Enalapril is a well-known drug often prescribed by doctors to stabilize blood pressure. The drug is well tolerated by patients. Rarely causes side effects. The Enalapril release form is convenient, which allows you to take the medication with you to work, on vacation and on a trip. The course of treatment and dosage is selected by the doctor individually for each patient. The medicine has contraindications, so it should not be used on its own, without a doctor's prescription.
"Enalapril": release form, composition
This medicine belongs to ACE inhibitors. Its active ingredient is enalapril maleate.
Enalapril release form - tablets with a dosage of 5, 10 and 20 mg. The pills are white and round in shape. biconvex. On the one hand, there is risk. Encased in laminated PVC. Each blister contains 10 tablets. Two blisters are packed in a cartonbox along with instructions for use.
Enalapril release form requires compliance with a certain storage mode. The drug should be stored at a temperature of 15-25 ° C in a place well protected from the sun and out of the reach of children.
Pharmacological properties
The tablet form of Enalapril makes it easier to take it and select the dosage. This drug is considered a “prodrug”: in the process of its hydrolysis, it creates enalaprilat. This substance inhibits ACE.
The mechanism of action is associated with a decrease in the formation of angiotensin II from angiotensin I. This property leads to a decrease in the release of aldosterone. This results in a decrease in peripheral vascular resistance. Both diastolic and systolic blood pressure decrease. The preload on the myocardium decreases.
The drug dilates arterial vessels more than venous ones. During this, there is no increase in heart rate.
Hypotensive effect is better manifested only when a high level of plasma renin is reached. With a reduced renin index, the hypotensive property is poorly expressed. Lowering blood pressure does not affect cerebral circulation. At the same time, blood flow in the vessels of the brain is maintained at the proper level, even at reduced pressure. Tablets can increase renal and coronary blood flow.
With long-term use of tablets, left ventricular myocardial hypertrophy decreases and myocyte hypertrophy decreasesarterial walls of the resistive type. A similar effect of the drug inhibits the progression of left ventricular dilatation and prevents the development of heart failure. The drug reduces platelet aggregation and stimulates myocardial blood supply. Has a diuretic effect.
After taking the pills, the hypotensive effect appears within an hour. The most powerful antihypertensive property of the drug appears after 4-6 hours. The action of the tablets lasts a day. A certain part of patients need long-term therapy, lasting from six months, to normalize blood pressure.
After oral administration of the drug, up to 60% of the active substance is absorbed. Food does not affect the degree of absorption of the drug. 50% of the drug binds to plasma proteins. "Enalapril" is metabolized in the liver quickly enough. This creates an active metabolite of enalaprilat. It is considered a more effective ACE inhibitor than the active ingredient enalapril. The highest concentration of enalapril in the blood is observed after an hour, enalaprilat - after three hours. Easily and without any problems, enalaprilat passes through histohematogenous barriers. The exception is the blood-brain barrier. A small part of the drug passes into the placenta and passes into breast milk.
The half-life of the drug is eleven hours. About 60% of the drug is excreted by the kidneys, 33% is excreted through the intestines.
Indications and contraindications
The release form of Enalapril in tablets is used in therapyarterial hypertension. In addition, the drug is indicated for use in heart failure in the chronic stage of development. In this case, the drug is used as part of complex therapy.
The release form of Enalapril and the dosage are prescribed by the doctor. And only in the absence of contraindications. Medicine not prescribed:
- with special sensitivity to the active substance and other ACE inhibitors;
- angioneurotic edema associated with ACE inhibitor therapy;
- porphyrin disease;
- pregnancy;
- breastfeeding;
- under the age of eighteen.
With caution, you need to use the medicine for primary hyperaldosteronism. Patients with bilateral renal artery stenosis, aortic, subaortic and mitral stenosis should be careful. During the period of treatment with Enalapril, patients who have undergone kidney transplantation, who have systemic diseases and who suffer from diabetes mellitus, should be under observation. The drug may be dangerous for people with renal insufficiency and cerebrovascular pathologies. This category includes patients on hemodialysis, as well as elderly people who have reached the age of 65.
