How to take Enap with high blood pressure? What do the instructions for use say? At what pressure should you drink? Is Enap effective for hypertension or not? Will this drug be enough to lower blood pressure? Proponents of drug treatment ask similar questions.

Today we will talk about the antihypertensive drug Enap, the action of which is aimed at relaxing and expanding the vascular walls, as well as suppressing the production of the hormone angiotensin-II, which leads to the onset of an antihypertensive effect. But the opinion that Enap increases blood pressure is erroneous.

Knowing the main effect of the medication, you will not be bothered by the question: does Enap increase or decrease blood pressure? Naturally, patients are interested in how to take pills and at what pressure. Below we will look at Enap's instructions and how to drink it with high blood pressure.

Release form and pharmacological action of Enap

Enap blood pressure tablets are produced by pharmaceutical companies in dosages of the active substance (enalapril maleate) of 2.5, 5, 10 and 20 mg with the addition of corn starch, sodium bicarbonate, magnesium stearate, lactose, talc.

Enap, in addition to its hypotensive effect, reduces the frequency of ventricular arrhythmias, improves the resistance of the myocardium to oxygen starvation and the metabolic processes of the heart muscle, and has a positive effect on the movement of blood through the vessels (coronal hemodynamics). The active substance enalapril maleate maintains potassium concentration in the body and causes the release of water and sodium compounds.

Reviews from hypertensive patients who took Enap indicate that the blood pressure medication does not impair libido. The drug improves the quality of life of people diagnosed with heart and vascular diseases. There is no negative effect of the drug on the processes of fat and carbohydrate metabolism.

Drugs related to ACE inhibitors, in the case of monotherapy, as studies by Western scientists show, normalize blood pressure in 70% of hypertensive patients, improving the overall prognosis in this category of patients.

Enap reduces blood pressure within 50-60 minutes after administration. But a pronounced therapeutic effect is observed after 4-6 hours. The antihypertensive drug is enough to be taken once a day, the effect of the drug lasts about 24 hours.

The drug Enap: indications for use

A medicine for blood pressure with the active substance in the form of enalapril maleate is used for:

Also, the drug Enap helps reduce the risks of developing myocardial infarction and ischemic disorders in the functioning of the heart muscle.

Enap: instructions for use, at what pressure to drink

In the initial stages of hypertension, Enap is taken orally, without chewing, with an optimal amount of water, from 5 mg per day. Depending on the situation, the dosage is adjusted to 20 mg. If the required therapeutic effect is not observed in this quantity, then the maximum permitted daily dose of the drug is 40 mg. It is drunk a day in two doses.

To avoid the risk of arterial hypotension, due to a sharp decrease in the volume of blood circulating through the vessels, three days before the start of treatment with Enap, the patient should stop taking diuretics.

Elderly patients should begin drug treatment with Enap with 1.25 mg of enalapril maleate per day. Then, based on the doctor's recommendation, the dosage is maintained or increased. During therapy, it is recommended to check the level of potassium in the blood and the condition of the kidneys.

You can take Enap even if you are a minor. The dosage depends on the weight of the young hypertensive patient and the severity of the disease. For chronic renal and congestive heart failure, the initial dose of enalapril maleate starts at 2.5 mg.

At what blood pressure can you take Enap? One of the most common questions among hypertensive patients. Enap is used to treat patients with mild (140-159/90-99), borderline (160-179/100-109) and severe (above 180/110) hypertension. The dosage of the drug depends on blood pressure and the degree of disease progression.

A higher effect of treatment will appear if the patient gives preference to a healthy lifestyle and minimizes the impact of various negative factors on the body.

Interaction of Enap with drugs

The antihypertensive effect of enalapril maleate on the body is enhanced if the patient takes Prazosin, Hydralazine, Methyldopa, calcium antagonists, beta-blockers. It should be remembered that the medicine in question does not interact with herbal medicines that have cardiotonic and antiarrhythmic effects (cardiac glycosides).

To avoid the risk of deterioration in kidney function, Enap is not used together with non-steroidal anti-inflammatory drugs (Diclofenac, Ibuprofen). The risk of experiencing hyperkalemia increases if enalapril maleate is taken with potassium-sparing diuretics. Treatment with Enap should not be accompanied by the consumption of alcoholic beverages, since alcohol can provoke arterial hypertension in this case.

Contraindications and side effects

Enap blood pressure tablets are not used if the patient has hypokalemia, diabetes mellitus, porphyria, depressed hematopoiesis, renal artery stenosis, angioedema (of the skin, mucous membranes and subcutaneous tissue). The list of contraindications also includes intolerance to the components of Enap and lactose.

During pregnancy, antihypertensive medications can harm the body. It is strictly not recommended for use in the 2nd and 3rd trimesters. Treatment is possible only in exceptional cases. Among the contraindications, as confirmed by doctors' reviews, is breastfeeding.

Side effects during treatment with Enap may manifest themselves in the form of allergies (urticaria, swelling, itching, skin rashes). Taking the drug may be accompanied by headache, sudden fatigue, dizziness, anemia, hypotension, muscle spasms, vomiting, nausea and diarrhea. Side effects of Enap also include a decrease in the number of platelets and leukocytes, and an increase in creatinine levels.

An overdose of Enap is characterized by severe hypotension, the functioning of the respiratory system is disrupted, and arrhythmia is observed. Excessive intake of enalapril maleate can lead to dehydration, dry cough, convulsions, and dizziness. The victim assumes a horizontal position. The patient should rinse the stomach, use activated charcoal, and administer sodium chloride (isotonic solution for injection).

Enap: analogues and substitutes

Enap tablets for blood pressure may not be suitable for the patient for various reasons. In this case, the specialist selects Enap substitutes for the patient, of which there are currently many:

Do not forget that Enap analogues may differ in the duration of drug treatment, so the issue of selecting a substitute must be entrusted to a specialized specialist.

Enap for pressure: reviews from patients who received it

Victor, 52 years old

Lately, I have often encountered a situation where the pharmacies in our city do not have the drug Ednit, which I have been taking for more than 15 years. It has a mild action. I consulted with a doctor, he recommended an analogue - Enap. The medicine exhibits cumulative properties, so it will not work to quickly lower blood pressure, like or. Enap tablets for high blood pressure are effective in maintaining normal blood pressure. I take it every day. The instructions for use are simple. Before drug therapy, I advise you to consult a doctor who will tell you at what pressure Enap can be used.

Elena, 47 years old

I have been taking the drug Enap-NL 20 for high blood pressure for two and a half years. I previously took Ko-Renitek, but often suffered from a dry cough. It temporarily disappeared from pharmacy shelves. The doctor suggested Enap-NL 20, which was similar to the previous one. I was satisfied with the effect and had virtually no side effects. My head might hurt a little, but it didn’t get dizzy. I take the pill after breakfast. Now my blood pressure is at 130/80. Although previously it was around 150-170/90-95. True, the diuretic effect of Enap, which I observe for 1.5-2.5 hours, is a little annoying. Because of this, sometimes you have to skip taking a pill. Single omissions have virtually no effect on blood pressure readings. But two days in a row is a disaster. Fluid is retained and swelling appears.

Larisa, 49 years old

Enap blood pressure tablets from KRKA have been in my medicine cabinet for just over 3 years. Every few years I alternate antihypertensive drugs to prevent addiction. I previously took Egilok and experienced dry mouth. Blood glucose levels increased slightly. The doctor insisted on replacing it with Enap. She explained at what pressure it can be taken. I read the instructions in detail and various information on the forums. Reviews of Enap from doctors, cardiologists and patients most often praised the product. But I was still afraid to buy medicine made in the Russian Federation and India, because there was a risk of developing a dry cough. I settled on the European Enap. Supposedly it is of better quality and very well cleaned. The remedy also helps against heart failure. I use this antihypertensive medicine once a day; if it doesn’t get better, I can increase the daily dosage, and then everything falls into place. My close friend uses Enap for high blood pressure of 160/100. She, like me, has no particular complaints. She claims that she managed to normalize her indicators in a couple of weeks, and now she maintains them within normal limits. True, not only the pills helped, but also giving up bad habits and maintaining a healthy lifestyle. Therefore, you should not rely only on medications, but rather fight the disease in a combined way.

Rules for reducing blood pressure without pills: video

Experts recommend fighting arterial hypertension in a comprehensive manner. If treatment allows you to normalize blood pressure in the early stages, then for grade 2 and 3 hypertension it will be a wonderful addition that enhances the effect of medications. Of course, the result of such therapy is largely individual, but reviews from herbalists and supporters of alternative medicine show that treatment with the gifts of nature significantly increases the chances of normalizing the condition of a hypertensive patient.

Arterial hypertension;

Chronic heart failure (as part of combination therapy);

Asymptomatic left ventricular dysfunction (as part of combination therapy).

