Enalapril 10mg tabs 20 pcs Hemofarm

Description

Composition
Active substance:
1 tablet contains enalapril maleate – 10 mg.
Excipients:
Lactose monohydrate, magnesium carbonate, gelatin, crospovidone, magnesium stearate.
Description:
Round, biconvex white with Valium on one side.
Product form:
Tablets 5 mg, 10 mg, 20 mg.
10 tablets in the blister of Al / Al, PVC and polyamide laminate film. 2 blisters together with instructions for use placed into cardboard pack.
Contraindications
Hypersensitivity to enalapril, other ingredients or other ACE inhibitors. Angioedema history associated with the use of ACE inhibitors, hereditary angioedema or idiopathic. The simultaneous use of aliskiren and / or aliskirensoderzhaschimi drugs in patients with diabetes and / or moderate to severe renal function (glomerular filtration rate (GFR) of less than 60 ml / min / 1.73 m2 body surface area). The simultaneous use of antagonists of angiotensin II (ARA II) patients with diabetic nephropathy. The simultaneous use of neutral endopeptidase inhibitors (e.g., preparations containing sakubitril) due to the high risk of angioedema. Age 18 years (effectiveness and safety have been established). Pregnancy and breast-feeding. Lactose intolerance, lactase deficiency, glucose-galactose malabsorption.
Dosage
10 mg
Indications
Essential hypertension of any severity. Renovascular hypertension. Heart failure of any severity. In patients with symptomatic heart failure drug is also indicated for: increasing patient survival; slowing the progression of heart failure reduce the incidence of hospitalizations for heart failure. Prevention of symptomatic heart failure. In patients without clinical symptoms of HF with left ventricular dysfunction drug is indicated for: delaying the progression of clinical manifestations of heart failure; reduction in hospitalizations for heart failure. Prevention of coronary ischemia in patients with left ventricular dysfunction.
The drug is indicated to: reduce the incidence of myocardial infarction; reducing the incidence of hospitalizations for unstable angina.
Interaction with other drugs
Other antihypertensives
An additive effect can be observed while applying enalapril and other antihypertensive therapy. In applying the drug simultaneously with other antihypertensive drugs, especially diuretics, antihypertensive effect enhancement can be observed. The simultaneous use of enalapril with beta-blockers, methyldopa, or blockers “slow” calcium channels increases the antihypertensive effect. Simultaneous use of the drug with alpha, beta-blockers and ganglioblokatorami should be under close medical supervision. The simultaneous use of enalapril with nitroglycerin, other nitropreparatov or other vasodilator enhances the antihypertensive effect.
Serum Potassium
Patients with hypertension who were taking enalapril monotherapy for more than 48 weeks, the increase in potassium content was observed in the serum by an average of 0.2 mmol / l. With simultaneous use of enalapril with diuretics, cause loss of potassium ions (thiazides or “loop” diuretics), hypokalemia, caused by the action of diuretics usually attenuated by the effect of enalapril. Risk factors for the development of hyperkalemia are renal failure, diabetes, simultaneous use of potassium-sparing diuretics (e.g., spironolactone, eplerenone, amiloride or triamterene) and potassium-based salts and additives. The use of potassium supplements, potassium-sparing diuretics or potassium-containing salt, especially in patients with impaired renal function, may lead to a significant increase in potassium in serum. If necessary, the simultaneous application of the above potassium-containing or potassium-enhancing drugs should be careful and regular monitoring the potassium content in the blood serum. The risk of hyperkalemia upgraded while the application of preparations containing cotrimoxazole (trimethoprim + sulphamethoxazole).
hypoglycemic agents
The simultaneous use of ACE inhibitors and hypoglycemic agents (insulin, hypoglycemic agents for oral administration) can enhance the hypoglycemic effect of the latter with the risk of hypoglycemia. This phenomenon is usually the most frequently observed during the first weeks of combination therapy, and in patients with impaired renal function. In patients with diabetes mellitus, host hypoglycemic agents for oral or insulin should regularly monitor the concentration of blood glucose, especially for the first month of simultaneous application with ACE inhibitors.
of lithium drugs
Like other drugs affecting the excretion of sodium, ACE inhibitors may reduce the lithium excretion by the kidneys, so while the use of drugs lithium and ACE inhibitors should regularly monitor the concentration of lithium in blood serum. Tricyclic antidepressant / antipsychotic drugs / agents for general anesthesia / drugs Simultaneous use of certain anesthetic drugs, tricyclic antidepressants and neuroleptics with ACE inhibitors may lead to a further decrease in blood pressure (see. The section “Special instructions”).
ethanol
Ethanol enhances the antihypertensive effect of the ACE inhibitors.
