Enalapril - instructions for use, reviews, analogs and formulations (tablets 5 mg, 10 mg and 20 mg Hexal, Acry) for the treatment of hypertension and pressure reduction in adults, children and pregnancy. Composition
In this article, you can read the instructions for using the drug Enalapril. Comments of visitors of the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Enalapril in their practice are presented. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Enalapril in the presence of existing structural analogues. Use to treat hypertension and reduce blood pressure in adults, children, as well as during pregnancy and lactation.
Enalapril - antihypertensive drug, ACE inhibitor. Pharmacological activity has a metabolite of enalapril - enalaprilat. Suppresses the formation of angiotensin 2 and eliminates its vasoconstrictive effect. At the same time, the OPSS, systolic and diastolic blood pressure, post- and preload on the myocardium decrease.
Expands arteries more than veins, with a reflex increase in heart rate is not noted. It also reduces preload, reduces pressure in the right atrium in a small circle of blood circulation, reduces hypertrophy of the left ventricle. Reduces the tone of the arterioles of the glomerulus of the kidneys, thereby reducing intraclubic hemodynamics, inhibits the development of diabetic nephropathy.
Does not affect the metabolism of glucose, lipoproteins and sexual function.
The maximum effect develops 6-8 hours after ingestion and persists for 24 hours. The therapeutic effect is achieved after several weeks of treatment.
Composition
Enalapril maleate + excipients.
Pharmacokinetics
After ingestion, about 60% of enalapril is absorbed from the digestive tract. Eating does not affect the absorption of the drug.It is subjected to hydrolysis with the formation of enalaprilate, which has a pronounced pharmacological activity. It is mainly excreted by the kidneys - 60% (20% in the form of enalapril and 40% in the form of enalaprilat), through the intestine - 33% (6% in the form of enalapril and 27% in the form of enalaprilate).
Indications
- arterial hypertension;
- chronic heart failure (as part of combination therapy);
- left ventricular dysfunction.
Forms of release
Tablets 5 mg, 10 mg and 20 mg (Acry, Hexal and others).
Instructions for use and dosage
Assign inside regardless of the time of ingestion.
With monotherapy of arterial hypertension, the initial dose is 5 mg once a day. If there is no clinical effect, after 1-2 weeks the dose is increased by 5 mg. After taking the initial dose, patients should be under medical supervision for 2 hours and an additional 1 hour until BP stabilizes. If necessary, and a fairly good tolerability dose can be increased to 40 mg per day in 2 divided doses. After 2-3 weeks pass to the maintenance dose - 10-40 mg per day, divided into 1-2 admission. With moderate arterial hypertension, the average daily dose is about 10 mg.
The maximum daily dose of the drug is 40 mg per day.
In case of appointment to patients receiving diuretics concomitantly, treatment with a diuretic should be stopped 2-3 days before the appointment of Enalapril. If this is not possible, the initial dose of the drug should be 2.5 mg per day.
With Renovascular hypertension, the initial dose is 2.5-5 mg per day. The maximum daily dose is 20 mg.
In chronic heart failure, the initial dose is 2.5 mg once, then the dose is increased by 2.5 to 5 mg every 3-4 days according to the clinical response to the maximum tolerated dose, depending on the values of blood pressure, but not more than 40 mg per day once or 2 reception. In patients with low systolic blood pressure (less than 110 mm Hg), therapy should be started at a dose of 1.25 mg per day. The dose should be selected within 2-4 weeks or in shorter periods. The average maintenance dose is 5-20 mg per day for 1-2 doses.
In elderly people, more pronounced hypotensive effect and lengthening of the action time of the drug are more frequent, which is associated with a decrease in the rate of excretion of enalapril, therefore the recommended initial dose for the elderly is 1.25 mg.
In chronic renal failure cumulation occurs with a decrease in filtration of less than 10 ml / min.With CC 80-30 ml / min, the dose is usually 5-10 mg per day, with QC up to 30-10 ml / min - 2.5-5 mg per day, with KK less than 10 ml / min - 1.25-2.5 mg per day only in the days of dialysis.
The duration of treatment depends on the effectiveness of therapy. With too pronounced decrease in blood pressure, the dose of the drug is gradually reduced.
The drug is used in both monotherapy and in combination with other antihypertensive agents.
Side effect
- excessive decrease in blood pressure;
- orthostatic collapse;
- retrosternal pain;
- angina pectoris;
- myocardial infarction (usually associated with a pronounced decrease in blood pressure);
- arrhythmias (atrial brady or tachycardia, atrial fibrillation);
- dizziness;
- headache;
- weakness;
- insomnia;
- anxiety;
- confusion of consciousness;
- increased fatigue;
- drowsiness (2-3%);
- depression;
- disturbances of the vestibular apparatus;
- noise in ears;
- dry mouth;
- anorexia;
- dyspeptic disorders (nausea, diarrhea or constipation, vomiting, abdominal pain);
- intestinal obstruction;
- unproductive dry cough;
- interstitial pneumonitis;
- bronchospasm;
- dyspnea;
- skin rash;
- itching;
- hives;
- angioedema;
- toxic epidermal necrolysis;
- stomatitis;
- glossitis;
- impaired renal function;
- alopecia;
- decreased libido;
- tides.
