ENAP 25 mg Instructions for use. ENAP-N - at elevated pressure

Date: 04.11.2019

Dosage form: & nbspPills. Structure:

1 tablet contains:

Active substances:

Enalapril Maleat10 MG

Hydrochlorothiazide25 mg.

Excipients:

Sodium bicarbonate, chinoline yellow dye (E104), monohydrate lactose, calcium hydrophosphate, anhydrous, starch corn, talc, magnesium stearate.

Description: Round, flat yellow tablets with beveled edge and risk on one side. Pharmacotherapeutic Group:hypotensive combined means (angiotensin glider enzyme inhibitor + diuretik). ATH: & NBSP

C.09.B.A.02 Enalapril in combination with diuretics

Pharmacodynamics:

The combined drug, the action of which is due to the components belonging to its composition; It has a hypotensive effect.

Enalapril Inhibits ACE, which promotes the conversion of angiotensin I to angiotensin P, reduces the concentration of the aldosterone in the blood, increases the release of renin by YUCSTAGLOMERAERAL cells in the walls of the kidney glomers, improves the functioning of the kallicrein-kinine system, stimulates the release of prostaglandins and an endothelial relaxing factor (NO), inhibits the sympathetic nervous system . In the aggregate, these effects eliminate spasm and expand the peripheral arteries, reduce the total peripheral resistance of the vessels, systolic and diastolic blood pressure (blood pressure), post- and preload on myocardium. Expands arteries to a greater extent than veins, while the reflex increase in heart rate (heart rate) is not marked. The hypotensive effect is more pronounced at a high concentration of renin in the blood plasma than with normal or reduced. Reducing blood pressure in therapeutic limits does not affect the brain circulation. Improves the blood supply to the ischemic myocardium. Enhances renal blood flow, while the speed of glomerular filtration does not change. In patients with initially reduced glomerular filtration, its speed is usually increasing.

The maximum effect of enalapril is developing after 6-8 hours. And is preserved up to 24 hours.

Hydrochlorothiazide - Tiazide diuretic average action. Reduces the reabsorption of sodium ions at the level of the cortical segment of the loop of Genla, without affecting its site passing in the cereal brain layer. Blocks carboangendra in the proximal department of convinced tubules, enhances the kidney removal of potassium ions, bicarbonates and phosphates. Practically does not affect the escort and ground state. Increases magnesium ions. Holds in the body of calcium ions. The diuretic effect develops after 1-2 hours, reaches a maximum after 4 hours, 10-12 hours continues. The action decreases with a decrease in the speed of glomerular filtration and stops with its value less than 30 ml / min. Reduces blood pressure by reducing the volume of circulating blood (OCC), changes in the reactivity of the vascular wall.

The use of the combination of enalapril and hydrochlorothiazide leads to a more pronounced decrease in blood pressure in comparison with monotherapy by each of the drugs separately and allows to maintain the hypotensive effect of the drug ENAP®, at least within 24 hours.

Pharmacokinetics:

Enalapril. After taking inside absorption - 60%. Meal does not affect suction. The liver is subjected to metabolism with the formation of an active metabolite of enalaprilalate, which is a more efficient ACE inhibitor than. Communication with blood plasma proteins of Enalaprilalate - 50-60%. The time to achieve maximum concentration (TSMAs) Enalapril -1ch, Enalaprilalate - 3-4 hours. Easily passes through histohematic barriers, excluding the hematorethelical barrier, the small amount penetrates through the placenta and in breast milk. The renal clearance of enalapril and enalaprilalate make up 0.005 ml / s (18 l / h) and 0.00225-0.00264 ml / s (8.1-9.5 l / h), respectively. The half-life (T1 / 2) of Enalaprilalate is 11 h. It is removed mainly by the kidneys - 60% (20% - in the form of enalapril and 40% - in the form of enalaprilalate), through the intestine - 33% (6% - in the form of enalapril and 27% - In the form of enalaprilalate). It is removed during hemodialysis (speed 38-62 ml / min) and peritoneal dialysis, the serum concentration of enalaprilalate after 4 hour hemodialysis decreases by 45-57%. In patients with reduced renal function, the removal slows down, which requires a reduction in the dose in accordance with the impaired of the kidney function, especially in patients with severe renal failure.

In patients with hepatic insufficiency, the metabolism of enalapril can be slowed down without changing its pharmacodynamic effect.

In patients with chronic heart failure (CXN), the absorption and metabolism of enalaprilalate slows down, the volume of distribution is also reduced.

Hydrochlorothiazideit is absorbed mainly in the duodenum and the proximal division of the small intestine. Absorption is 70% and increases by 10% when taking food. The maximum serum concentration is achieved after 1.5 - 5 hours. The distribution volume is about 3 l / kg. Communication with plasma proteins - 40%. Bioavailability - 70%. In the therapeutic range of doses, the average size of the area under the pharmacokinetic curve increases directly in proportion to the increase in the dose, when appointing 1 time per day, the cumulation is insignificant. Penetrates the hematoplazent barrier and in breast milk. Accumulates in amniotic fluid. The serum concentration of hydrochlorothiazide in the blood of the umbilical veins is almost the same as in maternal blood. The concentration in the amniotic fluid exceeds such in the serum from the umbilical vein (19 times). It is not metabolized in the liver, removed mainly by the kidneys: 95% unchanged and about 4% in the form of hydrolyzate-2-amino-4-chloro-M-benzennedisulfonamide by glomerular filtration and active channel secretion in the proximal nephron. The renal clearance of hydrochlorothiazide in healthy volunteers and patients with arterial hypertension is approximately 5.58 ml / s (335 ml / min). It has a two-phase derivation profile. T1 / 2 in the initial phase is 2 hours, in the final phase (10-12 hours after reception) - about 10 hours.

The elderly patients do not have a negative effect on the Pharmacokinetics of Enalapril, but the serum concentration of Enalaprilat is higher. When the hydrochlorothiazide is prescribed, patients with CXN found that its absorption decreases in proportion to the development of HSN - by 20-70%. T1 / 2 hydrochlorothiazide increases to 28.9 hours; The kidney clearance is 0.17 - 3.12 ml / s (10-187 ml / min) (average values \u200b\u200bof 1.28 ml / s (77 ml / min.

In patients who suffered an intestinal shunt operation about obesity, the absorption of hydrochlorothiazide can be reduced by 30%, and serum concentration by 50%, compared with healthy volunteers.

The simultaneous purpose of enalapril and hydrochlorothiazide does not affect the pharmacokinetics of each of them.

Indications: Arterial hypertension (patients who are shown combined therapy). Contraindications:

Increased sensitivity (including separate components of the drug or sulfonamide derivative);

Anuria, pronounced renal impairment (Creatinine clearance (CC) less than 30 ml / min);

An angioedema edema in history, associated with the use of previously ACE inhibitors, as well as hereditary or idiophagic angioedema edema;

Bilateral stenosis of renal arteries, stenosis of the artery of the only kidney;

Pregnancy and lactation period;

Age up to 18 years (efficiency and safety are not established);

Lactose intolerance, lactase deficiency or glucose-galactose malabsorption.

Carefully:

Pronounced stenosis of the mouth of aorta or idiopathic hypertrophic obstructive subaportal stenosis;

Ischemic heart disease and cerebrovascular diseases (including brainwater failure), because Excessive decrease in blood pressure can lead to the development of myocardial infarction and stroke;

Chronic heart failure; expressed

Atherosclerosis;

Severe autoimmune systemic diseases of the connective tissue (including systemic red lupus, sclerodermia);

Oppression of bone marrowing; Sugar diabetes, because Tiazide diuretics are able to reduce glucose tolerance;

Hypercalemia;

Condition after kidney transplantation;

Disorders of the liver and / or kidney function (QC 30-75 ml / min);

States accompanied by a decrease in the BCC (as a result of therapy with diuretics, while restricting the consumption of cooking salts, diarrhea and vomiting);

Elderly age.