Acetylsalicylic acid, thrombolytics and beta-blockers
Enalapril can be used simultaneously with acetylsalicylic acid (as an antiplatelet agent), thrombolytics and beta-blockers.
sympathomimetics
Sympathomimetics may reduce the antihypertensive effect of the ACE inhibitors. Nonsteroidal anti-inflammatory drugs (NSAIDs) NSAIDs, including selective cyclooxygenase-2 (COX-2), can reduce the effect of diuretics or other antihypertensives. Consequently, the antihypertensive effect of angiotensin II receptor antagonists (ARA II) or ACE inhibitors may be attenuated while the use of NSAIDs, including selective inhibitors of COX-2. In some patients with impaired renal function (e.g., in elderly patients or patients with dehydration, including receiving diuretics) receiving therapy with NSAIDs, including selective inhibitors of COX-2, the simultaneous use of ARA II or ACE inhibitors can cause further deterioration of the function kidneys, including the development of acute renal failure. These effects are generally reversible, so simultaneous use of these drugs should be used with caution in patients with impaired renal function.
Dual blockade of the renin-angiotensin-aldosterone system
Dual blockade of the RAAS using ARA II, ACE inhibitors or aliskiren (Renin inhibitor) is associated with an increased risk of arterial hypotension, syncope, hyperkalemia, and renal dysfunction (including acute renal failure) as compared with monotherapy. Requires regular monitoring of blood pressure, renal function and blood electrolytes in patients taking both enalapril and other drugs that affect the RAAS. The simultaneous use of ACE inhibitors with preparations containing aliskiren, contraindicated in patients with diabetes and / or with moderate or severe renal failure (GFR of less than 60 ml / min / 1.73 m2 body surface area) and are not recommended for other patients. The simultaneous use of ACE inhibitors with ARA II contraindicated in patients with diabetic nephropathy, and is not suitable for other patients. gold preparations
Symptom (nitratopodobnye reaction) comprising the “rush” of blood to the skin, nausea, vomiting, and hypotension observed in rare cases while applying gold preparations for parenteral administration (sodium aurothiomalate) and ACE inhibitors, including enalapril.
An increased risk of angioedema
The simultaneous use of ACE inhibitors with the following drugs increases the risk of angioedema: with inhibitors of mTOR (mammalian Target of Rapamycin – target of rapamycin in mammalian cells), e.g., temsirolimus, sirolimus, everolimus; with inhibitors of dipeptidyl peptidase type IV (DPP-IV) (gliptinami), e.g., sitagliptin, saxagliptin, vildagliptin, linagliptinom; with ratsekadotrilom (enkephalinase inhibitor used to treat acute diarrhea); with estramustine.
Inhibitors of neutral endopeptidase
Reported an increased risk of angioedema while the use of ACE inhibitors and racecadotril (enkephalinase inhibitor). With simultaneous use of ACE inhibitors with medicinal preparations containing sakubitril inhibitor (neprilysin), increases the risk of angioedema, and therefore the simultaneous use of these drugs is contraindicated. ACE inhibitors should be administered no sooner than 36 hours after drug withdrawal comprising sakubitril. Assignment contraindicated drugs containing sakubitril, patients receiving ACE inhibitors, as well as within 36 hours after discontinuation of ACE inhibitors.
Tissue plasminogen activator
Observational studies revealed an increased incidence of angioedema patients treated with ACE inhibitors, after applying alteplase for thrombolytic therapy for ischemic stroke.
Other drugs
There were no clinically significant pharmacokinetic drug interaction between enalapril and the following drugs: hydrochlorothiazide, furosemide, digoxin, timolol, methyldopa, warfarin, indomethacin, sulindac, and cimetidine. With simultaneous use of enalapril and enalaprilat propranolol reduced serum concentration, but this effect is not clinically significant.
Overdose
Symptoms: marked reduction of blood pressure until the development of collapse, myocardial infarction, acute stroke or thromboembolic complications, convulsions, stupor.
