Enanorm, pills 20+10mg, 30pcs

Composition

1 tablet contains:

active ingredients:

nitrendipine-20 mg,

enalapril maleate-10 mg;

excipients:

sodium bicarbonate – 5.00 mg,

microcrystalline cellulose-20.00 mg,

corn starch-20.00 mg,

sodium lauryl sulfate-8.00 mg,

povidone K 25-6.00 mg,

magnesium stearate-1.20 mg,

lactose monohydrate-63.58 mg

Pharmacological action

Pharmacodynamics

Enanorm is a combination of two antihypertensive agents that complement each other by reducing arterial pressure (BP): enalapril: angiotensin – converting enzyme (ACE) and nitrendipine, a slow calcium channel blocker (BMCC).

ENALAPRIL

Enalapril is a prodrug, as a result of its hydrolysis, an active metabolite is formed – enaprilat, which inhibits ACE. The mechanism of its action is associated with a decrease in the formation of angiotensin II from angiotensin I, a decrease in the content of which leads to a fifth decrease in the release of aldosterone. This reduces total peripheral vascular resistance (OPSS), systolic and diastolic blood pressure, afterload and preload on the myocardium.

Enalapril dilates the arteries to a greater extent than the veins, while there is no reflex increase in the heart rate (HR).

The angiohypertensive effect is more pronounced with high plasma renin activity than with normal or reduced renin activity. Lowering blood pressure within therapeutic limits does not affect cerebral circulation: blood flow in the brain vessels is maintained at a sufficient level and against the background of reduced blood pressure. Increases coronary and renal blood flow.

With prolonged use, hypertrophy of the left ventricle of the myocardium and myocytes of the walls of resistive arteries decreases, the progression of heart failure is prevented and the development of left ventricular dilation slows down. Enalapril improves blood supply to the ischemic myocardium.

The time of onset of the antihypertensive effect when taken orally is 1 hour, reaches a maximum in 4-6 hours and persists throughout the day.

NITRENDIPINE

Nitrendipine BMCC from the group of dihydropyridine derivatives has an antihypertensive effect. Reduces the flow of calcium ions into the smooth muscle cells of the coronary and peripheral arteries. Causes a slight increase in sodium and water excretion. Reduces afterload and myocardial oxygen demand, does not inhibit the conduction of the heart muscle.

Reduces the number of functioning channels, without affecting the time of their activation, inactivation and recovery. It separates the processes of excitation and contraction in the myocardium, mediated by tropomyosin and troponin, and in vascular smooth muscles, mediated by calmodulin. In therapeutic doses, it normalizes the transmembrane flow of calcium ions, which is disturbed in a number of pathological conditions, primarily in arterial hypertension.

The results of a clinical study of Enanorm in patients with arterial hypertension who did not achieve satisfactory blood pressure control during monotherapy with enalapril at a dose of 10 mg or nitrendipine at a dose of 20 mg showed that Enanorm has a more pronounced effect on reducing both diastolic and systolic blood pressure and the severity of the therapeutic response to therapy.

Pharmacokinetics

of ENALAPRIL

After oral use,60% is absorbed from the gastrointestinal tract. Food intake does not affect the absorption of enalapril.

The binding of enalapril to plasma proteins is 50-60%. Enalapril is rapidly metabolized in the liver to form the active metabolite enalaprilate. The bioavailability of enalapril is 40%.

The maximum concentration of enalapril in blood plasma is reached after 1 hour, enalaprilat-3-4 hours. Enalaprilat easily passes through the histohematicbarriers, excluding the blood-brain barrier, a small amount penetrates through the placenta and into the breast.

The half-life (T 1/2) of enalaprilat is about 1 h. enalapril is mainly excreted by the kidneys-60% (20% – in the form of enalapril and 40% – in the form of enalaprilat), through the intestine – 33% (6% – in the form of enapril and 27% – in the form of enalaprilat).

It is removed during hemodialysis (rate 62 ml / min) and peritoneal dialysis.

NITRENDIPINE

Rapidly absorbed from the gastrointestinal tract by 88%. Bioavailability is 20-30% due to the pronounced effect of “primary passage” through the liver, the connection with plasma proteins (albumin) is 96-99%. Hemodialysis is ineffective. The time to reach the maximum concentration in blood plasma is 1-3 hours after application.