Release form of the drug Enap

semi-finished granule 5 mg; plastic bag (bag) 2 kg, multilayer plastic bag (bag) 1;
semi-finished granule 5 mg; polyethylene bag (bag) 4 kg, multilayer polyethylene bag (bag) 1;
semi-finished granule 5 mg; polyethylene bag (bag) 6 kg, multilayer polyethylene bag (bag) 1;
semi-finished granule 5 mg; polyethylene bag (bag) 8 kg, multilayer polyethylene bag (bag) 1;
semi-finished granule 5 mg; polyethylene bag (bag) 10 kg, multilayer polyethylene bag (bag) 1;
semi-finished granule 5 mg; polyethylene bag (bag) 12 kg, multilayer polyethylene bag (bag) 1;
semi-finished granule 10 mg; plastic bag (bag) 2 kg, multilayer plastic bag (bag) 1;
semi-finished granule 10 mg; polyethylene bag (bag) 4 kg, multilayer polyethylene bag (bag) 1;
semi-finished granule 10 mg; polyethylene bag (bag) 6 kg, multilayer polyethylene bag (bag) 1;
semi-finished granule 10 mg; polyethylene bag (bag) 8 kg, multilayer polyethylene bag (bag) 1;
semi-finished granule 10 mg; polyethylene bag (bag) 10 kg, multilayer polyethylene bag (bag) 1;
semi-finished granule 10 mg; polyethylene bag (bag) 12 kg, multilayer polyethylene bag (bag) 1;
semi-finished granule 20 mg; plastic bag (bag) 2 kg, multilayer plastic bag (bag) 1;
semi-finished granule 20 mg; polyethylene bag (bag) 4 kg, multilayer polyethylene bag (bag) 1;
semi-finished granule 20 mg; polyethylene bag (bag) 6 kg, multilayer polyethylene bag (bag) 1;
semi-finished granule 20 mg; polyethylene bag (bag) 8 kg, multilayer polyethylene bag (bag) 1;
semi-finished granule 20 mg; polyethylene bag (bag) 10 kg, multilayer polyethylene bag (bag) 1;
semi-finished granule 20 mg; polyethylene bag (bag) 12 kg, multilayer polyethylene bag (bag) 1;
Compound
Tablets 1 tablet.
enalapril maleate 2.5 mg, 5 mg.
excipients: sodium bicarbonate; lactose monohydrate; corn starch; hydroxypropylcellulose (hyprolose); talc (magnesium hydrosilicate); magnesium stearate
in a blister of 10 pcs.; There are 2 blisters in a cardboard pack.

Tablets 1 tablet.
enalapril maleate 10 mg, 20 mg.
excipients: sodium bicarbonate; lactose monohydrate; corn starch; talc (magnesium hydrosilicate); magnesium stearate; coloring matter - “Sikofarm red 30” iron oxide red (E172) and “Sikofarm yellow 10” ​​iron oxide yellow (E172)
in a blister of 10 pcs.; in a cardboard pack 2 or (for hospitals) 10, 20, 50, 100 blisters.

Pharmacodynamics of the drug Enap

Antihypertensive drug, ACE inhibitor. Enalapril is a “prodrug”: as a result of its hydrolysis, enalaprilat is formed. The mechanism of action is associated with inhibition of ACE activity under the influence of enalaprilat. This leads to a decrease in the formation of angiotensin II, which causes a direct decrease in aldosterone secretion. As a result, there is a decrease in peripheral vascular resistance, a decrease in systolic and diastolic blood pressure, and post- and preload on the myocardium.

It dilates arteries to a greater extent than veins, but there is no reflex increase in heart rate.

The hypotensive effect is more pronounced with high plasma renin levels than with normal or reduced levels. A decrease in blood pressure within therapeutic limits does not affect cerebral circulation; blood flow in the vessels of the brain is maintained at a sufficient level even against the background of reduced blood pressure. Strengthens coronary and renal blood flow.

With long-term use, hypertrophy of the left ventricle of the myocardium and myocytes of the walls of resistive arteries decreases, prevents the progression of heart failure and slows down the development of left ventricular dilatation. Improves blood supply to ischemic myocardium.

Inhibits platelet aggregation.

Has some diuretic effect.

When taking the drug orally, the hypotensive effect develops after 1 hour, reaches a maximum after 4-6 hours and lasts up to 24 hours. In some patients, therapy is necessary for several weeks to achieve optimal blood pressure levels. In heart failure, a noticeable clinical effect is observed with long-term use - 6 months or more.

Pharmacokinetics of the drug Enap

Suction

After taking the drug orally, about 60% of enalapril is absorbed. Cmax of enalapril in blood plasma is achieved after 1 hour. Food intake does not affect absorption.

Distribution and metabolism

In the liver, enalapril is metabolized to form the active metabolite enalaprilat, which is a more active ACE inhibitor than enalapril. Cmax of enalaprilat in the blood serum is observed after 3-4 hours, Css - after 4 days.

Enalaprilat binding to plasma proteins is 50-60%.

Enalaprilat easily penetrates histohematic barriers, with the exception of the BBB. A small amount penetrates the placental barrier and is excreted in breast milk.

Removal

T1/2 of enalaprilat - 11 hours. Excreted mainly by the kidneys - 60% (20% - in the form of enalapril and 40% - in the form of enalaprilat), through the intestines - 33% (6% - in the form of enalapril and 27% - in the form of enalaprilat) .

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

Using the drug Enap during pregnancy

The drug is contraindicated for use during pregnancy and lactation (breastfeeding). If pregnancy occurs during treatment with Enap, the drug should be discontinued immediately.

Use of the drug Enap for impaired renal function

The dosage regimen is set depending on the severity of renal dysfunction or on CC values. For CC more than 30 ml/min, the initial dose is 5 mg/day, for CC less than 30 ml/min - 2.5 mg/day, the dose of the drug should be gradually increased until a satisfactory clinical effect is achieved.

For patients undergoing hemodialysis, on the day of dialysis the drug is prescribed at a dose of 2.5 mg; on other days the dose is adjusted depending on the blood pressure level.

Avoid prescribing the drug to patients with bilateral renal artery stenosis or stenosis of the artery of a single kidney.

Contraindications to the use of the drug Enap

History of angioedema (including those associated with the use of ACE inhibitors);

Porphyria;

Pregnancy;

Lactation (breastfeeding);

Hypersensitivity to enalapril and other components of the drug;

Hypersensitivity to other ACE inhibitors.

The drug should not be used in patients with a history of angioedema associated with previous use of ACE inhibitors (an allergic reaction with severe swelling of the lips, face, neck and possibly arms and legs, accompanied by suffocation and hoarseness of voice) or with other causes, in children and adolescents under 18 years of age (efficacy and safety have not been established).

The drug should be used with caution in patients with bilateral renal artery stenosis or stenosis of the artery of a single kidney; with primary hyperaldosteronism, hyperkalemia, after kidney transplantation, with aortic stenosis, mitral stenosis (with hemodynamic disorders), idiopathic hypertrophic subaortic stenosis, with systemic connective tissue diseases, coronary artery disease, cerebrovascular diseases, diabetes mellitus, with renal failure (proteinuria - more than 1 g /day), liver failure, in patients on a salt-restricted diet or on hemodialysis; simultaneously with immunosuppressants and saluretics; in elderly patients (over 65 years old).

Side effects of the drug Enap

From the cardiovascular system: excessive decrease in blood pressure, orthostatic collapse, rarely - chest pain, angina pectoris, myocardial infarction (usually associated with a pronounced decrease in blood pressure), arrhythmias (brady- or tachycardia, atrial fibrillation), palpitations, thromboembolism of the branches of the pulmonary artery, pain in the heart, fainting, Raynaud's syndrome.

From the central nervous system and peripheral nervous system: dizziness, headache, insomnia, weakness, increased fatigue, drowsiness (2-3%), very rarely confusion, increased fatigue, very rarely when used in high doses - increased excitability, depression, paresthesia .

From the senses: disturbance of the vestibular apparatus, impaired hearing and vision, tinnitus.

From the respiratory system: nonproductive dry cough, interstitial pneumonitis, bronchospasm/asthma, shortness of breath, rhinorrhea, pharyngitis, sore throat, hoarseness.

From the digestive system: dry mouth, anorexia, dyspeptic disorders (nausea, diarrhea or constipation, vomiting, abdominal pain), intestinal obstruction, pancreatitis, impaired liver function and biliary excretion, hepatitis (hepatocellular or cholestatic), jaundice, increased activity liver transaminases, hyperbilirubinemia.

From the urinary system: impaired renal function, proteinuria, hypercreatininemia.

Metabolism: increased urea content, hyperkalemia, hyponatremia.

From the hematopoietic system: decreased concentration of hemoglobin and hematocrit, thrombocytopenia, neutropenia, agranulocytosis (in patients with autoimmune diseases), eosinophilia.

Dermatological reactions: photosensitivity, pemphigus, alopecia.

Allergic reactions: skin rash, angioedema of the face, limbs, lips, tongue, glottis and/or larynx, dysphonia, erythema multiforme, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, itching, urticaria, photosensitivity, serositis, vasculitis, myositis, arthralgia, arthritis, stomatitis, glossitis, increased sweating.

Other: decreased libido, hot flashes, decreased potency, increased ESR.

A complex symptom complex may develop, which may include all or some of the following symptoms: fever, serositis, vasculitis, myalgia/myositis, arthralgia/arthritis, positive test for antinuclear antibodies, increased ESR, eosinophilia, leukocytosis.

Side effects observed when using Enap are usually mild, transient and do not require discontinuation of the drug.

Method of administration and dosage of the drug Enap

The drug is taken orally, regardless of food intake, at the same time of day. If you miss a dose of the drug, it should be taken as soon as possible. If there are only a few hours left before the next dose, then you need to take only the next dose according to the schedule and not take the missed dose. The dose should never be doubled. The dose of the drug should be adjusted depending on the patient's condition.

Dose adjustment is carried out depending on the achievement of a therapeutic effect (lowering blood pressure). If there is no clinical effect, the dose is increased after 1-2 weeks by 5 mg. Typically, the maintenance dose ranges from 10 mg to 20 mg; if necessary and if well tolerated, the dose can be increased to 40 mg/day. The maximum daily dose is 40 mg. It is advisable to divide the high dose into 2 doses.

For patients who continue to take diuretics, the initial dose of the drug is 2.5 mg 1 time / day.

For patients with hyponatremia (concentration of sodium ions in the blood serum less than 130 mmol/l) or serum creatinine more than 140 µmol/l, the initial dose is 2.5 mg 1 time/day.

For patients with kidney disease, the dose of Enap is determined depending on renal function and/or CC. For CC more than 30 ml/min, the initial dose is 5 mg/day; with CC less than 30 ml/min, the initial dose is 2.5 mg/day and is gradually increased until a clinical effect is achieved.

For patients undergoing hemodialysis, on the day of the procedure the drug is prescribed at a dose of 2.5 mg; on the remaining days, the doctor adjusts the dose in accordance with blood pressure levels.

Elderly patients are more likely to experience a more pronounced hypotensive effect and a longer duration of action of the drug, which is associated with a decrease in the rate of elimination of enalapril, so the recommended initial dose is 1.25 mg.

