Enalapril NL, tablets 12.5mg+10 mg 20 pcs

Enalapril inhibits ACE, which promotes conversion of angiotensin I into angiotensin II, decreases plasma aldosterone concentration, increases renin release, improves kallikrein-kinin system functioning, stimulates release of prostaglandins and endothelial relaxing factor, inhibits sympathetic nervous system. Taken together, these effects eliminate spasm and dilate peripheral arteries, reduce total peripheral vascular resistance, systolic and diastolic blood pressure (BP), post- and preload on the myocardium. It dilates arteries to a greater extent than veins, and there is no reflex increase in heart rate (HR).

The antihypertensive effect is more pronounced at high plasma renin concentration than at normal or reduced. Reduction of BP within therapeutic limits has no effect on the cerebral circulation. Improves blood supply to ischemic myocardium. Increases renal blood flow without changing glomerular filtration rate. In patients with initially decreased glomerular filtration its rate usually increases.

The maximum effect of enalapril develops after 6 to 8 hours and lasts up to 24 hours after oral administration. Hydrochlorothiazide is a thiazide diuretic of medium potency.

Limits sodium ions reabsorption at the level of the cortical segment of the loop of Genle without affecting its section passing in the medullary layer of the kidney. It blocks carboanhydrase in the proximal part of the convoluted tubules, increases renal excretion of potassium ions, hydrocarbonates and phosphates.

It has practically no effect on the acid-base state. Increases the excretion of magnesium ions. Delays calcium ions in the body. Diuretic effect develops after 1 – 2 hours, reaches a maximum after 4 hours, lasts for 10 – 12 hours. Its action decreases if glomerular filtration rate decreases and stops when its value is less than 30 ml/min.

Lower blood pressure by reducing the circulating blood volume (RBC) and changing the reactivity of the vascular wall. Combination of enalapril and hydrochlorothiazide results in more pronounced BP reduction compared to monotherapy with each of the drugs separately and allows to maintain antihypertensive effect of Enalapril H, Enalapril NL and Enalapril NL 20 for at least 24 h.

Indications

Arterial hypertension (patients who are indicated for combination therapy).

Active ingredient

Composition

Tablets are round, white or white with a beige tint, cylindrical, biconvex, with a ridge on one side.

1 tablet hydrochlorothiazide 12.5 mg enalapril maleate 20 mg

Excipients:

Lactose 129.5 mg,

Microcrystalline cellulose 20 mg,

povidone 6 mg,

croscarmellose sodium 8 mg,

colloidal silicon dioxide 2 mg,

magnesium stearate 2 mg.

How to take, the dosage

The drugs Enalapril N, Enalapril NL and Enalapril NL 20 should be taken regularly at the same time, preferably in the morning, regardless of the time of meals, without chewing, with a small amount of liquid, once a day. Recommended dose is 1 tablet per day, which is maximum daily dose of Enalapril NL. For Enalapril NL and Enalapril NL 20 the dose may be increased to 2 tablets taken once a day, this dose is maximum daily dose.

In patients taking diuretics, it is recommended that they be discontinued or the dose reduced at least 3 days before starting treatment with Enalapril H, Enalapril NL or Enalapril NL 20 to prevent the development of symptomatic arterial hypotension. Renal dysfunction: in patients with severe renal insufficiency (CK less than 30 ml/min) the drugs Enalapril H, Enalapril NL and Enalapril NL 20 are contraindicated.

In patients with renal insufficiency with creatinine clearance greater than 30 ml/min, Enalapril H, Enalapril NL and Enalapril NL 20 may be used only after stabilization of BP against treatment with Enalapril and Hydrochlorothiazide in separate dosage forms and selection of their doses. The recommended starting dose of Enalapril NL is 1/2 tablet once daily. Potassium and creatinine levels should be monitored regularly (every 2 months).

Contraindications

Hypersensitivity to enalapril or other ACE inhibitors, hydrochlorothiazide or other sulfonamide derivatives or other drug components; lactose intolerance, lactase deficiency or glucose-galactose malabsorption syndrome; anuria; history of angioedema (including that associated with ACE inhibitors); hereditary and/or idiopathic angioedema; severe liver function disorders (more than 9 points by Child-Pugh score); severe renal function disorders (CK less than 30 ml/min); pregnancy; lactation; age less than 18 years old (effectiveness and safety of the medicine have not been determined).

Similarities