effects

Often (≥ 1/10 ):

- blurred vision

• dizziness

Often (≥ 1/100- < 1/10 ):

hypotension (including orthostatic hypotension), fainting, pain in chest, violations heart rate, angina pectoris, tachycardia

headache, depression

fatigue

• diarrhea, abdominal pain, change in taste

  skin rash, angioedema of the face, limbs, lips, tongue, glottis and / or larynx

  hyperkalemia, increased creatinine levels

Sometimes (≥ 1/1 000 - < 1/100 ):

orthostatic hypotension, palpitations, myocardial infarction, or cerebral stroke, presumably as a result of an excessive drop in blood pressure in patients with high risk factors

confusion, drowsiness, insomnia, nervousness, dizziness, paresthesia

heartbeat

intestinal obstruction, pancreatitis, vomiting, dyspepsia, constipation, lack of appetite, symptoms of stomach irritation, dry mouth, peptic ulcer

anemia (including aplastic and hemolytic anemia)

rhinorrhea, sore throat and hoarseness, bronchospasm / asthma

sweating, itching, urticaria, alopecia

impaired renal function, renal failure, proteinuria

impotence

muscle cramps, hot flashes, tinnitus, malaise, fever

increased urea levels, hyponatremia, hypoglycemia

Rarely (≥ 1/10 000 - < 1/1000 ):

liver failure, hepatitis, cholestasis, jaundice, increased activity of "hepatic" transaminases, hyperbilirubinemia

neutropenia, decreased hemoglobin and hematocrit, thrombocytopenia, agranulocytosis, depression bone marrow, pancytopenia, enlarged lymph nodes, autoimmune diseases

changes in the nature of dreams, sleep disturbances

Raynaud's syndrome

pulmonary infiltrates, rhinitis, allergic alveolitis / eosinophilic pneumonia

stomatitis / aphthous ulcers, glossitis

liver failure, hepatitis - hepatocellular or cholestatic, including hepatic necrosis, cholestasis (including jaundice)

erythema multiforme, Stevens-Johnson syndrome, exfoliative dermatitis, toxic epidermal necrolysis, pemphigus, erythroderma

oliguria

gynecomastia

increased levels of liver enzymes, increased serum bilirubin levels

Very rarely (< 1/10 000 ):

angioedema of the intestine

Frequency unknown:

Parkhon's syndrome (syndrome of inappropriate antidiuretic hormone secretion)

A symptom complex has been reported, which may be accompanied by some or all of the following side effects: fever, serositis, vasculitis, myalgia / myositis, arthralgia / arthritis, increased antinuclear antibody (ANA) titer, increased ESR, eosinophilia, and leukocytosis. Skin rash, photosensitivity, or other skin manifestations may occur.

Contraindications

Hypersensitivity to enalapril, drug components or other ACE inhibitors

Hereditary or angioedema that occurs after

the use of angiotensin-converting enzyme inhibitors in

anamnesis

Porphyria

Primary hyperaldosteronism

Hyperkalemia (more than 6 mmol / L)

Aortic stenosis or low-output hypertrophic cardiomyopathy

Leukopenia or thrombocytopenia

Bilateral renal artery stenosis or stenosis of an artery of a solitary kidney

Hereditary fructose intolerance, Lapp-lactase enzyme deficiency, glucose-galactose malabsorption

Pregnancy and lactation

Children and adolescents under 18 years of age

Drug interactions

Food intake does not affect the absorption of enalapril.

With the simultaneous use of enalapril and potassium-sparing diuretics (spironolactone, triamterene, amiloride) or potassium preparations development of hyperkalemia is possible. With the simultaneous use of enalapril with diuretics, beta-blockers, methyldopa, nitrates, calcium channel blockers, hydralazine, prazosin it is possible to increase the hypotensive effect. When used simultaneously with non-steroidal anti-inflammatory drugs(including with acetylsalicylic acid) it is possible to reduce the effect of enalapril and increase the risk of developing renal dysfunction. Enalapril weakens the effect of drugs containing theophylline. With the simultaneous use of enalapril and lithium preparations, the excretion of lithium is slowed down and its effect is enhanced (control of the concentration of lithium in the blood plasma is shown). With the simultaneous use of enalapril and cimetidine, the half-life of enalapril is lengthened.

Concomitant use of ACE inhibitors and antidiabetic drugs(insulin, oral hypoglycemic agents) can cause a decrease in blood glucose levels, which is accompanied by the risk of hypoglycemia. This effect is more often observed during the first weeks of combination treatment, as well as in patients with impaired renal function.

Sympathomimetics may reduce antihypertensive effect ACE inhibitors. Rarely, the occurrence of nitritoid reactions (facial flushing, nausea, vomiting and arterial hypotension) has been reported in patients who receive treatment with gold injections (sodium aurothiomalate) and at the same time ACE inhibitors, including enalapril.

Concomitant use of other antihypertensive drugs or vasodilators may enhance the hypotensive effect of enalapril.

Alcohol enhances the hypotensive effect of ACE inhibitors.

special instructions

Symptomatic hypotension

Hypotension is rare in uncomplicated arterial hypertension.

With a lack of fluid in the body, for example, as a result of diuretic therapy, a depleted diet, dialysis, diarrhea or vomiting in patients suffering from arterial hypertension, with the treatment of Enalapril, symptomatic hypotension develops more often. Patients with heart failure - with or without renal failure - have symptomatic hypotension. In particular, this may apply to patients with severe heart failure, whose severity is expressed in high doses of loop diuretics, hyponatremia, or decreased renal function. Treatment of such patients - if a new dose of Enalapril and / or a diuretic is to be selected - must be started and carried out under the supervision of a physician. This is also done in the case of patients with ischemic disease heart or cerebrovascular disease, in which an excessive drop in blood pressure can lead to myocardial infarction or cerebral stroke.

