Enalapril N, tablets 25 mg+10 mg 20 pcs

Pharmgroup:

Hypertensive combined agent (ACE inhibitor+diuretic).

Pharmic action:

A combination drug whose action is due to its constituent components; has a hypotensive effect.

Hydrochlorothiazide is a medium-acting diuretic that increases urinary excretion of Na+, Cl-, water, hydrocarbonate. Reducing the concentration of Na+ in the vascular wall leads to their dilatation, reduces the sensitivity to vasoconstrictors.

Enalapril inhibits ACE, which promotes the conversion of angiotensin I into angiotensin II, reduces the concentration of aldosterone in the blood, increases the release of renin, improves the functioning of kallikrein-kinin vasodepressive system, stimulates the release of Pg and NO, suppresses the sympathetic nervous system. Taken together, these effects eliminate spasm and dilate peripheral arteries, reduce ROS, BP and BPD, post- and preload on the myocardium.

Hydrochlorothiazide reduces blood K+ concentration, enalapril causes its retention; when these drugs are used together, normal maintenance of blood K+ concentration is ensured.

Indications

Arterial hypertension.

Active ingredient

Composition

Hydrochlorothiazide+Enalapril: 25 mg+10 mg.

Auxiliary substances:

lactose monohydrate,

potato starch,

Microcrystalline cellulose,

povidone,

How to take, the dosage

Over the oral route, regardless of meals, 1-2 tablets once a day (in patients with decreased glomerular filtration up to 30 ml/min, individual selection of the dose is required, in enalapril – 5-10 mg/day).

Special Instructions

Therapy should be discontinued before parathyroid function is investigated. Subjected to dialysis. Dose adjustment on days when dialysis is not performed should be made depending on BP. BP, renal function and plasma K+ concentration should be monitored before and during treatment.

Caution should be exercised when prescribing in patients with decreased BOD (as a result of diuretic therapy, restriction of table salt intake, hemodialysis, diarrhea and vomiting) due to increased risk of sudden arterial hypotension after using even the initial dose. Transient arterial hypotension is not a contraindication for continuing treatment with the drug after BP stabilization. In case of repeated occurrence of severe arterial hypotension, the dose should be reduced or the drug should be discontinued.

In case of excessive arterial hypotension the patient is transferred to a horizontal position with a low headrest, if necessary 0.9% NaCl solution is administered (to increase plasma volume). Patients with decompensated CHF, coronary artery disease and cerebrovascular disease in whom a sharp decrease in BP may lead to myocardial infarction or stroke, impaired renal function should be monitored.

The use of dialysis membranes AN69 in combination with ACE inhibitors is not recommended.

Contraindications

Hypersensitivity (including to other sulfonamide derivatives), anuria, history of angioedema associated with ACE inhibitors, hereditary or idiopathic angioedema, pregnancy, lactation, childhood.

With caution. Renal/hepatic insufficiency, severe systemic connective tissue diseases (including SLE, scleroderma), bilateral renal artery stenosis, single renal artery stenosis, condition after renal transplantation, aortic stenosis, CHD, CHD, suppression of bone marrow hematopoiesis, cerebrovascular diseases (including cerebrovascular insufficiency).cerebrovascular diseases (including insufficiency of cerebral circulation), diabetes, hyperkalemia, Na+-restricted diet, conditions accompanied with the decrease of the blood circulation (including diarrhea, vomiting), elderly age.

Side effects

Most common: dizziness, increased fatigue.

1-2%: muscle cramps, nausea, asthenia, orthostatic hypotension, headache, cough, impotence.

Systems: fainting, decreased BP, palpitations, tachycardia, chest pain.

Allergic reactions: angioedema (face, tongue, lips, vocal cords, larynx, extremities, intestines), erythema malignant exudative (Stevens-Johnson syndrome).

Nervous system disorders: dizziness, insomnia or somnolence, paresthesia, hyperexcitability.

Respiratory system disorders: shortness of breath.

Digestive system disorders: dry mouth, dyspepsia (including nausea, vomiting, flatulence), diarrhea or constipation, abdominal pain, pancreatitis.

Urogenital system disorders: renal dysfunction, renal failure, decreased libido.

Skin disorders: skin rash, itching, sweating.

Laboratory measures: hyperglycemia, hyper- or hypokalemia, increased concentration of urea in serum, hypercreatininemia, hyperuricemia, increased activity of liver transaminases, hyperbilirubinemia, decreased Hb and hematocrit.

Others: gout, tinnitus, arthralgia, lupus-like syndrome (fever, serositis, vasculitis, myalgia/myositis, arthralgia/arthritis, positive antinuclear antibody test, increased CRP, eosinophilia, leukocytosis, skin rash, photosensitization).

Overdose

Symptoms: excessive decrease in BP up to the development of collapse, myocardial infarction, acute cerebral circulation disorder or thromboembolic complications; convulsions, stupor.

Treatment: gastric lavage, oral administration of saline solution, intravenous administration of plasma substitutes, angiotensin II, hemodialysis (excretion rate – 62 ml/min).

Similarities