Enam 20mg tab 20 pc


Enam 20mg tab 20 pc



Active substance:
1 tablet contains: enalapril maleate 2.5 mg, 5 mg, 10 mg or 20 mg.
The tablets 2.5 mg and 5 mg lactose anhydrous 198 / 195.5 mg, maleic acid 2 mg, 2.5 mg zinc stearate; tablets 10 mg and 20 mg lactose anhydrous 192 / 275.5 mg, zinc stearate 3 / 4.5 mg.
White or almost white round tablets with bevelled edges, embossed “EMT” on one side and the numeral “2.5” or “5” or “10” or “20” and the dividing line on the other side.
Product form:
Tablets of 2.5 mg, 5 mg, 10 mg and 20 mg.
Tablets of 2.5 mg.
10 tablets in an aluminum strip. By 2 strips are packed in a cardboard box with instructions for use.
Tablets 5 mg, 10 mg, 20 mg.
10 tablets in an aluminum strip. 2, 5, 6, 10 or strips are packed in a cardboard box with instructions for use.
Hypersensitivity to enalapril or other ACE inhibitors.
Pregnancy and lactation.
Angioedema in history against the background of ACE inhibitor therapy, hereditary or idiopathic angioedema.
Age 18 years (effectiveness and safety have been established).
Aortic stenosis, cerebrovascular diseases (including cerebrovascular insufficiency), ischemic heart disease, coronary insufficiency, severe autoimmune systemic connective tissue disease (including systemic lupus erythematosus, scleroderma), inhibition of bone marrow hematopoiesis, diabetes mellitus, hyperkalaemia, bilateral stenosis of the renal artery, renal artery stenosis sole condition after kidney transplantation, renal and / or liver failure, diet restriction sodium , A condition associated with decreased blood volume (including diarrhea, vomiting), primary aldosteronism, old age.
20 mg
Various forms of hypertension, including renovascular hypertension. Enam® effective in chronic heart failure (in a combination therapy).
Interaction with other drugs
Potentiates the effect of ethanol, slows down lithium.
Reduces the effect of drugs containing theophylline.
Hypotensive effect reduce non-steroidal antiinflammatory drugs, estrogens; amplify-diuretics, other antihypertensive drugs (beta-blockers, methyldopa, nitrate, calcium channel blockers slow (BCCI), hydralazine, prazosin), drugs for general anesthesia, ethanol.
Potassium-sparing diuretics and kalisodergaszczye drugs increase the risk of hyperkalemia.
Medications that cause bone marrow suppression, increase the risk of neutropenia and / or agranulocytosis.
Immunosuppressants, allopurinol, cytostatics reinforce haematotoxicity.
With simultaneous use of ACE inhibitors and drugs gold (sodium aurothiomalate) describes a symptom, including facial flushing, nausea, vomiting and reduced blood pressure.
Simultaneous treatment with insulin and oral hypoglycemic drugs increases the risk of hypoglycemia.
Symptoms: excessive blood pressure reduction, 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 ingestion and brine, in more serious cases, measures aimed at stabilizing BP: intravenous injection of 0.9% sodium chloride solution, plasma expanders, if necessary – intravenous angiotensin II, hemodialysis (elimination rate enalaprilata- 62 ml / min).
pharmachologic effect
Pharmacological group:
An angiotensin-converting enzyme (ACE).
Enam® refers to a group of ACE has an antihypertensive action, mechanism of development of which is associated with a decrease in the formation of angiotensin I angiotensin II, reduction of the concentration of which leads to a direct reduction in the secretion of aldosterone. 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 in heart rate is not observed. Reduces the degradation of bradykinin, increases the synthesis of prostaglandins. The hypotensive effect is more pronounced at high concentrations of renin in plasma than in normal or reduced.
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 background decreased BP. Strengthens the coronary and renal blood flow. With prolonged use reduces hypertrophy of the left ventricle of the heart. Reduces the tonus of the arteries of the resistive type. Prevents the progression of chronic heart failure (CHF), slows the progression of left ventricular dilatation, prevents the development of diabetic nephropathy. It improves blood flow to the ischemic myocardium.
Reduces platelet aggregation. Prolongs life expectancy in patients with chronic heart failure, slow the progression of left ventricular dysfunction in patients with myocardial infarction without clinical manifestations of heart failure.
It has some diuretic effect. Intraglomerular reduces hypertension, slowing the development of glomerulosclerosis and the risk of chronic renal failure.
The pharmacological activity has formed during hydrolysis metabolite of enalapril, enalaprilat, which inhibits ACE.
the onset of the hypotensive effect of time when administered 1 h, it reaches 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 CHF, a significant clinical effect observed during long-term treatment of 6 months or more.
After oral absorption-60%. Food intake does not affect absorption. The liver is metabolized to the active metabolite – enalaprilat, which is a more effective inhibitor of ACE than enalapril. Connection with the plasma protein-50-60% enalaprilat. The time to reach maximum concentration (TCmax) enalapril-1 h-enalaprilat 3-4 hours. The equilibrium drug concentration (Css) in plasma reached after 4 days. Enalaprilat easily passes through the blood-tissue barriers, excluding the blood-brain barrier, a small quantity penetrates through the placenta and into breast milk.
. The half-life (T1 / 2) of enalaprilate 11 hours is derived mainly kidneys -60% (20% in the form of enalapril and a 40% -to enalaprilat) through the intestine-33% (6% in the enalapril and a 27% – as enalaprilat).
Removed during hemodialysis (rate 62 ml / min) and the peritoneal dialysis.
Conditions of supply of pharmacies
On prescription.
side effects
Cardio-vascular system: excessive fall in blood pressure, orthostatic collapse, rarely, chest pain, angina pectoris, myocardial infarction (usually associated with a marked decrease in blood pressure), arrhythmia (atrial or bradi- tachycardia, atrial fibrillation), palpitations, thromboembolism of pulmonary artery branches .