If hypotension develops, the patient should be placed in horizontal position and - if necessary - administer an intravenous infusion of sodium chloride solution. A transient hypotonic reaction is not a contraindication for further treatment, which, as a rule, can be carried out without problems after normalization (with the help of replenishing the circulating blood volume) blood pressure.

In some patients with heart failure, whose blood pressure is normal or low, under the influence of Enalapril, a further decrease in systemic blood pressure may occur. This is by no means an unexpected effect, usually, is not a reason for discontinuation of the drug. If the decrease in blood pressure becomes symptomatic, i.e. will be accompanied by symptoms, it may be necessary to reduce the dose of Enalapril and / or a diuretic and / or discontinue Enalapril.

Aortic or mitral stenosis / hypertrophic cardiomyopathy

As with other vasodilators, special caution is recommended when using an ACE inhibitor in patients who have valve obstruction and obstruction in the outflow tract in the left ventricle. In shock, accompanied by circulatory failure, and a hemodynamically obvious obstruction in the outflow tract, the use of these drugs should be avoided.

Renal dysfunction

In patients with decreased renal function (creatinine clearance< 80 мл/мин) начальную дозу эналаприла малеата следует подбирать в зависимости от клиренса креатинина у пациента.

The maintenance dose is selected depending on the patient's response to treatment. In these patients, serum potassium and creatinine control is routine as part of their usual medical supervision.

In particular, renal failure has been reported in association with the use of enalapril maleate in patients with severe heart failure or with underlying renal disease, including renal artery stenosis. With timely diagnosis and appropriate treatment, renal failure during therapy with enalapril maleate is usually reversible.

In some hypertensive patients who do not have kidney disease, the combination of enalapril maleate with a diuretic can lead to an increase in serum urea and creatinine levels. In such cases, it may be necessary to reduce the dose of enalapril maleate and / or withdraw the diuretic. Thus it is necessary to think about the possible stenosis of the renal arteries as the cause of these phenomena.

Renovascular hypertension

In patients with bilateral renal artery stenosis or renal artery stenosis in a single functioning kidney, treatment with an ACE inhibitor poses a particular risk of falling blood pressure or developing renal failure. In this case, loss of renal function can occur, often manifested only by mild changes in serum creatinine levels. Treatment of these patients should be started with low doses and under close medical supervision, carefully titrating the dose and monitoring renal function.

Kidney transplant

There is no experience with the use of Enalapril in patients who have recently undergone kidney transplantation. Therefore, the treatment of such patients with this drug is not recommended.

Liver failure

In the treatment of ACE inhibitors, a syndrome was occasionally observed, starting with cholestatic jaundice and progressing to fulminant hepatic necrosis (sometimes fatal). The pathogenesis of this syndrome is unclear. In the case of patients who develop jaundice or a clear increase in the level of liver enzymes during the treatment of an ACE inhibitor, the abolition of the ACE inhibitor and appropriate treatment is necessary.

Neutropenia / agranulocytosis

Neutropenia / agranulocytosis, thrombocytopenia, and anemia have been reported in patients receiving an ACE inhibitor. In patients with normal renal function and no specific risk factors, neutropenia is rare. Enalapril maleate should be used with extreme caution in patients suffering from collagenoses with involvement of the vessels in the process, as well as being treated with immunosuppressants, allopurinol, procainamide or in patients with several of the listed risk factors, enalapril maleate should be used with extreme caution, especially if there is a decrease in renal function. Some of these patients experienced severe infectious diseases, which in some cases did not respond to intensive antibiotic therapy. If these patients are taking enalapril maleate, then they are recommended to regularly monitor the number of leukocytes, and they should also be obliged to inform their doctor about all signs of any infection.

Hypersensitivity / angioedema

Angioneurotic edema involving the face, limbs, lips, tongue, vocal folds and / or larynx has been reported in patients treated with an ACE inhibitor, including Enalapril. During treatment, they can appear at any time. In these cases, Berlipril® must be canceled immediately. To ensure that symptoms have reversed completely before discharge from the hospital, the patient must be closely monitored. Even if angioedema affects only the tongue in the absence of respiratory failure, long-term observation is still necessary, since the administration of antihistamines and corticosteroids may not be enough.

It has been reported about extremely rare cases of lethal outcomes against the background of the development of angioedema of the larynx or tongue. Swelling of the tongue, epiglottis, or larynx increases the risk of obstruction respiratory tract, especially in patients who have undergone airway surgery. Angioedema with involvement of the larynx can be fatal. If the tongue, vocal folds, or larynx are involved and there is a threat of airway obstruction, appropriate treatment should be initiated immediately (for example, subcutaneous administration of 0.3-0.5 ml epinephrine solution [dilution 1: 1,000]) and / or measures should be taken to ensure airway patency ...

In black patients compared with non-black patients, a higher incidence of angioedema was reported with ACE inhibitors.

Patients with a history of angioedema caused by a non-ACE inhibitor may have an increased risk of developing it when taking an ACE inhibitor.

Anaphylactic reactions during desensitizing therapy against Hymenoptera venom

Occasionally when performing desensitizing therapy against a poison insects, and simultaneous use Anaphylactic reactions that are life-threatening have been observed with ACE inhibitors. If specific immunotherapy (desensitization) directed against the poison is indicated insects, the ACE inhibitor must be temporarily replaced with other agents for the treatment of arterial hypertension or heart failure.

