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Additional ingredients: sodium propylparaben, lactose, sodium methylparaben, corn starch, PVPK-30, microcrystallic cellulose, talc, krakhmalglikolit sodium, magnesium stearate, silicon dioxide.
Enapril-N is issued in the form of tablets, on 20 pieces in packaging.
Pharmacodynamics and pharmacokinetics
The combined anti-hypertensive Enapril-N medicine is included by two lowering ABP active ingredient – enalapril and Hydrochlorthiazidum.
Enalapril is a competitive high-specific antagonist (suppresses activity) APF thanks to what there is no transformation of angiotensin I in angiotensin II which just and promotes considerable vasoconstriction and, as a result, increase of the ABP. Also enalapril reduces development of Aldosteronum that leads to reduction in blood of concentration of Aldosteronum and angiotensin II. Owing to these effects reduction of arterial pressure, general vascular peripheric resistance, pressure in a small circle of blood circulation and the right auricle is observed, and also cordial emission amplifies. Because of influence of enalapril gradual reduction of diastolic and systolic pressure, decrease in a hypertrophy of a left ventricle and normalization of coronary circulation is noted.
Hydrochlorthiazidum is diuretic drug which efficiency is connected with lowering of a reabsorption of the ionized forms of chlorine and sodium in proximal tubules. Also suppression of a reabsorption of bicarbonates and potassium is observed. Diuretic (diuretic) action is shown in case of acidosis and an alkalosis, and at long use decreases.
The combination in one drug of these two active ingredients leads to increase in hypotensive efficiency, reduction of hypostases of fabrics and decrease in load of a myocardium.
Enalapril possesses good absorption in a gastrointestinal tract (about 60%). It is hydrolyzed in a liver with release of the enalaprilat which is an active metabolite. Bioavailability of drug equals 40%. Plasma Cmax of enalapril is observed in 60 minutes, its active metabolite – in 3-4 hours.
Communication of enalaprilat with plasma proteins happens less than for 50%. A third of the accepted dose is removed by intestines (27% – in the form of enalaprilat and 6% – in the form of enalapril) and kidneys (18% – in the form of enalaprilat and 61% – in the form of enalapril). T1/2 of enalaprilat equals to 11 hours, and renal clearance of 150±44 ml/min.
Fast absorption of Hydrochlorthiazidum allows to observe diuretic effect in 1-2 hours. Hydrochlorthiazidum gets into milk of mother and through a placenta. The elimination of drug passes quickly enough and approximately for 95% with urine.
Indications to use
The tablets Enapril-N are shown to use for the purpose of therapy of an arterial hypertension (hypertensia).
- Quincke's edema in the anamnesis;
- hypersensitivity to enalapril, Hydrochlorthiazidum or the HP additional ingredients;
- heavy pathologies of a liver;
- gout of a heavy current;
- heavy pathologies of kidneys (including a diabetic nephropathy, an anury and OPN);
- feeding by a breast;
- heavy manifestations of a diabetes mellitus;
- stenosis of an aorta or renal arteries;
- age till 12 years;
- hypertrophic cardiomyopathy with obstruction.
- nausea (with the subsequent vomiting or without that);
- dry cough;
- feeling of dizziness;
- dryness in an oral cavity;
- disturbances of hepatic function (increase in level of serumal transaminases) with symptomatology of a secondary cholestasia;
- hyponatremia, weakness of muscles, hypopotassemia (in case of long use);
- increase in content of creatinine and urea, proteinuria (at diseases of kidneys).
Enapril-N, application instruction
The tablets Enaprila-N are intended for peroral (in) reception once at 24 o'clock. Reception of tablets is carried out in time of day, convenient for the patient, in independence of food. Duration of use of Enaprila-N and its daily dosages are defined according to weight of an observed disease.
As a rule, the beginning of therapy of arterial hypertension there passes in a daily dose 1 tablet. In the subsequent, being coordinated with a clinical picture, the dosage can be increased to 2-4 tablets. The most admissible daily dose is defined in an individual order depending on the general state of health of the patient, weight of a hypertension and existence of associated diseases, and also when monitoring indicators of renal functionality and serumal level of potassium.
Selection of doses at pathologies of kidneys has to lean on CC (clearance of creatinine). At KK more than 30 ml/min. it is necessary to lower an initial dose twice (0,5 tablets) and to raise gradually, watching a condition of kidneys, before achievement of optimum efficiency.
Most often overdose of Enaprilom-N is shown by hypotonia with symptomatology of the general weakness, nausea, feeling of dizziness, pallor, headaches, a hyperhidrosis, disturbances of water and electrolytic balance.
At the first reliable signs of overdose carry out a gastric lavage of the patient and appoint adsorbents. Advise the patient to accept horizontal position with the hung head. In the subsequent, for adjustment of blood volume, recommend in/in introduction (in the form of a dropper) sodium chloride (9%), and if necessary and angiotensin II.
All procedures are carried out against monitoring of the vital indicators of the general condition of the patient, and also serumal level of potassium, creatinine and urea.
In case of a hypopotassemia introduction of an asparaginat of potassium and solution of potassium chloride, in a daily dose to 2 grams is shown. At a gipokhloremichesky alkalosis carry out administration of sodium chloride. In especially hard cases hold a hemodialysis session.
At parallel use of other anti-hypertensive HP, barbituraturat, alcohol, derivatives of a fenotiazin and drugs increase in hypotensive efficiency is observed that demands a constant control of the ABP and possible decrease in doses of Enaprila-N.
The concomitant use with sodium chloride and NPVS reduces hypotensive action.
The combined use with glucocorticoids leads to an electrolytic imbalance (in particular to a hypopotassemia); with not depolarizing muscle relaxants to increase in their action; with pressor amines to lowering of pressor reaction.
Parallel use of Enaprila-N and drugs of a foxglove strengthens effects of the last.
Due to the negative impact of Hydrochlorthiazidum on lithium removal, it is necessary to exclude combined use with the drugs supporting him as it can lead to forming of lithium intoxication.
The concomitant use with kaliysberegayushchy HP (Triamterenum, Amiloride, Spironolactonum) can increase the plasma content of potassium.
Terms of sale
For purchase of Enaprila-N the recipe is necessary.
Indicators of temperature of storage of tablets have to be within 15-25 °C.
Period of validity
From the date of production – 3 years.
For the purpose of prevention of displays of hypotension in 2-3 days prior to purpose of Enaprila-N it is necessary to stop reception of diuretics and to interrupt an electrolyte-deficient diet, in case of their previous use and at a satisfactory general condition of the patient. After the first reception of a tablet it is necessary to watch some time the patient's ABP, at the same time it has to be in a prone position. Passing hypotension cannot serve as contraindication to reception of Enaprila-N as most often its subsequent doses after correction of the ABP and blood volume are transferred well. In case of supervision of long symptomatic hypotension it is necessary to lower dosages of drug or to cancel therapy with selection of another hypotensive HP.
Patients with an arterial stenosis of kidneys can be subject to deterioration in their function in this connection they demand special approach and supervision in a specialized hospital.
In case of expected research of functionality of epithelial bodies, reception of Enaprila-N needs to be interrupted.
At insufficiency of kidneys it is required to carry out frequent control of clearance of creatinine and plasma content of electrolytes.
Care of appointment is demanded by such painful states as: generalized atherosclerosis, a subaortal idiopathic stenosis or a stenosis of the mouth of an aorta in severe forms.
Periodically conducted examinations have to include surely an assessment of renal function and electrolytic balance.
Coincidence on the ATH code of the 4th level:
- Hartil, etc.
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