The volume of distribution at steady state is 5-9 l / kg, so hemodialysis and plasmapheresis are ineffective.

It is metabolized in the liver mainly by oxidation. Metabolites are pharmacologically inactive. Nitrendipine is mainly excreted through the kidneys: approximately 77% of the dose taken is excreted as metabolites, less than 0.1% of the dose taken is excreted unchanged. The rest of nitrendipine is excreted through the intestines.

T1 / 2 of nitrendipine after oral use is 8-12 hours. Neither nitrendipine nor its metabolites accumulate in the body. In elderly patients, T 1/2 increases, in cirrhosis of the liver, the area under the concentration – time curve (AUC) increases, and the maximum concentration in blood plasma increases.

No dose adjustment is required in patients with impaired renal function.

The study of interactions between enalapril and nitrendipine in healthy volunteers did not reveal changes in the pharmacokinetics of nitrendipine. As for enalaprilat, its bioavailability slightly increases when used concomitantly with nitrendipine, but this does not seem to have clinical significance. The bioavailability of nitrendipine with the use of a combined drug is higher than with the use of two drugs separately.

Indications

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

Use during pregnancy and lactation

Pregnancy

The use of ACE inhibitors in the first trimester of pregnancy is not recommended. Epidemiological data on the risk of teratogenicity of ACE inhibitors in the first trimester of pregnancy are not convincing; however, an increase in this risk cannot be excluded. If the continued use of ACE inhibitors during pregnancy is not considered absolutely necessary, then patients should be transferred to alternative therapy, the safety of which has been established during pregnancy, when planning pregnancy. It is known that the use of ACE inhibitors in the second and third trimesters of pregnancy has a toxic effect on the fetus (impaired renal function, lack of water, delayed ossification of the skull) and newborns (impaired renal function, hypotension, hyperkalemia). If ACE inhibitors were used in the second and third trimesters of pregnancy, it is recommended to conduct an ultrasound examination to assess kidney function and the condition of the skull bones. Newborns should also be carefully monitored for hypotension if the mother has taken ACE inhibitors.

Breast-feeding period

There are few pharmacokinetic data on very low concentrations of enalapril in breast milk. Although these concentrations are not clinically significant, it is not recommended to use the drug during breastfeeding of premature infants, as well as in the first few weeks after birth, due to the theoretical possibility of a risk of action on the cardiovascular system and kidneys of newborns and due to the lack of sufficient clinical data. In older infants, breastfeeding women may be considered if such treatment is necessary for the mother, and if the child is being monitored for any adverse events.

Contraindications

• Hypersensitivity to enalapril, nitrendipine or any subsidiary of the drug substance of Uninorm and other derivatives of dihydropyridine;
• a history of angioedema associated with treatment with ACE inhibitors;
• hereditary or idiopathic angioedema;
• shock, collapse;
• acute heart failure;
• various pathological syndromes (chronic heart failure in the stage of decompensation, requiring inotropic therapy) and state if they were noted for unstable hemodynamics (e. g., cardiovascular shock, acute heart failure, acute coronary syndrome, acute period of stroke);
• bilateral renal artery stenosis or stenosis of the artery to a solitary kidney;
• hemodynamically significant stenosis of the aortic or mitral valve disease and hypertrophic obstructive cardiomyopathy;
• severe renal dysfunction (CC less than 10 ml/min) and hemodialysis;
• severe disturbances of liver function;
• galactose intolerance, lactase deficiency or glucose-galactose malabsorption (product contains lactose);
• severe hypotension (systolic BP less than 90 mm Hg. calendar);
• pregnancy and lactation;
• age to 18 years (efficacy and safety not established);
• under conditions of hemodynamic instability: acute myocardial infarction (within the first 4 weeks after myocardial infarction), chronic heart failure III-IV functional class (NYHA classification);

With caution: aortic stenosis, cerebrovascular diseases (including cerebrovascular insufficiency), coronary heart disease, coronary insufficiency, severe autoimmune systemic diseases of connective tissue (includingsystemic lupus erythematosus, scleroderma), inhibition of bone marrow hematopoiesis, diabetes mellitus, hyperkalemia, post-kidney transplant condition, renal failure, mild or moderate liver function disorders, conditions accompanied by a decrease in BCC (including diarrhea, vomiting), diet with restriction of table salt, old age.

