Enalapril, tablets 5 mg, 20 pcs.

Enalapril is an ACE inhibitor. It is a prodrug, from which the active metabolite enalaprilat is formed in the body.

Indications

Arterial hypertension (including renovascular);
Chronic heart failure (as part of combination therapy).

Active ingredient

How to take, the dosage

In treatment of arterial hypertension (essential and renovascular) and chronic heart failure, the average daily dose of the drug is 10-20 mg. The frequency of administration is 1 time per day.

If necessary the drug dose can be increased up to 40 mg per day. If there is insufficient monitoring of the patient, the daily dose of 40 mg is recommended to be divided into 2 doses.

The starting dose of the drug in patients with renal insufficiency and in patients taking diuretics is 2.5 mg.
Two to three days before starting Enalapril treatment, diuretics should be stopped.

Interaction

Concomitant administration of enalapril with nonsteroidal anti-inflammatory drugs (NSAIDs), including selective cyclooxygenase-2 inhibitors (COX-2 inhibitors) may reduce the hypotensive effect of enalapril; with potassium-saving diuretics (spironolactone, triamterene, amiloride) may lead to hyperkalemia; with lithium salts – to delayed lithium excretion (plasma lithium concentration control is indicated).

In some patients with impaired renal function, and taking NSAIDs, including COX-2 inhibitors, concomitant use of ACE inhibitors may lead to further deterioration of renal function. These changes are reversible.
Simultaneous use with antipyretics and analgesics may reduce the effectiveness of the drug.
Enalapril attenuates the effect of drugs containing theophylline.

The hypotensive effect of enalapril is increased by diuretics, beta-adrenoblockers, methyldopa, nitrates, “slow” calcium channel blockers of dihydropyridine series, hydralazine, prazosin.

Immunosuppressants, allopurinol, cytostatics increase hematotoxicity. Drugs that cause bone marrow suppression increase the risk of neutropenia and/or agranulocytosis.

The combined use of ACE inhibitors and hypoglycemic agents (insulin, hypoglycemic agents for oral administration) may increase the hypoglycemic effect of the latter with the risk of hypoglycemia. This is most often observed during the first weeks of co-administration, as well as in patients with renal insufficiency.

In diabetic patients receiving oral hypoglycemic agents and insulin, blood glucose control is necessary, especially during the first month of co-administration with ACE inhibitors.
ACE inhibitors decrease renal excretion of lithium and increase the risk of lithium intoxication. Serum lithium levels should be monitored if lithium salts need to be administered.

A symptom complex including facial redness, nausea, vomiting and arterial hypotension have been described in rare cases when parenteral gold drugs (sodium aurothiomalate) and ACE inhibitors (enalapril) are used together.

Special Instructions

Caution should be exercised when prescribing to patients with decreased circulating blood volume (as a result of diuretic therapy, restriction of table salt intake, hemodialysis, diarrhea and vomiting) the risk of a sudden and pronounced decrease of blood pressure after using even the initial dose of ACE inhibitor is increased. Transient arterial hypotension is not a contraindication for continuation of treatment with the drug after stabilization of blood pressure (BP). In case of repeated pronounced BP decrease, the dose should be reduced or the drug should be discontinued.

The use of high-strength dialysis membranes increases the risk of anaphylactic reaction. Adjustment of the dosing regimen on days free of dialysis should be made depending on the BP level.

Before and during treatment with ACE inhibitors, periodic monitoring of BP, blood parameters (hemoglobin, potassium, creatinine, urea, activity of “liver” enzymes), urine protein is necessary.

Patients with severe chronic heart failure, coronary heart disease, and cerebrovascular disease in whom a rapid decrease of BP may result in myocardial infarction, stroke, or impaired renal function should be closely monitored.

The abrupt withdrawal of treatment does not cause “ricochet” syndrome (high blood pressure).

In newborns and infants who have had intrauterine exposure to ACE inhibitors should be closely monitored for the timely detection of marked BP decline, oliguria, hyperkalemia, and neurologic impairment that may result from reduced renal and cerebral blood flow when ACE inhibitor-induced blood pressure decreases. In oliguria, it is necessary to maintain BP and renal perfusion by administration of appropriate fluids and vasoconstrictors.

Before the study of parathyroid gland function should be canceled.

Alcohol increases the hypotensive effect of the drug.

At the beginning of treatment, until the end of the dosing period, one should refrain from driving and engaging in potentially hazardous activities requiring increased concentration and rapid psychomotor reactions because dizziness is possible, especially after the initial dose of ACE inhibitor in patients taking diuretics.

Before surgical procedures (including dentistry), the surgeon/anesthesiologist should be warned about the use of ACE inhibitors.

Contraindications

An history of angioedema;
Progressive azotemia with bilateral renal artery stenosis or renal artery stenosis of the single kidney;
Pregnancy;
Lactation;
Childhood;
Hypersensitivity to ACE inhibitors.

Side effects

Most side effects are temporary and do not require withdrawal.

Possible: headache, dizziness, fatigue, fatigue, nausea, orthostatic hypotension, palpitations, tachycardia.

Rarely: allergic reactions in the form of skin rash, itching, dry cough, liver and/or kidney function disorders, hyperkalemia, proteinuria.

Extremely rare: with high doses, sleep disorders, depression, paresthesias may occur.

Overdose

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

Treatment: the patient is transferred to a horizontal position with a low headboard. In mild cases gastric lavage and oral intake of saline solution are indicated, in more severe cases – measures aimed at BP stabilization: intravenous infusion of saline solution, plasma substitutes, angiotensin II administration, hemodialysis if necessary (elimination rate of enalaprilat – 62 ml/min).

Similarities