Anaphylactic reactions during LDL apheresis (low density lipoprotein plasmapheresis)

During LDL apheresis with dextran sulfate and concomitant use of an ACE inhibitor, life-threatening anaphylactic reactions have rarely occurred. If LDL apheresis is indicated, then an ACE inhibitor must be temporarily replaced with other drugs for the treatment of arterial hypertension or heart failure.

Patients undergoing hemodialysis treatment

Anaphylactoid reactions have been reported with the use of high-flux membranes (eg "AN 69") during dialysis and concomitant use of an ACE inhibitor. For such patients, the question of using a different type of dialysis membrane or prescribing an antihypertensive drug of a different class should be considered.

Hypoglycemia

Patients suffering diabetes mellitus and those on treatment with oral antidiabetic drugs or insulin, at the beginning of treatment with an ACE inhibitor, they should be advised of the need for careful monitoring of blood glucose levels, especially in the first month of concomitant use of these drugs.

Cough

A cough has been reported associated with the use of an ACE inhibitor. Typical is the absence of sputum, the cough is persistent and disappears after discontinuation of treatment. At differential diagnosis cough should also take into account the cough caused by the ACE inhibitor therapy.

Surgery / Anesthesia

In patients undergoing major surgery or anesthesia with drugs that lower blood pressure, enalapril maleate inhibits - in response to compensatory renin secretion - the production of angiotensin II. With the development of hypotension on this basis, it can be corrected by replenishing the volume of circulating blood.

Hyperkalemia

In some patients treated with an ACE inhibitor, including enalapril, an increase in the concentration of serum potassium was observed. Risk factors for the development of hyperkalemia are: renal failure, impaired renal function, elderly age(over 70 years of age), diabetes mellitus, intercurrent factors such as dehydration, acute cardiac decompensation, metabolic acidosis and concomitant treatment with potassium-sparing diuretics (e.g. spironolactone, eplerenone, triamterene or amiloride), taking potassium or potassium-containing salt substitutes, and simultaneous treatment with other drugs that can lead to an increase in serum potassium levels (eg, heparin). When using potassium preparations, potassium-sparing diuretics and salt substitutes containing potassium, in patients with impaired renal function, a significant increase in the concentration of potassium in the blood is possible. Hyperkalemia can cause the development of severe arrhythmias, including fatal ones. If the use of the above drugs simultaneously with enalapril is still considered appropriate, then treatment should be carried out with caution, regularly monitoring the concentration of potassium in the blood serum.

Lithium

Double blockade of the renin-angiotensin-aldosterone system (RAAS)

There is evidence that joint application ACE inhibitors, angiotensin II receptor blockers or aliskiren increases the risk of arterial hypotension, hyperkalemia and decreased renal function (including acute renal failure). Therefore, conducting a double blockade of the RAAS with the joint administration of ACE inhibitors, angiotensin II receptor blockers or aliskiren is not recommended.

If dual blockade therapy is absolutely necessary, then it should only be carried out under the supervision of a specialist, as well as with close monitoring of renal function, electrolytes and blood pressure.

The combined use of ACE inhibitors and angiotensin II receptor blockers is contraindicated in patients with diabetic nephropathy.

Lactose

Enalapril contains lactose. Therefore, patients with rare hereditary galactose intolerance, lactase deficiency in the body or glucose-galactose malabsorption syndrome should not take this drug. The lactose content in one Enalapril tablet does not exceed 200 mg.

Ethnic differences

The severity of the hypotensive effect of enalapril - as in the case of other ACE inhibitors - in black patients, obviously, may be less than in non-black patients; this is presumably due to the fact that black patients with arterial hypertension often have decreased plasma renin levels.

Pregnancy and lactation.

The drug is not prescribed during pregnancy, since ACE inhibitors can cause disease or death of the fetus or newborn, including arterial hypotension, renal failure, hyperkalemia, hypoplasia of the newborn's skull, and oligohydramnios may also develop (contracture of the limbs, deformation of the facial bones of the skull, hypoplasia of the lungs).

The drug in trace concentrations is excreted in breast milk. If necessary, use it during lactation, breast-feeding must stop.

Features of the effect of the drug on the ability to manage vehicle and other potentially dangerous mechanisms.

During the period of using the drug, you should, if possible, refrain from any activity related to driving and potentially dangerous mechanisms, due to the possible development of side effects such as dizziness.

Overdose

Symptoms: arterial hypotension. Taking enalapril at a dose of 300-400 mg leads to the emergence of a drug level in the blood 100-200 times higher than the therapeutic one. Characterized by the development of acute arterial hypotension up to collapse, cerebrovascular accident, myocardial infarction, thromboembolism or angioedema, stupor and seizures may also develop.

Treatment: drug withdrawal, gastric lavage using activated charcoal, prescribing saline laxatives, transferring the patient to a horizontal position with raised legs, replenishing the circulating blood volume with isotonic sodium chloride solution and plasma-substituting solutions, supportive and symptomatic therapy. In severe cases, hemodialysis is performed.

P N013864 / 01

Tradename drug: ENALAPRIL

International non-proprietary name:

Enalapril

Dosage form:

pills

Composition:

1 tablet 5 mg contains:
Active ingredient: enalapril maleate - 5 mg.
Excipients: lactose monohydrate - 106,000 mg, magnesium carbonate - 71.645 mg, gelatin - 7,800 mg, crospovidone - 7,800 mg, magnesium stearate - 1,755 mg.
1 tablet 10 mg contains:
Active ingredient: enalapril maleate - 10 mg.
Excipients: lactose monohydrate - 125,000 mg, magnesium carbonate - 84,600 mg, gelatin - 9,200 mg, crospovidone - 9,200 mg, magnesium stearate - 2,000 mg.
1 tablet 20 mg contains:
Active ingredient: enalapril maleate - 20 mg.
Excipients: lactose monohydrate - 116,400 mg, magnesium carbonate - 120,000 mg, gelatin - 10,700 mg, crospovidone - 10,700 mg, magnesium stearate - 2,200 mg.