In the treatment of chronic heart failure, the recommended initial dose is 2.5 mg 1 time / day. The dose of Enap should be increased gradually until the maximum clinical effect is achieved, usually after 2-4 weeks. The usual maintenance dose is from 2.5 mg to 10 mg 1 time / day; the maximum maintenance dose is 20 mg 2 times a day.

When treating asymptomatic left ventricular dysfunction, the recommended initial dose is 2.5 mg 2 times a day. Dose adjustment depends on tolerability of the drug. Usually the maintenance dose is 10 mg 2 times a day.

Treatment with Enap is long-term, usually throughout life, unless circumstances arise that require its cancellation.

The tablets should be swallowed whole with a small amount of liquid.

Overdose of Enap

Symptoms: excessive decrease in blood pressure up to the development of collapse, myocardial infarction, acute cerebrovascular accident or thromboembolic complications, convulsions, stupor.

Treatment: the patient should be placed in a horizontal position with a low headboard. In mild cases, gastric lavage and ingestion of saline solution are indicated; in more serious cases - measures aimed at stabilizing blood pressure, intravenous administration of saline, plasma substitutes, if necessary - intravenous administration of angiotensin II, hemodialysis (enalaprilat excretion rate - 62 ml/min).

Interactions of the drug Enap with other drugs

The simultaneous use of enalapril and diuretics or other antihypertensive drugs increases the effectiveness of these drugs.

Interactions with drugs used to treat heart failure (cardiac glycosides) are not clinically significant.

With the simultaneous use of enalapril and NSAIDs, incl. acetylsalicylic acid may reduce the effectiveness of enalapril and increase the risk of renal dysfunction.

With the simultaneous use of certain diuretics (spironolactone, amiloride or triamterene) and/or additional administration of potassium supplements, an increase in the level of potassium in the blood serum (hyperkalemia) is possible.

Enalapril weakens the effect of products containing theophylline. Concomitant use of lithium preparations may increase the side effects of lithium.

Drugs containing cimetidine increase the duration of action of enalapril.

Patients receiving enalapril are at risk of developing arterial hypotension during general anesthesia.

Ethanol enhances the hypotensive effect of enalapril.

Special instructions when taking Enap

During treatment with Enap, regular medical examinations are required, especially at the beginning of treatment and/or when selecting the optimal dose of the drug. The frequency of medical examinations is determined by the attending physician.

It should be borne in mind the possibility of developing arterial hypotension (even several hours after taking the first dose) in patients with severe heart failure, severe renal impairment, as well as in patients with water and electrolyte imbalance caused by treatment with diuretics, a salt-free diet, diarrhea, vomiting, as well as in patients on hemodialysis.

A pronounced decrease in blood pressure is usually manifested by nausea, increased heart rate, and fainting. If arterial hypotension develops, the patient should be transferred to a horizontal position with a low headboard, and medical supervision is required.

Arterial hypotension and its severe consequences are rare and transient. Transient arterial hypotension is not a contraindication to further treatment with the drug. As soon as blood pressure has stabilized, drug therapy can be continued at the average recommended doses. Hypotension can be avoided by interrupting diuretic treatment and avoiding a salt-free diet before starting treatment with Enap, if possible. The patient should be warned that if relapses of arterial hypotension occur, accompanied by nausea, increased heart rate and fainting, then consultation with a doctor is necessary.

Renal function should be monitored before starting treatment and during therapy.

During treatment with Enap, an increase in potassium levels in the blood serum is possible, especially in patients with chronic renal failure, diabetes mellitus, while prescribing potassium-sparing diuretics (such as spironolactone, amiloride and triamterene) or potassium supplements. Such patients should be informed of the need to consult a doctor if muscle weakness and arrhythmia occur.

Patients receiving Enap® should not drink alcohol due to the risk of developing arterial hypotension.

In case of side effects or Quincke's edema (severe swelling of the lips, face, neck, arms and legs, accompanied by suffocation and hoarseness), Enap® should be discontinued and appropriate treatment prescribed.

The drug should be discontinued before testing the function of the parathyroid glands.

Before carrying out a planned surgical intervention, the anesthesiologist should be informed that the patient is receiving Enap®, since there is a risk of developing arterial hypotension during general anesthesia.

It should be borne in mind that during treatment with Enap, the development of allergic reactions is possible due to the use of certain types of filter membranes used in hemodialysis or other types of blood filtration.

During the period of treatment of allergy (desensitization) to wasp or bee venom, patients receiving Enap® may develop a hypersensitivity reaction.

Use in pediatrics

The drug should not be prescribed to children, because the effectiveness and safety of its use in pediatrics have not been established.

Impact on the ability to drive vehicles and operate machinery

In some cases, the drug can cause severe arterial hypotension and dizziness, especially at the beginning of treatment, thus having an indirect and transient effect on the ability to drive vehicles and operate machinery.

Storage conditions for the drug Enap

List B.: In a dry place, at a temperature not exceeding 25 °C.

Shelf life of the drug Enap

The drug Enap belongs to the ATX classification:

C Cardiovascular system

C09 Drugs affecting the renin-angiotensin system

C09A Angiotensin-converting enzyme (ACE) inhibitors

C09AA ACE inhibitors

KNF (medicine included in the Kazakhstan National Formulary of Medicines)

ALO (Included in the List of free outpatient drug provision)

Manufacturer: KRKA, d.d., Novo Mesto

Anatomical-therapeutic-chemical classification: Enalapril

Registration number: No. RK-LS-5 No. 010410

Registration date: 14.11.2017 - 14.11.2022

Limit price: 7.26 KZT

Instructions

• Russian

Tradename

ENAP®

International nonproprietary name

Enalapril

Dosage form

Tablets 5 mg, 10 mg or 20 mg

Compound:

One tablet contains

active substance- enalapril maleate 5 mg, 10 mg or 20 mg,

Excipients

dosage 5 mg: sodium bicarbonate, lactose monohydrate, corn starch, hydroxypropylcellulose, talc, magnesium stearate,

dosage10 mg: sodium bicarbonate, lactose monohydrate, corn starch, talc, magnesium stearate, iron (III) oxide red (E 172),

dosage20 mg: sodium bicarbonate, lactose monohydrate, corn starch, talc, magnesium stearate, iron (III) oxide red (E 172), iron oxide yellow ((E 172).

Description

White, round tablets with a flat surface, beveled edges and a score line on one side (for a dosage of 5 mg).

Tablets are red-brown, round in shape, interspersed with white on the surface and in the mass of the tablets, with a flat surface, with beveled edges and a score on one side (for a dosage of 10 mg).

Tablets are light orange, round in shape, interspersed with white on the surface and in the mass of the tablets, with a flat surface, with beveled edges and a score on one side (for a dosage of 20 mg).

Pharmacotherapeutic group

Angiotensin converting enzyme (ACE) inhibitors.

ATS code C09AA02

Pharmacological properties

Pharmacokinetics

Enalapril is rapidly absorbed from the gastrointestinal tract, the maximum concentration of enalapril in the blood serum is observed within 1 hour after administration. The absorption rate is 60% and is independent of food intake. After absorption, enalapril rapidly undergoes hydrolysis to form the active substance enalaprilat, a potent angiotensin-converting enzyme (ACE) inhibitor. The maximum concentration of enalaprilat in the blood serum is observed 4 hours after taking enalapril. The effective half-life of enalaprilat during a course of oral administration of the drug is 11 hours. In individuals with normal renal function, the equilibrium concentration of enalaprilat is achieved by day 4 from the start of taking enalapril.

IN therapeutic range doses tying with proteins blood plasma -

60%. It is excreted mainly through the kidneys. The main metabolites detected in urine are enalaprilat, accounting for approximately 40% of the dose, and unchanged enalapril (about 20%).

For renal failure

Exposures to enalapril and enalaprilat are increased in patients with renal impairment. In patients with mild or moderate renal impairment (creatinine clearance 0.6 to 1 ml/sec), steady-state AUC (area under crooked " concentration-time") of enalaprilat is approximately two times higher than in patients with normal renal function after a dosage of 5 mg once daily. In severe renal impairment (creatinine clearance ≤ 0.5 ml/sec), AUC increases by approximately 8 times The effective half-life of enalaprilat is prolonged at this level by renal impairment.

Enalapril can be removed from the systemic circulation using hemodialysis. The clearance of enalaprilat by dialysis is 1.03 ml/sec.

Pharmacodynamics

Enap® is a maleic salt acids and enalapril, a derivative of two amino acids, L-alanine and L-proline. Angiotensin converting enzyme (ACE) is peptidyl dipeptidase, which catalyzes the conversion of angiotensin I to the vasoconstrictor form angiotensin II. After absorption, enalapril is hydrolyzed to form enalaprilat, which inhibits ACP. Inhibition of ACE results in a decrease in plasma levels of angiotensin II, which leads to an increase in plasma renin activity (due to the loss of the negative feedback mechanism of renin release), and a decrease in aldosterone secretion. AKP is identical to kinase II. Thus, enalapril can also block the destruction of bradykinin, a peptide that has a vasodilating effect.

Although Enap® lowers blood pressure by suppressing the renin-angiotensin-aldosterone system, which plays an important role in the regulation of blood pressure, the drug reduces blood pressure even in patients with low-renin hypertension. Prescribing Enap® to patients with arterial hypertension leads to a decrease in blood pressure both in the standing and horizontal positions, without a significant increase in heart rate.

In some patients, achieving optimal blood pressure reduction may require several weeks of therapy. Sudden discontinuation of Enap® therapy does not lead to a sharp increase in blood pressure.

Effective inhibition of ACE activity usually develops 2-4 hours after a single oral dose of enalapril. The onset of the hypotensive effect usually occurs within 1 hour, the maximum effect of lowering blood pressure is observed 4-6 hours after taking the drug. The duration of action depends on the dose, but when using recommended doses, the hypotensive effect and hemodynamic effects persist for 24 hours.