Pregnancy and lactation:

The drug ENAP® H is contraindicated during pregnancy.

The impact of ACE inhibitors on the fruit in the first trimester of pregnancy is not established. The use of ACE inhibitors in the second and third trimesters of pregnancy was accompanied by a negative impact on the fruit and a newborn. The newborn has arterial hypotension, renal failure, hypercalemia, and / or hypoplasia of the bones of the skull are possible the development of an olig hydromanion.

apparently, due to the violation of the renal function of the fetus. This can lead to the contracture of the limbs, deformation of the bones of the skull, including its facial part, and lung hypoplasia.

The use of diuretics during pregnancy is not recommended, because it can cause jaundice of the fetus and newborn, thrombocytopenia, and possibly other, unwanted reactions observed in adults.

Enalapril and penetrate into breast milk. Therefore, when appointing the drug ENAP® during lactation, it is necessary to abandon breastfeeding.

Method of use and dose:

In patients who are on therapy with diuretics, it is recommended to cancel treatment or reduce dose diuretics at least 3 days before the start of treatment with the drug ENAP® to prevent the development of symptomatic arterial hypotension. Before starting treatment, the kidney function should be investigated. The duration of treatment is established by a doctor.

Dose with impaired kidney function

In patients with renal failure with KK 30-75 ml / min, the drug ENAP® should be used only after preliminary doses of enalapril and hydrochlorothiazide, respectively, doses in the ENAP® combined preparation.

Side effects:

Classification of the frequency of the side effects of the World Health Organization (WHO):

Very often (\u003e 1/10)

Often (\u003e 1/100 and< 1/10)

Infrequent (\u003e 1/1000 and< 1/100)

Rarely (\u003e 1/10000 and< 1/1000)

Rarely (< 1/10000), включая отдельные сообщения.

From the system of blood formation and lymphatic system:

rarely: neutropenia, reduced hemoglobin and hematocrit, thrombocytopenia, leukopenia, inhibition of bone marrow function;

Metabolic and nutrition disorders

infrequently: gout;

From the central nervous system:

very often: dizziness, weakness; Often: Headache, Asthenium;

infrequently: insomnia, drowsiness, paresthesia, increased excitability;

From the senses:

infrequently: noise in the ears;

From the side of the cardiovascular system:

often: orthostatic hypotension;

infrequently: fainting, pronounced decrease in blood pressure, feeling of heartbeat, tachycardia, chest pain;

From the respiratory system:

often: cough; infrequently: shortness of breath;

From the digestive system:

often: nausea;

infrequently: diarrhea, vomiting, dyspepsia, abdominal pain, meteorism, constipation, dry mouth;

rarely: cholestatic jaundice, fulminant necrosis;

Allergic reactions:

infrequently: Stevens-Johnson syndrome;

rarely: angioedema edema;

very rarely: intestinal angioedema swelling;

From the side of the skin:

infrequently: skin rash, itching, increased sweating, skin necrosis, alopecia;

From the urogenital system:

infrequently: impaired renal function, acute renal failure, impotence, reduced libido;

From the musculoskeletal system:

often: muscle spasms; infrequently: arthralgia;

Laboratory Indicators:

rarely: hyperglycemia, hyperuricemia, hypocalemia, hypercalemia, hyponatremia, increased urea concentration and creatinine in serum, increasing the activity of "liver" transaminase and bilirubin;

Others:

a symptom complex, which may include fever, Malgia and arthralgia, serozite, vasculitis, increase the rate of erythrocyte sedimentation, leukocytosis and eosinophilia, skin rash, positive test for antinuclear antibodies.

Overdose:

Symptoms: reinforced diuresis, a pronounced decline in Hell with bradycardia or other heart rate disorders, convulsions, disturbances (including someone), acute renal failure, disruption of the acid-base condition and water-electrolyte blood balance.

Treatment: The patient is translated into a horizontal position with raised legs. In light cases, the washing of the stomach and reception inside the activated carbon is shown, in more serious cases - measures aimed at stabilization of blood pressure-backed administration of plasma proofs, infusion of 0.9% sodium solution chloride. The patient needs to control the level of blood pressure, heart rate, respiratory frequency, serum concentration of urea, creatinine, electrolytes and diuresis, if necessary, the introduction of angiotensin II, hemodialysis (the rate of elimination of enalaprilalate -62 ml / min).

Interaction:

Potassium serum blood

The use of potassium additives, potassium-saving means or preparations containing potassium substitutes of salt, especially in patients with renal failure, can lead to a significant increase in serum potassium content. Potassium loss against the background of tiazide diuretics, as a rule, decreases under the action of Enalapril. The content of potassium in serum usually remains within the normal range.

Lithium

With simultaneous use with lithium preparations, the deceleration of lithium removal (strengthening of cardiotoxic and neurotoxic lithium action).

Non-polarizing muscle relaxants

Tiazide diuretics can enhance the effect of chloride tube.

N. arcotic analgesics / neuroleptics

The simultaneous use of thiazide diuretics, narcotic analgesics or phenothiazine derivatives can lead to orthostatic hypotension.

Other antihypertensive means

The use of beta-adrenoblastors, alpha adrenoblockers, gangli-blocking agents, methyldopes or "slow" calcium channels can additionally reduce the blood pressure can additionally lower the blood pressure channels with enalapril.

Allopurinol, cytostatic and immunosuppressants

Simultaneous use with ACE inhibitors can increase the risk of leukopenia.

Glucocorticosteroids. Calcithonin

Simultaneous reception of thiazide diuretics can lead to development

hypokalemia.

Cyclosporin

Simultaneous reception with ACE inhibitors can increase the risk of developing hypercalemia.

Nonteroidal anti-inflammatory drugs

The simultaneous use of non-steroidal anti-inflammatory drugs (NSAIDs) (including selective cyclookigensee-2 inhibitors) can weaken the antihypertensive effect of ACE inhibitors.

NSAIDs and ACE inhibitors have an additive effect on the increase in serum potassium content, which can lead to a deterioration in the kidney function, especially in patients with impaired kidney function. This effect is reversible. NSAIDs can reduce diuretic and antihypertensive effects of diuretics.

Antacids

Antacids can reduce the bioavailability of ACE inhibitors.

Sympathomimetics Can reduce the antihypertensive effect of ACE inhibitors. Tiazide diuretics can reduce the effect of adrenomimetics ().

Ethanol. Enhances the hypotensive effect of ACE inhibitors and tiazide diuretics, which can cause an orthostatic hypotension.

Hypoglycemic drugs for intake and insulin

Epidemiological studies provide grounds to assume that the simultaneous use of ACE and hypoglycemic inhibitors can lead to hypoglycemia. More often, hypoglycemia is developing in the first weeks of therapy in patients with impaired kidney function. Long and controlled clinical studies of Enalapril do not confirm this data and do not limit the use of enalapril in patients with diabetes mellitus. Nevertheless, such patients must be under regular medical supervision.

The use of hypoglycemic drugs for intake and insulin with thiazide diuretics may require correction of their doses.

Kolistramin and Kolsestipol

A single reception of a colestaffine or a bearson reduces the absorption of hydrochlorothiazide in the gastrointestinal tract by 85% and 43%, respectively.

Gold preparations

With the simultaneous use of ACE inhibitors and gold () drugs () intravenously, a symptom complex is described, which includes hyperemia of the skin of the face, nausea, vomiting and arterial hypotension.

Special instructions:

Arterial hypotension

Arterial hypotension with all clinical consequences may be observed after the first reception of the Tablets of the ENAP® drug in patients with severe CHN and hyponatremia, expressed by the renal failure or dysfunction of the left ventricle and, in particular, in patients with hypovolemia, as a result of therapy with diuretics, volatile diet, diarrhea , vomiting or hemodialysis.