Description
For tablets 5 mg, 10 mg and 20 mg - round, biconvex white tablets with a scored on one side.

Pharmacotherapeutic group:

angiotensin-converting enzyme inhibitor.

ATX code:[S09AA02]

Pharmacological properties
Pharmacodynamics
Enalapril is an antihypertensive drug from the group of ACE inhibitors. Enalapril is a "prodrug": as a result of its hydrolysis, enalaprilat is formed, which inhibits ACE. The mechanism of its action 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. This decreases the total peripheral vascular resistance, systolic and diastolic blood pressure (BP), post- and preload on the myocardium.
Expands arteries to a greater extent than veins, while there is no reflex increase in heart rate.
The antihypertensive effect is more pronounced when high level plasma renin than at normal or reduced levels. A decrease in blood pressure within the therapeutic range does not affect cerebral circulation, blood flow in the vessels of the brain is maintained at sufficient level and against the background of low blood pressure.
Strengthens coronary and renal blood flow.
With prolonged use, the hypertrophy of the left ventricle of the myocardium and myocytes of the walls of the arteries of the resistive type decreases, prevents the progression of heart failure and slows down the development of left ventricular dilatation. Improves blood supply to the ischemic myocardium. Reduces platelet aggregation.
Has some diuretic effect.
The time of the onset of the hypotensive effect when administered orally is 1 hour, reaches a maximum after 4–6 hours and lasts up to 24 hours. In some patients, therapy for several weeks is required to achieve an optimal blood pressure level. With heart failure, a noticeable clinical effect is observed with prolonged use - 6 months or more.
Pharmacokinetics
After oral administration, 60% of the drug is absorbed. Food intake does not affect the absorption of enalapril. Enalapril binds up to 50% to blood proteins. Enalapril is rapidly metabolized in the liver to form the active metabolite of enalaprilat, which is a more active ACE inhibitor than enalapril. The bioavailability of the drug is 40%. The maximum concentration of enalapril in blood plasma is reached after 1 hour, enalaprilat - after 3-4 hours. Enalaprilat easily passes through the histohematological barriers, excluding the blood-brain, a small amount crosses the placenta and into breast milk.
The half-life of enalaprilat is about 11 hours.Enalapril is excreted mainly by the kidneys - 60% (20% - in the form of enalapril and 40% - in the form of enalaprilat), through the intestines - 33% (6% - in the form of enalapril and 27% - in the form of enalaprilat ).
It is removed during hemodialysis (speed - 62 ml / min) and peritoneal dialysis.

Indications for use
- arterial hypertension,
- with chronic heart failure (as part of combination therapy).

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).
Carefully use for 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 who observe a diet with limited salt or those on hemodialysis, while taking with immunosuppressants and saluretics, in the elderly (over 65 years).

Method of administration and dosage
Assign inside, regardless of the time of the meal.
For monotherapy of arterial hypertension, the initial dose is 5 mg once a day.
If there is no clinical effect after 1-2 weeks, the dose is increased by 5 mg. After taking the initial dose, patients should be under medical supervision for 2 hours and an additional 1 hour until blood pressure stabilizes. If necessary and sufficiently well tolerated, the dose can be increased to 40 mg / day in 2 divided doses. After 2-3 weeks, they switch to a maintenance dose of 10-40 mg / day, divided into 1-2 doses. With moderate arterial hypertension, the average daily dose is about 10 mg.
The maximum daily dose of the drug is 40 mg / day.
In the case of prescribing to patients simultaneously receiving diuretics, diuretic treatment should be discontinued 2-3 days before the appointment of Enalapril. If this is not possible, then the initial dose of the drug should be 2.5 mg / day.
For patients with hyponatremia (the concentration of sodium ions in the blood serum is less than 130 mmol / L) or the concentration of creatinine in the blood serum is more than 0.14 mmol / L, the initial dose is 2.5 mg once a day.
For renovascular hypertension, the initial dose is 2.5–5 mg / day. The maximum daily dose is 20 mg.
In chronic heart failure, the initial dose is 2.5 mg once, then the dose is increased by 2.5–5 mg every 3-4 days in accordance with the clinical response to the maximum tolerated dose, depending on the blood pressure values, but not higher than 40 mg / days once or in 2 doses. In patients with low systolic blood pressure (less than 110 mm Hg), therapy should be started with a dose of 1.25 mg / day. Dose titration should be done over 2–4 weeks or less. The average maintenance dose is 5–20 mg / day. for 1-2 admission.
In older people, a more pronounced hypotensive effect and an increase in the duration of the drug's action are more often observed, which is associated with a decrease in the rate of elimination of enalapril, therefore the recommended initial dose for the elderly is 1.25 mg.
In chronic renal failure, accumulation occurs with a decrease in filtration of less than 10 ml / min. With creatinine clearance (CC) 80-30 ml / min, the dose is usually 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 depends on the effectiveness of therapy. With a too pronounced decrease in blood pressure, the dose of the drug is gradually reduced.
The drug is used both in monotherapy and in combination with other antihypertensive drugs. Side effect
Enalapril is generally well tolerated and in most cases does not cause side effects requiring discontinuation of the drug.
On the part of the cardiovascular system: excessive decrease in blood pressure, orthostatic collapse, rarely - chest pain, angina pectoris, myocardial infarction (usually associated with a pronounced decrease in blood pressure), extremely rarely - arrhythmias (atrial brady or tachycardia, atrial fibrillation), palpitations, thromboembolism of the branches pulmonary artery.
From the side nervous system: dizziness, headache, weakness, insomnia, anxiety, confusion, increased fatigue, drowsiness (2-3%), very rarely when high doses are used - nervousness, depression, paresthesia.
From the senses: disorders of the vestibular apparatus, hearing and vision disorders, tinnitus.
From the digestive tract: dry mouth, anorexia, dyspeptic disorders (nausea, diarrhea or constipation, vomiting, abdominal pain), intestinal obstruction, pancreatitis, impaired liver function and bile secretion, hepatitis, jaundice.
From the respiratory system: unproductive dry cough, interstitial pneumonitis, bronchospasm, shortness of breath, rhinorrhea, pharyngitis.
Allergic reactions: skin rash, pruritus, urticaria, angioedema, extremely rarely - dysphonia, erythema polymorphism, exfoliative dermatitis, Steven-Johnson syndrome, toxic epidermal necrolysis, pemphigus, photosensitivity, serositis, vasculitis, myositis, arthralgia, arthritis, stomatitis, glossitis, arthralgia, arthritis.
On the part of laboratory parameters: hypercreatininemia, increased urea content, increased activity of "liver" enzymes, hyperbilirubinemia, hyperkalemia, hyponatremia. In some cases, a decrease in hematocrit, an increase in ESR, thrombocytopenia, neutropenia, agranulocytosis (in patients with autoimmune diseases), eosinophilia are noted.
From the urinary system: impaired renal function, proteinuria. Others: alopecia, decreased libido, hot flashes.