From the digestive system: dry mouth, loss of appetite, dyspepsia (nausea, diarrhea or constipation, vomiting, abdominal pain), ileus, pancreatitis, liver dysfunction and biliary excretion, hepatitis, jaundice.
The respiratory system: nonproductive “dry” cough, interstitial pneumonitis, bronchospasm, dyspnea, rhinorrhea, pharyngitis.
From the nervous system: dizziness, fainting, headache, fatigue, insomnia, paresthesia, anxiety, depression, confusion, fatigue, sleepiness (2-3%), it is very rare when used in high doses – nervousness, depression, paresthesia .
From the senses: vestibular disorders, hearing and visual impairment, tinnitus.
Allergic reactions: skin rash, angioedema face, extremities, lips, tongue, glottis and / or throat, dysphonia, exfoliative dermatitis, erythema multiforme exudative (including Stevens-Johnson syndrome), toxic epidermal necrolysis (Lyell’s syndrome), pemphigus (pemphigus), pruritus, rash, photosensitivity, serositis, vasculitis, myositis, arthralgia, arthritis, stomatitis, glossitis. Very rarely – angioneurotic edema of the gastrointestinal tract (including intestinal swelling).
From the laboratory parameters: hypercreatininemia, increasing concentrations of urea, increased activity of “liver” transaminases, hyperbilirubinemia, hyperkalemia, hyponatremia, decreased hemoglobin and hematocrit, increased erythrocyte sedimentation rate, thrombocytopenia, neutropenia, agranulocytosis (in patients with autoimmune diseases), eosinophilia. Reported cases of hypoglycemia in patients with diabetes who take insulin and oral hypoglycemic drugs.
From the urinary system: renal dysfunction, proteinuria.
Other: alopecia, decreased libido, “tides” of blood to the face.
special instructions
Care must be taken when administered to patients with a reduced volume of circulating blood (bcc) resulting diuretic therapy, while limiting the consumption of salt, hemodialysis, diarrhea and vomiting as an increased risk of sudden and pronounced decrease in blood pressure after the application of even 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.
With the development of excessive reduction in blood pressure of the patient to the supine position with a low headboard, if necessary, are administered 0.9% chloride and sodium plazmozameschayuschie medicaments solution.
Application vysokoprotochnyh dialysis membranes increases the risk of an anaphylactic reaction. Correction of dosage regimen in the days free from dialysis, must be carried out depending on the blood pressure level.
Prior to and during treatment with ACE inhibitors is necessary to monitor blood pressure, blood parameters (hemoglobin, potassium, creatinine, urea, the activity of “liver” enzymes), protein in the urine.
Should be carefully observed for patients with decompensated heart failure, ischemic heart disease and cerebrovascular disease, 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 the syndrome of “lifting” (a sharp rise in blood pressure).
In patients with an indication for the development of angioedema in history have an increased risk of developing cancer while taking ACE inhibitors.
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 in blood pressure reduction, the called ACE inhibitors. When oliguria need to maintain blood pressure and renal perfusion by introducing the liquids and vasoconstrictive drugs.
In patients with renal function decline, reduce single dose or increase the interval between doses of enalapril.
Before examining the function of the parathyroid glands enalapril should be discontinued.
Caution should be exercised during exercise or in hot weather (risk of development of dehydration and excessive loss of blood pressure due to a decrease BCC).
Prior to surgery (including dental), you must notify the surgeon / anesthetist on the use of ACE inhibitors.
During treatment, care must be taken when driving and other lesson. Potentially hazardous activities that require high concentration and psychomotor speed reactions (dizziness, especially after receiving the starting dose of ACE inhibitor in patients taking diuretic drugs).
Storage conditions
In a dry, dark place at a temperature not higher than 25 C.
Keep out of the reach of children!.
Dosing and Administration
Inside, regardless of the meal.
In monotherapy hypertension-5 initial dose of 1 mg once a day. If no effect after 1-2 weeks the dose was raised to 5 mg. After 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 1-2 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 is 40 mg.
In the case of appointment of Enam patients receiving diuretics, diuretic therapy should be discontinued for 2-3 days prior to drug administration. If this is not possible, the initial dose Enam is 2.5 mg / day.
Patients with hyponatremia (sodium concentration in the blood serum of less than 130 mmol / l) or creatinine concentration in the serum of more than 0.14 mmol / l initial dose of 2.5 mg 1 time per day.
Renovascular hypertension: initial dose – 2.5-5 mg / day. The maximum daily dose of 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 tolerated dose (depending on blood pressure) but not higher than 40 mg / day, once or in 2 hours. Patients with low systolic blood pressure (less than 110 mm Hg. V.) Therapy should be initiated with a dose of 1.25 mg. dose selection should be carried out for 2-4 weeks or more in a short time. Average maintenance dose of 5-20 mg / day in 1-2 doses.
In chronic renal failure accumulation occurs at lower filtration of less than 10 ml / min. If creatinine clearance 80-30 ml / min dose is usually 5-10 mg / day, creatinine clearance 30-10 ml / min 2.5-5 mg / day, less than 10 ml / min 1.25-2.5 mg / day only on the days of dialysis.
The duration of treatment depends on the effectiveness of therapy. Too marked decrease in blood pressure dose gradually.
Appearance may differ from that depicted in the picture. There are contraindications. You need to read the manual or consult with a specialist

Additional information

Weight0.100 kg


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