In the event of an arterial hypotension, it is necessary to put the patient on the back with a low headboard and, if necessary, adjust the volume of the OCC by infusion of a solution of 0.9% sodium chloride. Arterial hypotension arising after receiving the first dose is not a contraindication for further treatment. Care requires in patients with coronary heart disease, severe cerebrovascular diseases, aortic stenosis or idiopathic hypertrophic obstructive subaartal stenosis, which prevents the outflow of blood from the left ventricle, expressed atherosclerosis, in the elderly patients as a result of the risk of the development of the arterial hypotension and deterioration in the blood supply of the heart, brain and kidney.

Disorders of the water and electrolyte balance

Regular control of the serum concentration of electrolytes during the treatment period to identify possible imbalances and timely adoption, necessary measures are necessary. Determination of serum concentration of electrolytes is required for patients with long-term diarrhea, vomiting.

In patients taking the drug ENAP®, it is necessary to identify signs of violation of the water and electrolyte balance, such as dry mouth, thirst, weakness, drowsiness, increased excitability, myalgia and convulsions (mainly icy muscles), decreased blood pressure, tachycardia, oliguria and Gastrointestinal disorders (nausea, vomiting).

Violation of kidney function

The drug ENAP® in patients with renal failure (KK 30-75 ml / min) should be used only after preliminary detection of doses of enalapril and hydrochlorothiazide separately, respectively, doses in the combined drug ENAP®.

Violation of the liver function

The ENAP® drug is necessary with caution to apply in patients with hepatic insufficiency or progressive liver diseases, as it can cause hepatic to whom even with minimal disorders of water and electrolyte balance. Several cases of the development of acute liver failure with cholestatic jaundice, fulminant liver necrosis and fatal outcome (rarely) during the treatment of ACE inhibitors are reported. In the event of a jaundice and increasing the activity of "liver" transaminase treatment with the drug ENAP® should be immediately discontinued, patients must be supervised.

Metabolic and endocrine effects

Caution is necessary in all patients receiving treatment with hypoglycemic agents for intro or insulin, as it can weaken, and increase their action.

Tiazide diuretics can reduce the removal of calcium with the kidneys and cause a slight and transient increase in the content of calcium in serum. Pronounced hypercalcemia can be a sign of a hidden hyperparathyroidism before conducting a study of the function of parathyroid glands, thiazide diuretics must be canceled.

Against the background of treatment with thiazide diuretics, cholesterol concentrations and serum triglycerides can increase.

Therapy of thiazide diuretics in some patients can exacerbate hyperuricemia and / or escalate the course of gout. However, it enhances the removal of uric acid by the kidneys, thereby counteracting the hyperurientichemical effect of hydrochlorothiazide

Allergic reactions / angioedema edema

In the event of angioedema swelling, the face is usually enough to cancel therapy and the appointment of antihistamine patient.

The angioedema edema of the tongue, pharynx or larynx can be lethal. In the angioemic edema of the language, pharynx or larynx, which can lead to obstruction of the respiratory tract, must be immediately introduced (0.3-0.5 ml of epinephrine solution (adrenaline) subcutaneously in the ratio of 1: 1000) and maintain the airway passability (intubation or tracheostomy ).

Among the patients of the Negroid race, receiving therapy by the ACE inhibitor, the frequency of the angioedema edema is higher than among patients with different racial affiliation.

Patients with an angionaewic edema in an anamnesis, not related to ACE inhibitors, have an increased risk of developing an angioedema edema when receiving any ACE inhibitor.

In patients taking thiazide diuretics, the reaction of increased sensitivity can develop both in the presence and in the absence of allergic reactions. It has been reported about the deterioration of the flow of systemic red lupus.

Due to the increase in the risk of anaphylactic reactions, it should not be prescribed by the drug ENAP® patients in hemodialysis using high-flow polyacrylonitrile membranes(AN 69®), subscribe low-density lipoproteins with dextran sulfate and immediately before the desensitization procedure to the axis or bee poison.

Surgical Interventions / General Anesthesia

Before surgical intervention (including dentistry), it is necessary to warn a anesthesiologist's doctor about the use of ACE inhibitors. During surgical interventions or carrying out general anesthesia using arterial hypotension funds, the ACE inhibitors can block the formation of angiotensin II in response to the compensatory release of Renin. If the pronounced decrease in the blood pressure is developing, explained by this mechanism, it can be corrected by an increase in the volume of circulating blood.

Cough

When using ACE inhibitors, cough was celebrated. Dry cough, long, which disappears after stopping the reception of ACE inhibitors. With a differential diagnosis of cough, it is necessary to take into account cough caused by the use of ACE inhibitors.

Impact on the ability to control the transc. cf. And Meh.:At the beginning of treatment with ENAP® drug, a pronounced decrease in blood pressure, dizziness and drowsiness may arise, which can reduce the ability to control vehicles, engage in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions. Therefore, at the beginning of treatment, it is not recommended to manage vehicles and engage in other potentially hazardous activities that require increased concentrations of attention and speed of psychomotor reactions. Release form / Dosage:Tablets 25 mg + 10 mg. Packaging: 10 tablets in the blister. 2 blisters are placed in a pack of cardboard along with instructions for use. Storage conditions: Russia Date of updating information: & NBSP01.01.2016 Illustrated instructions

Hinoline yellow dye (E104), monohydrate lactose, calcium hydrophosphate anhydrous, starch corn, talc, magnesium stearate.

10 pieces. - Blisters (2) - packs cardboard.

pharmachologic effect

Combined drug, the action of which is due to the properties of the components included in its composition. It has an antihypertensive effect.

Enalapril inhibits an ACE, which promotes the conversion of angiotensin I in angiotensin II, reduces the concentration of aldosterone in the blood, increases the release of renin by YUKSTAGLOMERAL cells in the walls of the kidney glomers, improves the functioning of the kallicrein-kinin system, stimulates the release of prostaglandins and endothelial relaxing factor (NO), inhibits the sympathetic nerve System. In the aggregate, these effects eliminate spasm and expand peripheral arteries, reduce OPS, systolic and diastolic blood pressure, post- and preload on myocardium. Expands the arteries to a greater extent than the veins, while the reflex increase in the heart rate is not marked. The hypotensive effect is more pronounced at a high concentration of renin in the blood plasma than with normal or reduced. Reducing blood pressure in therapeutic limits does not affect the brain circulation. Improves the blood supply to the ischemic myocardium. Enhances renal blood flow, while the speed of glomerular filtration does not change. In patients with initially reduced glomerular filtration, its speed is usually increasing.

The maximum effect of enalapril is developing after 6-8 hours and is preserved up to 24 hours.

Hydrochlorothiazide is a thiazide diuretic of the average action. Reduces the reabsorption of sodium ions at the level of the cortical segment of the loop of Genla, without affecting its site passing in the cereal brain layer. Blocks carboangendra in the proximal department of convinced tubules, enhances the kidney removal of potassium ions, bicarbonates and phosphates. Practically does not affect the escort and ground state. Increases magnesium ions. Holds in the body of calcium ions. The diuretic effect develops after 1-2 hours, reaches a maximum after 4 hours, 10-12 hours continues. The action decreases with a decrease in the speed of glomerular filtration and stops with its value less than 30 ml / min. Reduces blood pressure by reducing the BCC, changes in the reactivity of the vascular wall.

The use of the combination of enalapril and hydrochlorothiazide leads to a more pronounced decrease in blood pressure in comparison with monotherapy by each of the drugs individually and allows to maintain the hypotensive effect of ENAP®-H preparation at least within 24 hours.