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 a 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 saline, plasma substitutes, if necessary - the introduction of angiotensin II, hemodialysis (the rate of elimination of enalaprilat averages 62 ml / min).

Interaction with other medicinal products
With the simultaneous appointment of Enalapril with non-steroidal anti-inflammatory drugs (NSAIDs), a decrease in the hypotensive effect is possible; with potassium-sparing diuretics (spironolactone, triamterene, amiloride) can lead to hyperkalemia; with lithium salts - to slow down the excretion of lithium (control of the concentration of lithium in the blood plasma is shown).

Concomitant use with antipyretic and pain relievers can reduce the effectiveness of enalapril.

Enalapril weakens the effect of drugs containing theophylline.

The hypotensive effect of enalapril is enhanced by diuretics, beta-blockers, methyldopa, nitrates, blockers of "slow" calcium channels, hydralazine, prazosin.

Immunosuppressants, allopurinol, cytostatics increase hematotoxicity.

Bone marrow suppression drugs increase the risk of neutropenia and / or agranulocytosis.

special instructions
Care must be taken when prescribing Enalapril to patients with reduced circulating blood volume (as a result of diuretic therapy, with restriction of sodium chloride intake, hemodialysis, diarrhea and vomiting) - the risk of a sudden and pronounced decrease in blood pressure after using even the initial dose is increased 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, activity of "liver" enzymes), 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 dysfunction

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. You may need 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 prescribed with caution in patients with diabetes mellitus because of 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.

Before examining the functions of the parathyroid glands, the drug should be canceled.

Alcohol enhances the hypotensive effect of the drug.

At the beginning of treatment, until the end of the dose selection period, it is necessary to refrain from driving vehicles and practicing potentially dangerous species activities requiring an increased concentration of attention and speed of psychomotor reactions, since dizziness is possible, especially after the initial dose of an ACE inhibitor in patients taking diuretics.

Before surgery (including dentistry), the surgeon / anesthetist should be warned about the use of ACE inhibitors.

Release form
Tablets 5 mg, 10 mg, 20 mg.
10 tablets per A1 / A1 blister, laminated with PVC and polyamide film. 2 blisters, together with instructions for use, are placed in a cardboard box.

Storage conditions
List B.
Store in a dry place at temperatures between 15 and 25 ° C.
Keep out of the reach of children.

Shelf life
3 years.
Do not use after the expiration date.

Conditions of dispensing from pharmacies
On prescription.

Manufacturer
1. Manufacturer
Hemofarm A.D., Serbia
26300 Vrsac, Beogradsky way bb, Serbia
Consumer claims should be sent to:
Russia, 603950, Nizhny Novgorod GSP-458, st. Salganskaya, 7.
In the case of packaging at Hemofarm LLC. Russia:
Produced by: Hemofarm A.D., Vrsac, Serbia
Packed:

LLC "Hemofarm", 249030, Russia, Kaluga region, Obninsk, Kiev highway, 62.

OR
2. Manufacturer
LLC "Hemofarm", 249030, Russia, Kaluga region, Obninsk, Kiev highway, 62.
Organization accepting claims from consumers:
LLC "Hemofarm", 249030, Russia, Kaluga region, Obninsk, Kiev highway, 62.

Enalapril is a fairly old, but still in demand and effective antihypertensive drug. It belongs to the representatives of the group of angiotensin converting enzyme inhibitors (ACE inhibitors). Angiotensin (from the Latin angio - vessel and tension - pressure) is a protein-derived substance that directly affects the muscular wall of blood vessels, as it causes its spasm. Also, angiotensin releases aldosterone from the adrenal glands, which in turn retains salt and water in the body, indirectly increasing pressure. The role of angiotensin in the regulation of blood pressure is enormous. Enalapril and similar drugs directly affect the conversion of angiotensin, reducing its effect on the vascular bed.

Release form and dose

Enalapril (Enap, Berlipril and others) is available in tablets, each of which contains enalapril maleate - the active ingredient - 5 mg, 10 mg and 20 mg. From pharmacies, medicine is dispensed only with a doctor's prescription.

pharmachologic effect

As we have already said, the main task of Enalapril is to slow down the conversion of angiotensin and reduce the release of aldosterone. What are the effects of this reaction?