"Enalapril": instructions for use
Reviews analogues of this medicine are praised. They are said to be more efficient, even though they are more expensive. Despite this, doctors often use Enalapril in their practice.
Drugtake inside. When using the drug in monotherapy, the initial dose is 5 mg. It is drunk once a day. If the clinical effect was not achieved with the use of this dose, then the amount of the drug is increased by 5 mg. After using the initial dosage, patients are under constant medical supervision for two hours after taking the pill and for another hour until the blood pressure finally stabilizes.
If the drug is well tolerated and if necessary, the dosage is increased to 40 mg/day. This amount of medicine is divided into two doses. After fourteen days, patients are switched to maintenance dosage, which can range from 10 to 40 mg/day. This amount of the drug is consumed in the morning and evening. If moderate arterial hypertension occurs, then the daily dosage is 10 mg. The maximum allowed dosage is 40 mg/day.
If tablets are prescribed to patients taking diuretics, then their intake should be canceled three days before treatment with Enalapril. If treatment with diuretics cannot be stopped, then the initial dosage should not exceed 2.5 mg / day. This dose should be consumed at one time.
When diagnosed with renovascular hypertension, the starting dosage ranges from 2.5 to 5 mg/day. The maximum allowable daily allowance is 20 mg.
With heart failure in the chronic stage of development, the starting dosage is 2.5 mg, it is drunk once. The dose is increasedgradually, every four days at 2.5-5 mg. When increasing the dosage, pay attention to the patient's response, clinical effect and blood pressure. The maximum permitted dose for heart failure is 40 mg/day. It is divided into two doses. With reduced systolic pressure, treatment begins with 1.25 mg / day. The dosage of "Enalapril" (the form of release of the drug - tablets) is selected by the doctor individually for a month. The maintenance dose ranges from 5 to 20 mg/day and depends on the condition of the patient.
In the treatment of elderly people, a strong hypotensive effect can be observed. The drug affects them longer than younger patients. This is due to the lower rate of drug elimination. Therefore, doctors recommend that older people start treatment with 1.25 mg of Enalapril.
This medicine can be used as an independent medicine and in combination with other antihypertensive medicines.
If for some reason this drug did not fit for treatment, then you can always replace Enalapril with an analogue. The instruction describes in detail the side effects in which it is worth abandoning the use of this medication.
Side effects
"Enalapril" and its analogues of the latest generation with prolonged use can cause a negative reaction of the body. If the side effects are minor and the patient generally feels well, then drug withdrawal is not required. In case of severe negative reactions, stop taking the tablets and seek medical advice.medical assistance.
As a rule, when taking Enalapril, problems from the cardiovascular system can be observed. Among them - a strong decrease in blood pressure, collapse, pain behind the sternum. Patients may experience arrhythmias, palpitations, and pulmonary arterial thromboembolism.
Treatment with Enalapril can cause negative reactions from the central nervous system. Most often it is a headache, increased weakness of the body, dizziness. There may be anxiety, sleep disturbance, confusion. When taking the drug in large doses, patients experienced nervousness, paresthesia, and depression.
Among the adverse reactions is a violation of the vestibular apparatus, problems with hearing and visual perception, tinnitus. Patients may experience dry mouth, anorexia, nausea, constipation, and diarrhea. There may be a gag reflex, abdominal pain, intestinal obstruction. Some patients were worried about pancreatitis, abnormal liver function, increased activity of liver transaminases.
During the treatment with Enalapril, dry cough, shortness of breath, bronchospasm, pneumonitis, pharyngitis, rhinorrhea may occur. Patients during therapy may be disturbed by allergic reactions, including urticaria, skin rashes, itching, angioedema.
Overdose
If the drug for treatment is not suitable, then the analogue of Enalapril for pressure should be selected by the doctor. If high doses are used for treatmentdrug, overdose symptoms may occur. These include a sharp drop in blood pressure, which can cause collapse, myocardial infarction, destabilization of cerebral circulation. In this case, there is a possibility of thromboembolic complications. There may be stupor or cramps in the limbs.
When treating symptoms of an overdose, the patient is placed in a horizontal position, always with a low headboard. Do gastric lavage with saline solution. If the situation is critical, then first of all they try to stabilize blood pressure. Intravenously administered saline, plasma substitutes. If necessary, use angiotensin I or do hemodialysis.