Pharmacokinetics

Enalapril

Suction

After taking inside absorption - 60%. Meal does not affect suction. The liver is subject to metabolism with the formation of an active metabolite of enalaprilat, which is a more efficient ACE inhibitor than enalapril. The time of reaching CMAX Enalapril is 1 h, Enalaprilalate - 3-4 h.

Distribution

Enalaprylate easily passes through histohematic barriers, excluding the BC, a small amount penetrates through the placenta and in breast milk. Communication with blood plasma proteins of Enalaprilalate - 50-60%.

Metabolism

In the liver, enalapril is hydrolyzed to active metabolite - enalaprilalate, which is subjected to further metabolism.

Election

The renal clearance of enalapril and enalaprilalate is 0.005 ml / s (18 l / h) and 0.00225-0.00264 ml / s (8.1-9.5 l / h), respectively. T1 / 2 Enalaprilalate - 11 h. It is removed mainly by the kidneys - 60% (20% - in the form of enalapril and 40% - in the form of enalaprilalate), through the intestine - 33% (6% - in the form of enalapril and 27% - in the form of enalaprilate) .

It is removed during hemodialysis (speed 38-62 ml / min) and peritoneal dialysis, the serum concentration of enalaprilalate after 4-hour hemodialysis decreases by 45-57%.

In patients with reduced renal function, the removal slows down, which requires a reduction in the dose in accordance with the impaired of the kidney function, especially in patients with severe renal failure.

In patients with hepatic insufficiency, the metabolism of enalapril can be slowed down without changing its pharmacodynamic effect.

In patients with chronic heart failure, the suction and metabolism of enalaprilalate slows down, VD is also reduced.

Hydrochlorothiazide

Suction

Hydrochlorothiazide is absorbed mainly in the duodenum and the proximal division of the small intestine. Absorption is 70% and increases by 10% when taking food. Cmax in blood serum is achieved after 1.5-5 hours. Bioavailability - 70%.

Distribution

VD - about 3 l / kg. Bonding with blood plasma proteins - 40%. In the therapeutic dose range, the average value of AUC increases directly proportional to the increase in the dose, when appointing 1 time / day, the cumulation is insignificant. Penetrates through the placental barrier and in breast milk. Accumulates in amniotic fluid. The serum concentration of hydrochlorothiazide in the blood of the umbilical veins is almost the same as in maternal blood. The concentration in the amniotic fluid exceeds such in the serum from the umbilical vein (19 times).

Metabolism

Hydrochlorothiazide is not metabolized in the liver.

Election

The hydrochlorothiazide is removed mainly with urine - 95% unchanged and about 4% in the form of hydrolyzate 2-amino-4-chloro-M-benzennedisulfonamide by glomerular filtration and active channel secretion in the proximal department of the nephron.

The renal clearance of hydrochlorothiazide in healthy volunteers and patients with arterial hypertension is approximately 5.58 ml / s (335 ml / min). Hydrochlorothiazide has a two-phase removal profile. T1 / 2 in the initial phase is 2 hours, in the final phase (10-12 hours after reception) - about 10 hours.

Pharmacokinetics in special clinical cases

In elderly patients, hydrochlorothiazide does not negatively affect the pharmacokinetics of Enalapril, but the serum concentration of enalaprilate is higher.

When the hydrochlorothiazide is prescribed, patients with chronic heart failure have been established that its absorption decreases in proportion to the degree of the disease by 20-70%. T1 / 2 hydrochlorothiazide increases to 28.9 h. Kidney clearance is 0.17-3.12 ml / s (10-187 ml / min), mean values \u200b\u200b1.28 ml / s (77 ml / min).

In patients undergoing the operation of intestinal shunting over obesity, the absorption of hydrochlorothiazide can be reduced by 30%, and a serum concentration by 50% than in healthy volunteers.

The simultaneous use of enalapril and hydrochlorothiazide does not affect the pharmacokinetics of each of them.

Enap-n: Dosage

ENAP®-H should be taken regularly at the same time, preferably in the morning, during or after eating, without chewing, drinking with a small amount of fluid.

In patients who are on diuretics therapy, it is recommended to cancel treatment or reduce dosage doses at least 3 days before the start of treatment with ENAP®-H preparation to prevent the development of symptomatic hypotension. Before starting treatment, the kidney function should be investigated.

The duration of treatment is established by the doctor individually.

In patients with renal failure with KK 30-75 ml / min, the drug ENAP®-H should be used only after preliminary detection doses of Enalapril and hydrochlorothiazide separately, respectively, doses in the ENAP®-n combined preparation.

Overdose

Symptoms: reinforced diuresis, a pronounced decline in Hell with bradycardia or other heart rate disorders, convulsions, disturbances (including to some), acute renal failure, violation of the KSR and the water and electrolyte balance of blood.

Treatment: The patient is translated into a horizontal position with raised legs. In light cases, the washing of the stomach and reception inside the activated carbon are shown, in more serious cases - measures aimed at stabilization of blood pressure - in / in the introduction of plasma reforms, infusion of 0.9% solution. In the patient, it is necessary to control the level of blood pressure, heart rate, respiratory frequency, serum concentration of urea, creatinine, electrolytes and diuresis, if necessary, in / in the introduction of angiotensin II, hemodialysis (the elimination rate of enalaprilalate - 62 ml / min).

Medicinal interaction

The use of potassium supplements, potassium-saving drugs or preparations containing potassium substitutes, especially in patients with renal failure, can lead to a significant increase in serum potassium content. Potassium loss against the background of tiazide diuretics, as a rule, decreases under the action of Enalapril. The content of potassium in serum usually remains within the normal range.

With simultaneous use with lithium preparations, a deletion of lithium removal (amplification of cardiotoxic and neurotoxic lithium action) occurs.

Tiazide diuretics can enhance the effect of chloride tube.

The simultaneous use of thiazide diuretics, opioid analgesics or phenothiazine derivatives can lead to orthostatic hypotension.

The use of beta-adrenoblastors, alpha-adrenobloclars, gangli-blocking agents, methyldopes or block plants of slow calcium channels can additionally reduce blood pressure, with enalapril.

The simultaneous use of allopurinol, cytostatics and immunosuppressants with ACE inhibitors can increase the risk of leukopenia.

The simultaneous intake of thiazide diuretics with GCS, calcitonin can lead to the development of hypokalemia.

The simultaneous reception of cyclosporine with ACE inhibitors can increase the risk of hypercalemia.

The simultaneous use of NSAIDs (including selective COX-2 inhibitors) can weaken the antihypertensive effect of ACE inhibitors. NSAIDs and ACE inhibitors have an additive effect on the increase in serum potassium content, which can lead to a deterioration in the kidney function, especially in patients with impaired kidney function. This effect is reversible. NSAIDs can reduce diuretic and antihypertensive effects of diuretics.

Antacids can reduce the bioavailability of ACE inhibitors.

Sympathomimetics can reduce the antihypertensive effect of ACE inhibitors.

Tiazide diuretics can reduce the effect of adrenomimetics (epinephrine).

Ethanol enhances the hypotensive effect of ACE inhibitors and thiazide diuretics, which can cause an orthostatic hypotension.

The one-time reception of the kolhesistramine or the bears is reduces the absorption of hydrochlorothiazide in the gastrointestinal tract by 85% and 43%, respectively.

With the simultaneous use of ACE inhibitors and gold preparations (sodium ahurohythomalat) in / B, a symptom complex, which includes hyperemia of the skin of the face, nausea, vomiting and arterial hypotension.

Pregnancy and lactation

The drug ENAP®-H is contraindicated during pregnancy.

The effect of ACE inhibitors on the fruit in the I trimester of pregnancy is not established. The use of ACE inhibitors in the II and III of trimesters of pregnancy was accompanied by a negative impact on the fruit and a newborn. The newborn has arterial hypotension, renal failure, hypercalemia, and / or hypoplasia of the bones of the skull. The development of an olighydramnion, apparently, due to the violation of the renal function of the fetus. This can lead to the contracture of the limbs, deformation of the bones of the skull, including its facial part, and lung hypoplasia.