1. Relaxes the vascular wall. The arteries are more susceptible to the influence of enalapril than the veins.
2. Reduces systolic (upper) and diastolic (lower) pressure.
3. Improves blood flow in coronary arteries heart and renal arteries.
4. Reduces water retention in the body, reduces the total peripheral vascular resistance.
5. Reduces pre- and afterload on the heart.
6. With prolonged use, it is able to reduce the already developed hypertrophy of the heart muscle of the left heart.
7. Prevents the development of heart failure.
8. Slightly reduces platelet aggregation (clumping), thus preventing the risk of thrombosis.
9. Has a slight diuretic effect.

With a single intake of Enalapril, a decrease in pressure occurs within an hour and lasts about a day. Due to a sufficiently long wait for the effect, the drug is not suitable for providing emergency with hypertensive crises. With regular intake of an adequate dose, the optimal decrease in pressure occurs within one to two weeks. For noticeable effects, provided by Enalapril on the heart muscle, you need to take the medicine for at least six months.

What does Enalapril help from and at what pressure

Enalapril is an antihypertensive drug aimed at stabilizing the hemodynamic process. For emergency care in a hypertensive crisis, it is not suitable, however, in the treatment of hypertension and cardiac dysfunction, it shows high efficiency.

Taking the drug is justified in the following situations:

1. Treatment of essential hypertension (primary increase in blood pressure without pathological processes of the cardiovascular network), even if the blood pressure does not exceed 130/90 mm Hg. Art. nutritional disorders of the brain and heart muscle are already being observed. Any excess of the norm (120/80 mm Hg) is a direct indication for the appointment of Enalapril. The dosage and course of treatment is selected by the doctor based on the results of the study on the state of the cardiovascular and system, and the background diseases of the patient;
2. Treatment of hypertension at any stage of the development of the disease with blood pressure over 120/80 mm Hg. Art. for normotonics, with the initial form of hypertension, it is prescribed, as well as in complicated and advanced courses in combination with other drugs. It is important to remember that not all drugs are compatible with each other, complex treatment carried out only under the joint supervision of a therapist and a cardiologist, which reduces the risk of complications. The dosage of Enalapril can be changed during therapy, is selected individually under dynamic monitoring of blood pressure and general condition the patient.
3. The minimum dosage of 1.25 ml of the drug is prescribed for people with a pressure of 120/80 mm Hg. Art. under condition of working pressure 100/60 mm Hg. Art. (treatment of high blood pressure in hypotensive patients is carried out for short courses of 1–3 months in case of disturbance of health);
4. Therapy of renovascular disease (persistent increase in blood pressure due to primary or secondary narrowing of the renal arteries) with a timely appointment of Enalapril, it is possible to maintain blood pressure levels for a long time without surgery;
5. Long-term use of the drug allows you to suspend the abnormal growth of myocardial muscles in asymptomatic left ventricular hypertrophy;

As part of complex therapy, Enalapril is effectively used by cardiologists in the following situations:

• The recovery period after myocardial infarction;
• Ischemic heart disease, angina pectoris;
• Congestion in the large or small circle of blood circulation caused by weakness of the myocardium or an increase in the volume of circulating blood.

Contraindications

• Allergy to Enalapril or to other members of his group.
• Porphyria is a rare blood disorder.
• Pregnancy and breastfeeding.
• Children under 18 years of age, due to the lack of drug research in this age group.

Caution is prescribed in the following cases:

• primary hyperaldosteronism;
• bilateral narrowing of the renal arteries or stenosis of an artery of a solitary kidney;
• after kidney transplantation;
• heart defects;
• renal and hepatic failure;
• diabetes mellitus;
• cerebrovascular diseases;
• the use of immunosuppressants and some diuretics;
• in persons over 65 years of age.

How to take Enalapril correctly

The medicine is taken orally before, after or during meals. Enalapril maleate can be used as the only antihypertensive agent or in combination with other drugs for blood pressure, diuretics, metabolic agents.

Monotherapy

With the initial appointment, the trial dosage of Enalapril will be 5 mg. In the absence of the expected decrease in pressure within 1-2 weeks, the dose is gradually increased by 5 mg until the desired effect is achieved. Usually, with a moderate increase in blood pressure, the daily dose is 10 mg in two divided doses. The maximum safe dose is 40 mg per day, divided into two doses.

Complex therapy

For the treatment of chronic heart failure, the initial dose of Enalapril is 2.5 mg per day. Then every three to four days the dose is increased by 2.5-5 mg until the desired effect is achieved. The average dose for chronic heart failure is 5-20 mg per day in two divided doses. The maximum daily dose is 40 mg per day.

With renovascular (renal) hypertension the initial daily dose is 2.5 mg, and the maximum is 20 mg.

In older people the initial dose of the drug is 1.25 mg per day, since due to a reduced metabolism, the drug is excreted more slowly and has a stronger effect.

Overdose

Symptoms after taking large doses of Enalapril:

1. Collapse is a severe drop in blood pressure.
2. Myocardial infarction.
3. Ischemic disorders in the brain.
4. Thromboembolism.
5. Convulsions.
6. Stupor.

To save the patient, it is necessary to urgently lay him down with his legs raised, and rinse the stomach. Saline or plasma substitutes, angiotensin-2 are injected intravenously. Sometimes the patient needs a hemodialysis procedure.

Drug interactions

• The effect of Enalapril decreases when taken with NSAIDs.
• The action and toxicity of the drug increase along with some diuretics, beta-blockers, methyldopa, calcium channel blockers, nitrates, prazosin, hydralazine, immunosuppressants, allopurinol.
• Enalapril itself can weaken the effects of theophylline, prevents the excretion of lithium salts from the body.
• When taken simultaneously with spironolactone and other potassium-sparing diuretics, an increase in serum potassium is observed.

