Enap R, 1.25mg/ml 1 ml 5 pcs

Enap is an antihypertensive drug whose mechanism of action is associated with inhibition of angiotensin-converting enzyme activity, resulting in reduction of angiotensin-II formation.

Enalapril is a “prodrug”: as a result of its hydrolysis it produces enalaprilate which inhibits ACE. Its mechanism of action is related to the reduction of angiotensin I to angiotensin II, the reduction of which leads to a direct reduction of aldosterone secretion. This decreases total peripheral vascular resistance, systolic and diastolic blood pressure (BP), post- and preload on myocardium.

Dilates arteries to a greater extent than veins, and there is no reflex increase in heart rate.

The hypotensive effect is more pronounced at high plasma renin levels than at normal or reduced levels. Reduction of blood pressure (BP) within therapeutic limits has no effect on the cerebral blood flow, the blood flow in the brain vessels is maintained at a sufficient level even against the background of reduced blood pressure. It enhances coronary and renal blood flow.

Long-term use reduces hypertrophy of the left ventricular myocardium and myocytes of the resistive arterial walls, prevents the progression of heart failure and slows the development of left ventricular dilatation. Improves blood supply to ischemic myocardium. Reduces platelet aggregation.

It has some diuretic effect.

The time of onset of hypotensive effect when taken orally is 1 hour, reaches a maximum after 4-6 hours and lasts up to 24 hours. In some patients, therapy for several weeks is necessary to achieve optimal blood pressure levels. In heart failure, a noticeable clinical effect is observed with long-term use – 6 months or more.

Indications

Active ingredient

Composition

1 ml:

– enalaprilat 1.25 mg

Supplementary substances:

benzyl alcohol,

sodium chloride,

sodium hydroxide,

water d/i.

How to take, the dosage

Enap is administered at a dose of 1.25 mg (1 mL) every 6 hours, including patients who have previously taken oral enalapril. Treatment should only be given as an inpatient.

The drug is given by IV infusion slowly (over 5 min) or by drop infusion diluted in 20-50 ml of 5% dextrose (glucose) solution or 0.9% sodium chloride solution.

If the therapeutic effect is not satisfactory 1 h after administration, the drug in a dose of 1.25 mg (1 ml) may be repeated and after 6 h the treatment may be continued according to the usual schedule (1.25 mg every 6 h).

In patients taking diuretics, the initial dose of the drug is reduced to 0.625 mg (0.5 ml). If the therapeutic effect is unsatisfactory 1 h after administration, the same dose may be administered again, and after 6 h, treatment is continued with the full dose (1.25 mg every 6 h).

In mild to moderate chronic renal failure with CK > 30 ml/min (serum creatinine less than 265.2 µmol/L), the dose of Enap P is 1.25 mg (1 ml) every 6 h, which means no dose adjustment is required.

If CK < 30 mL/min (serum creatinine greater than 265.2 µmol/L), the starting dose is 0.625 mg (0.5 mL) followed by 1 h monitoring to detect excessive BP reduction.

If there is no effect after 1 h, the 0.625 mg dose is repeated and treatment is continued at a dose of 1.25 mg every 6 h. For patients on hemodialysis, the dose of Enap P is 0.625 mg (0.5 mL) every 6 h for 48 h.

Interaction

The patient should refrain from drinking alcoholic beverages because ethanol increases the reduction of blood pressure (BP) with enalapril.

The concomitant use of enalapril and diuretics or other hypotensive agents increases the effectiveness of these drugs.

The interaction with drugs used to treat heart failure (cardiac glycosides) is not clinically relevant.

Before surgery, the physician should be told that the patient is taking enalapril because of the risk of arterial hypotension during general anesthesia.

The concomitant use of enalapril and nonsteroidal anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid (aspirin) as well as estrogen may decrease the effectiveness of enalapril and increase the risk of renal impairment.

The concomitant use of some diuretics (spironolactone, amiloride or triamterene) and/or additional administration of tablets containing potassium may cause increased serum potassium levels (hyperkalemia).

Drugs that cause bone marrow suppression increase the risk of neutropenia and/or agranulocytosis.

Immunosuppressants, allopurinol, cytostatics increase hematotoxicity.

Enalapril weakens the effect of agents containing theophylline.
Simultaneous use of lithium drugs may increase the side effects of lithium.

The concomitant use of Enap with cimetidine increases the half-life (T 1/2) of Enap. If a patient is already taking the above medications or is advised to take any of them, they should tell their physician that they are taking Enap.

Special Instructions

With caution use Enap in motorists. When concomitant use with diuretics, beta-blockers the effect of Enap is increased, and with nonsteroidal anti-inflammatory drugs the effect is reduced.

Hypotension (rapid decrease in blood pressure) may be observed (even several hours after the first dose) in patients with severe heart failure or significant renal dysfunction as well as in patients with electrolyte-water balance disorders due to diuretic treatment, salt-free diet, diarrhea, vomiting or patients on hemodialysis. A marked decrease in blood pressure (BP) is usually manifested by nausea, increased heart rate (HR) and fainting.

If hypotension develops, the patient needs to be in a horizontal, low-headed position and the physician needs to be called.

Contraindications

Side effects

Overdose

If a patient has taken too many pills in one sitting, a doctor should be called immediately.
Symptoms: excessive decrease in blood pressure (BP) up to the development of collapse, myocardial infarction, acute cerebral circulation disorder or thromboembolic complications, convulsions, stupor.
Treatment: the patient is transferred to the horizontal position with a low headboard. In mild cases gastric lavage and oral administration of saline solution are indicated, in more severe cases – measures aimed at stabilization of arterial pressure (BP), IV administration of saline solution, plasma substitutes, if necessary – IV administration of angiotensin II, hemodialysis (elimination rate of enalaprilat – 62 ml/min).