In patients with primary arterial hypertension, a decrease in blood pressure is accompanied by a decrease in peripheral arterial resistance with an increase in cardiac output and virtually no change in heart rate. After administration of enalapril, renal blood flow increases, but the glomerular filtration rate remains unchanged. There are no signs of sodium or water retention. However, if patients had a low glomerular filtration rate before treatment, it usually increases. After taking enalapril, diabetic and non-diabetic patients with kidney disease experience a decrease in albuminuria and urinary excretion of IgG (immunoglobulin) and total urine protein.

When combined with thiazide diuretics, the effect of enalapril in lowering blood pressure becomes more pronounced. Enalapril may reduce or prevent the development of hypokalemia caused by diuretics. In patients with heart failure treated with digitalis and diuretics, treatment with enalapril reduces peripheral resistance and blood pressure. Cardiac output increases while heart rate (usually higher in patients with heart failure) decreases. Pulmonary capillary pressure decreases. According to the recommendations of the New York Heart Association, treatment with enalapril increases resistance to physical activity and reduces the signs and severity of heart failure. These effects continue throughout long-term therapy with Enap®. In patients with mild to moderate heart failure, Enap® slows progressive cardiac dilatation/expansion and failure (decrease in left ventricular ejection fraction, end-diastolic and systolic volumes and improvement in ejection fraction). In patients with left ventricular dysfunction, Enap® reduces the risk of major ischemic events, the incidence of myocardial infarction and the number of hospitalizations due to unstable angina.

Enap® also has a beneficial effect on cerebral circulation in patients with hypertension and chronic cerebral vascular disease.

Indications for use

Essential arterial hypertension

Symptomatic hypertension in kidney disease (also in

renal failure and impaired renal function caused by

diabetes mellitus)

Chronic heart failure

Asymptomatic left ventricular dysfunction (as part of a combined

Directions for use and doses

Hypertension The initial dose ranges from 5 mg to 20 mg, depending on the degree of hypertension and the patient's condition. Enap® should be taken once a day. For mild hypertension, the recommended starting dose is 5 mg to 10 mg per day. Patients with a highly activated renin-angiotensin-aldosterone system (eg, renovascular hypertension, salt and fluid deficiency, heart failure, or severe hypertension) may experience an excessive decrease in blood pressure early in treatment. In such patients, an initial dose of 5 mg or less is recommended, and initiation of treatment should be carried out under close medical supervision. Pre-treatment with high doses of diuretics may lead to fluid deficiency and the risk of hypotension when initiating enalapril therapy. In such patients, an initial dose of 5 mg or less is recommended. If possible, diuretic therapy should be discontinued 2-3 days before starting enalapril therapy. During treatment, renal function and plasma potassium levels should be monitored. The usual maintenance dose is 20 mg once daily. The maximum dose is 40 mg per day.

Heart failure/asymptomatic left ventricular dysfunction The initial dose of Enap® in patients with symptomatic heart failure or asymptomatic left ventricular dysfunction is 2.5 mg once daily. The primary effect of the drug on blood pressure should be carefully monitored.

In the treatment of heart failure, enalapril maleate is usually used in combination with diuretics and beta blockers and, if necessary, with cardiac glycosides.

If there is no effect, or after appropriate correction of symptomatic hypotension, in patients with heart failure after initiation of therapy, the dose should be gradually increased to the usual maintenance dose of 20 mg, which is prescribed either as a single dose or divided into two doses (depending on the patient's tolerability of the drug).

♦Special precautions should be taken in patients with impaired renal function and those taking diuretics.

Both before and after starting treatment with Enap®, careful monitoring of blood pressure and renal function should be carried out, since there have been reports of hypotension and (much less frequently) renal failure as a result of taking the drug. In patients treated with diuretics, the dose of the drug should be reduced, if possible, before starting treatment with enalapril. The development of hypotension after the initial dose of enalapril does not mean that hypotension will persist during long-term treatment with enalapril, and does not indicate the need to discontinue the drug. During treatment, potassium levels in the blood plasma should also be monitored. .

Dosage for renal failure

In patients with renal failure, the interval between doses of enalapril should be increased and/or the dosage reduced.

Enalapril undergoes dialysis, dosage adjustment V days when dialysis is not performed should be carried out depending on the blood pressure level.

Elderly patients

The dose is prescribed according to renal function in elderly patients.

The dose of the drug is always adjusted depending on the patient's condition.

Side effects

Often (≥ 1/10)

Blurred vision

Dizziness

Nausea

Asthenia

Often (from≥ 1/100 to<1/10):

- headache, depression

- hypotension (including orthostatic hypotension), syncope, pain

in the chest rhythm disturbances, angina pectoris, tachycardia

Diarrhea, abdominal pain, change in taste

Rash, hypersensitivity/angioedema of the face,

Fatigue

Hyperkalemia, increased plasma creatinine

Uncommon (from≥ 1/1,000 to<1/100)

Anemia (including aplastic and hemolytic)

Hypoglycemia

- confusion, drowsiness, insomnia, nervousness, paresthesia,

dizziness

Palpitations, myocardial infarction or cerebrovascular complications*,

in patients at increased risk

Rhinorrhea, sore throat, hoarseness, bronchospasm/asthma

Intestinal obstruction, pancreatitis, vomiting, dyspepsia, constipation,

anorexia, stomach irritation, dry mouth, peptic ulcer

Sweating, itching, urticaria, alopecia

Renal dysfunction, renal failure, proteinuria

Impotence

Convulsions, flushing, tinnitus, general malaise,

fever

Increased plasma urea, hyponatremia

Rarely (from≥ 1/10,000 to<1/1,000)

Neutropenia, hypohemoglobinemia, decreased hematocrit,

thrombocytopenia, agranulocytosis, bone marrow suppression,

pancytopenia, lymphadenopathy, autoimmune diseases

Insomnia, sleep disturbance

Raynaud's phenomenon

Infiltrates in the lungs, rhinitis, allergic alveolitis/eosinophilic

pneumonia

Stomatitis/aphthous ulcers, glossitis

Liver failure, hepatitis, including hepatocellular or

cholestatic hepatitis, including necrosis, cholestasis, jaundice

Erythema multiforme, Stevens-Johnson syndrome, exfoliative

dermatitis, toxic epidermal necrolysis, pemphigus, erythroderma

Oliguria

Gynecomastia

Increased liver enzymes, increased bilirubin in blood plasma

Very rarely (<1/10,000)

Intestinal angioedema

Unknown(cannot be estimated based on available data)

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

*Incidence rates were comparable to those in placebo and active placebo control groups in clinical trials.

A complex of symptoms was noted: fever, serositis, vasculitis, myalgia/myositis, arthralgia/arthritis, positive antinuclear antibody test ( A.N.A. ) , ESR acceleration , eosinophilia and leukocytosis. Rash, photosensitivity and other dermatological manifestations may also occur.

If serious side effects occur, treatment should be stopped.

Contraindications

Hypersensitivity to enalapril and other components

drug or other ACE inhibitors

History of angioedema associated with previous

use of ACE inhibitors

Hereditary or idiopathic angioedema

Pregnancy, lactation period

Children and teenagers up to 18 years of age

Drug interactions

Potassium-sparing diuretics, foodpotassium supplements

ACE inhibitors reduce potassium loss caused by diuretics. The use of potassium-sparing diuretics ( spironolactone, triamterene or amiloride), other drugs that increase serum potassium levels (eg, heparin), potassiumadditives or potassiumcontaining salt substitutes may lead to hyperkalemia. Such simultaneous use is therefore not recommended.

If concomitant use is necessary due to hypokalemia, they should be used with caution and with frequent monitoring of plasma potassium levels.

Diuretics ( thiazide or loop diuretics)

Pre-treatment with high doses of diuretics may lead to fluid deficiency and the risk of hypotension when initiating enalapril therapy. The antihypertensive effect may be reduced by discontinuing diuretics, increasing salt and fluid intake, or initiating therapy with a low dose of enalapril.

Other antihypertensive drugs

The simultaneous use of these drugs may increase the hypotensive effect of enalapril. Simultaneous use with nitroglycerin, other nitrates or other vasodilators may lead to a greater decrease in blood pressure.

Lithium Reversible increases in plasma lithium concentrations and toxicity have been reported with concomitant use of lithium and ACE inhibitors. Concomitant use with thiazide diuretics may further increase lithium levels and lead to the risk of lithium toxicity. The simultaneous use of these drugs is not recommended, but if necessary, careful monitoring of plasma lithium levels should be carried out.

Tricyclic antidepressants and/or antipsychotics and/or anesthetics and/or narcotics

Concomitant use of certain anesthetics, tricyclic antidepressants and antipsychotics with ACE inhibitors may lead to an additional decrease in blood pressure.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Long-term use of NSAIDs may reduce the antihypertensive effect of ACE inhibitors. NSAIDs (including COX-2 inhibitors) and ACE inhibitors have an additive effect on increasing plasma potassium levels, which may lead to deterioration of renal function. This effect is usually reversible. In rare cases, acute renal failure may occur, especially in patients with impaired renal function (elderly patients or patients with severe hypovolemia, including those taking diuretics). Patients should be appropriately hydrated and renal function monitored upon initiation and periodically during concomitant therapy.

Gold preparations With simultaneous therapy with ACE inhibitors, including enalapril, and injections of gold preparations ( sodium aurothiomalate) In rare cases, nitrite reactions (facial flushing, nausea, vomiting and hypotension) have been reported.

Antidiabetic drugs

Epidemiological studies have shown that the simultaneous use of ACE inhibitors and antidiabetic drugs (insulin, oral hypoglycemic agents), may cause an increased hypoglycemic effect with a risk of hypoglycemia. This phenomenon is more often observed during the first weeks of combination treatment and in patients with renal failure.

Alcohol Alcohol enhances the hypotensive effect of ACE inhibitors.

Sympathomimetics Sympathomimetics may reduce the antihypertensive effect of ACE inhibitors.