Treatment: the patient is transferred to a horizontal position with a low headboard. In mild cases shown gastric lavage and intake of brine, in more severe cases – actions to stabilize blood pressure: intravenous administration of saline, plasma expanders, optionally – administering angiotensin II, hemodialysis (speed enalaprilat excretion averages 62 ml / min ).
pharmachologic effect
Pharmacological group:
Angiotensin-converting enzyme inhibitor.
Pharmacodynamics:
Enalapril – antihypertensive from the group of ACE inhibitors. Enalapril is a “prodrug”: as a result of hydrolysis enalaprilat is formed, which inhibits ACE. Its mechanism of action is associated with a decrease in the formation of angiotensin I angiotensin II, reduction of which leads to a direct decrease in aldosterone release. In this decreases total peripheral vascular resistance, systolic and diastolic blood pressure (BP), and post-preload on the myocardium.
Artery expands to a greater extent than the vein, the reflex increase of heart rate frequency is not observed.
The hypotensive effect is more pronounced at high plasma renin level than at normal or reduced its level. Reduction of blood pressure in the therapeutic range has no effect on cerebral blood flow, cerebral blood flow in vessels is maintained at a sufficient level and the background of decrease in blood pressure. Strengthens the coronary and renal blood flow.
With prolonged use of reduced left ventricular hypertrophy and myocyte walls resistive arteries prevents the progression of heart failure and slows the development of left ventricular dilation. It improves blood flow to the ischemic myocardium.
Reduces platelet aggregation.
It has some diuretic effect.
onset of antihypertensive effect during ingestion -. 1 h, reaching a maximum after 4-6 hours and lasts up to 24 hours in some patients to achieve optimal blood pressure level needed therapy for a few weeks… In heart failure, a significant clinical benefit observed with prolonged use – more than 6 months.
Pharmacokinetics:
Suction
After oral administration, enalapril is rapidly absorbed in the gastrointestinal tract. Enalapril maximum concentration in serum is attained within 1 hour after ingestion. The degree of suction enalapril ingestion is approximately 60%. Simultaneous food intake does not affect the absorption of enalapril. After absorption, enalapril is rapidly hydrolysed to the active metabolite enalaprilat – powerful ACE inhibitor. Enalaprilat maximum concentration in serum is observed after about 4 hours postdose into enalapril. The duration of suction and hydrolysis of enalapril is similar for any recommended therapeutic doses. In healthy volunteers with normal renal function, the equilibrium concentration of enalaprilat in serum is achieved by day 4 from the beginning of the reception of enalapril.
Distribution
The therapeutic dose range enalaprilat binding to plasma proteins, blood does not exceed 60.
Metabolism
No data on other important metabolic pathways of enalapril, except hydrolysis to enalaprilat. Excretion Excretion of enalapril is carried out mainly through the kidneys. The major metabolites in urine determined are enalaprilat, constituting about 40% of the dose, and enalapril unaltered (approximately 20%). Curve enalaprilat concentration in blood plasma has a long terminal phase, apparently due to its binding to ACE. The half-life at enalaprilat exchange application the drug inside is 11 hours.
Pharmacokinetics in special patient groups
Patients with impaired renal function
The area under the curve “concentration-time» (AUC) of enalapril and enalaprilat is increased in patients with renal insufficiency. Patients with mild to moderate severity of renal failure (creatinine clearance (CC) of 40-60 ml / min) after receiving a dose of enalapril is 5 mg 1 time per day equilibrium value enalaprilat AUC was approximately 2 times higher than that of patients with unmodified renal function. In patients with severe renal failure (creatinine clearance less than 30 mL / min) AUC value is increased by about 8 times. The effective half-life after repeated use enalaprilat enalapril in patients with severe renal failure increased, and the onset of equilibrium concentrations of enalaprilate delayed (see. The section “Method of administration and dose”). Enalaprilat may be derived from the general circulation via hemodialysis. Clearance in hemodialysis is 62 ml / min.
Breastfeeding
After a single oral administration of enalapril in a dose of 20 mg in patients postpartum average maximum concentration of enalapril in the breast milk was 1.7 g / L (from 0.54 to 5.9 g / l) in 4-6 hours after administration. The average maximum concentration enalaprilat was 1.7 g / l (1.2 to 2.3 g / l) and observed at various times during the 24 h after administration. Given the data on maximal concentrations in breast milk maximum estimated intake enalapril child under full breastfeeding is 0.16% of the dose, calculated taking into account the body weight of the mother. Upon receiving enalapril oral dose of 10 mg 1 time per day for 11 months, the maximum concentration of enalapril in the breast milk was 2 mg / l after 4 hours after administration, maximum concentrations of enalaprilate – 0.75 g / L after approximately 9 hours after administration . Average concentration in breast milk for 24 h after administration of enalapril was 1.44 g / l and enalaprilat – 0.63 g / l. After a single dose of enalapril in a dose of 5 mg and 10 mg enalaprilat concentration in breast milk was below detection limit (less than 0.2 mg / l) after 4 hours after administration. The concentration of enalapril has not been determined.