Side effects

Usually Enalapril tablets do not cause severe side effects. Of the unpleasant effects witnessed by the manufacturer, they note:

• A strong drop in pressure, orthostatic collapse - a sharp drop in pressure when moving from a prone position to a standing position.
• Retrosternal pain, angina pectoris and myocardial infarction are infrequent and are almost always associated with inappropriate intake.
• Cardiac arrhythmias, tachycardia, bradycardia.
• Thromboembolism is extremely rare.
• Headaches and dizziness.
• Insomnia or drowsiness, anxiety, rarely depression.
• Dry mouth, constipation or diarrhea, lack of appetite, sometimes intestinal obstruction and pancreatitis.
• Allergic reactions.
• Increased levels of creatinine, urea, bilirubin, potassium, decreased sodium levels.
• Anemia, increased ESR, thrombocytopenia, leukopenia.
• Decreased renal function, the appearance of protein in the urine - proteinuria.
• Dry obsessive cough - unfortunately, frequent side effect the whole group of ACE inhibitors.

The therapy regimen for a specific patient can be prescribed and changed only by a doctor. During the reception of Enalapril, it is important to control blood pressure, choose the minimum effective dose for treatment, constantly monitor laboratory parameters of blood and urine, the state of the heart and kidneys.

If problems arise with blood pressure, many receive recommendations from the attending physicians to take the drug "Enalapril" (tablets). What does this medicine help to get rid of? From the consequences of the disease (that is, directly from an increase in blood pressure), or does it act in several directions, restoring the normal activity of the cardiovascular system, as a result of which blood pressure returns to normal? To understand how the Enalapril pressure pills work, you should familiarize yourself with official instructions on the use of this medication. In addition, we will consider a number of analogs of this drug by the active substance and the effect it has.

Description of the drug, release form, storage features and conditions of dispensing from pharmacies

Enalapril pressure pills » produced by many pharmaceutical companies worldwide. The main active ingredient of this drug is enalapril maleate, which in its group belongs to ACE blockers. Currently, there are tablets with an active ingredient content of 5, 10 and 20 mg. Due to the fact that the drug for pressure "Enalapril" directly affects the functioning of the CVS and a number of other systems in the body, its dispensing from pharmacies is carried out by prescription.

The terms of sale and use of this drug are limited to 3 years from the date of its manufacture. At the same time, the tablets do not lose their therapeutic properties if the storage rules are observed. Manufacturers recommend keeping the medication in a dry place, protected from direct sunlight, at a temperature of at least 15 and no more than 25 degrees.

Analogues of "Enalapril" have the same properties, therefore, the recommendations applicable to the drug can be observed during storage.

Pharmacodynamics of the drug

Enalapril maleate (active substance of tablets) by itself does not affect the processes occurring in the human body. The fact is that this compound is considered a kind of "prodrug", which, as a result of a few hydrolysis reactions, forms a completely new substance - enalaprilat.

It is this that has a depressing effect on active ACE, which provokes a significant decrease in the amount of aldosterone in human body... In short, the effect of "Enalapril" is to lower blood pressure (both diastolic and systolic) and reduce the load on the heart muscle (myocardium).

As a result of long-term observations, it was possible to find out that, despite the decrease in blood pressure, after taking the drug "Enalapril", the patients did not have an insufficient level of blood circulation in the brain. In addition, taking the pills increased renal and coronary blood flow.

Long-term use of the drug has shown high efficiency in relation to hypertrophied tissues localized in the left ventricle of the heart muscle, which helped to prevent the progress of heart failure. In addition, therapy with "Enalapril" for 6 months improved the condition of patients with dilatation of the left ventricle and impaired blood circulation in the myocardium resulting from ischemia.

The active substance of the drug is found in the blood plasma 1 hour after taking the tablets and reaches a maximum after 4-6 hours. The antihypertensive effect lasts up to 24 hours.

Same pharmacological properties also have analogues of "Enalapril" for the active substance.

Pharmacokinetics of the drug

As mentioned above, the assimilation of the active substance of the drug occurs rather quickly. Only about 60% of enalapril maleate is absorbed, while almost the entire volume enters into contact with plasma proteins. Experts draw the attention of consumers to the fact that absorption of the compound does not depend on food intake.

The high degree of penetration of enalapril through the GGB barriers is due to the molecular structure of the active substance. It is also able to cross placental barriers and is found in breast tissue and milk in lactating women.

Excretion of the drug is carried out mainly by the kidneys (60%). In this case, about 20% is excreted unchanged, and 40% is excreted in the form of a metabolite. The remains of the active substance are released through the intestines, while the ratio of enalapril / enalaprilat has indicators of 6-8% / 25-27%.

Indications and contraindications for use

The indication for the use of the drug "Enalapril" is a persistent increase in blood pressure caused by diseases such as scleroderma and CHF. In addition, the drug is very often used in preventive therapy in patients with diagnosed coronary ischemia, LV dysfunction (including asymptomatic). These are the indications for use of the drug "Enalapril", however, self-medication is by no means recommended. Only a specialist can draw up the correct treatment regimen and determine the dosage.