Acetylsalicylic acid, thrombolytics and ß-blockers The simultaneous use of enalapril with acetylsalicylic acid (in cardiac doses), thrombolytics and beta-blockers is safe.

special instructions

Symptomatic hypotension

Symptomatic hypotension is rare in the treatment of uncomplicated hypertension, but may occur in patients with fluid deficiency (diuretic therapy, salt-restricted diet, hemodialysis, diarrhea, or vomiting. Symptomatic hypotension may occur in patients with heart failure with or without associated renal failure. It may also occur in patients with more severe heart failure who are taking high-dose loop diuretics, hyponatremia, or renal insufficiency.In these patients, initiating treatment and changing the dose of enalapril and/or diuretic should be under close medical supervision.Similar precautions should be used in the treatment of patients with angina or cerebrovascular disease, where an excessive decrease in blood pressure can lead to myocardial infarction or stroke.

If arterial hypotension occurs, the patient should be transferred to a horizontal position and, if necessary, plasma volume should be corrected by intravenous administration of 0.9% sodium chloride solution. Transient arterial hypotension is not a contraindication for further use of enalapril. Typically, after normalization of blood pressure due to the introduction of additional volume, further doses of the drug are well tolerated by patients.

In some heart failure patients with normal or low blood pressure, additional reductions in blood pressure may occur with enalapril. This effect is expected and, as a rule, is not a reason to stop treatment. If hypotension becomes symptomatic, dose reduction and/or discontinuation of diuretics and/or enalapril is warranted.

Aortic and mitral valve stenosis, hypertrophic cardiomyopathy Like all vasodilators, ACE inhibitors should be used with caution in the treatment of patients with left ventricular outflow tract obstruction and to avoid cases of cardiogenic shock and hemodynamically significant left ventricular outflow tract obstruction.

Renal dysfunction

In patients with impaired renal function (creatinine clearance<1,33 мл/с), начальную дозу следует подбирать в зависимости от клиренса креатинина, затем в зависимости от реакции на лечение.

Plasma creatinine and potassium levels should be monitored regularly. In patients with severe heart failure or latent kidney disease, including renal artery stenosis, renal failure may occur during treatment with enalapril. With prompt and appropriate treatment, it is usually reversible.

In some patients with invisible but pre-existing kidney disease, minor and transient increases in plasma urea and creatinine levels occurred after taking enalapril concomitantly with diuretics. Therefore, it may be necessary to reduce the dose of the ACE inhibitor and/or discontinue diuretics. This situation provokes the appearance of latent renal artery stenosis.

Renovascular hypertension

There is an increased risk of hypotension and renal failure when patients with bilateral renal artery stenosis or arterial stenosis of a single functioning kidney are treated with ACE inhibitors. Loss of kidney function can occur only with moderate changes in plasma creatinine levels. In such patients, treatment should begin with low doses and under close medical supervision; During treatment, doses should be titrated with caution and renal function monitored.

Kidney transplant

Due to lack of experience, treatment with enalapril is not recommended for patients who have recently undergone renal transplantation.

Liver failure

During therapy with ACE inhibitors, in rare cases, a syndrome may develop that begins with cholestatic jaundice and then progresses to fulminant liver necrosis and (sometimes) death. The mechanism of development of this syndrome is unclear. If jaundice or elevated liver enzyme levels occur while taking an ACE inhibitor, the drug should be discontinued immediately and the patient should be closely monitored and receive appropriate therapy if necessary.

Neutropenia and agranulocytosis

In patients taking ACE inhibitors, cases of neutropenia/agranulocytosis, thrombocytopenia and anemia have been reported. In patients with normal renal function in the absence of other complications, neutropenia rarely develops.

Enalapril should be used with great caution in patients with collagen diseases (for example, systemic lupus erythematosus, scleroderma), concomitantly receiving immunosuppressant therapy, allopurinol or procainamide, as well as a combination of these factors, especially with existing renal dysfunction. These patients may develop severe infections that do not respond to intensive antibiotic therapy. When prescribing the drug, it is recommended to periodically monitor the number of leukocytes in the blood. The patient should be warned that if any signs of infection appear, they should immediately consult a doctor.

Increased sensitivity and angioedema

Among patients taking ACE inhibitors, including enalapril, the development of angioedema of the face, extremities, lips, tongue, glottis and/or larynx has been reported in rare cases. It can occur at any time during treatment. In this case, treatment should be stopped and appropriate measures taken to ensure complete resolution of the patient's symptoms. Even in cases where only swelling of the tongue appears without breathing problems, long-term monitoring of the patient's condition after treatment with antihistamines and corticosteroids may be required, which may not be sufficient for treatment to be effective. In very rare cases, death has been reported with swelling of the tongue and larynx. Patients with swelling of the tongue, glottis, or larynx are likely to experience airway obstruction, especially those patients who have had airway surgery. If swelling of the tongue, glottis or larynx threatens the development of airway obstruction, it is necessary to carry out emergency treatment as soon as possible - subcutaneous injection of a solution of adrenaline 1:1000 (0.3-0.5 ml) and take measures to ensure airway patency.

Angioedema has been reported to occur more frequently in black patients treated with ACE inhibitors compared with non-black patients.

Patients with a history of angioedema not associated with ACE inhibitor therapy have an increased risk of angioedema while taking ACE inhibitors.

Anaphylactoid reactions at Hymenoptera desensitization

In patients receiving ACE inhibitors during a course of desensitization with bee or wasp venom, life-threatening anaphylactoid reactions are possible in rare cases. The development of these reactions can be avoided by temporarily withdrawing the ACE inhibitor before each desensitization procedure.

Anaphylactoid reactions during apheresis ​​ LDL

Life-threatening anaphylactoid reactions have been reported in rare cases in patients receiving ACE inhibitors during low-density lipoprotein (LDL) apheresis with dextran sulfate. The development of these reactions can be avoided by temporarily discontinuing the ACE inhibitor before each apheresis procedure.

Patients on hemodialysis

The development of hypersensitivity, anaphylactoid reaction, has been reported among patients undergoing hemodialysis using polyacrylonitrile membranes (AN 69) and concomitantly taking ACE inhibitors. If hemodialysis is necessary, it is necessary to use a different type of membrane, or transfer the patient to take a suitable drug from a different class of antihypertensive agents.

Hypoglycemia In patients with diabetes mellitus receiving oral antidiabetic agents or insulin, blood sugar levels should be carefully monitored during the first month of treatment with ACE inhibitors.

Cough During treatment with ACE inhibitors, a persistent, dry, nonproductive cough may occur, which resolves after discontinuation of therapy. This should be considered as part of the differential diagnosis of cough.

Surgery and anesthesia

In patients taking antihypertensive drugs following major surgery during general anesthesia, enalapril may block the formation of angiotensin II secondary to compensatory renin release. If the doctor suspects this mechanism of arterial hypotension, treatment may be aimed at increasing the volume of circulating blood.

Hyperkalemia Increases in plasma potassium levels have been observed in some patients receiving ACE inhibitors, including enalapril. Risk factors for the development of hyperkalemia include renal failure, deterioration of renal function, age (> 70 years), diabetes mellitus, intervening events such as dehydration, acute heart failure, metabolic acidosis, and concomitant use of potassium-sparing diuretics (spironolactone, eplerenone, triamterene, or amiloride). ), potassium supplements and potassium-containing salt substitutes, as well as taking other drugs that increase the level of potassium in the blood plasma (for example, heparin). The use of potassium supplements or potassium-containing salt substitutes or potassium-sparing diuretics may result in significant increases in plasma potassium levels, especially in patients with impaired renal function. Hyperkalemia can cause serious, sometimes fatal arrhythmias. If concomitant use of enalapril with any of the above agents is considered appropriate, they should be used with caution and plasma potassium levels should be monitored frequently.

Lithium The combined use of lithium and enalapril is not recommended.

Pregnancy and lactation

During pregnancy, you should not start taking ACE inhibitors. As long as treatment with ACE inhibitors is necessary, patients planning pregnancy should switch to alternative antihypertensive drugs that have an established safety profile for use during pregnancy. If pregnancy is diagnosed, treatment with ACE inhibitors should be stopped immediately and, if appropriate, alternative treatment initiated. Taking ACE inhibitors in the second and third trimesters of pregnancy is known to cause fetotoxicity (decreased renal function, oligohydramnios, delayed cranial ossification) and neonatal toxicity (renal failure, hypotension, hyperkalemia) in humans. If ACE inhibitors were taken in the second trimester of pregnancy, it is recommended to perform an ultrasound of the kidneys and skull. Infants whose mothers took ACE inhibitors should be closely monitored for hypotension.

Ethnic differences

Like other angiotensin-converting enzyme inhibitors, enalapril is less effective in lowering blood pressure in black people than in others, possibly due to a higher prevalence of low renin status.

Enap® contains lactose. Patients with rare hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption syndrome should not take this drug

Features of the effect of the drug on the ability to drive a vehicle or potentially dangerous mechanisms

When driving vehicles or other machinery, the likelihood of dizziness and fatigue should be taken into account.

Overdose

Symptoms: severe arterial hypotension, beginning approximately 6 hours after taking the drug. Symptoms associated with overdose include circulatory shock, electrolyte disturbances, renal failure, hyperventilation, tachycardia, palpitations, bradycardia, dizziness, anxiety and cough.

Treatment: intravenous infusion of saline solution. If possible, treatment with angiotensin II infusion and/or intravenous catecholamines may also be considered. It is necessary to take measures to prevent absorption of the drug (for example, induction of vomiting, gastric lavage, administration of absorbents and sodium sulfate). Enalaprilat can be removed from the systemic circulation using hemodialysis (enalaprilat elimination rate is 62 ml/min).

With resistant To Cardiac stimulating therapy is indicated for the treatment of bradycardia. Basic indicators of the body's condition, the concentration of electrolytes and creatinine in the blood plasma should be constantly monitored.

