Enalapril tablets from pressure - instructions for use, analogues. Enalapril: instructions for use, analogues and reviews, prices in pharmacies in Russia Enalapril daily dose

Date: 27.07.2020

Enalapril is considered one of the most effective medicines in its group. With its help, you can reduce blood pressure and control it throughout the entire period of treatment. Enalapril is classified as an ACE inhibitor.

In addition to the pronounced hypotensive effect, it has the ability to improve blood flow and prevent some diseases. Today we will learn about the features of this medication, indications, instructions for the use of Enalapril, its price, analogues and reviews of doctors and patients about it.

Features of the drug

The drug is not recommended to be combined with alcoholic beverages, so as not to increase the hypotensive effect.
Enalapril affects the ability to concentrate, therefore it is recommended to refrain from working with complex mechanisms.
At the initial stage of treatment, it is also necessary to abandon complex work, including those associated with danger or requiring attention, since dizziness is possible.
During treatment, you need to be more careful in hot weather, as well as when engaging in physical activity, since there is a risk of a stronger decrease in blood pressure due to low circulating blood volume.

Doctors should always be warned about treatment with Enalapril before surgical intervention, including dental.

The following video will tell you in more detail about the features of the drug Enalapril:

Composition

The tablet contains the active substance enalapril maleate in a dosage of 5, 10, 20 mg. Components that are auxiliary:

sugar,
magnesium stearate or calcium stearate,
lactose,
medical gelatin,
potato starch.

Dosage forms

Enalapril is available in tablet form. The price category is very affordable. So, in the smallest dosage (5 mg), 2 blisters of 10 tablets will cost 10-20 rubles. The cost of the drug usually does not exceed 100 rubles.

Pharmacological action and pharmacodynamics

The drug belongs to the group of antihypertensive drugs. Its action is aimed at inhibiting the activity of angiotensin enzymes, which directly leads to a decrease in the production of aldosterone. The consequence of this is a decrease in diastolic and systolic blood pressure.
Enalapril also helps to dilate blood vessels, improves blood flow to the kidneys and brain.
After long-term use, there is a decrease in left ventricular hypertrophy, which makes it possible to slow down or completely prevent development.
The blood supply to the myocardium also improves.
Enalapril has some diuretic effect and reduces platelet aggregation.

Already after an hour, the hypotensive effect is noticeable, it will be maximum after 6 hours. The effect is fully preserved throughout the day. In some groups of patients, longer therapy (usually several weeks) is required for a lasting result.

If there is heart failure, then treatment should last about 6 months for a noticeable clinical effect to appear.

Pharmacokinetics

Absorption of the drug after use is 60%. About half of the agent binds to proteins. In the process of metabolism, a metabolite is formed, which is absorbed in the body. Enalapril is modified into enalaprilat - a more bioavailable (40%) and active ACE inhibitor.

The medication is able to penetrate into breast milk and placenta. The half-life is about 11 hours. Up to 60% is excreted by the kidneys, and another 33% through the intestines. With peritoneal dialysis and hemodialysis, it is completely removed.

Indications

Enalapril is necessary for different types. It often replaces low-potency antihypertensive drugs. For use, it is also prescribed in the presence of:

bronchospastic conditions,
heart failure
diabetic nephropathy,
chronic renal failure,
Raynaud's disease, as well as as a complex therapy for other diseases.

It is not recommended for appointment during pregnancy, as it is capable of exerting some negative consequences on the fetus. However, it can be used if the comparative benefit from it is much higher than the possible risks.

Children are not prescribed Enalapril, since there is no data on the effectiveness and safety of such treatment.

Instructions for use

Inside. Application is not related to mealtime. The initial dosage should be 5 mg, then it is adjusted after getting used to it.

Usually, for treatment, it is enough to take 10 mg of Enalapril once. The maximum dosage of the drug is 40 mg. After taking the drug and until blood pressure stabilizes (usually 2-3 hours), the patient is monitored. After therapy with Enalapril at the maximum dosage, you should switch to maintenance treatment with 10-20 mg per day.

Before starting therapy, stop taking diuretics 2-3 days before the first use of the pills. If it is impossible to cancel them, the initial dosage should be significantly reduced (up to 2.5 mg).

In the presence of renovascular hypertension, the maximum dosage is 20 mg. Treatment begins with a small dose.
At an initial dosage of 2.5 mg, increasing it every few days.
Patients with low systolic blood pressure should start therapy with 1.25 mg tablets. The dose is adjusted within 4 weeks.