The use of diuretics during pregnancy is not recommended, because it can cause jaundice of the fetus and newborn, thrombocytopenia, and possibly other, unwanted reactions observed in adults.

Enalapril and hydrochlorothiazide penetrate into breast milk. Therefore, when appointing the drug ENAP®-H during lactation, it is necessary to abandon breastfeeding.

ENAP-N: Side effects

Classification of the frequency of the side effects of WHO: Very often (\u003e 1/10), often (\u003e 1/100 and 1/1000 and 1/10 000 and

From the side of the blood formation system: rarely - neutropenia, reduced hemoglobin and hematocrit, thrombocytopenia, leukopenia, inhibition of bone marrow function.

From the metabolism: infrequently - gout.

From the CNS: Very often - dizziness, weakness; Often - headache, asthenia; Infrequently - insomnia, drowsiness, paresthesia, increased excitability, noise in the ears.

From the side of the cardiovascular system: often - orthostatic hypotension; Infrequently fainting, a pronounced decline of blood pressure, a feeling of heartbeat, tachycardia, chest pain.

From the side of the respiratory system: often - cough; Infrequently - shortness of breath.

From the digestive system: often - nausea; Infrequently - diarrhea, vomiting, dyspepsia, abdominal pain, meteorism, constipation, dry mouth; Rarely - cholestatic jaundice, fulminant necrosis.

Allergic reactions: Radiously - Stevens-Johnson syndrome; rarely - angioedema edema; Very rarely - intestinal angioedema swelling.

Dermatological reactions: infrequently - skin rash, itching, increased sweating, skin necrosis, alopecia.

From the urogenital system: infrequently - impaired kidney function, acute renal failure.

From the reproductive system: infrequently impotence, a decrease in libido.

From the side of the musculoskeletal sisthem: often - muscle spasms; Infrequently - arthralgia.

From the side of the laboratory indicators: rarely - hyperglycemia, hyperuricemia, hypokalemia, hypercalemia, hyponatremia, an increase in the concentration of urea and creatinine in serum, increasing the activity of hepatic transaminases and bilirubin.

Others: A symptom complex, which may include fever, Malgia and arthralgia, serozite, vasculitis, ESP, leukocytosis and eosinophilia, skin rash, positive anti-rotary antibody test.

Terms and Storage Terms

List B. The drug should be stored in a dry, inaccessible place at a temperature not higher than 25 ° C. Shelf life - 3 years.

Indications

arterial hypertension (patients,
which are shown combination therapy).

Contraindications

anuria;
pronounced renal impairment (QC
Angioedema edema in history,
associated with the use of previously ACE inhibitors;
Hereditary or idiopathic angioedema edema;

Bilateral stenosis of renal arteries,
stenosis of the arteries of the only kidney;
Lactose intolerance
lactase deficiency or glucose / galactose malabsorption;
Pregnancy;

Lactation period;

Children's and adolescent age up to 18 years old (efficiency and safety are not established);

Increased sensitivity to the components of the drug or sulfonamide derivative.

With caution, it should be used the drug with a pronounced stenosis of the aorta's mouth or idiopathic hypertrophic subaartal stenosis,
IHD and cerebrovascular diseases (incl.
in case of brainwater failure),
excessive decrease in blood pressure may lead to the development of myocardial infarction and stroke,
chronic heart failure
pronounced atherosclerosis
severe autoimmune systemic diseases of the connective tissue (incl.
sclerodermia)
oppression of bone marrowing,
diabetes mellitus (because
tiazide diuretics are able to reduce glucose tolerance),
hypercalemia
condition after kidney transplantation,
violations of liver and / or kidney functions (QC 30-75 ml / min),
states
accompanied by a decrease in the BCC (as a result of therapy with diuretics,
when restricting consumption of cook salt,
diarrhea and vomiting)
in elderly patients.

special instructions

The arterial hypotension with all clinical consequences may be observed after the first reception of the ENAP®-H tablets in patients with severe heart failure and hyponatremia, severe renal failure, arterial hypertension or left ventricle dysfunction and, in particular, in patients in the state of guilolemia, as a result of patients Therapies of diuretics, pelvic diet, diarrhea, vomiting or hemodialysis.

In the event of an arterial hypotension, it is necessary to put the patient on the back with a low headboard and, if necessary, adjust the volume of the BCC by infusion of 0.9% sodium solution of chloride. Arterial hypotension arising after receiving the first dose is not a contraindication for further treatment.

Care in patients with IBS, expressed cerebrovascular diseases, aortic stenosis or idiopathic hypertrophic obstructive stenosis, preventing blood outflow from left ventricle, expressed atherosclerosis, in elderly patients as a result of the risk of the development of arterial hypotension and deterioration in the blood supply of the heart, brain and kidneys.

In patients receiving the drug ENAP®-H, it is necessary to identify signs of violation of water and electrolyte balance, such as dry mouth, thirst, weakness, drowsiness, increased excitability, myalgia and convulsions (mainly icy muscles), decreased blood pressure, tachycardia, oliguria and gastrointestinal disorders (nausea, vomiting).

The drug ENAP®-H in patients with renal failure (KK 30-75 ml / min) should be used only after preliminary detection doses of enalapril and hydrochlorothiazide separately, respectively, doses in the combined drug ENAP®-N.

The drug ENAP®-H is necessary with caution to apply in patients with hepatic insufficiency or progressive liver diseases, because Hydrochlorothiazide can cause hepatic to whom even with minimal disorders of water and electrolyte balance. Several cases of the development of acute liver failure with cholestatic jaundice, fulminant liver necrosis and fatal outcome (rarely) during the treatment of ACE inhibitors are reported. In the event of jaundice and increasing the activity of hepatic transaminases, the treatment of ENAP®-H should be immediately discontinued, patients should be under observation.

Caution is necessary in all patients receiving treatment with hypoglycemic agents for intake or insulin, since hydrochlorothiazide can weaken, and enalapril enhance their action.

Tiazide diuretics can reduce the removal of calcium with the kidneys and cause a slight and transient increase in the content of calcium in serum.

Pronounced hypercalcemia can be a sign of hidden hyperparathyroidism. Before conducting a study of the function of the parathyroid glands, thiazide diuretics must be canceled.

Against the background of treatment with thiazide diuretics, cholesterol concentrations and serum triglycerides can increase.

Therapy of thiazide diuretics in some patients can exacerbate hyperuricemia and / or escalate the course of gout. However, enalapril enhances the removal of urinary acid by the kidneys, thereby counteracting the hyperurientichemic effect of hydrochlorothiazide.

In the event of angioedema swelling, the face is usually enough to cancel therapy and the appointment of antihistamine patient.

The angioedema swelling of the language, pharynx or larynx can be lethal. With an angioemotic edema of the language, pharynx or larynx, which can lead to the obstruction of the respiratory tract, it is necessary to immediately introduce epinephrine (0.3-0.5 ml of epinephrine solution (adrenaline) P / K in a ratio of 1: 1000) and maintain the airway passability (intubation or tracheostomy) .

Among the patients of the Negroid race, receiving therapy therapy inhibitor ACE, the incidence of angioedema edema is higher than among other racial patients.

Patients with angioedema edema in history that are not associated with ACE inhibitors have an increased risk of developing angioedema edema when receiving any ACE inhibitor.

Due to the increase in the risk of anaphylactic reactions, the drug ENAP®-H patients in hemodialysis should not be prescribed using high-flow polyacrylonitrile membranes (AN 69®) subjected to a low density lipoprotein with decastran sulfate and immediately before the desensitization procedure to the aspen or bee poison.