Side effects

Classification of adverse developmental events (ADRs) :

• very common (1/10);
• common (1/100,1/10);
• infrequent (1l1000,1/100);
• rare (1/10000,1/1000);
• very rare (1/10000, including individual messages);
• frequency unknown (cannot be estimated based on available data).

Adverse reactions observed with the use of Enanorm are similar to the reactions to taking each of the components of the drug separately.

From the cardiovascular system: often-flushes of blood to the skin of the face, peripheral edema; infrequently-tachycardia, dizziness, pronounced decrease in blood pressure; very rarely-violation of peripheral blood circulation, shortness of breath.

From the nervous system: often-headache; very rarely-asthenia, hypothermia, drowsiness, paresthesia, tremor, convulsions.

From the respiratory system: often-cough; very rarely-pharyngitis, tracheitis, dyspnoea.

From the digestive system: infrequently-nausea, dyspepsia; very rarely-flatulence.

Skin and subcutaneous tissue disorders: infrequently-erythematous rash.

From the side of the kidneys and urinary tract: very rarely – hematuria.

Musculoskeletal and connective tissue disorders: very rare – muscle spasm.

Laboratory and instrumental data: very rarely – increased activity of “hepatic” transaminases, hypokalemia.

The following adverse side effects were observed when taking drugs containing similar components::

ENALAPRIL

From the cardiovascular system: infrequently-especially at the beginning of treatment and in patients with reduced BCC and/or salts, worsening of Raynaud’s disease, heart failure, severe arterial hypertension or renal hypertension, as well as after increasing the dose of enalapril and/or using diuretics and/or in the “standing” position, there were: dizziness, weakness, visual disturbances; rarely – fainting; very rarely – due to increased antihypertensive effect tachycardia, rapid heartbeat, atrial bradycardia, atrial fibrillation, chest pain, angina pectoris, myocardial infarction, and transient cerebrovascular accident also occurred. Cardiac arrest, embolism and infarction of the lungs, pulmonary edema.

From the side of the kidneys and urinary tract: infrequently-the appearance or increase of impaired renal function; very rarely-acute renal failure; rarely-oliguria, proteinuria in some cases with concomitant deterioration of renal function, pain in the iliac region.

From the respiratory system: infrequently-dry cough, sore throat, hoarseness, bronchitis; rarely – shortness of breath, sinusitis, rhinitis; very rarely-bronchospasm, an attack of bronchial asthma, pulmonary infiltrates, stomatitis, glositis, dry mouth, pneumonia, angioedema affecting the pharynx, larynx and/or tongue and leading in some cases to a fatal outcome; more often in patients of non-hispanic race.

From the digestive system: infrequently-nausea, upper abdominal pain, digestive disorders; rarely-vomiting, diarrhea, constipation, loss of appetite, change or temporary loss of taste sensations, anosmia; very rarely-pancreatitis, intestinal obstruction, stomatitis, glossitis.

From the liver and biliary tract: very rarely-impaired liver function, hepatitis, liver failure, a syndrome that begins with cholestatic jaundice and progresses to liver necrosis, in some cases with a fatal outcome.

Endocrine system disorders: very rarely gynecomastia.

From the skin and subcutaneous tissues: infrequently – exanthema; rarely – urticaria, pruritus, angioedema of the lips, face and/or upper and lower extremities; very rarely – severe skin reactions, for example, pemphigus, pemphigus erythema multiforme, exfoliative dermatitis, Stevens-Johnson syndrome or toxic epidermal necrolysis; phenomena resembling psoriasis, photosensitivity, hot flashes blood to the skin of the face, increased sweating, alopecia, onycholysis. Skin manifestations may be accompanied by fever, myalgia/myositis, arthralgia/arthritis, vasculitis, serositis, eosinophilia, leukocytosis, increased erythrocyte sedimentation rate and / or antinuclear antibody titers. If a severe skin reaction is suspected, treatment is discontinued.

Nervous system disorders: infrequently-headache, weakness; rarely-dizziness, depression, sleep disorders, impotence, peripheral neuropathy with paresthesia, balance disorders, muscle spasms, nervousness, confusion.

From the side of the organ of hearing: rarely-tinnitus.

From the side of the organ of vision: rarely-blurred vision, dry eyes, increased lacrimation.