Release form and packaging

Enap is an antihypertensive drug whose action is aimed at reducing high blood pressure. The drug is called a “prodrug”, the breakdown of which releases the substance enalaprilat, which promotes ACE inhibition. When taken, there is a decrease in vascular resistance, blood pressure, preload and afterload on the myocardial heart muscle.

In contact with

Indications and contraindications

Instructions for use of Enap contain information about at what pressure it should be taken and from what. Due to the smaller expansion of veins compared to arteries the heart does not experience impulsive high-frequency contractions. What does the medicine help with? Only a cardiologist can give a complete answer to the question.

What does Enap help with?

The pharmaceutical drug Enap has the following indications:

• hypertension;
• combined treatment of chronic heart failure;
• prevention of coronary ischemic disease, accompanied by disruption of the left ventricle, thereby preventing the development of heart attack and angina pectoris;
• preventive measures aimed at preventing clinical symptoms of heart failure.

The medication is part of predominantly complex therapy. Only hypertensive patients can take it as an independent medicine.

Enap contraindications has these:

• Quincke's edema of a hereditary nature;
• lactose deficiency;
• porphyria;
• angioedema of an idiopathic nature;
• pregnancy;
• lactation period;
• age under 18 years;
• individual intolerance to the components of the drug, ACE inhibitors.

How to take Enap for high blood pressure

Before using Enap, contraindications should be excluded. The patient should not suffer from excessive potassium levels in the body, kidney and liver dysfunction, diabetes mellitus, hyperaldosteranism, bilateral renal arterial stenosis, aortic stenosis, mitral stenosis.

Use of the drug

The tablets should be taken whole. You need to drink boiled or thoroughly purified water. During the course of treatment, you should determine a convenient appointment time for yourself and adhere to the schedule throughout the entire course of therapy. If you miss a pill, take the next dose and do not swallow the missed dose.

During the treatment period, you should undergo regular medical examinations. In particular, this applies to the start of therapy. The number of diagnostics is determined by the attending physician, who will also adjust the dosage of the medication based on the patient’s well-being.

Enap is produced in the form of white tablets and intravenous injections. The main active ingredient is enalapril maleate. Also, the effectiveness of the drug is affected by its auxiliary ingredients.

Dosage

How to take Enap is determined by the doctor. For high blood pressure, the patient is prescribed 5 mg of the drug in one dose daily. After taking the first dose, the patient is observed by a doctor for at least three hours: he monitors the behavior of blood pressure until it is completely stabilized.

The dose may be increased in the following cases:

• lack of a positive result after two weeks of treatment;
• slight decrease in blood pressure after taking the medicine.

On average, the optimal dosage of Enap is 10-20 mg. If the drug is well tolerated by the body, then the volume is increased to 40 mg. If necessary, take a larger dose, it is better to divide it into two times.

A person taking diuretics is initially prescribed 2.5 mg once a day. Patients with hyponatremia or excessive creatinine levels are given the same dose.

In older people, decreased levels and prolonged effects of the drug are often observed. These processes are associated with delayed withdrawal of enalapril. Treatment begins with 1.25 mg.

For chronic heart failure, the starting dose does not exceed 2.5 mg. The amount of medication should be increased gradually if necessary.

Important! The doctor must notify the patient how long Enap can be taken.

In most cases, treatment lasts a lifetime, but as soon as certain conditions appear, the drug is replaced with another.

Action

Enap has a hypotensive effect, resulting in a decrease in blood pressure. The active component inside the body begins to be converted into enalaprilat, which has a hypotensive effect on the desired structures.

Attention! As a result of taking Enap, the heart rate decreases gradually and smoothly, regardless of body position, the pulse does not accelerate.

In rare cases it may orthostatic hypotension is observed– a sharp decrease in heart rate. To achieve a stable and obvious result, the medicine must be taken for a long period.

How long does it take for the drug to work? The first obvious results begin to appear an hour after administration. The maximum effect is achieved after 5-6 hours. The waiting time depends on the dosage.

When undergoing a course of treatment, the period of action of the pill taken is observed within 24 hours. The heart rate begins to decrease, hemodynamic parameters normalize. The use of the drug is indicated for patients with cardiac and vascular pathologies.

In heart failure, a hypotonic effect occurs, the vascular walls increase their resistance, the heart pumps out blood better, and the heart muscle contracts less frequently. The development of cardiac dysfunction slows down and may stop altogether. The medication also prevents the progression of coronary artery disease.

Alcohol compatibility

When a person cannot completely stop drinking alcoholic beverages, he should adhere to some rules, the observance of which will help protect against unwanted consequences.

Enap should not be taken with alcohol

The medicine can be taken:

• for men a day before drinking alcohol;
• women 32 hours before drinking alcoholic beverages;
• for men 14 hours after drinking alcohol;
• women 20 hours after drinking;
• two weeks after the course of treatment for all patients.

To prevent complications, it is better not to take Enap and alcohol together.

Use for children

Newborn children whose mothers used Enap during pregnancy must be under strict medical supervision. Young patients experience low blood pressure. The medicine easily penetrates the placenta.

It can be partially removed from the baby's circulatory system using peritoneal dialysis. In theory, an exchange blood transfusion is considered an effective method of cleansing a child’s body from enalapril.

Residual doses of the drug are found in breast milk. Breastfeeding women using Enap should avoid treatment with this drug. The doctor selects the amount of medication for children on an individual basis. The dosage of the drug depends on the type of disease, sensitivity to components, and blood pressure. Children weighing 20-50 kg are prescribed an initial daily dose of 2.5 mg. With a weight of 50 kg or more, the dose increases to 5 mg.

special instructions

After taking an excessive dose of the drug, a rapid increase in blood pressure is possible.

Typically, such processes occur in people with the following diseases:

• acute cardiac dysfunction;
• impaired kidney function;
• problems with water and electrolyte balance as a result of taking diuretics;
• strict salt-free diet;
• digestive system disorders;
• vomit.

A sharp drop in pressure is manifested by the following symptoms:

• accelerated heartbeat;
• nausea;
• fainting.

If signs of hypotension are pronounced, the patient should lie down. Legs should be higher than head level. You need to call an ambulance. This condition is rare and may be transient.

How to take Enap before or after meals

The presence of transient hypotension is not an obstacle to further therapy. When the person’s condition stabilizes and blood pressure normalizes, treatment with the drug is continued in the previous dosages of Enap.

Hypotension can be prevented in the following ways:

• stop taking diuretics;
• Avoid salt-free foods if possible.

If hypotension recurs, you need to consult a cardiologist and undergo a thorough examination.

Overdose symptoms

An overdose is characterized by a sharp drop in blood pressure. The rapid development of hypotension can lead to myocardial infarction, thromboembolic processes, and pathology in the cerebral circulation. Often, if the dose is not followed, seizures occur. The listed symptoms are treated with the following methods:

• the patient is placed on a bed with a low headboard;
• in case of a slight overdose, the stomach is washed and symptomatic treatment is carried out;
• in severe cases, a range of procedures are performed aimed at normalizing blood pressure: hemodialysis, intravenous injections of saline, blood plasma substitutes.

Analogs

Pharmacies offer a huge number of antihypertensive drugs. Some of them may well be used as substitutes if their active ingredient is enalapril. The principle of action, indications and warnings are identical for all types of drugs. The main differences may be cost and auxiliary ingredients.

The drug has analogues on VKontakte

from ≥1/100 to

Enap is an ACE inhibitor.

Composition of Enap and release form

The drug is available in the form of tablets in dosages of 2.5 mg, 5 mg, 10 mg and 20 mg. The active component of the drug is enalapril maleate.

Additional components: lactose monohydrate, hyprolose, magnesium stearate, talc, sodium bicarbonate, corn starch.

Blisters contain 10 tablets. 20 tablets in a cardboard package (two blisters).

The following drugs are analogues of Enap: Berlipril, Enalozide, Enam, Ednit, Enalapril, Enapharm, etc.

pharmachologic effect

According to the instructions, Enap is an ACE inhibitor, an antihypertensive drug and a “prodrug” that results in the formation of enalaprilat. The mechanism of action of Enap is caused by inhibition of ACE activity, which occurs under the influence of enalaprilat. This leads to a decrease in systolic and diastolic blood pressure, as well as a decrease in the load on the myocardium.

According to reviews, Enap dilates arteries rather than veins to a greater extent. There is no significant reflex increase in heart rate.

Within therapeutic limits, a decrease in blood pressure does not affect cerebral circulation and, against the background of reduced pressure, blood flow in the vessels of the brain is maintained at a sufficient level. In addition, the use of Enap causes increased blood supply to the renal and coronary blood flow.

Long-term use of Enap causes a decrease in myocytes in the walls of resistive arteries and a decrease in left ventricular hypertrophy of the myocardium, slows down the development of left ventricular dilatation and prevents the development of heart failure. Blood circulation of the ischemic myocardium improves.

Enalapril inhibits platelet aggregation and produces a mild diuretic effect.

The drug or an analogue of Enap begins to act approximately an hour after taking it, and after four hours it reaches its maximum. The drug works throughout the day.

Indications for use

Enap according to the instructions is indicated for arterial hypertension.

Indications for Enap in combination with other drugs are:

• chronic heart failure;
• left ventricular dysfunction without significant symptoms.

Contraindications

The instructions for Enap indicate the following contraindications:

• porphyria;
• hypersensitivity to enalapril and additional components of the drug;
• history of angioedema;
• period of pregnancy and breastfeeding;
• children up to six years of age.

According to reviews, Enap should be prescribed with caution when:

• renal artery stenosis;
• diabetes mellitus;
• hyperkalemia;
• idiopathic hypertrophic subaortic stenosis;
• primary hyperaldosteronism;
• aortic stenosis;
• coronary heart disease;
• renal failure;
• systemic connective tissue diseases.

Method of use of Enap and dosage regimen

According to the instructions, Enap is intended for oral administration. It is preferable to take the drug at the same time to achieve the greatest therapeutic effect.