Before surgical intervention (including dentistry), it is necessary to warn a anesthesiologist's doctor about the use of ACE inhibitors.

During surgical interventions or carrying out general anesthesia using arterial hypotension funds, the ACE inhibitors can block the formation of angiotensin II in response to the compensatory release of Renin. If the pronounced decrease in the blood pressure is developing, explained by a similar mechanism, it can be adjusted to an increase in the BCC.

Impact on the ability to driving vehicles and control mechanisms

At the beginning of the treatment with ENAP®-H, a pronounced decrease in blood pressure, dizziness and drowsiness may arise, which can reduce the ability to control vehicles, to the occupation of other potentially hazardous activities that require increased concentration and speed of psychomotor reactions. Therefore, at the beginning of treatment, it is not recommended to manage vehicles and engage in other potentially hazardous activities that require increased concentrations of attention and speed of psychomotor reactions.

Application in violation of the kidney function

The use of the drug under Anururia, pronounced disorders of the kidney function (QC

With caution, the drug should be used in bilateral stenosis of the renal arteries, stenosis of the arteries of the only kidney, disorders of the kidney function (KK 30-75 ml / min), the state after the transplantation of the kidneys, severe renal impairment.

Application in violation of the liver function

The use of the drug during porphyry is contraindicated.

With caution, use the drug with severe liver function disorders.

Pills ENAP N is a weak diuretic that promotes the normalization of high blood pressure. It is used for combined therapy in the treatment of hypertension. It is a more efficient means compared with its predecessor - the drug ENAP.

There are a number of reasons that do not allow to apply this particular drug to individual groups of people:

Also, the assignment of ENAP H should be pondering for patients with heart disease, the brain: stenosis of the aortic aorta, idiopathic hypertrophic subaartal stenosis, IBS, cerebrovascular diseases, insufficient cerebral circulation. Cause - excessive, sharp decrease in blood pressure can become a catalyst for myocardial infarction, stroke. It is also possible to develop:

It is undesirable to the prescription of the drug by patients after a kidney transplantation, in violation of functions, both this organ and liver, under states that are accompanied by a decrease in circulating blood, elderly people.
ENAP N: Features of the reception, dosage
Preparation It is advisable to drink at the same time daily, in the morning during breakfast or after it. The tablet should not be chewed, drink (better use water). Doctors recommend drinking 1 tab. in a day.
If Anap N is assigned to people using diuretics, it is recommended to reduce the dose of diuretics in advance (at least for 3 days) before receiving ENAP H or cancel the treatment at all. In the opposite case, the patient inevitably the development of symptomatic hypotension. Also before treatment, it is necessary to conduct a study of the kidney functions in the patient.
The duration of treatment establishes a doctor, it depends on several factors and is determined individually.
If the patient suffers to renal failure, while the QC is equal to 30-75 ml / min, the use of Enapa H is possible only after the dose of Enalapril and hydrochlorothiazide will separately pass with a titrimetric analysis.
Overdose
The use of an unnecessary amount of Tablets ENAP N 25mg / 10mg may cause:
Treatment in overdose begins with the fact that the patient is put in a horizontal position, lifting his legs. If the patient drank a small amount of tablets - a light case - you need to wash the stomach to him, give a drink of activated carbon.
If the case is serious, then the operations for stabilization of blood pressure are necessary: \u200b\u200bin / in the introduction of plasma proceeds, sodium infusion chloride (solution of 0.9%). During such treatment, it is necessary to follow:
Changes in the level of blood pressure, heart rate;
How often the patient began to breathe, behind the most insignificant changes in respiration;
Serum concentration of urea, electrolytes;
Urine volume.

If necessary, administration of intravenous hemodialysis, angiotensin II is prescribed.
ENAP N: Interaction with various drugs
Application during pregnancy and during breastfeeding
The appointment of ENAP N during pregnancy is contraindicated. There are no studies that would show the consequences of the use of ACE inhibitors on the fruit in the first trimester. The use of the drug in the second and third trimester leads to irreversible consequences on the fruit and a newborn:
Arterial hypotension develops;
Hypercalemia;
Gypoplasia bones of the skull.

Also possible is the development of an oligohydramnion, pathology of lowland leads to deformation of the bones of the skull, the contracture of the limbs, lung hypoplasia.
Diuretics during pregnancy become the cause of jaundice at the fetus / infant, thrombocytopenia. Various effects on adult health are also possible.
If it is impossible to avoid the use of ENAP N during lactation, then it is necessary to refuse to feed the baby's chest.
Side effects
In accordance with the classification of WHO, the frequency of the development of side effects is next:
Very often - more than one patient for 10 people;
Often - more than 1 person per 100 patients, but at the same time less than 1 per 10 patients;
Infrequently - more than 1 per 1000 people, but less than 1 per 100 patients;
Rarely - more than 1 per 10 thousand people, but less than 1 per 1000;
Very rarely - less than 1 per 10 thousand patients.

Blood-formation system. Rarely: neutropenia, inhibition of bone marrow functions, thrombocytopenia, reduction of hematocrit and hemoglobin, leukopenia.
Metabolism. The gout seriously develops.
CNS.. Very often appears dizziness, general weakness. Often patients feel headache, impotence (asthenia). The side effect is infrequently manifested in the form of insomnia, paresthesia, drowsiness, high excitability, noise in the ears.
The cardiovascular system. Often, patients complain about orthostatic hypotension, infrequently fainting, feeling of heartbeat, pronounced decline in blood pressure, tachycardia, chest pain.
Respiratory system. Completely appears cough, the shortness of breath can begin.
Digestive system. Frequent side effect - nausea. Infrequently patients complain about diarrhea, vomiting, dyspepsia, abdominal pain, constipation, flatulence, dry mouth. Rarely appears cholestatic jaundice, necrosis (fulminant).
Allergy. Stevens-Johnson syndrome is infreed. Rarely observed angioedema swelling. An intestinal angioedema swelling is very rare.
Dermatology. Infrequently manifests the side reaction in the form of a rash, itching, increased sweating, skin necrosis, alopecia.
GOOD SYSTEM. Incidentally, the manifestation of violations of kidney functions, acute renal failure is possible.
Reproductive system. Impotence or a decrease in libido is rarely possible.
Bone-muscular system. Often patients complain about muscle spasms, infrequently - to arthralgia.
Among other side effects there is fever, Malgia, Arthralgia, serozite, vasculitis, skin rash, an increase in SE, etc.
special instructions
AnAP N.
Berlipril Plus;
Ko-Renaten;
Prienna;
Enalapril;
Enafarm and others.

Many analogs have a different dosage, like ENAP N.
What is better to ENAP or ENAP N?
Both drugs have a single basic active ingredient - enalapril Maleat. But in ENAP H, it additionally includes hydrochlorostiazide, which is a diuretic product. Thus, the ENAP N is a combined and more efficient drug.

In accordance with the WHO data, 70% of patients suffering from hypertension are needed in combination treatment. The main reasons lies in the insufficient effectiveness of monotherapy and the low commitment of patients with treatment, which is associated with side effects.
Fixed combinations of low-volume antihypertensive components are a full-fledged replacement of 2-3 medicines, which makes it possible to follow the recommendations of the doctor, provides a decrease in the pharmacological load, minimizes the likelihood of side effects, improves pharmacotherapy tolerance, reduces the cost of treatment.
One of these drugs is ENAP-H, which is prescribed with arterial hypertension. The drug is recommended for use also in the pathologies of the heart muscle, it is very important to strict adherence to the dosage.