Pregnancy and breast-feeding
Use of the drug during pregnancy is not recommended. When pregnancy occurs the drug should be discontinued immediately, unless the drug is not considered essential for the mother. Epidemiological studies indicate a possible increase in the risk of major congenital malformations in infants whose mothers took ACE inhibitors during the I trimester of pregnancy. ACE inhibitors can cause illness or death of the fetus or newborn when used pregnant during II and III trimester of pregnancy. The use of ACE inhibitors in these periods accompanied by negative effects on the fetus and newborn, which manifested itself in the form of hypotension, renal failure, hyperkalemia and / or hypoplasia of bones of the skull of the newborn. Also reported prematurity, intrauterine growth retardation and cleft blood (Botallova) duct, but it is unclear whether these cases are associated with the action of ACE inhibitors. Perhaps oligohydramnios development occurs due to decrease fetal kidney function. This complication can cause contractures limb deformation of the skull bones, including its front part, hypoplastic fetal lung. In the appointment of the drug during pregnancy is necessary to inform the patient about the potential risk to the fetus. These adverse effects on the embryo and fetus, apparently, are not the result of intrauterine action of ACE inhibitors during the I trimester of pregnancy. In those rare cases where ACE inhibitor use during pregnancy is deemed necessary, it should conduct periodic ultrasound examinations to assess the amniotic fluid index. In case of detection in the ultrasound oligohydramnios should stop taking the drug unless the drug is not considered essential for the mother. Nevertheless, and the patient, and the physician should be aware that oligohydramnios develops in irreversible damage to the fetus. If ACE inhibitors are used during pregnancy and the development of oligohydramnios is observed, then depending upon the week of pregnancy to assess the functional state of the fetus may be necessary to conduct a stress test, non-stress test or definition of fetal biophysical profile. Newborns whose mothers have taken enalapril during pregnancy should be evaluated in relation to the identification of arterial hypotension, oliguria and hyperkalemia. With the development of oliguria, special attention should be directed to the maintenance of blood pressure and renal perfusion. Enalapril crosses the placental barrier. It can be partially removed from the circulation of the newborn via peritoneal dialysis. Theoretically, it may also be removed by exchange transfusion. Enalapril and enalaprilat are excreted in breast milk of mothers in trace amounts. If necessary, use during breastfeeding patient should discontinue breastfeeding.
Conditions of supply of pharmacies
On prescription.
side effects
Enalapril is generally well tolerated and in most cases does not cause side effects requiring discontinuation of the drug.
The incidence of adverse reactions is provided in accordance with the World Health Organization classification: very common (> 10%), common (> 1% and
Blood disorders and lymphatic system: rarely – anemia (including haemolytic and aplastic anemia); rarely – neutropenia, decreased hemoglobin, decreased hematocrit, thrombocytopenia, agranulocytosis, bone marrow suppression, pancytopenia, lymphadenopathy, autoimmune diseases.
Нарушения со стороны эндокринной системы: частота неизвестна – синдром неадекватной секреции антидиуретического гормона.
Нарушения со стороны обмена веществ и питания: нечасто – гипогликемия (см. раздел «Особые указания»).
Нарушения со стороны обмена веществ и питания: нечасто – гипогликемия (см. раздел «Особые указания»).
Нарушения со стороны нервной системы и нарушения психики: очень часто – головокружение; часто – головная боль, депрессия; нечасто – спутанность сознания, сонливость, бессонница, нервозность, парестезия, вертиго; редко – необычные сновидения, нарушения сна.
Нарушения со стороны органа зрения: очень часто – нечеткость зрения.
Нарушения со стороны слуха и лабиринтные нарушения: нечасто – шум в ушах.
Нарушения со стороны сердца и сосудов: часто – выраженное снижение АД, обморок, боль в груди, нарушения сердечного ритма, стенокардия, тахикардия; нечасто – ортостатическая гипотензия, ощущение сердцебиения, инфаркт миокарда или инсульт (возможно, обусловленные выраженным снижением АД у пациентов групп высокого сердечного риска) (см. раздел «Особые указания»); редко – синдром Рейно.
