Enalapril Hexal pills 20 mg 20 pcs.
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Active ingredients
Enalapril
Release form
Pills
Composition
Active ingredient: Enalapril maleate Concentration of active ingredient (mg): 20
Pharmacological effect
Enalapril reduces OPSS (afterload), the pressure of jamming in the pulmonary capillaries (preload) and the resistance in the pulmonary vessels; increases heart volume and load tolerance.
Pharmacokinetics
After ingestion, about 60% of enalapril is absorbed from the gastrointestinal tract. Eating does not affect the absorption of the drug. Plasma protein binding is less than 50%. Subjected to hydrolysis with the formation of enalaprilat, with pronounced pharmacological activity. The maximum serum concentration of enalapril is reached after 1 hour, enalaprilat after 3-4 hours. 4 days after the start of administration, the T1 / 2 value is 11 hours. It is mainly excreted by the kidneys - 60% (20% - as enalapril and 40% - in the form of enalaprilat), through the intestine - 33% (6% - in the form of enalapril and 27% - in the form of enalaprilat).
Indications
Arterial hypertension (including renovascular), chronic heart failure (as part of combination therapy).
Contraindications
Angioedema in history, bilateral renal artery stenosis or renal artery stenosis of a single kidney, hyperkalemia, pregnancy, hypersensitivity to enalapril and other ACE inhibitors.
Precautionary measures
It is used with extreme caution in patients with autoimmune diseases, diabetes mellitus, abnormal liver function, severe aortic stenosis, subaortic muscular stenosis of unknown origin, hypertrophic cardiomyopathy, with loss of fluids and salts. In the case of prior treatment with saluretics, in particular in patients with chronic heart failure, the risk of orthostatic hypotension increases, so before starting treatment with enalapril, it is necessary to compensate for the loss of fluid and salt.
Use during pregnancy and lactation
Contraindicated.
Dosage and administration
When ingested, the initial dose is 2.5-5 mg 1 time / Average dose - 10-20 mg / in 2 doses. When administered by mouth - 1.25 mg every 6 hours. To detect excessive hypotension in patients with sodium deficiency and dehydration due to prior diuretic therapy, in patients receiving diuretics, as well as in renal insufficiency, an initial dose of 625 mg is administered.With an inadequate clinical response, this dose can be repeated after 1 hour and continue treatment at a dose of 1.25 mg every 6 hours. The maximum daily dose for oral administration is 80 mg.
Side effects
On the part of the central nervous system and peripheral nervous system: dizziness, headache, fatigue, fatigue; very rarely when used in high doses - sleep disorders, nervousness, depression, imbalance, paresthesia, tinnitus. On the part of the cardiovascular system: orthostatic hypotension, syncope, heartbeat, pain in the heart area; very rarely when used in high doses - hot flashes. From the digestive system: nausea; rarely - dry mouth, abdominal pain, vomiting, diarrhea, constipation, abnormal liver function, increased activity of hepatic transaminases, increased concentration of bilirubin in the blood, hepatitis, pancreatitis; very rarely when used in high doses - glossitis. From the hematopoietic system: rarely - neutropenia; in patients with autoimmune diseases - agranulocytosis. From the urinary system: rarely - renal dysfunction, proteinuria. From the respiratory system: dry cough. From the reproductive system: very rarely used in high doses - impotence. use in high doses - hair loss. Allergic reactions: rarely - skin rash, angioedema. Others: rarely - hyperkalemia, muscle cramps.