For arterial hypertension, the recommended dosage of the drug or Enap analogue is 5 mg once a day, with a gradual increase in dosage, but not more than once every two weeks. As a rule, the maintenance dosage is 10-20 mg per day. The maximum dosage per day is 40 mg. It is advisable to divide the too high dosage into two doses.

For patients taking diuretics, the initial dosage of enalapril is 2.5 mg per day.

In case of hyponatremia or serum creatinine content more than 140 µmol/l, the initial dosage of the drug should not exceed 2.5 mg per day.

For kidney diseases, the dosage is determined depending on the indications for Enap and renal function. For CC more than 30 ml per minute, the initial dosage should not exceed 5 mg per day; with CC less than 30 ml per minute - no more than 2.5 mg per day, with a gradual increase in dosage to the optimal one.

In old age, taking the drug or an analogue of Enap can cause a prolongation of its action time and a more pronounced hypotensive effect, therefore the initial dosage should not exceed 1.25 mg, with a gradual increase to the optimal one.

For chronic heart failure, the initial dosage of Enap according to the instructions is 2.5 mg once a day, with a gradual increase to the optimal dosage, but not more than once every two weeks. On average, the optimal dosage is 10-20 mg per day.

For the treatment of asymptomatic left ventricular dysfunction, the recommended dosage of Enap is 2.5 mg twice a day, with a gradual increase to 10 mg twice a day.

Most often, treatment with Enap is long-term, usually throughout life, unless unwanted side effects arise that require its discontinuation.

Overdose

An overdose of Enap, according to reviews, causes a strong decrease in blood pressure, up to the development of myocardial infarction, collapse, thromboembolic disorders or acute cerebrovascular accident. Often an overdose is accompanied by convulsions and stupor.

Treatment must be carried out as follows:

• place the patient on a bed with a low headboard;
• in case of mild overdose, it is recommended to perform gastric lavage and symptomatic treatment;
• in more severe cases, it is necessary to carry out a number of measures in order to stabilize the pressure (introduction of intravenous saline and plasma expanders, hemodialysis).

Side effects of Enap

According to reviews, Enap causes the following side effects, which, as a rule, are mild in nature and do not require discontinuation of the drug:

• Cardiovascular system: chest pain, orthostatic collapse, decreased blood pressure, arrhythmia, pain in the heart, palpitations, Raynaud's syndrome, thromboembolism of the branches of the pulmonary artery.
• Sense organs: tinnitus, visual and hearing impairment, vestibular apparatus disorder.
• Peripheral and central nervous systems: headache, confusion, dizziness, drowsiness or insomnia, fatigue and weakness, depression, paresthesia.
• Respiratory system: bronchospasm, hoarseness and sore throat, cough, pharyngitis, rhinorrhea, shortness of breath.
• Digestive system: vomiting, abdominal pain, constipation or diarrhea, nausea, pancreatitis, increased activity of liver enzymes, intestinal obstruction, liver dysfunction.
• Metabolism: hyponatremia, hyperkalemia.
• Urinary system: hypercreatininemia, proteinuria, renal dysfunction.
• Hematopoietic system: agranulocytosis, thrombocytopenia, eosinophilia, neutropenia.
• Allergies: angioedema, photosensitivity, urticaria, skin rash and itching, exfoliative dermatitis.
• Dermatological reactions: alopecia, pemphigus.
• Other side effects: hot flashes, increased ESR, decreased libido and potency.

Storage conditions

The drug Enap is stored at room temperature for no longer than 36 months.

In this article you can read the instructions for use of the drug Enap. Reviews of site visitors - consumers of this medicine, as well as the opinions of specialist doctors on the use of Enap in their practice are presented. We kindly ask you to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not stated by the manufacturer in the annotation. Analogues of Enap in the presence of existing structural analogues. Use for the treatment of arterial hypertension and blood pressure reduction in adults, children, as well as during pregnancy and lactation. Concomitant use with alcohol and consequences.

Enap- antihypertensive drug, ACE inhibitor. Enalapril (the active substance of the drug Enap) is a “prodrug”: as a result of its hydrolysis, enalaprilat is formed. The mechanism of action is associated with inhibition of ACE activity under the influence of enalaprilat. This leads to a decrease in the formation of angiotensin 2, which causes a direct decrease in aldosterone secretion. As a result, there is a decrease in peripheral vascular resistance, a decrease in systolic and diastolic blood pressure, and post- and preload on the myocardium.

It dilates arteries to a greater extent than veins, but there is no reflex increase in heart rate.

The hypotensive effect is more pronounced with high plasma renin levels than with normal or reduced levels. A decrease in blood pressure within therapeutic limits does not affect cerebral circulation; blood flow in the vessels of the brain is maintained at a sufficient level even against the background of reduced blood pressure. Strengthens coronary and renal blood flow.

With long-term use, hypertrophy of the left ventricle of the myocardium and myocytes of the walls of resistive arteries decreases, prevents the progression of heart failure and slows down the development of left ventricular dilatation. Improves blood supply to ischemic myocardium.

Inhibits platelet aggregation.

Has some diuretic effect.

When taking the drug orally, the hypotensive effect develops after 1 hour, reaches a maximum after 4-6 hours and lasts up to 24 hours. In some patients, therapy is necessary for several weeks to achieve optimal blood pressure levels. In heart failure, a noticeable clinical effect is observed with long-term use - 6 months or more.

Pharmacokinetics

After taking the drug orally, about 60% of enalapril is absorbed. Eating does not affect absorption. In the liver, enalapril is metabolized to form the active metabolite enalaprilat, which is a more active ACE inhibitor than enalapril. Enalaprilat easily penetrates histohematic barriers, with the exception of the blood-brain barrier. A small amount penetrates the placental barrier and is excreted in breast milk. Excreted primarily by the kidneys - 60% (20% - in the form of enalapril and 40% - in the form of enalaprilat), through the intestines - 33% (6% - in the form of enalapril and 27% - in the form of enalaprilat).

Indications

• arterial hypertension;
• chronic heart failure (as part of combination therapy);
• asymptomatic left ventricular dysfunction (as part of combination therapy);
• hypertensive crisis (R form of Enap);
• hypertensive encephalopathy (R form).

Release forms

Tablets 2.5 mg, 5 mg, 10 mg and 20 mg.

Enap NL (HL) tablets, in combination with the diuretic hydrochlorothiazide.

Enap N (H) tablets, in combination with the diuretic hydrochlorothiazide.

Solution for intravenous administration Enap R (R).

Instructions for use and dosage

The drug is taken orally, regardless of food intake, at the same time of day. If you miss a dose of the drug, it should be taken as soon as possible. If there are only a few hours left before the next dose, then you need to take only the next dose according to the schedule and not take the missed dose. The dose should never be doubled. The dose of the drug should be adjusted depending on the patient's condition.

Dose adjustment is carried out depending on the achievement of a therapeutic effect (lowering blood pressure). If there is no clinical effect, the dose is increased after 1-2 weeks by 5 mg. Usually the maintenance dose is from 10 mg to 20 mg; if necessary and if well tolerated, the dose can be increased to 40 mg per day. The maximum daily dose is 40 mg. It is advisable to divide the high dose into 2 doses.

For patients who continue to take diuretics, the initial dose of the drug is 2.5 mg 1 time per day.

Elderly patients are more likely to experience a more pronounced hypotensive effect and a longer duration of action of the drug, which is associated with a decrease in the rate of elimination of enalapril, so the recommended initial dose is 1.25 mg.

In the treatment of chronic heart failure, the recommended initial dose is 2.5 mg once a day. The dose of Enap should be increased gradually until the maximum clinical effect is achieved, usually after 2-4 weeks. The usual maintenance dose is from 2.5 mg to 10 mg once a day; the maximum maintenance dose is 20 mg 2 times a day.

When treating asymptomatic left ventricular dysfunction, the recommended initial dose is 2.5 mg 2 times a day. Dose adjustment depends on tolerability of the drug. Usually the maintenance dose is 10 mg 2 times a day.

Treatment with Enap is long-term, usually throughout life, unless circumstances arise that require its cancellation.

The tablets should be swallowed whole with a small amount of liquid.

Side effect

• excessive decrease in blood pressure;
• orthostatic collapse;
• chest pain;
• angina pectoris;
• myocardial infarction (usually associated with a pronounced decrease in blood pressure);
• arrhythmias (bradycardia or tachycardia, atrial fibrillation);
• heartbeat;
• thromboembolism of the branches of the pulmonary artery;
• pain in the heart area;
• fainting;
• Raynaud's syndrome;
• dizziness;
• headache;
• insomnia;
• weakness;
• increased fatigue;
• drowsiness (2-3%);
• confusion;
• increased fatigue;
• increased excitability;
• depression;
• paresthesia;
• vestibular apparatus disorder;
• hearing and vision impairment;
• noise in ears;
• bronchospasm/asthma;
• dyspnea;
• a sore throat;
• hoarseness of voice;
• dry mouth;
• anorexia;
• dyspeptic disorders (nausea, diarrhea or constipation, vomiting, abdominal pain);
• intestinal obstruction;
• renal dysfunction;
• thrombocytopenia, neutropenia, agranulocytosis (in patients with autoimmune diseases), eosinophilia;
• photosensitivity;
• alopecia;
• skin rash;
• angioedema of the face, limbs, lips, tongue, glottis and/or larynx;
• dysphonia;
• erythema multiforme;
• exfoliative dermatitis;
• toxic epidermal necrolysis;
• hives;
• vasculitis;
• stomatitis;
• glossitis;
• increased sweating;
• decreased libido;
• tides;
• decreased potency;
• increase in ESR.

Contraindications

• history of angioedema (including those associated with the use of ACE inhibitors);
• porphyria;
• pregnancy;
• lactation (breastfeeding);
• children and adolescents under 18 years of age (efficacy and safety have not been established);
• hypersensitivity to enalapril and other components of the drug;
• hypersensitivity to other ACE inhibitors.