During the examination, the doctor will also be able to establish the presence or absence of possible contraindications... These include the following diseases and organ dysfunctions:

1. An increased level of sensitivity to the active substance of the drug (analogs of "Enalapril" in this case, too, must be canceled, since in most cases they have a composition similar to this drug).
2. Pregnancy, lactation and childhood under 18 years old.
3. Previous angioedema during treatment with drugs from the ACE inhibitor group.
4. Insufficiency of cerebral circulation, as well as other cerebrovascular diseases.
5. Disorders of cerebral hematopoiesis.
6. Kidney disease, including (bilateral or unilateral), renal failure, the presence of a transplanted organ.
7. Liver disease.
8. Diseases gastrointestinal tract accompanied by diarrhea and vomiting.
9. Scleroderma and other autoimmune diseases affecting connective tissues.
10. Violations metabolic processes in the body, including hyperkalemia.
11. Diabetes.

Reception of "Enalapril" in all situations described above should be canceled, or therapy is carried out under the constant supervision of specialists.

Medication "Enalapril": a list of side effects

Despite the great benefits of the drug, when it is taken, patients can experience a variety of side effects that affect almost all organ systems. Information on adverse events is contained in the table below.

Adverse reactions of the body to taking the drug

Organs and systems	Side effects
	Often or sometimes
The cardiovascular system	Excessive decrease in blood pressure, palpitations, orthostatic collapse.	Arrhythmia, including tachycardia and bradycardia, chest pain, myocardial infarction, angina pectoris, pulmonary embolism.
Digestive system	Feeling of dry mouth, epigastric pain, belching, nausea and vomiting, diarrhea or constipation.	Intestinal obstruction, hepatitis and yellowness, pancreatitis.
urinary system	Changes in kidney function, proteinuria.	______
Nervous system	Headaches, dizziness, fatigue.	Fainting, insomnia, drowsiness, depressive states, increased nervous excitement and anxiety levels, confusion.
Sense organs	Noise in ears.	Impaired coordination in space, blurred vision or changes in visual perception.
Respiratory system	Rhinorrhea, pharyngitis, long-term dry cough.	Bronchospasm, pneumonitis (interstitial).
Skin and other allergic reactions	Urticaria-like rash, angioedema in the head area (including the mucous membranes of the mouth and throat), itching, exudative erythema (including Steven-Johnson syndrome), various forms dermatitis.	Pemphigus (blistering eruptions), Lyell's syndrome, myositis, arthritis and arthralgia, glossitis, serositis, photosensitivity, vasculitis, allergic stomatitis.
Changes in blood count and other laboratory samples	Increased ESR, increased concentration of urea in samples, hyponatremia and hyperkalemia.	Increased activity, decreased hematocrit, agranulocytosis, eosinophilia.
		Hot flashes, decreased sex drive, focal hair loss.

First of all, these phenomena are provoked by the direct influence on the body of the main active substance of the drug "Enalapril". Analogs (instructions for use for them contain detailed information on this issue) can also cause similar violations. It is important for the patient and his attending physician to notice the signs of the appearance of side effects in time, since ignoring them can lead to serious disturbances in the functioning of the body.

How to take Enalapril tablets: methods and dosage

To stabilize blood pressure, experts recommend long-term use the drug (including its analogues, for example, the drug "Enalapril Hexal"). On initial stage for the treatment of arterial hypertension, it is recommended to take the drug at a dose of 5 mg per day. With a systematic increase in pressure during a two-week therapy, the dosage is increased by 5 mg. It should be noted that the first 2-3 hours after the start of treatment, the patient should be under the supervision of a doctor. This helps to identify side effects at the very beginning of their development. Maximum dose the drug should not exceed 40 mg per day, but even the use of such an amount of medication is possible only if absolutely necessary and satisfactory tolerability of the medication.

After 2-3 weeks after the start of monotherapy with the drug "Enalapril", patients are transferred to a maintenance regimen of taking the drug. During this period, the daily dose of the drug is 10-40 mg. You need to take tablets 1-2 times a day. It is recommended that blood pressure be measured regularly during treatment.

The above recommendations apply to those patients who do not suffer from comorbidities such as hyponatremia and in what doses should they take the drug? As a rule, it depends on the individual characteristics of the patient and the degree of development of the disease. The initial dose in any case can only be calculated by the attending physician.

The duration of taking the drug depends on several factors, including the patient's condition and the results of laboratory tests. Experts note that abrupt withdrawal of the drug can lead to negative consequences. Therefore, even with an excessive decrease in blood pressure while taking the drug "Enalapril", it is necessary to gradually reduce the dosage.

Symptoms and treatment of drug overdose

So, we examined the main characteristics of the drug "Enalapril" (tablets): what they help from and what their use can lead to in the end. It's time to move on to discussing such an issue as an overdose of this drug. Often, patients tend to take large doses of drugs in the hope of getting rid of unpleasant symptoms faster. If this happens to a person taking Enalapril, the consequences can be very serious. Against the background of a decrease in blood pressure, patients may collapse, which often leads to myocardial infarction or serious cerebrovascular accident.

As a rule, the first symptoms of an overdose are loss of consciousness, a state of stupor, or the appearance of seizures. There may also be other signs of damage to the cerebral circulatory system and cardiac abnormalities: pallor of the skin, severe headache, chest pain.

Treatment of a patient with an overdose with Enalapril is symptomatic. With a mild degree of poisoning, the intake of a saline solution and gastric lavage are indicated. In more severe cases, intravenous saline and plasma substitutes may be required, as well as hemodialysis.

Drug interactions

Enalapril tablets are capable of acting atypically when taken simultaneously with other medications. Non-steroidal anti-inflammatory medicines("Ibuprofin", etc.) and estrogen-containing drugs significantly reduce its hypotensive effect. Adrenergic blockers, nitrate-containing drugs, anesthetics and ethanol enhance the effect of the drug "Enalapril". Diuretics taken with pills to lower blood pressure can cause hyperkalemia. Special care should be taken with drugs from the group of immunosuppressants, since they, when taken together with drugs containing enalapril, significantly increase its hematotoxicity.