Overdose
Medication Guide for Radar> Drugs and Substances Encyclopedia Indexes> Alphabetical Index of Drugs and Substances>>> substance: Enalapril * (Enalaprilum) Contents 3d images Composition and release form Pharmacological action Pharmacodynamics Pharmacokinetics Indications Contraindications Secondary actions Interaction Method of administration and doses(primary) hypertension I15 Secondary hypertension I50.1 Left ventricular failure I50.9 Heart failure unspecified 3D images 07.05.201507.05.2015Structure and form of release Tablets 1 tab. active substance: enalapril maleate 5 mg adjuvants: sodium bicarbonate, lactose monohydrogen monolide, olecane 5 maleate 5 mg adjuvants: sodium bicarbonate, lactose monohydrate, oleaginate maleate 5 mg. magnesium stearate in blister 10 pcs .; in a carton of 2 blister packs. Tablets 1 tab. active substance: enalapril maleate 10 mg adjuvants: sodium bicarbonate; lactose monohydrate; corn starch; talc; magnesium stearate; ferric oxide red in a blister, 10 pcs .; in a stack of cardboard 2 blisters. Tablets 1 tab. active substance: enalapril maleate 20 mg adjuvants: sodium bicarbonate; lactose monohydrate; corn starch; talc; magnesium stearate; iron oxide red, iron oxide yellow in a blister, 10 pcs .; in a carton of 2 blister packs. Description of dosage form 5 mg pills: white, oblong, biconvex, with a smooth surface, notch on one side and the inscription “EN 5”, on the opposite side - notch at 140 degrees . 10 mg pills: red-brown, biconvex, oblong, with darker or lighter patches, smooth surface, notch on one side and the inscription “EN 10”, on the opposite side - notch at 140 degrees (“Snap-tab "). Tablets of 20 mg: light orange, biconvex, oblong, with lighter and darker patches, a smooth surface, a notch on one side and the inscription “EN 20”, on the opposite side - a notch at an angle of 140 degrees (“Snap-tab"). Pharmacological action APF.FarmakodinamikaAFT inhibitor. Pharmacological activity has enalapril metabolite - enalaprilat. Suppresses the formation of angiotensin II and eliminates its vasoconstrictor action. At the same time, CRRD, SBP and DBP, post- and preload on the myocardium decrease. It expands the arteries to a greater extent than the veins, and there is no reflex increase in the heart rate. It also reduces the preload, reduces pressure in the right atrium in the pulmonary circulation, reduces left ventricular hypertrophy. It reduces the tone of the outgoing arterioles of the glomeruli of the kidneys and prevents diabetic nephropathy. It does not affect the metabolism of glucose, lipoproteins and sexual function. The maximum effect develops in 6–8 hours and lasts for 24 hours.The therapeutic effect is achieved after several weeks of treatment. Pharmacokinetics After ingestion, about 60% of enalapril is absorbed from the gastrointestinal tract. Eating does not affect the absorption of the drug. Plasma protein binding is less than 50%. Subjected to hydrolysis with the formation of enalaprilat, with pronounced pharmacological activity. The maximum serum concentration of enalapril is reached after 1 hour, enalaprilat after 3-4 hours. 4 days after the start of administration, the T1 / 2 value is 11 hours. It is mainly excreted by the kidneys - 60% (20% - as enalapril and 40% - in the form of enalaprilat), through the intestine - 33% (6% - in the form of enalapril and 27% - in the form of enalaprilat). Indalapril drug indications drug and other ACE inhibitors; angioedema in history, including and while taking ACE inhibitors; stenosis (unilateral or bilateral) of the renal arteries; liver or kidney disease; pregnancy; breastfeeding; age up to 18 years (efficacy and safety not established) .Side effects Most of the side effects are temporary and do not require discontinuation of the CVS: at the beginning of therapy, rarely - arterial hypotension (including orthostatic), dizziness, weakness, impaired vision; very rarely - back pain, angina pectoris, palpitations, thromboembolism of the branches of the pulmonary artery. , diarrhea or constipation, vomiting, abdominal pain), intestinal obstruction, pancreatitis, abnormal liver function and biliary excretion, hepatitis, jaundice. From the nervous system and sensory organs: in rare cases feel headache, dizziness, weakness, fatigue, drowsiness, stupor of consciousness; extremely rarely (when taken in high doses) - depression, sleep disturbance, peripheral neuropathy and paresthesia, muscle cramps, nervousness, tinnitus, blurred vision, and taste changes.These disorders are temporary and normalized after discontinuation of the drug. For kidney function: rarely, poor kidney function, proteinuria, the development of hyperkalemia and hyponatremia (symptoms are temporary and normalized after the drug is discontinued). For reproductive system: very rarely use in high doses - impotence. Allergic reactions: skin rash, angioedema of the face, extremities, lips, tongue, glottis and / or larynx, dysphonia, exfoliative dermatitis, multiforme I have exudative erythema (including Stevens-Johnson syndrome), toxic epidermal necrolysis, pemphigus, pruritus, urticaria, photosensitization, serosis, vasculitis, myositis, arthralgia, arthritis, stomatitis. Laboratory indicators: hemoglobin, hematocrit and platelet count. In very rare cases, especially in patients with impaired renal function, diffuse connective tissue diseases, or during simultaneous therapy with allopurinol, procainamide, or