Enap-N pills 25mg+10mg, 20pcs

Composition

of 1 tab. :

– enalapril maleate 10 mg

-hydrochlorothiazide 25 mg

Auxiliary substances:

sodium bicarbonate,

quinoline yellow dye (E 104),

lactose monohydrate,

calcium hydrophosphate anhydrous,

corn starch,

talc,

magnesium stearate.

Pharmacological action

Pharmacogroup:

antihypertensive combined agent (ACE inhibitor+diuretic).

Pharmaceutical action:

Enap-H is a combined drug, the action of which is determined by the properties of the components that make up its composition. It has an antihypertensive effect.

– Enalapril inhibits ACE, which promotes the conversion of angiotensin I to angiotensin II, reduces the concentration of aldosterone in the blood, increases the release of renin by juxtaglomerular cells in the walls of the arterioles of the renal glomeruli, improves the functioning of the kallikrein-kinin system, stimulates the release of prostaglandins and endothelial relaxing factor (NO), inhibits the sympathetic nervous system.

Together, these effects eliminate spasm and dilate peripheral arteries, reduce OPSS, systolic and diastolic blood pressure, and post-and preload on the myocardium. Dilates the arteries to a greater extent than the veins, while there is no reflex increase in heart rate. The hypotensive effect is more pronounced at high plasma renin concentrations than at normal or reduced levels. Lowering blood pressure within therapeutic limits does not affect cerebral circulation. Improves blood supply to the ischemic myocardium. Increases renal blood flow, while the glomerular filtration rate does not change. In patients with initially reduced glomerular filtration rate, its rate usually increases.

The maximum effect of enalapril develops in 6-8 hours and persists up to 24 hours

. – Hydrochlorothiazide-thiazide diuretic of medium strength. Reduces the reabsorption of sodium ions at the level of the cortical segment of the Henle loop, without affecting its section passing in the medulla of the kidney. Blocks carbonic anhydrase in the proximal part of the convoluted tubules, increases the excretion of potassium ions, bicarbonates and phosphates by the kidneys.

Practically does not affect the acid-base state. Increases the elimination of magnesium ions. Detains calcium ions in the body. The diuretic effect develops in 1-2 hours, reaches a maximum in 4 hours, and lasts 10-12 hours. The effect decreases when the glomerular filtration rate decreases and stops when its value is less than 30 ml / min. Reduces blood pressure by reducing BCC, changes in the reactivity of the vascular wall.

The use of a combination of enalapril and hydrochlorothiazide leads to a more pronounced decrease in blood pressure compared to monotherapy with each of the drugs separately and allows maintaining the antihypertensive effect of Enap® – H for at least 24 hours.

Indications

• arterial hypertension
• chronic heart failure.

Contraindications

• severe renal impairment
• hypersensitivity to Enap-H.

Side effects

• nausea, vomiting, abdominal discomfort
• dizziness when suddenly rising from a prone position, headache, dizziness
• dry cough
• allergic reactions.

Interaction

The use of potassium supplements, potassium-sparing agents or preparations containing potassium, salt substitutes, especially in patients with renal insufficiency, can lead to a significant increase in the content of potassium in the blood serum.

Potassium loss in patients taking thiazide diuretics is usually reduced by enalapril. The level of potassium in the blood serum usually remains within the normal range.

When used concomitantly with lithium preparations, lithium excretion slows down (increasing the cardiotoxic and neurotoxic effects of lithium). Thiazide diuretics may increase the effect of tubocurarin chloride.

Concomitant use of thiazide diuretics, opioid analgesics, or phenothiazine derivatives may result in orthostatic hypotension.

Co-use of beta-blockers, alpha-blockers, ganglion blockers, methyldopa, or slow calcium channel blockers with enalapril may further reduce blood pressure.

Concomitant use of allopurinol, cytostatics, and immunosuppressants with ACE inhibitors may increase the risk of leukopenia.

Concomitant use of thiazide diuretics with corticosteroids, calcitonin may lead to the development of hypokalemia.

Concomitant use of cyclosporine with ACE inhibitors may increase the risk of hyperkalemia.

Concomitant use of NSAIDs (including selective COX-2 inhibitors) may weaken the antihypertensive effect of ACE inhibitors. NSAIDs and ACE inhibitors have an additive effect on increasing serum potassium, which can lead to deterioration of renal function, especially in patients with impaired renal function. This effect is reversible. NSAIDs may reduce the diuretic and antihypertensive effects of diuretics.

Antacids may reduce the bioavailability of ACE inhibitors. Sympathomimetics may reduce the antihypertensive effect of ACE inhibitors.

Thiazide diuretics may reduce the effect of adrenomimetics (epinephrine). Ethanol increases the hypotensive effect of ACE inhibitors and thiazide diuretics, which can cause orthostatic hypotension. Epidemiological studies suggest that the simultaneous use of ACE inhibitors and hypoglycemic agents may lead to hypoglycemia.

More often, hypoglycemia develops in the first weeks of therapy in patients with impaired renal function. Long-term and controlled clinical trials of enalapril do not confirm these data and do not limit the use of enalapril in patients with diabetes mellitus. However, such patients should be under regular medical supervision. The use of hypoglycemic agents for oral use and insulin with thiazide diuretics may require dose adjustment.

A single dose of colestyramine or colestipol reduces the absorption of hydrochlorothiazide in the gastrointestinal tract by 85% and 43%, respectively. With the simultaneous use of ACE inhibitors and gold preparations (sodium aurothiomalate) IV, a symptom complex is described, including hyperemia of the facial skin, nausea, vomiting and arterial hypotension.

How to take, course of use and dosage

Usually the initial and maintenance dose of the drug Enap-H is 1 tab. per day.

In the absence of proper effect, the dose can be increased to 2 tablets per day. In general, the maximum effect is achieved within 3 weeks after the start of treatment.

Overdose

Symptoms: increased diuresis, marked decrease in blood pressure with bradycardia or other cardiac arrhythmias, convulsions, impaired consciousness (including coma), acute renal failure, violation of KSHR and water-electrolyte balance of the blood.

Treatment:  the patient is moved to a horizontal position with raised legs. In mild cases, gastric lavage and ingestion of activated carbon are indicated, in more serious cases-measures aimed at stabilizing blood pressure – intravenous use of plasma substitutes, infusion of 0.9% sodium chloride solution.

The patient should be monitored for blood pressure, heart rate, respiratory rate, serum concentration of urea, creatinine, electrolytes and diuresis, if necessary – intravenous use of angiotensin II, hemodialysis (the rate of elimination of enalaprilat-62 ml / min).

Special instructions

During treatment Enap-H requires regular monitoring of liver function, kidney function, and blood pressure.

2-3 days before starting treatment with the drug Enap-H therapy with diuretics should be discontinued. Simultaneous use is not recommended Enap-H with lithium and potassium preparations.

A combination of the drug is possible Enap-H with beta blockers.

Form of production

Enap-H tablets are yellow, round, flat, with a beveled edge and a risk on one side.

Storage conditions

Store in a place protected from moisture at a temperature not exceeding 25°C.

Active ingredient

Hydrochlorothiazide, Enalapril

Conditions of release from pharmacies

By prescription

Dosage form

Tablets

Purpose

For adults as directed by your doctor

Indications

Heart Failure, Hypertension