Laboratory and instrumental data: infrequently – decreased hemoglobin, hematocrit, white blood cells or platelets; rarely – anemia, thrombocytemia, neutropenia, eosinophilia (in some cases – agranulocytosis or pancytopenia), especially in patients with impaired renal function, with systemic connective tissue diseases, patients receiving allopurinol, procainamide or immunosuppressants; increased serum urea, creatinine and potassium concentrations hyperkalemia (in patients with diabetes mellitus), decreased excretion of albumin by the kidneys (especially in patients with impaired renal function, severe heart failure), renovascular hypertension; very rarely – hemolysis/hemolytic anemia (also in combination with glucose-6 – phosphate dehydrogenase deficiency), increased bilirubin concentration and increased activity of “oven” transaminases.

NITRENDIPINE

Immune system disorders: infrequently-flu-like syndrome.

From the cardiovascular system: infrequently-arrhythmia, tachycardia, palpitation, peripheral edema, “flushes” of blood to the skin of the face, increased symptoms of vasodilation; rarely-a pronounced decrease in blood pressure, angina pectoris, chest pain.

From the gastrointestinal tract: infrequently-nausea, diarrhea; rarely-abdominal pain, constipation, dyspepsia, vomiting; very rarely-gum hyperplasia.

From the endocrine system: very rarely – gynecomastia.

From the blood and lymphatic system: very rarely – leukopenia, agranulocytosis.

From the side of the seletmuscular and connective tissue: rarely-myalgia.

From the nervous system: infrequently-headache, asthenia; rarely-nervousness, paresthesia, tremor, dizziness.

From the respiratory system: rarely-shortness of breath.

From the skin and subcutaneous tissues: rarely-pruritus, rash, urticaria.

From the side of the organ of vision: rarely-visual disturbances.

From the side of the kidneys and urinary tract: very rarely-increased frequency of urination, polyuria.

Laboratory and instrumental data: very rarely – increased activity of “liver” enzymes.

If any of the side effects listed in the instructions get worse, or any other side effects not listed in the instructions are noticed, you should inform your doctor.

Interaction

The antihypertensive effect of Enanorm may be enhanced when used concomitantly with other antihypertensive agents, such as diuretics, beta – blockers, or alpha-blockers. In addition, when applied simultaneously, individual components of the repair product may exhibit the following interactions::

ENALAPRIL

Combinations that should be used with caution:

Potassium-sparing diuretics and potassium supplements

Angiotensin converting enzyme inhibitors (ACE inhibitors) reduce diuretic-induced potassium loss. Potassium-sparing diuretics, potassium supplements, and other drugs that can increase serum potassium (for example, heparin) may have an additive effect on serum potassium, especially in patients with impaired renal function. If the combined use of such drugs is necessary, for example, to eliminate hypokalemia, then caution should be exercised and often monitor the content of potassium in the blood serum.

Lithium

Use in combination with lithium is not recommended due to the risk of a significant increase in the concentration of lithium in the blood serum, followed by the development of severe nephotoxicity. If the combined use of these drugs is necessary, then the concentration of lithium in the blood serum should be carefully monitored.

Nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) and ACE inhibitors additionally increase the serum potassium content, which can lead to deterioration of renal function. In elderly patients and patients with reduced BCC, this combination can cause acute renal failure by directly affecting the glomerular filtration rate. Moreover, NSAIDs may weaken the antihypertensive effect of ACE inhibitors.

Hypoglycemic agents for oral administration

Enalapril may increase the hypoglycemic effect of these drugs, so the concentration of glucose in the blood should be carefully monitored.

Baclofen

May enhance the antihypertertensive effect. If combined use is not necessary, blood pressure should be monitored and the dose adjusted.

Neuroleptics

Use together with these drugs may cause orthostatic hypotension.

Antidepressants

Use in combination with tricyclic antidepressants may cause orthostatic hypotension.

Allopurinol, cytostatics, immunosuppressants, systemic corticosteroids (applied parenterally or orally), procainamide

Simultaneous use may cause leukopenia.

Combinations to consider:

Amifostin

The combination enhances the antihypertensive effect.

NITRENDIPINE

Cimetidine and ranitidine

Cimetidine and, to a lesser extent, ranitidine may increase the concentration of nitrendipine in blood plasma, but the clinical significance of these data is unknown.

Digoxin

Enalapril is co-administered with digoxin without any evidence of a clinically significant adverse interaction. Concomitant use of nitrendipine and digoxin may lead to an increase in the concentration of digoxin in blood plasma. Therefore, the appearance of symptoms of digoxin overdose should be monitored or, if necessary, the concentration of digoxin in the blood plasma should be monitored.