immunosuppressants, anemia, thrombocytopenia, neuropathy, increased urea, hypercreatininemia, eosinophilia may occur; in isolated cases - increased activity of hepatic transaminases, agranulocytosis or pancytopenia. It is necessary to regularly monitor the values of the above laboratory parameters before and during treatment, especially in patients at risk. Interaction Allopurinol: a decrease in the number of leukocytes in the blood, leukopenia. Anaergy, NSAIDs (eg acetylsalicylic acid, indomethacin): possible weakening of the hypotensive effect of enalapril. Antihypertensives: enhance the hypotensive effect of enalapril, especially When taking diuretics at the same time. Anesthetics and narcotic drugs: increased blood pressure reduction. Kaliy, potassium-saving diuretics (especially spironolactone, amiloride, triamterene), as well as other drugs (for example, heparin): increased serum potassium. Cooking salt: reducing the antihypertensive effect .Lithium: an increase in the level of lithium in the blood serum (regular monitoring of the lithium content is necessary). Oral antidiabetic agents, insulin: in rare cases, the hypoglycemic effect of oral administration may be enhanced GOVERNMENTAL hypoglycemic agents (e.g. sulfonylurea / biguanide) and insulin.In such cases, a reduction in the dose of glucose-lowering agents is required. Novocainamide: a decrease in the number of leukocytes in the blood, leukopenia. Cytostatics, immunosuppressors, systemic corticosteroids: a decrease in the number of leukocytes in the blood, leukopenia. washing it down with enough liquid. Daily doses are usually taken in the morning, but the drug can be divided into 2 times - morning and evening. At the same time taking diuretics may increase the hypotensive effect. Arterial hypertension: the initial dose is 5 mg in the morning (1 tab. 5 mg of enalapril maleate). If the amount of blood pressure is not normalized when receiving this dose, the daily dose may be increased to 10 mg. The interval between doses should be at least 3 weeks. The maintenance dose is usually 10 mg of enalapril maleate. The maximum daily dose should not exceed 40 mg per day (2 times 20 mg of enalapril maleate). Chronic heart failure: the initial dose is 2.5 mg in the morning. The dose should be increased gradually, depending on the patient's condition. The maintenance dose is usually 5-10 mg (1-2 pills. 5 mg each, or 1 table. 10 mg of enalapril maleate). The maximum daily dose should not exceed 20 mg (2 pills of 10 mg or 1 table of 20 mg). Left ventricular dysfunction: the initial dose is 2.5 mg of enalapril maleate 2 times a day, dose adjustment is possible depending on the state the patient. The average maintenance dose is 10 mg 2 times a day. Patients with moderately impaired kidney function (Cl creatinine 30–60 ml / min) and patients over the age of 65: the initial dose is 2.5 mg in the morning. The maintenance dose is, as a rule, 5–10 mg (1–2 pills. 5 mg each or 1 tablet. 10 mg each) enalapril maleate per day. The maximum daily dose should not exceed 20 mg (2 pills of 10 mg, or 1 table of 20 mg) of enalapril. Patients with severe impaired renal function (Cl creatinine less than 30 ml / min) and on hemodialysis: the initial dose is 2 , 5 mg enalapril maleate per day. Patients on hemodialysis should take the drug after dialysis. The maintenance dose is usually 5 mg (1 tab. 5 mg) of enalapril per day.The maximum daily dose should not exceed 10 mg (1 tab. 10 mg or 2 tab. 5 mg) per day. It is possible to use the drug in the form of monotherapy or in combination with other antihypertensive drugs, especially with diuretics. Symptoms: pronounced decrease in blood pressure, up to the development of collapse, myocardial infarction, acute cerebral circulation or thromboembolic complications, seizures, stupor. position with a low head position. In mild cases, gastric lavage and ingestion of a saline solution are shown, in more severe cases, measures aimed at stabilizing blood pressure: IV injection of saline, plasma substitutes, if necessary, angiotensin II administration, hemodialysis (the average elimination rate of enalaprylate is 62 ml / min)
Interaction with other drugs
With simultaneous use with immunosuppressants, cytostatics, the risk of developing leukopenia increases. With simultaneous use of potassium-saving diuretics (including spironolactone, triamterene, amiloride), potassium preparations, salt substitutes and dietary supplements containing potassium, hyperkalemia may develop (especially with impaired renal function), because ACE inhibitors reduce aldosterone levels, which leads to a delay of potassium in the body against the background of limiting the excretion of potassium or its supplemental intake in the body. When opioid analgesics and anesthetics are used simultaneously, the antihypertensive effect of enalapril is enhanced. . There is a risk of hypokalemia. Increased risk of impaired renal function. When used simultaneously with azathioprine, anemia may develop, which is caused by the inhibition of erythropoietin activity under the influence of ACE inhibitors and azathioprine.
special instructions
With long-term treatment with enalapril, it is necessary to periodically monitor the picture of peripheral blood. Sudden discontinuation of enalapril does not cause a sharp increase in blood pressure. During surgical interventions during the period of treatment with enalapril, hypotension may develop, which should be corrected by administering a sufficient amount of fluid.