The duration of treatment determines the effectiveness of therapy. In the presence of a pronounced effect of lowering blood pressure, the dose of Enalapril is reduced. The medication is suitable for the complex use of antihypertensive drugs, as well as for monotherapy.

Contraindications

Age under 18;
sensitivity to the components of the product;
a history of angioedema, if the cause of its appearance was associated with therapy with ACE inhibitors;
pregnancy;
lactation;
porphyria.

Side effects

Digestive system: pancreatitis, hepatitis, jaundice, impaired liver function, dry mouth, abdominal pain, problems with stools, nausea, increased activity of hepatic transaminases.
urinary system: protein in urine, impaired renal function.
Nervous system: tiredness and fatigue, dizziness, headaches. At high dosages, paresthesias, nervousness, sleep problems, tinnitus, depression are possible.
Heart and blood vessels: hot flashes - in rare cases; orthostatic hypotension, pain in the region of the heart and rapid pulse, fainting, hot flashes.
Respiratory system: cough, bronchospasm, pharyngitis, shortness of breath, interstitial pneumonitis, rhinorrhea.
Hematopoiesis: in the presence of autoimmune diseases, agranulocytosis is noted; neutropenia is rare but possible.
Impact on reproductive performance: sometimes impotence appears when high doses are taken.
Allergic reactions: Quincke's edema, itching, skin rash, polymorphic erythema, serositis, myositis, vasculitis, Steven-Johnson syndrome, stomatitis, angioedema of the extremities and face.
Impact on laboratory parameters: increased ESR, decreased hemoglobin and hematocrit; neutropenia, hyperbilirubinemia, increased urea, eosinophilia.
Muscle cramps and hyperkalemia develop relatively rarely. There may be problems with the vestibular apparatus, the appearance of alopecia.

special instructions

Caveats

Always use Enalapril with extreme caution when:

liver failure
renal artery stenosis,
salt-free diet,
complex therapy with immunosuppressants,
weakened state after surgery,
hyperkalemia,
diabetes mellitus.

It is also important to know:

It is also important to monitor patients over 65 years of age. Particular attention is paid to people with cardiovascular diseases, in whom a sharp drop in blood pressure can provoke, or other serious consequences.
If the reception of Enalapril was previously preceded by treatment with saluretics, there is a risk of orthostatic hypotension. To eliminate the likelihood of its development, it will be necessary to restore the level of salts and liquid before using the tablets.
Long-term therapy requires regular monitoring of the composition of peripheral blood. If surgery is performed during the treatment period, a sufficient amount of fluid is injected to prevent arterial hypotension.
With the forced reception of Enalapril during pregnancy, it is necessary to establish control over the condition of the newborn. This will help to timely determine the deterioration of cerebral and renal blood flow, which occurs under the influence of ACE inhibitors, oliguria, neurological disorders and hyperkalemia.
A single dose should be adjusted and decreased if the patient suffers from decreased renal function. Cancel Enalapril before examining the function of the parathyroid glands.

Overdose

Overdose treatment is associated with symptomatic therapy, as well as the introduction of sodium chloride (isotonic solution) intravenously. Before this, the patient is transferred to a horizontal position, and the head should be located lower. For mild cases, gastric lavage is sufficient. An overdose is accompanied by the following symptoms:

cerebrovascular accident in acute form,
myocardial infarction,
collapse,
a state of psychological lethargy,
convulsions.

Interaction with other drugs

The risk of leukopenia increases with simultaneous therapy with cytostatics and immunosuppressants.
Hyperkalemia is most likely to develop when potassium preparations and dietary supplements are used together with Enalapril. ACE inhibitors lead to the retention of potassium in the body, which can aggravate the condition.
The antihypertensive effect is increased if the patient is taking opioid analgesics. The same effect is possible with loop diuretics.
There is a risk of impaired renal function and hyperkalemia.
The development of anemia occurs with the use of azathioprine, since it, together with Enalapril, has a depressing effect on the activity of erythropoietin.

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

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

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

Inhibitors of the angiotensin-converting enzyme (or ACE for short), to which Enalapril belongs, rarely cause side complications and practically do not have a significant effect on the patient's usual lifestyle.

How does the drug fight high blood pressure?