The medication allows you to quickly get rid of the symptoms of arterial hypertension, the ignoring of which can lead to a fatal outcome.
pharmachologic effect
The effect of the drug is due to its composition components, it has a hypotensive effect. The diuretic of the middle force of the hydrochlorothiazide provides excretion from the body of bicarbonate, water, Na +, Cl-. The decrease in the content of Na ions in the vessels ensures their dilatation, the resulting sensitivity to vasoconductive factors is reduced.
Hydrochlorothiazide provides a decrease in the K + plasma, enalapril provokes its delay. Simultaneous reception of these LS provides normal support for the content of K + in plasma. Hydrochlorothiazide contributes to the normalization of the removal of phosphates and hydrocarbonates. The substance does not negative impact on the brain and kidney, which indicates the safety of the drug for vital systems and organs.
Under the influence of enalapril, an ACE inhibition is ensured, which contributes to the transformation of angiotensin I in angiotensin II. As a result of the drug intake, the content of aldosterone is reduced in plasma, the release of renin, Pg and endothelial relaxing velocity factor increases, the inhibition of the sympathetic nervous system is observed, the operation of the kallicrein-kinin vasodepressive system is improved.
The combination of these factors contributes to the elimination of spasms, the OPS, diastolic and systolic blood pressure, post-and preload on myocardium, is also expanding the peripheral arteries. The effect of the expansion of the arteries is not accompanied by an active increase in heart rate, as it happens on the reflex level.
Increased pressure does not cause circulatory disorders in the brain, which also testifies to the drug. As a result of improving blood circulation in myocardium, the patient's recovery process accelerates.
As a result of the proper admission of ENAP-H, the renal blood flow is activated, while the glomerular filtering is accelerated and its functionality is expanding.
Compliance with the Rules for receiving medication provides a rapid pressure reduction than if you receive components separately.
Indications for use
The main indication is arterial hypertension, ENAP is also recommended for use in heart failure of any extent.
The reception of the drug is also shown in order to reduce the risk of the occurrence of unstable angina and myocardial infarction.
Mode of application
Tablets must be taken without chewing, regardless of meals. The initial dosage should not exceed 5 mg per day, there is a gradual increase in the dose of up to 20 mg, sometimes up to 40 mg, two-fold drug intake is provided.
With severe arterial hypertension and cardiac decompensation, a significant decrease in blood pressure may be observed. For this reason, there is a reception of small doses under the supervision of the doctor.
If the patient passed therapy with diuretic drugs, the technique of ENAP-H can provoke a decrease in the volume of circulating blood and cause the development of the arterial hypotension. In such a situation, there is a decrease in the initial dose of less than 5 mg / day. In the treatment of a child, the dose is calculated based on its mass, if it is less than 20-50 kg of dose should not exceed 2.5 mg.
Release form, composition
Annotation states that the unique composition of the drug helps in a short time to get rid of symptoms. The developers emphasize that many years of work was carried out on the medication, as a result, it was possible to create a unique drug, analogs of which are considered less efficient and effective.
The main active ingredients of ENAP-H are hydrochlorothiazide, Enalapril, Maleat.
Auxiliary components:
corn starch - has a soothing effect;

magnesium stearat - satures the cells of the heart and other magnesium organs necessary to ensure the functioning of the body;

talc - has a normalizing effect on the body;

sodium bicarbonate - struggling with heart disease diseases;

lactose monohydrate - feeds cells, ensures an increase in the concentration of utility substances;

hinoline dye - gives a yellowish color tablets.

ENAP-N is available in tablets, in one blister of 10 pcs, in a pack of 2 blisters.
Interaction with other drugs
ENAP-H enters the following medicinal interactions:
potassium in pure form, potassium supplements, potassium drugs - a sharp distribution of serum potassium content (especially with renal failure, kidney pathologies);

lithium prepartes - a decrease in its removal, which has a negative impact on the functioning of many systems;

tiazide diuretics - enhance the effect of chloride removal;

opioid analgesics and drugs that include phenothiazine - the development of orthostatic hypotension;

calcium channels, alpha and beta-adrenoblays, an additional decrease in blood pressure during treatment;

kolistramin - a decrease in the absorption of the drug by 85%;

allopurinol and immunosuppressants - an increase in the risk of development of leukopenia;

tiazide diuretics together with GKS - contribute to the development of hypokalemia,

Ignoring the compatibility of drugs can provoke hyperemia of the skin of the face, arterial hypotension, pronounced vomiting. If these deviations are detected, it is recommended to seek medical attention.
Side effects
Failure to follow the instructions may cause the following side effects:
Violations and pathology of the blood formation system Gout, reduction of hemoglobin content, depression of bone marrow, leukopenia.
Diseases of the central nervous system Strong cough, shortness of breath, increased excitability, insomnia / drowsiness, headache, noise in the ears, constant dizziness.
Cardiovascular disease Hypotension, chest pain, faint, tachycardia.
Violations of the functioning of the GTC Meteorism, a feeling of dryness in the mouth, pain in the abdomen, diarrhea, vomiting, nausea.
GOOD SYSTEM Impotence, a decrease in libido.
If there are one or more symptoms, the doctor's help is recommended, which after analyzes will prescribe treatment.
Overdose
Overdose is accompanied by the following symptoms:
sharp decline in blood pressure;

violation of the KSR;

loss of consciousness up to coma;

renal failure;

diuresis;

convulsions;

violation or change in the frequency of the heart rhythm;

change of water and electrolyte balance.

In this case, treatment is assigned - the patient is placed in a horizontal position with raised upside down. In easy cases, washing the stomach and the reception of activated carbon is prescribed.
In severe cases, the blood stabilization is carried out by introducing a sodium solution of chloride and plasma substitutes. Under the control of the doctor, such indicators such as pulse, respiratory frequency, serum content in urea.
With a worsening of the state, all activities should be discontinued.
Contraindications
Reception of medication is prohibited in the following cases:
anuria;

age up to eighteen years;

stenosis of the renal arteries;

allergic reactions, intolerance and lactase deficiency;

anamnesis edema caused by the intake of ACE inhibid;

disorders of the kidney function;

hypersensitivity to components.

pregnancy or breastfeeding;

age under 18 years old;

high sensitivity to the constituent drug.

Caution should be followed in the following cases:
cerebrovascular pathologists;

brain circulation failure;

idiopathic stenosis;

stenosis of aortic.

ENAP-H is also not recommended with constantly increased blood pressure or diseases that cause it, it can lead to autoimmune pathologies of connective tissue, atherosclerosis, stroke, heart failure, infarction.
During pregnancy
During pregnancy, ENAP-H is prohibited.
Terms and Storage Terms
ENAP-N is recommended to be stored at temperatures not higher than 30 degrees for five years from the date of production.
Price
average price in Russia On ENAP-N begins from 158 rubles.
average cost in Ukraine starts from 22 UAH.
Analogs
Anip-n analogs are the following drugs: Berlipril, Mioto

The preparations against high pressure are the pills of ENAP-N. The pharmaceutical product is actively used in patients with different age groups and gives a good therapeutic effect. About the composition, pharmacological properties of tablets, testimony and contraindications to use, let's talk further.

Description, Composition and Properties

ENAP-N is a medicine from the group of ACE inhibitors, the main properties of which are caused by the active ingredients and the active substances that are included in its composition.

The combined drug has a pronounced hypotensive effect and refers to the category of weak diuretics providing normalization of blood pressure. Most often, the tablet is used as part of a complex of medical measures in patients suffering from arterial hypertension.

The drug includes:

Enalapril Melat. ACE inhibitor, relieving vessel spasms and expanding the clearance of the arteries. The substance reduces the resistance of the vessels and contributes to a decrease in blood pressure (both systolic and diastolic). Reduces and post-loading on cardiac valves, without increasing heart rate frequencies. The maximum hypotensive effect from the component in the composition is developing in 6-8 hours and is preserved over the next day.

Hydrochlorothiazide. Diuretik, having an average action. It actively lowers blood pressure by reducing the volumes of circulating blood.

Excipients - Talc, sodium bicarbonate, dyes, lactose, corn starch.