Нарушения со стороны дыхательной системы, органов грудной клетки и средостения: очень часто – кашель; часто – одышка; нечасто – ринорея, боль в горле, охриплость голоса, бронхоспазм/бронхиальная астма; редко – легочные инфильтраты, ринит, аллергический альвеолит/эозинофильная пневмония.
Нарушения со стороны пищеварительной системы: очень часто – тошнота; часто – диарея, боль в животе, нарушения вкусовых ощущений; нечасто – кишечная непроходимость, панкреатит, рвота, диспепсия, запор, анорексия, синдром «раздраженного желудка», сухость слизистой оболочки полости рта, язва желудка и двенадцатиперстной кишки; редко – стоматит/афтозные язвы, глоссит; очень редко – интестинальный отек.
Нарушения со стороны печени и желчевыводящих путей: редко – печеночная недостаточность, гепатит (гепатоцеллюлярный или холестатический), включая печеночный некроз, холестаз (включая, желтуху).
Нарушения со стороны кожи и подкожных тканей: часто – кожная сыпь, реакции гиперчувствительности/ангионевротический отек: ангионевротический отек лица, конечностей, губ, языка, голосовых складок и/или гортани (см. раздел «Особые указания»); нечасто – повышенное потоотделение, кожный зуд, крапивница, алопеция; редко – мультиформная эритема, синдром Стивенса-Джонсона, эксфолиативный дерматит, токсический эпидермальный некролиз, пемфигус, эритродермия. Сообщалось о развитии симптомокомплекса, который может включать все или некоторые из следующих симптомов: лихорадку, серозит, васкулит, миалгию/миозит, артралгию/артрит, положительный тест на антинуклеарные антитела, увеличение скорости оседания эритроцитов (СОЭ), эозинофилию и лейкоцитоз. Могут также возникать кожная сыпь, фотосенсибилизация и другие кожные реакции.
Нарушения со стороны почек и мочевыводящих путей: нечасто – нарушение функции почек, почечная недостаточность, протеинурия; редко – олигурия.
Нарушения со стороны половых органов и молочной железы: нечасто – эректильная дисфункция; редко – гинекомастия.
Общие расстройства: очень часто – астения; часто – повышенная утомляемость; нечасто – мышечные судороги, «приливы» крови к коже лица, чувство дискомфорта, лихорадка.
Лабораторные и инструментальные данные: часто – гиперкалиемия, увеличение концентрации креатинина в сыворотке крови; нечасто – повышение концентрации мочевины в крови, гипонатриемия; редко – повышение активности «печеночных» трансаминаз, увеличение концентрации билирубина в сыворотке крови.
Нежелательные явления, выявленные в период постмаркетингового применения эналаприла (причинно-следственная связь не установлена): инфекция мочевыводящих путей, инфекция верхних дыхательных путей, бронхит, остановка сердца, фибрилляция предсердий, опоясывающий герпес, мелена, атаксия, тромбоэмболия ветвей легочной артерии и инфаркт легкого, гемолитическая анемия, включая случаи гемолиза у пациентов с дефицитом глюкозо-6-фосфатдегидрогеназы.
special instructions
Care must be taken when assigning Enalapril in patients with reduced circulating blood volume (as a result of diuretic therapy, while limiting the consumption of salt, hemodialysis, diarrhea and vomiting) – increased risk of sudden and pronounced blood pressure lowering even after applying the initial dose of ACE inhibitor. Transient hypotension is not a contraindication for the continuation of treatment after stabilization of blood pressure. In the case of re-expressed BP reduction should reduce or stop the drug dose.
The use of highly permeable dialysis membranes increases the risk of an anaphylactic reaction. Correction of dosing regimen in days free from dialysis, must be carried out depending on the blood pressure level.
Prior to and during treatment with ACE inhibitors requires periodic monitoring of blood pressure, blood parameters (hemoglobin, potassium, creatinine, urea, “liver” enzymes), protein in the urine.
Should be carefully observed for patients with severe heart failure, coronary heart disease and diseases of the brain, in which a sharp decrease in blood pressure can lead to heart attack, stroke, or renal dysfunction.
The sudden cancellation of treatment does not lead to a syndrome “cancel” (a sharp rise in blood pressure).