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

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

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

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

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

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

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

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

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

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

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

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

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

Indications for the use of Enalapril are the following diseases:

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

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

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

These include:

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

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

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

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

Enalapril: instructions, dosage features

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In recent years, an increasing number of people suffer from cardiovascular diseases. Many of them are young. Therefore, it is so important to find the right treatment.

Enalapril is a drug that works to lower blood pressure. Has an effect on the renin-angiotensin system. The drug has a pronounced hypotensive natriuretic, cardioprotective effect.

Enalapril is prescribed in the treatment of hypertension and as a prophylactic agent. Rarely causes side effects. Manufacturer - Serbian pharmaceutical company Hemofarm.

magnesium carbonate;
lactose monohydrate;
magnesium stearate;
gelatin.

Release form - in tablets with a round shape. They have a characteristic aroma and beige tint. The amount of active ingredient per tablet can be 5, 10, 25 mg.

pharmachologic effect

ACE inhibitor. When taking pills, diastolic and systolic blood pressure decreases. At the same time, afterload decreases, vasodilation occurs, and aldosterone in the adrenal glands decreases.

With prolonged treatment, the risk of developing myocardial infarction is reduced. Improves coronary and renal blood flow.

It is absorbed quickly by the organs of the digestive tract. It is metabolized in the liver. Active action begins within 1-2 hours after taking the pill.

Excretion - in the urine unchanged. It binds to blood proteins by 45-50%. Bioavailability is about 45%.

Has the ability to pass into breast milk.

Indications for use

in the treatment of arterial hypertension;
after a heart attack;
cardiac ischemia;
with chronic heart failure (as an additional treatment);
with diabetic nephropathy;
violation of the left ventricle.

The drug is prescribed for any indicators of high blood pressure. If more than 120/80 indicators are exceeded, the agent is prescribed in the treatment of the initial stage of the disease.

Enalapril tablets are taken with a little water. It can be taken both before and after meals. Dosages are set individually for each patient, taking into account the stage of the disease and the specifics of the organism.

Moderate hypertension - 5 mg once a day (half a tablet). If necessary, the dosage is gradually increased, but not more than 40 mg per day.
Severe hypertension - initially taken at 2.5 mg once a day. The dose is gradually increased. In severe cases of the disease, the drug is administered intravenously.
In the treatment of chronic heart failure, the first days of taking 2.5 drugs must be taken. The dose is gradually increased to 5-40 mg.
After a heart attack, the drug is prescribed on the third day of treatment. It is taken three times a day, a dosage of 1/2 tablet (10 mg). Then the dosage is increased to the maximum.
For patients with kidney disease, the drug is prescribed in a dosage of 40 ml (divided into three doses). If the lung disease is severe, the daily dose should not exceed 12.5 mg.

Contraindications

hypersensitivity of the body;
lung disease accompanied by shortness of breath;
pregnancy;
severe exhaustion;
porphyria;
breastfeeding;
with impaired kidney function;
aortic stenosis;
liver disease in the acute stage;
children under 18 years of age;
with obstructed outflow of blood from the left ventricle;
Quincke's edema;
hyperkalemia;
after kidney transplantation;
with lactose intolerance.

Treatment is carried out under medical supervision for elderly people, with impaired stool, after chronic intervention. The dosage per day should not exceed 40 mg.

Reception during pregnancy and lactation period

Enalapril is contraindicated in pregnancy at any time. Studies have shown that taking an ACE inhibitor disrupts the course of pregnancy and causes pathologies in the development of the fetus. If a pregnant woman has taken the drug, it is necessary to conduct a complete clinical study and ultrasound to assess the state of the body of the woman and the child.

When feeding with breast milk, the active active ingredient enters the baby's body. The result is stool disturbance, nausea, colic, fainting, low blood pressure and other complications.

Possible side reactions

tachycardia;
vomiting;
tide;
allergy;
depressed state;
laryngeal edema;
upset stool;
soreness of the abdomen;
redness of the skin;
decreased vision;
nausea;
fatigue;
fainting;
soreness in the chest area;
increased calcium concentration;
angina pectoris;
a sharp increase in blood pressure;
rash;
increased sensitivity to the sun;
headache;
with problems falling asleep;
bronchospasm;
dry mouth;
violation of taste;
peptic ulcer;
sharp weight loss;
pneumonia;
circulatory disorders in the brain;
bleeding gums;
stomatitis;
drowsiness.

If side effects occur, the drug is discontinued.