Use during pregnancy and breastfeeding

The drug is contraindicated for use during pregnancy and lactation (breastfeeding). If pregnancy occurs during treatment with Enap, the drug should be discontinued immediately.

special instructions

During treatment with Enap, regular medical examinations are required, especially at the beginning of treatment and/or when selecting the optimal dose of the drug. The frequency of medical examinations is determined by the attending physician.

It should be borne in mind the possibility of developing arterial hypotension (even several hours after taking the first dose) in patients with severe heart failure, severe renal impairment, as well as in patients with water and electrolyte imbalance caused by treatment with diuretics, a salt-free diet, diarrhea, vomiting, as well as in patients on hemodialysis.

A pronounced decrease in blood pressure is usually manifested by nausea, increased heart rate, and fainting. If arterial hypotension develops, the patient should be transferred to a horizontal position with a low headboard, and medical supervision is required.

Arterial hypotension and its severe consequences are rare and transient. Transient arterial hypotension is not a contraindication to further treatment with the drug. As soon as blood pressure has stabilized, drug therapy can be continued at the average recommended doses. Hypotension can be avoided by interrupting diuretic treatment and avoiding a salt-free diet before starting treatment with Enap, if possible. The patient should be warned that if relapses of arterial hypotension occur, accompanied by nausea, increased heart rate and fainting, then consultation with a doctor is necessary.

Renal function should be monitored before starting treatment and during therapy.

During treatment with Enap, an increase in potassium levels in the blood serum is possible, especially in patients with chronic renal failure, diabetes mellitus, while prescribing potassium-sparing diuretics (such as spironolactone, amiloride and triamterene) or potassium supplements. Such patients should be informed of the need to consult a doctor if muscle weakness and arrhythmia occur.

Patients receiving Enap should not drink alcohol due to the risk of developing arterial hypotension.

In case of side effects or Quincke's edema (severe swelling of the lips, face, neck, arms and legs, accompanied by suffocation and hoarseness), Enap should be discontinued and appropriate treatment prescribed.

The drug should be discontinued before testing the function of the parathyroid glands.

Before carrying out a planned surgical intervention, the anesthesiologist should be informed that the patient is receiving Enap, since there is a risk of developing arterial hypotension during general anesthesia.

It should be borne in mind that during treatment with Enap, the development of allergic reactions is possible due to the use of certain types of filter membranes used in hemodialysis or other types of blood filtration.

During the period of treatment of allergy (desensitization) to wasp or bee venom, patients receiving Enap may develop a hypersensitivity reaction.

Impact on the ability to drive vehicles and operate machinery

In some cases, the drug can cause severe arterial hypotension and dizziness, especially at the beginning of treatment, thus having an indirect and transient effect on the ability to drive vehicles and operate machinery.

Drug interactions

The simultaneous use of Enap and diuretics or other antihypertensive drugs increases the effectiveness of these drugs.

Interactions with drugs used to treat heart failure (cardiac glycosides) are not clinically significant.

With the simultaneous use of Enap and non-steroidal anti-inflammatory drugs, incl. acetylsalicylic acid may reduce the effectiveness of enalapril and increase the risk of renal dysfunction.

With the simultaneous use of certain diuretics (spironolactone, amiloride or triamterene) and/or additional administration of potassium supplements, an increase in the level of potassium in the blood serum (hyperkalemia) is possible.

Enap weakens the effect of products containing theophylline. Concomitant use of lithium preparations may increase the side effects of lithium.

Drugs containing cimetidine increase the duration of action of enalapril.

Patients receiving enalapril are at risk of developing arterial hypotension during general anesthesia.

Ethanol (alcohol) enhances the hypotensive effect of Enap.

Analogues of the drug Enap

Structural analogues of the active substance:

• Bagopril;
• Berlipril;
• Vazolapril;
• Vero-Enalapril;
• Invoril;
• Corandil;
• Miopril;
• Renipril;
• Renitek;
• Ednit;
• Enazil 10;
• Enalacor;
• Enalapril;
• Enalapril maleate;
• Enam;
• Enarenal;
• Enafarm;
• Envas;
• Envipril.

If there are no analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps and look at the available analogues for the therapeutic effect.

Tablets "Enap", which helps this medicine of the ACE inhibitor group. The drug has antihypertensive properties. The instructions for use suggest taking Enap tablets for high blood pressure and heart failure.

Release form and composition

Produced in tablet form. Enap tablets, which help the medicine for heart problems, include 2.5, 5, 10, 20 mg of the active element - enalapril maleate. Their appearance is different. Tablets "Enap", 10 mg have a red, brown tint, 20 mg - orange, 2.5 and 5 - white.

The Enap NL (HL) variety is supplemented with hydrochlorothiazide, which creates a diuretic effect.

Enap N (N) tablets are also combined with hydrochlorothiazide.

In addition, they sell a solution for injection into a vein “Enap R” (R).

Pharmacological properties

Enap tablets, which help the drug cope with high blood pressure, slow down and inhibit the activity of ACE, promote the formation of enalaprilat. As a result, blood pressure decreases, as does the load on the heart. The medicine has a vasodilating effect, and this mostly affects the arteries.

If the permissible dosage is observed, the decrease in pressure does not have a negative effect on the blood circulation in the brain. The use of Enap accelerates coronary and renal blood flow. With prolonged use, hypertrophy of the left ventricle of the heart muscle decreases, the development of heart failure stops, and myocardial blood circulation returns to normal.

The active substance of the drug slows platelet aggregation and has a slight diuretic effect. After consuming the tablet, the effect is observed after 30 minutes, which reaches its peak after 4 hours and continues throughout the day.

Tablets "Enap": what does the medicine help with?

Indications for use include:

• chronic heart failure (while taking other medications);
• prevention of CHF with left ventricular dysfunction;
• myocardial infarction to prevent relapse;
• unstable angina;
• hypertension.

Contraindications

The instructions prohibit the use of Enap when:

• angioedema;
• pregnancy;
• lactation;
• children under 18 years of age;
• hypersensitivity to Enap N tablets, which can cause allergic reactions;
• porphyria.

Caution during therapy must be observed in patients diagnosed with:

• primary hyperaldosteronism;
• aortic stenosis;
• renal failure;
• subaortic stenosis;
• hyperkalemia;
• ischemia;
• renal artery stenosis.

The drug "Enap": instructions for use

The tablets are taken orally with water. To get a lasting therapeutic effect, it is recommended to take the medicine at the same time. The drug "Enap" and its analogues for arterial hypertension are prescribed in a daily dosage of 5 mg. Once every two weeks the volume of the drug is increased. The maintenance dose reaches 10-20 mg per day. You can drink no more than 40 mg per day. The maximum dosage is divided into 2 times.

For patients using diuretics, as well as for hyponatremia, 2.5 mg per day is prescribed at the initial stage. Elderly people should begin treatment by taking 1.25 mg of the drug, gradually increasing the dosage.

For the treatment of chronic heart failure, treatment begins with 2.5 mg, increasing the intake to 10-20 mg per day. If the functioning of the left ventricle is impaired, the drug is taken 2 times a day, 2.5 mg. The dosage of Enap tablets is adjusted to 10 mg 2 times a day.

The medicine is taken throughout the entire period of a person’s life in the absence of negative reactions from the body.

Side effect

The drug may cause the following side effects:

• pharyngitis, decreased potency;
• eosinophilia;
• deterioration of libido;
• confusion;
• orthostatic collapse;
• visual and hearing impairment;
• skin itching, cough;
• headache, bronchospasm;
• sleep disorders, pemphigus;
• stool disorders;
• hoarseness and sore throat;
• hot flashes, thrombocytopenia;
• dizziness, chest pain;
• abdominal pain;
• rash, rhinorrhea;
• vomiting, nausea, shortness of breath;
• hyperkalemia, neutropenia;
• arrhythmia, tinnitus;
• pancreatitis, low blood pressure;
• urticaria, hyponatremia;
• agranulocytosis, vestibular disorder;
• general weakness;
• impaired renal or liver function;
• heartbeat;
• exfoliative dermatitis;
• increased fatigue;
• alopecia;
• thromboembolism, depression;
• intestinal obstruction;
• photosensitivity;
• Raynaud's syndrome;
• paresthesia;
• pain symptoms in the heart area;
• increased activity of liver transaminases.

Analogs

"Enap" can be replaced with the following drugs containing enalapril as an active ingredient:

1. "Bagopril."
2. "Korandil."
3. "Enam."
4. "Enazil 10".
5. "Renipril."
6. "Enalapril maleate."
7. "Renitek".
8. "Enalapril."
9. "Vero-Enalapril."
10. "Vazolapril."
11. "Enarenal."
12. "Envas."
13. "Miopril".
14. "Ednit."
15. "Envipril."
16. "Berlipril."
17. "Enapharm".
18. "Enalakor."
19. "Invoril."

"Enalapril" or "Enap" - which is better?

These drugs have an identical active element and produce the same effect. Doctors say there is no significant difference between the medications.

"Enam" and "Enap" - differences

These drugs work in a similar way. The difference lies in the manufacturers of these products.

"Enap" and "Enap N" - differences

The second type, in addition to enalapril, contains the active ingredient hydrochlorothiazide. In addition to the hypotensive effect, the medicine has a diuretic effect.

For children

The medication should not be used by children and adolescents under 18 years of age.

With alcohol

Since alcohol enhances the blood pressure-lowering effect, you should not drink Enap and alcohol at the same time.

Price

In Moscow, you can buy Enap tablets for 85 rubles. Pharmacies may ask for a prescription. In Kyiv, the medicine “Enap N” costs 53-149 hryvnia. In Minsk its price reaches 3-5 bel. rubles, in Kazakhstan – 980 tenge.

Opinions of patients and doctors

Patients give positive reviews of the drug "Enap". They confirm the effectiveness of the drug. Doctors say that proper use of the drug significantly improves the lives of patients. There are also reviews about the development of side effects.

Many people talk about a bothersome dry cough. If your condition worsens after taking the tablets, you should contact a specialist to adjust the dosage or prescribe analogues of the drug "Enap".