Contraindications
- presence in the anamnesis of an angioedema, associated with the treatment with ACE inhibitors;
- porphyria;
- pregnancy;
- lactation period;
- age under 18 years (effectiveness and safety not established);
- increased sensitivity to enalapril and other ACE inhibitors.
special instructions
Caution should be exercised when prescribing Enalapril to patients with reduced BCC (due to diuretic therapy, restriction of salt intake, hemodialysis, diarrhea and vomiting), the risk of a sudden and severe decrease in blood pressure after applying even an initial dose of an ACE inhibitor is increased. Transient arterial hypotension is not a contraindication for continuing treatment with the drug after BP stabilization. In the case of a re-expressed decrease in blood pressure should reduce the dose or cancel the drug.
The use of high permeability dialysis membranes increases the risk of developing an anaphylactic reaction. Correction of the dosing regimen on days free from dialysis should be performed depending on the level of blood pressure.
Before and during treatment with ACE inhibitors, periodic monitoring of blood pressure, blood counts (hemoglobin, potassium, creatinine, urea, hepatic enzyme activity) and protein in the urine is necessary.
It should be carefully monitored for patients with severe heart failure, coronary heart disease and cerebrovascular disease, in which a sharp decrease in blood pressure can lead to myocardial infarction, stroke, or renal dysfunction.
Sudden abolition of treatment does not lead to the syndrome of "withdrawal" (a sharp rise in blood pressure).
For newborns and infants who have been exposed to the intrauterine effect of ACE inhibitors, careful monitoring is recommended to timely detect a marked decrease in blood pressure, oliguria, hyperkalemia and neurological disorders, possibly due to a decrease in renal and cerebral blood flow with a decrease in BP caused by ACE inhibitors. In oliguria it is necessary to maintain BP 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. Such patients may require the administration of smaller doses of the drug.
In patients with hypertension and unilateral or bilateral stenosis of the renal arteries, an increase in urea and creatinine in the blood serum is possible.
These patients need to monitor kidney function during the first few weeks of therapy. You may need to reduce the dosage of the drug.
The risk-to-benefit ratio of enalapril should be considered in patients with coronary and cerebrovascular insufficiency due to the risk of increased ischemia in cases of excessive arterial hypotension.
The drug should be administered with caution to patients with diabetes because of the risk of developing hyperkalemia.
Patients with a history of anginaurotic edema may have an increased risk of developing angioedema while enalapril is being treated.
In patients with severe autoimmune diseases, for example, systemic lupus erythematosus or scleroderma, the risk of developing neutropenia or agranulocytosis in patients receiving Enalapril is increased.
Caution is advised when administering Enalapril for the therapy of chronic heart failure in patients receiving cardiac glycosides and / or diuretics.
Before the study of parathyroid gland functions, the drug should be discontinued.Alcohol enhances the hypotensive effect of the drug.
Before surgery (including dentistry), it is necessary to alert the surgeon / anesthesiologist about the use of ACE inhibitors.
Impact on the ability to drive vehicles and manage mechanisms
At the beginning of the treatment, before the completion of the dose selection period, it is necessary to refrain from driving vehicles and practicing potentially dangerous activities that require an increased concentration of attention and speed of psychomotor reactions, since dizziness is possible, especially after the initial dose of an ACE inhibitor in patients taking diuretics.
Drug Interactions
With the simultaneous administration of Enalapril with non-steroidal anti-inflammatory drugs, hypotensive effect may decrease; with potassium-sparing diuretics (spironolactone, triamterene, amiloride) can lead to hyperkalemia; with lithium salts - to slow down the excretion of lithium (shown control of the concentration of lithium in blood plasma).
Simultaneous administration with antipyretic and analgesic agents may decrease the effectiveness of enalapril.
Enalapril weakens the effect of drugs containing theophylline.
Hypotensive effect of enalapril increase diuretics, beta-blockers, methyldopa, nitrates, calcium channel blockers slow, hydralazine, prazosin.
Immunosuppressants, allopurinol, cytostatics increase hematotoxicity.
Drugs that cause bone marrow depression, increase the risk of developing neutropenia and / or agranulocytosis.
Analogues of the drug Enalapril
Structural analogs for the active substance:
- Bagopril;
- Berlipril 10;
- Berlipril 20;
- Berlipril 5;
- Vazolapril;
- Vero-Enalapril;
- Involor;
- The Korandil;
- Myopril;
- Renipril;
- Renitek;
- Ednit;
- Enazil 10;
- Enalacor;
- Enalapril HEXAL;
- Enalapril-Aggio;
- Enalapril-AKOS;
- Enalapril-Acry;
- Enalapril-UBF;
- Enalapril-FPO;
- Enalapril maleate;
- Enam;
- Enap;
- Enarenal;
- Enafarm;
- Envas;
- Envipril.
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