Muscle relaxants

The use of nitrendipine may increase the duration and severity of the effects of muscle relaxants, for example, pancuronium bromide.

Grapefruit juice suppresses the oxidative metabolism of nitrendipine. Taking the latter with grapefruit juice increases the concentration of nitrendipine in the blood plasma, which may enhance its antihypertensive effect.

Nitrendipine is metabolized by the cytochrome P 450 isoenzyme CYP3A4 in the intestinal mucosa and in the liver. Inducers of the SURZA 4 isoenzyme, such as anticonvulsants (phenytoin, phenobarbital, carbamazepine) and rifampicin, can significantly reduce the bioavailability of nitrendipine. Inhibitors of the SURZA 4 isoenzyme, for example, antifungal imidazoles (itraconazole, etc. ) can increase the concentration of nitrendipine in blood plasma.

Beta-blockers

Nitrendipine and beta-blockers act synergistically. This may be particularly important for patients in whom additional beta-adrenergic blockade does not compensate for sympathetic vascular responses, and caution is recommended in relation to such patients.

How to take, course of use and dosage

Enanorm is prescribed inside no more than 1 tablet per day. Tablets should be swallowed whole, not broken or chewed, with a sufficient amount of water.

It is recommended to select the dose of the components by adjusting the dose individually.

Patients with impaired liver function

Enanorm is contraindicated in patients with severe hepatic impairment. In patients with mild to moderate hepatic impairment, monotherapy with either enalapril or nitrendipine is not contraindicated, but due to the fact that there is no experience of using Enanorm in such patients, the drug should be prescribed with caution.

Patients with impaired renal function

Enanorm is contraindicated in patients with severe renal impairment (creatinine clearance less than 10 ml / min) and patients undergoing hemodialysis. In patients with moderate renal insufficiency (creatinine clearance greater than 30 ml/min, serum creatinine less than 3 mg/ml), no dose adjustment is necessary. At the same time, renal function should be evaluated during treatment.

Children and teenagers

Enanorm should not be used in children and adolescents under 18 years of age due to the lack of data on its use.

Overdose

To date, overdose of this combination has not been reported.

Symptoms: the most likely manifestation of an Enanorm overdose will be a marked decrease in blood pressure.

Treatment: there is no specific antidote. Gastric lavage, use of adsorbents (if possible, in the first 30 minutes. Vital functions should be monitored.

In case of a marked decrease in blood pressure, the patient is transferred to a horizontal position with a low headboard. In mild cases, gastric lavage and ingestion of saline sodium chloride are indicated, in more severe cases-measures aimed at stabilizing blood pressure; intravenous use of 0.9% sodium chloride solution; plasma – substituting solutions; if necessary, use of angiotensin II, hemodialysis (the rate of use of enalaprilat is 62 ml/min).

Special instructions

Use strictly as directed by your doctor.

Angioedema

Angioedema of the extremities, face, lips, mucous membranes, tongue, larynx or pharynx may develop when ACE inhibitors are used, especially in the first weeks, and in rare cases after prolonged use. In such cases, the treatment is immediately canceled.

If angioedema of the tongue, larynx or lower leg is fatal, in these cases, emergency therapy should be carried out with hospitalization, the patient should be monitored for at least 12-24 hours, and the patient can be discharged from the hospital only after the symptoms completely disappear.

Neutropenia/agranulocytosis

Enalapril should be used with extreme caution in patients with systemic connective tissue diseases, in patients receiving immunosuppressants, allopurinol or procainamide, or a combination of them, especially in the presence of impaired renal function. When using Enanorm in such patients, it is recommended to monitor the leukocyte formula. During treatment, patients should be instructed to report any signs of infection to the doctor. Enanorm should be discontinued if neutropenia is detected or suspected (neutrophil count less than 1000/mmZ).

Impaired renal function

In patients with impaired renal function when using ACE inhibitors, monitoring of renal function is necessary, especially in the first weeks of treatment. Caution should be exercised in patients with an activated renin-angiotensin system.

For patients with moderate renal impairment (creatinine clearance greater than 30 ml/min, serum creatinine < 1 mg/ml), no dose adjustment is required, but monitoring of renal function is necessary.