Overdose

In case of an overdose, there is a sharp decrease in pressure, sudden weakness, confusion. Gastric lavage is performed, antihistamines are given. In severe cases, hospitalization is necessary.

Interaction with other medicines

The assimilation of Enalapril while taking diuretics, beta-blockers begins to increase.

It is forbidden to jointly take other means, the action of which is aimed at reducing pressure.
With the simultaneous administration of NSAIDs, the effect of Enalapril decreases.

Simultaneous treatment with immunosuppressants leads to a violation of the hematological type.

The drug increases the therapeutic effect of drugs containing potassium, which causes negative reactions.

Hepatotoxicity increases with the simultaneous administration of cytostatics.

If the patient is taking other medications, a doctor's consultation is necessary.

special instructions

If the tablets are prescribed regularly or for a long time, it becomes necessary to conduct a kidney examination.

If after taking a dry cough begins, the intake must be discontinued. Otherwise it can cause pneumonia.

The drug in high doses can cause anaphylactic reactions.

Simultaneous intake with alcohol is prohibited.

The remedy can cause dizziness, confusion, and a tendency to fall asleep. Therefore, it is forbidden to engage in activities requiring increased attention and drive cars.

Storage

The product is stored in a dry place at a temperature not higher than +25 degrees. Shelf life is three years from the date indicated by the manufacturer on the package.

The drug is available with a prescription.

Analogs

Enarenal;
Golten;
Renitek;
Sandoz;
Blockordil;
Captopres;
Envas;
Vasolapril;
Norton;
Korandil;
Epistron;
Biosynthesis.

What do hypertensive patients write on the forums

Maria Semyonovna
Enalapril is a good, effective remedy. It can be taken at any high blood pressure. The main thing is to follow the dosages recommended in the instructions. Quickly helps to return to normal. The cost is cheap. Before that, I tried many other drugs, only this helped in the treatment of hypertension. The drug is well tolerated. The remedy is a proven one, I have been taking it for many years.

Alexandra
I never thought that I would have high blood pressure. I have always suffered from hypotension. And then suddenly it became bad, the headache was such that I thought I could not stand it, it darkened in my eyes. I went to the clinic and it turned out that my blood pressure was 180 to 120. The doctor immediately prescribed Enalapril. Start with the lowest dosage. The condition immediately improved, literally in 10 minutes. I drank the course, the pressure does not bother me anymore. But if anything, I know which drug will help me now.

People, don't drink this stuff! Enalapril leads to asthma, cough and bouts of bronchospasm within a month and a half after taking it! Checked on myself.

Aset Sarapalova

For two months with a break of 10 days, I saw Enalapril 1-2r a day, half a tablet. The result - choking at night, because of which I practically did not sleep and the inability to take a full breath - a cough began and, more interestingly, it was almost impossible to cough, dryness immediately appeared in my throat, followed by choking. I suffered for six months, the doctors did not help, only the inhaler was prescribed. Now I take everything from pressure, but not pills. I did not use an inhaler - folk remedies helped.

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

Product group

Cardiovascular drugs

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

Forms of issue

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

Description of the dosage form

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

pharmachologic effect

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

Pharmacokinetics

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

Special conditions

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

Composition

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

Enalapril indications for use

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

Enalapril contraindications

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

Enalapril dosage

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

Enalapril side effects

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

Drug interactions

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

Overdose

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

Storage conditions

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

Information provided by the State Register of Medicines.

Synonyms

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

High blood pressure is a common condition, and the older the person is, the higher the risk of developing it. At first, hypertension manifests itself only as dizziness, weakness, increased fatigue and poor sleep. However, if high blood pressure is left untreated, it can result in serious problems, including heart attack, kidney failure, and loss of vision. One of the leading groups of medicines in the treatment of arterial hypertension and chronic heart failure is angiotensin-converting pump inhibitors (ACE inhibitors, ACE inhibitors). Enalapril also belongs to this group of medicines.

Release form and composition

Preparations with the main active ingredient enalapril are available in tablet form. The number, weight and appearance of the tablets vary depending on the manufacturer. One tablet may contain 2.5 mg, 5 mg, 10 mg and up to 20 mg of the active substance. Usually in a cardboard box there are two or three blisters of 10 pcs. tablets in each (except for the drug called "Renitek" - it contains 14 tablets per pack). In addition to the active substance, the tablet contains auxiliary substances - usually lactose monohydrate, corn starch and / or potato sludge, magnesium stearate, etc.