For newborns and infants who have been exposed in utero ACE inhibitors should be closely monitored for early detection of significant decrease in blood pressure, oliguria, hyperkalemia and neurological disorders, possible due to the reduction of renal and cerebral blood flow with a decrease in blood pressure caused by ACE inhibitors. When oliguria need to maintain blood pressure and renal perfusion by introducing the liquids and vasoconstrictors. In the presence of renal failure may be reduced excretion of the active metabolite, resulting in an increase in its concentration in plasma. Such patients may require the appointment of lower doses of the drug.
In patients with hypertension and unilateral or bilateral renal artery stenosis may increase the content of urea and creatinine in serum.
These patients need to monitor renal function during the first few weeks of therapy. You may need to reduce the dosage of the drug.
risk ratio should be considered and the potential benefits with enalapril in patients with coronary artery and cerebrovascular insufficiency, due to the increased threat of ischemia in excessive hypotension.
The drug should be used with caution in patients with diabetes because of the risk of hyperkalemia.
Patients with a history of instructions to angioedema may be at increased risk of angioedema during treatment with enalapril.
In patients with severe autoimmune diseases such as systemic lupus erythematosus or scleroderma, increased risk of neutropenia or agranulocytosis in patients receiving enalapril.
Caution is recommended when enalapril for the treatment of chronic heart failure in patients treated with cardiac glycosides and / or diuretics.
Before examining the function of the parathyroid glands drug should be discontinued.
Alcohol enhances the hypotensive effect of the drug.
At the beginning of the treatment until the completion of dose titration period, you must refrain from driving motor vehicles and activities potentially hazardous activities that require high concentration and psychomotor speed reactions as dizziness, especially after the initial dose of ACE inhibitor in patients taking diuretics.
Prior to surgery (including dental), you must notify the surgeon / anesthetist on the use of ACE inhibitors.
Storage conditions
Stored in a dry place at a temperature of 15 to 25C.
Keep out of the reach of children.
Dosing and Administration
Assign inside regardless of mealtime.
При монотерЭрмитальапии артериальной гипертензии начальная доза — 5 мг один раз в сутки.
In the absence of clinical effect after 1-2 weeks the dose was raised to 5 mg. After receiving the initial dose, patients should be under medical observation for a further 2 hours and 1 hour, until it stabilizes blood pressure. If necessary and sufficiently well tolerated dose could be increased to 40 mg / day in 2 divided doses. After 2-3 weeks, transferred to a maintenance dose – 10-40 mg / day, divided into 1-2 doses. At moderate hypertension average daily dose is about 10 mg.
The maximum daily dose of 40 mg / day.
In the case of appointment to patients concomitantly receiving diuretics, diuretic therapy should be discontinued for 2-3 days prior to enalapril. If this is not possible, the initial dose should be 2.5 mg / day.
Patients with hyponatremia (concentration of sodium ions in serum of less than 130 mmol / l) or creatinine concentration in the serum of more than 0.14 mmol / l initial dose – 2.5 mg 1 time per day.
When renovascular hypertension initial dose – 2.5-5 mg / day. The maximum daily dose is 20 mg.
In chronic heart failure the initial dose of 2.5 mg once, then increase the dose of 2,5 – 5 mg every 3-4 days according to the clinical response to the maximum tolerable doses depending on the values ​​of blood pressure, but not exceeding 40 mg / day in single or 2 divided doses. Patients with low systolic blood pressure (less than 110 mm Hg. V.) Therapy should be initiated with a dose of 1.25 mg / day. dose selection should be carried out within 2-4 weeks or in a shorter time. The average maintenance dose – 5-20 mg / day. 1-2 reception.
Older people more likely to occur more pronounced antihypertensive effect and the elongation of the preparation time, which is associated with a decrease in the rate of elimination of enalapril, therefore, the recommended initial dose to elderly – 1.25 mg.
In chronic renal failure accumulation occurs at lower filtration of less than 10 ml / min. If creatinine clearance (CC) 80-30 ml / min dose is usually 5-10 mg / day, with CC to 30-10 ml / min -. 2.5-5 mg / day, with CC less than 10 ml / min. – 1.25-2.5 mg / day. Only in the days of dialysis.
The duration of treatment depends on the effectiveness of therapy. Too marked decrease in blood pressure dose gradually.
The drug used in both monotherapy and in combination with other antihypertensive agents.
Information
Appearance may differ from that depicted in the picture. There are contraindications. You need to read the manual or consult with a specialist