In some patients, a marked decrease in blood pressure at the beginning of treatment with ACE inhibitors may lead to a slight further deterioration in renal function. Under these circumstances, acute renal failure has been reported, which is usually reversible.

There is no experience of using Enanorm in patients who have recently undergone a kidney transplant.

Proteinuria

Patients with impaired renal function have rarely developed proteinuria. In patients with clinically significant proteinuria (more than 1 g / day) Enanorm can be used only after a thorough assessment of the risk-benefit ratio and with regular monitoring of clinical and biochemical blood parameters.

Patients with impaired liver function

There is no experience of using Enanorm in patients with mild or moderate hepatic impairment, so this drug should be used in such patients with caution, if there are indications for this.

Since individual cases of the syndrome beginning with cholestatic jaundice and progressing to fatal liver necrosis have been described, if jaundice or pronounced activity of “liver” transaminases occurs, treatment should be discontinued and patients should be monitored.

Orthostatic hypotension

In some cases, Enanorm may cause orthostatic hypotension, which increases the risk in patients with an activated renin-angiotensin-aldosterone system. For example, with a reduced blood volume or a violation of the water-electrolyte balance of the blood or salt deficiency due to the use of diuretics, the use of a low-salt diet, hemodialysis, the presence of diarrhea or vomiting, as well as with a weakening of the left ventricular function and with renovascular hypertension. In such patients, first you need to adjust the blood volume or salt concentration. Patients with heart failure (with or without concomitant renal impairment) may develop symptomatic hypotension. The risk of hypotension in these patients is increased with severe heart failure, when using high doses of loop diuretics, and in the presence of hyponatremia or impaired renal function.

A transient hypotensive reaction is not a contraindication for continued use of Enanorm, and usually does not present difficulties after recovery of circulating blood volume and blood pressure.

Aortic valve stenosis

ACE inhibitors should be used with caution in patients with aortic valve stenosis. Enalapril is contraindicated in patients with hemodynamically significant stenosis.

Primary hyperaldosteronism

The use of enalapril in patients with primary aldosteronism is not recommended.

Patients undergoing hemodialysis

The use of Enanorm during dialysis through high-strength membranes (made of polyacrylonitrile, sodium methylallyl sulfonate, for example, AN69) can lead to anaphylactic reactions, including facial edema, “flushes of blood to the skin of the face, severe orthostatic hypotension and shortness of breath within a few minutes after the start of dialysis, so such combinations should be avoided.

Anaphylactoid reactions in the process of LDL apheresis and desensitization to hymenopteran venom

The use of ACE inhibitors in low-density lipoprotein (LDL) apheresis with dextran sulfate may be accompanied by life-threatening anaphylactoid reactions. The use of ACE inhibitors during specific immunotherapy (desensitization) to insect poisons (bees, wasps) can be accompanied by anaphylactoid reactions, which in some cases can be life-threatening. If LDL apheresis or specific immunotherapy (desensitization) to insect poisons is necessary, AGIF should be temporarily replaced with other means of treating high blood pressure or heart failure.

Surgery/Anesthesia

When performing major surgical operations or anesthesia with the use of drugs that cause orthostatic, enalapril blocks the synthesis of angiotensin II, due to the compensatory release of renin. In such cases, if orthostatic hypotension develops (and it is assumed that the development of orthostatic hypotension occurs by this mechanism), then it should be corrected by increasing the volume of blood plasma.

Impact on fertility

In some cases of in vitro fertilization, slow calcium channel blockers, similar to nitrendipine, caused reversible biochemical changes in sperm heads, which can lead to impaired sperm function. In case of repeated unsuccessful attempts at artificial insemination, the use of slow calcium channel blockers such as nitrendipine should also be taken into account, among other factors.

Racial differences

Like other angiotensin converting enzyme inhibitors, enalapril as a fixed-dose combination component is likely to reduce blood pressure less effectively in black diluents than in patients of other races. This may be due to the higher prevalence of low renin activity in black people with arterial hypertension.

Influence on the ability to drive vehicles and other mechanisms that require increased concentration of attention

When using Enanorm, care should be taken when driving vehicles and complex mechanisms.

Form of production

Tablets

Storage conditions

At a temperature not exceeding 30 °C

Shelf life

3 years

Active ingredient

Nitrendipine, Enalapril

Conditions of release from pharmacies

By prescription

Dosage form

Tablets