How Enalapril works

The principle of action of ACE inhibitors, to which Enalapril belongs, is inhibition of the action of the enzyme, which is responsible for the appearance in the body of the hormone responsible for narrowing the walls of blood vessels. After taking Enalapril, peripheral vascular resistance decreases, which allows blood to flow more easily and the heart to pump it more efficiently. Cardiac output, or the volume of pumped blood per unit of time, increases, but the heart rate remains virtually unchanged.

Pharmacokinetics

The drug begins to act within an hour after administration, and the greatest decrease in pressure occurs after 4-5 hours. The medicinal effect of enalapril lasts about 24 hours. The degree of absorption of the drug by the gastrointestinal tract is 60%; it is excreted through the kidneys and intestines.

Indications for the use of Enalapril

Drugs with Enalapril are used to normalize high blood pressure, and in combination with other drugs, to treat heart failure. Sometimes Enalapril is used to normalize kidney function in diabetes mellitus.

Instructions for the use of Enalapril

The dosage and time of taking Enalapril depend on the manufacturer and the amount of active substance in the tablets. As a rule, Enalapril is taken once or twice a day before or after meals (it is advisable to take the tablets at the same time of the day - it is easier to notice if you miss a dose). Usually, your doctor suggests starting with a small dose first and increasing it gradually. You should not arbitrarily change it without consulting a doctor, and even more so you should not refuse to take it, even if the patient feels well - Enalapril is not able to miraculously cure heart failure or completely relieve high blood pressure. It only relieves these conditions with constant intake.

With arterial hypertension, start taking Enalapril with a dose of 5 mg once a day. Gradually, your doctor may increase the dose from 5 mg to 10 mg or 40 mg per day (taken in whole or in two divided doses). 40 mg is the maximum possible dose of the drug. If Enalapril is taken in combination with diuretics (for example, hydrochlorothiazide), then the initial dose is 2.5 mg per day, and the average daily dose is about 10 mg per day.

Enalapril for chronic heart failure is prescribed from 2.5 mg once a day.

For children weighing 20 to 50 kg, the initial dose is 2.5 mg, the maximum dose is 20 mg per day.

For children weighing over 50 kg, the initial dose is 5 mg, the maximum dose is 40 mg per day. Depending on the patient's response to enalapril, the dose can be reduced or, conversely, increased.

Should I take Enalapril for prophylactic purposes?

When treating high blood pressure, you may need to take Enalapril and / or other medications of a similar effect for a long time - sometimes until the end of your life. In addition to taking medication, for a healthy cardiovascular system and blood pressure, it is recommended to follow the principles of a healthy diet, exercise for at least 15-30 minutes every day, do not smoke and drink alcohol in moderation.

Contraindications

The use of Enalapril should be abandoned in case of diseases of the kidneys, liver, electrolyte imbalance (with a high sodium content in the blood), after a stroke, as well as with increased individual sensitivity to any component of the tablets.

Allergy. If you are allergic to ACE inhibitors, such as benazepril, captopril, fosinopril (monopril), lisinopril, etc., as well as any other ingredients contained in the tablets, you should inform your doctor about it and refuse to take the drug. Also, you should refrain from using Enalapril if your relatives are allergic to ACE inhibitors.

Pregnancy and breastfeeding. In no case should you take Enalapril during pregnancy - all ACE inhibitors can lead to illness or even death of the fetus or newborn baby if Enalapril is prescribed to a mother in the second or third trimester of pregnancy. Also, during breastfeeding, Enalapril passes into breast milk, therefore, breastfeeding should be discontinued while taking the drug.

Side effects

Like many medicines, Enalapril can cause side effects. Although the frequency of their occurrence is low, if they occur regularly when taking the drug and continue for a long time, you should consult a doctor - it may be worth reducing the dose or even giving up taking the drug altogether.

Dizziness, headache. These side effects have been most commonly seen with Enalapril. Increased fatigue, general weakness, drowsiness, poor sleep, and increased anxiety are slightly less common.

Allergic reactions. In rare cases, angioedema of the face, throat, lips, arms, legs, ankles, and legs can be observed. With these symptoms, you should immediately consult a doctor.

Dysfunction of the kidneys and liver. Renal failure, oliguria, proteinuria, yellowing of the skin and / or whites of the eyes.

The cardiovascular system. Strong heartbeat, slow heartbeat, weak pulse, irregular heart rhythm.