When negative reactions and symptoms of an overdose appear, the patient is recommended to replace Enalapril with modern analogues of a new generation.
Cheap analogues
In the event of side effects, cheap analogues will help replace Enalapril. Russians are no worse than foreign ones, and they act quickly. The most popular are:
- "Renipril". Produced in tablets. It is used to treat all forms of arterial hypertension. It costs from 40 rubles.
- Enap L Combi. Combined preparation of Russian production. It contains two active ingredients: enalapril and lercanidipine. It relaxes the muscle tissue of blood vessels. Gives a long antihypertensive effect. Its price is 100 rubles.
- Enapharm. Another Russian drug that can replace Enalapril. The medicine is well tolerated by the body. Does not affecton cerebral circulation. Increases coronary and renal blood flow. Indicated in arterial hypertension. The price for 10 tablets is 20 rubles.
In addition to the above drugs, the following drugs are cheap analogues
- "Enam". The drug is manufactured in India. It costs about 30 rubles for 10 tablets.
- Renitek. Produced in the Netherlands. Five pills can be purchased for 30 rubles.
- "Ednit". Country of manufacture - Hungary. The cost of 10 tablets is about 30 rubles.
- "Enap". Made in Slovenia. Its cost starts from 120 rubles.
The above synonyms and analogues of Enalapril, if necessary, can serve as substitutes. They should be selected by the attending physician, individually for each patient.
Analogues of the latest generation
Modern analogues of the new generation can replace Enalapril. Among these drugs it is worth noting:
- Cardosal;
- Rasilez;
- Fosinopril;
- "Captopril";
- "Lisinopril";
- Ramipril;
- "Perindopril";
- Gopten;
- Lotensin.
Enalapril analogues of the latest generation continue to treat patients if negative reactions of the body occur or clinical efficacy has not been achieved.
Which is better - Enalapril or analogues?
Some analogues of Enalapril are similar betweenthemselves in composition and practically do not differ in the mechanism of action. Other substitutes have a completely different composition, but act on the body in a similar way and belong to the same group of drugs as Enalapril. Below are some comparisons.
If we compare Lisinopril and Enalapril, then both drugs have a similar effect. But the first medication has a longer period of action and can be used once a day, while Enalapril is drunk twice a day. It is believed that the first drug harms the body less than the second.
Between "Enap" and "Enalapril" differences are minimal. The first drug has a more extensive range of dosages, including tablets of 2.5 ml. Therefore, when prescribing small doses, it is more convenient to take it. Otherwise, the effect of the drugs is similar, although patient reviews claim that Enap is more effective than Enalapril.
The drugs "Captopril" and "Enalapril" belong to the same pharmaceutical group, but their action is different from each other. "Captopril" acts quickly and for a short time. Suitable only for the relief of a hypertensive crisis. And unlike Enalapril, it is not prescribed for continuous use, but is used from time to time.
Enalapril and Enalapril N are slightly different from each other. They have the same analogues and substitutes. But the second drug is considered better, as it contains the diuretic component hypothiazide. Because of what it works faster and more efficiently.
What is better - "Enalapril" or its analogues? To this questiononly the attending physician can answer. After all, it is he who should be engaged in the selection of analogues after a thorough assessment of the patient's condition.
Price, user reviews
"Enalapril" is a medicine available to everyone. Its cost is about 50 rubles for 20 tablets and around 200 rubles for 50 pills.
Analogues of "Enalapril" reviews are considered more effective. Patients note that "Enap" acts softer, but is more expensive. Some patients recommend drinking Renitek for pressure. They say that the difference between Enalapril and Renitek is colossal and the first medicine loses to the second. Many people consider Enalapril obsolete and recommend its use in case of emergency. According to them, Valz, Berlipril, Noliprel can serve as a good substitute for him.
Despite the above reviews, Enalapril was ideal for many patients. It helps keep blood pressure in check. Does not cause side effects. Helps with diabetes and heart failure. It is inexpensive. Often this factor plays a decisive role when choosing Enalapril.