The main actors provide the main pharmacological properties of the drug.

Monotherapy with enalapril and hydrochlorothiazide does not give such a pronounced hypotensive effect as their combination.

Who shows the application?

Tablets are used in the treatment of arterial hypertension in comprehensive treatment. The tool is used in patients whose tonometer indicators are stably shown above 140/90.

Method of application and dosage

The average dosage of the drug for patients suffering from arterial hypertension is 1 tablet per day.

Before receiving an enap-n hypertension, it is mandatory to see the diagnosis of kidneys to determine their function.

The duration of the use of the drug for each patient determines the doctor individually, taking into account:

severity of the main ailment;

overall health;

contraindications of concomitant diseases and pathologies are available.

To achieve the maximum therapeutic effect on the reception of ENAP-H, the following recommendations should be followed:

daily drink the drug at the same time or at regular intervals;

drink a tablet in the first half of the day, preferably in the morning during or after breakfast;

the tablet should not be chewed, but to swallow the whole, drinking with a small amount of pure drinking water.

Compatibility with other drugs

ENAP H is a drug that can enhance or reduce the therapeutic effect of other drugs. Parallel reception with other medications can cause the development of side effects.

The manufacturer warns about the following interaction of ENAP-H tablets with other drugs:

Simultaneous reception with potassium additives and substitutes of salt leads to an increase in the amount of potassium in serum.

Joint treatment with lithium preparations strengthens the cardiotoxic effects of the latter.

ENAP-H enhances the effect of chloride tubaurine.

Taking tablets in parallel with opium analgesics can cause arterial hypotension.

Parallel treatment of ENAP-H and immunosuppressants at times raises the risk of leukopenia.

Non-steroidal anti-inflammatory agents weaken the hypotensive effect of the ACE inhibitor. Simultaneous reception with NSAIDs also negatively affects the work of the kidneys, worsening their functions, causing renal failure.

Combined therapy with hypoglycemic drugs and ACE inhibitors causes the development of hypoglycemia. First of all, the complication is diagnosed in patients with impaired kidney functions.

In patients parallel to taking diuretics, before the start of administration, ENAP-N should reduce the dosage of the diuretic to at least three days before the first taking of the drug. Otherwise there is a high risk of developing hypotension.

Special instructions regarding the application

ENAP-N is a medicinal tool that should be taken in compliance with the recommendations of the doctor and the consideration of the special guidelines of the manufacturer:

The first receiving tablets can cause arterial. A decrease in pressure indicators in the first days of treatment is not a reason for the cancellation of therapy.

In all patients, without exception, during the reception of the drug, it is necessary to control the serum concentration of electrolytes. In particular, hypertensive, whose vomiting or diarrhea is observed.

When signs of a sharp decrease in blood pressure, the patient should immediately be put in a horizontal position and ensure the location of the legs above the head.

When jaundice appears against the background of Enap-n, it is important to immediately stop using the drug and consult a doctor.

Tablets should not be combined with alcohol intake and any ethanol-containing drugs. Ethanol, cause enhanced by the hypotensive effect of ENAP-H and provoke the arterial hypotension at simultaneous reception.

Contraindications

Despite its high efficiency, ENAP-H tablets are allowed to use far from all patients suffering from arterial hypertension. The manufacturer reports basic contraindications in the instructions. So, to refuse to treat pills with pills:

with severe impaired kidney functions;

with angioedema edema;

with any violations of the passability of the urethra;

with the individual intolerance to the ACE inhibitors in history;

with lactose intolerance;

in children and adolescents under the age of 18 (studies regarding the safety of the use of the drug in this category of patients were not conducted).

with individual intolerance, increased sensitivity or allergies to individual components included in the tablet.

With particular care, ENAP-N is prescribed to the patient:

suffering from cardiovascular system;

with violations of cerebral circulation;

with ischemic heart disease;

under cerebrovascular diseases;

with the narrowing of the mouth of the aorta.

Intensive decrease in blood pressure using tablets with the above-described states and diseases may result in irreversible consequences and cause development or.

It is extremely undesirable to use tablets in senior patients, as well as people who previously undermining a kidney or liver transplant.

Application in pregnant women

ENAP-H is prohibited for use in pregnant women. There are currently no information regarding the safety of the drug reception in 1 trimester of pregnancy. At 2 and 3 trimesters of pregnancy, the treatment of pregnant women inhibitors of ACE leads to malformations of the fetus and severe complications for the newborn.

Possible side effects

ENAP-N, like any ACE inhibitor, quite often causes adverse reactions. Even compliance with the prescribed dosage doctor and recommendations regarding the reception of pills does not guarantee the absence of side effects by the authorities and their systems.

The most frequent cork effects that occur in patients undergoing therapy with Tablets ENAP-N:

on the part of the central nervous system - dizziness, the feeling of weakness, general alert, insomnia, headaches, fast fatigue, the feeling of noise in the ears;

from heart and vessels -, fainting, rapid decrease in blood pressure;

from the sides of the respiratory - dry obsessive cough, shortness of breath;

from the head of the gastrointestinal bids - abdominal pain, vomiting, diarrhea or constipation, increased gas formation in the intestine, dryness sensation in the mouth;

from the side of the excretory system - acute renal failure and other malfunctions in the work of the kidneys;

from the reproductive system, a decrease in sexual entry.

When taking Enap-N, cases of the appearance of various allergic reactions in the form of edema, itching, rash, increased sweating are recorded.

Other side effects, often developing on the background of receiving tablets:

raising ESP;

malgy;

fevering condition;

vasculitis.

Overdose

Violation of the maximum daily dosage of the drug in 10-25 mg can lead to overdose. The latter manifests itself:

amplification of diuresis (urination);

the appearance of convulsion;

a sharp decrease in blood pressure with the advent of pronounced heart rate disorders;

violation of consciousness (with the most severe cases, the patient can be in to whom);

the emergence of acute renal failure;

violations of salt metabolism.

When suspected overdose and the appearance of any of the above symptoms, the patient should be immediately put into the horizontal position and lift the lower limbs. With a slight overdose, stomach washing, as well as the reception of any absorbents. For example, activated carbon.

With complex forms of overdose, more radical measures are carried out to stabilize the patient's condition:

sodium chloride infusion;

introduction of plasma processes;

performance of intravenous hemodialysis.

When conducting such procedures, strict monitoring of changes in the level of blood pressure, heart rate, respiratory rate, urine volumes are needed.

Analogs

In allergies, the appearance of adverse reactions to the doctor can be recommended analogues of ENAP-N. The most common of them:

Adena;

Enafarm;

ENAP.

What is better: ENAP or ENAP-N?

As part of both drugs, there is a common active ingredient - enalapril Maleat. ENAP-H further comprises a hydrochlorodiazide, which enhances the hypotensive effect of the drug. Consequently, ENAP-H due to a combination of the main drug components is considered a more effective drug. It is the combined impact that provides a long effect and reduces blood pressure to optimal indicators for the whole day.

ENAP-H has a more pronounced therapeutic effect, in comparison with its analogue - ENAP tablets.

ENAP N is a fairly popular medicinal agent against arterial hypertension, which has both positive and negative effects on the body. The drug in addition to the positive therapeutic effects quite often causes adverse reactions, so it must be assigned a strict doctor.

Violations and pathology of the blood formation system	Gout, reduction of hemoglobin content, depression of bone marrow, leukopenia.
Diseases of the central nervous system	Strong cough, shortness of breath, increased excitability, insomnia / drowsiness, headache, noise in the ears, constant dizziness.
Cardiovascular disease	Hypotension, chest pain, faint, tachycardia.
Violations of the functioning of the GTC	Meteorism, a feeling of dryness in the mouth, pain in the abdomen, diarrhea, vomiting, nausea.
GOOD SYSTEM	Impotence, a decrease in libido.