Digestive system. Nausea, vomiting, constipation, diarrhea, intestinal obstruction, loss of appetite.

Respiratory system. Dry cough, difficulty breathing, bronchospasm,.

Signs of infection include high fever, chills, sore throat.

Signs of electrolyte imbalance. Enalapril affects the level of electrolytes in the body, so taking it can cause hyperkalemia or hyponatremia with the following symptoms: tingling in the fingertips, muscle weakness or muscle tension, involuntary muscle contractions, cramps.

Not all of the side effects that Enalapril can cause are listed here; their appearance largely depends on the individual response of the patient. If the patient regularly feels any unpleasant changes after taking the medicine, you should consult your doctor.

special instructions

Nausea, vomiting, diarrhea, excessive sweating - all these conditions while taking Enalapril can lead to dehydration, lower blood pressure, dizziness and symptoms of electrolyte imbalance.

Salt substitutes containing potassium (potassium chloride). Before using them while taking Enalapril, you should consult your doctor. If your doctor prescribes a diet that is low in salt and sodium, it should be followed.

When taking Enalapril, it is recommended to regularly measure your own blood pressure in order to track the body's response to the medicine. It is also recommended that urine and blood tests be done to check liver and kidney function. This is especially important in kidney diseases such as bilateral narrowing of the renal arteries, renal artery stenosis, and cardiovascular diseases that interfere with the smooth flow of blood from the left ventricle.

Drug overdose

In case of an overdose of Enalapril, blood pressure can drop up to the development of myocardial infarction, cerebrovascular accident, cause convulsions, collapse or stupor. Overdose is treated by gastric lavage. More serious cases may require an IV or hemodialysis.

Interaction of Enalapril with other drugs

Taking Enalapril and other medicines together may affect its effectiveness or increase the risk of side effects. It is advisable to draw up a list of constantly taken medications (this also includes dietary supplements, medicinal herbs and vitamins) and, when prescribing a new medication, show it to the doctor. The doctor may advise the patient to change the dose of the medication they are taking or to closely monitor the side effects while taking them. During the course of taking Enalapril, it is undesirable to start taking a new drug or change the dose or stop taking the old one without first consulting your doctor.

Non-steroidal anti-inflammatory drugs (aspirin, paracetamol). Weaken the pressure-lowering effect of enalapril.

Diuretics Enalapril, while taking diuretics, can disrupt the electrolyte balance in the body, therefore, it is advisable to stop taking diuretics 2-3 days before taking Enalapril or gradually stop taking them after consulting a doctor.

Preparations containing lithium. If Enalapril is taken together with lithium drugs, the elimination of lithium from the body slows down, which, if accumulated, can have a toxic effect on the body.

Medicines that affect the amount of potassium in the body (for example, potassium-sparing diuretics). When taken together with Enalapril, they can cause hyperkalemia.

Heart failure medications such as Valsartan and Sakubitril. If the patient takes (or has taken within the last two days) Valsartan and Sasutril, you should inform your doctor about it; with a high degree of probability, the doctor will suggest that you stop taking Enalapril.

Diabetes medications such as Aliskiren. It is impossible to combine the reception of Enalapril with these drugs - hypoglycemia may occur.

Interaction of Enalapril with alcohol

Alcohol, like Enalapril, lowers blood pressure, while ethanol enhances the effect of the drug. The joint use of Enalapril and alcohol can lead to serious side effects - from dizziness to a sharp drop in blood pressure up to collapse.

Terms of sale

Sold by prescription.

Storage conditions

It is best to keep preparations containing enalapril in a tightly closed container, out of the reach of children and pets. The medicine should be stored at room temperature (15 ° to 25 °) and low humidity; therefore, the usual storage areas for drugs - the refrigerator and the bathroom cabinet - are not suitable for enalapril.

Shelf life

The shelf life of drugs containing enalapril is from 2.5 to 3 years.

The price of medicines containing enalapril

The price may vary depending on the weight of the tablet, the number of tablets in the package, the manufacturer and the price policy of the pharmacy. In general, the cost of medicines containing enalapril varies from 70 to 210 rubles.

Enalapril's analogs

Preparations, the main active ingredient of which is enalapril: Renitek, Renipril, Enap, Berlipril, Enam, Ednit, Involir, Myopril, etc.

Other ACE inhibitors similar in action to enalapril: captopril, ramipril, lisinopril, fosinopril.