Enalapril is a well-known drug often prescribed by doctors to stabilize blood pressure. The medication is well tolerated by patients. Rarely causes side effects. The enalapril release form is convenient, which allows you to take the medicine 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 consumed on its own, without a doctor's prescription.
Enalapril: release form, composition
This medication belongs to ACE inhibitors. Its active ingredient is enalapril maleate.
The release form of "Enalapril" - tablets with a dosage of 5, 10 and 20 mg. The pills are white, have a round shape. Biconvex. On the one hand - risk. Enclosed in laminated PVC. Each blister contains 10 tablets. Two blisters are packed in a cardboard box along with instructions for use.
The release form of Enalapril requires compliance with a specific storage regimen. The drug should be stored at a temperature of 15-25 ° C in a place that is protected from the sun and out of the reach of children.
Pharmacological properties
The tablet form of release of Enalapril facilitates its administration and dosage selection. This drug is considered a "prodrug": in the process of its hydrolysis enalaprilat creates. This substance also inhibits ACE.
The mechanism of action is associated with a decrease in the formation of angiotensin II angiotensin II. This property leads to a decrease in aldosterone output. In this case, a decrease in peripheral vascular resistance occurs. Both diastolic and systolic blood pressure decreases. The preload on the myocardium is reduced.
The drug dilates the arterial vessels more than venous. During this, an increase in heart rate does not occur.
The antihypertensive effect is better manifested only when a high level of plasma renin is reached. With a reduced renin index, the hypotensive property is weakly 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 with reduced pressure. Pills can increase renal and coronary blood flow.
With prolonged use of tablets, left ventricular myocardial hypertrophy decreases and hypertrophy of myocyte arterial walls belonging to the resistive type decreases. A similar effect of the drug inhibits the progression of dilatation of the left ventricle and prevents the development of heart failure. The drug reduces platelet aggregation and stimulates the blood supply to the myocardium. It has a diuretic effect.
After taking the tablets, the hypotensive effect is manifested within an hour. The most powerful hypotensive property of the drug appears after 4-6 hours. The action of the tablets lasts a day. A certain part of patients for the normalization of blood pressure needs long-term therapy, lasting from six months.
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 quite quickly. This creates an active metabolite of enalaprilat. It is considered a more potent ACE inhibitor than the active component of 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 histohematological 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 lasts eleven hours. About 60% of the drug is excreted by the kidneys, 33% passes through the intestines.
Indications and contraindications
The release form of Enalapril in tablets is used in the treatment of arterial 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 form of release of Enalapril and the dosage are prescribed by the doctor. And only in the absence of contraindications. The medicine is not prescribed:
- with special sensitivity to the active substance and other ACE inhibitors;
- history of angioedema, which is associated with therapy with ACE inhibitors;
- porphyrin disease;
- pregnancy
- breastfeeding;
- under the age of eighteen.
With caution, you need to use the medicine for primary hyperaldosteronism. Caution should be given to patients with bilateral renal artery stenosis, aortic, subaortic, and mitral stenosis. During the treatment with Enalapril, patients who have undergone kidney transplantation, have systemic diseases and suffer from diabetes should be monitored. The drug can be dangerous for people with kidney failure and cerebrovascular pathologies. This category includes hemodialysis patients, as well as elderly people who have reached 65 years of age.
"Enalapril": instructions for use
Reviews of analogues of this medicine are praised. They say that they are more effective, although they are more expensive. Despite this, doctors often use Enalapril in their practice.
The drug is taken orally. When using the drug in monotherapy, the initial dose is 5 mg. She is drunk once a day. If the clinical effect was not achieved with this dose, 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.
With good tolerability of the drug and if necessary, the dosage is increased to 40 mg / day. This amount of medicine is divided into two doses. After fourteen days, patients switch to a maintenance dosage, which can range from 10 to 40 mg / day. This amount of the drug is consumed in the morning and evening. If there is moderate arterial hypertension, then the daily dosage is 10 mg. The maximum permitted dosage is 40 mg / day.
If the tablets are prescribed for patients taking diuretics, then their administration must be canceled three days before the treatment with Enalapril. If treatment with diuretics cannot be stopped, the initial dosage should not be more than 2.5 mg / day. This dose should be taken at a time.
With a diagnosis of "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 increased gradually, every four days by 2.5-5 mg. With an increase in dosage, attention is paid to the patient's response, the clinical effect and the value of 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 the drug is 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 a lower rate of drug elimination. Therefore, doctors advise older people to start treatment with 1.25 mg of Enalapril.
This medication can be used as an independent drug and in combination with other antihypertensive drugs.
If for some reason this drug did not fit the treatment, then you can always replace Enalapril with an analog. The instruction describes in detail the side effects in which you should abandon the use of this medication.
Side effects
"Enalapril" and its analogues of the last generation with prolonged use can cause a negative reaction of the body. If side effects are minor and the patient feels well overall, drug withdrawal is not required. With severe negative reactions, you should stop taking the tablets and seek medical help.
As a rule, when taking Enalapril, problems with the cardiovascular system may occur. Among them - a strong decrease in blood pressure, collapse, pain behind the sternum. Patients may be disturbed by arrhythmia, heart palpitations, as well as pulmonary arterial thromboembolism.
Enalapril treatment can cause negative reactions from the central nervous system. Most often, this is a headache, increased weakness of the body, dizziness. Anxiety, sleep disturbance, confusion can be observed. When taking the drug in large doses, patients experienced nervousness, paresthesia, and a depressive state.
Among the adverse reactions, there is a malfunction of the vestibular apparatus, problems with hearing and visual perception, tinnitus. Patients may be concerned about dry mouth, anorexia, nausea, constipation, and diarrhea. There may be a vomiting reflex, abdominal pain, bowel obstruction. Some patients were worried about pancreatitis, impaired liver function, increased activity of hepatic transaminases.
During treatment with Enalapril, a dry cough, shortness of breath, bronchospasm, pneumonitis, pharyngitis, rhinorrhea may occur. During therapy, patients may be disturbed by allergic reactions, including urticaria, skin rashes, itching, angioedema.
Overdose
If the preparation didn’t fit for treatment, then the doctor should pick up the analogue of “Enalapril” for pressure. If high doses of the drug are used for treatment, then overdose symptoms may occur. These include a sharp drop in blood pressure, which can cause collapse, myocardial infarction, and destabilization of cerebral circulation. In this case, there is a chance of thromboembolic complications. Stupor or convulsions of the limbs may occur.
When treating the symptoms of an overdose, the patient is placed in a horizontal position, always with a low headboard. Do gastric lavage with saline. If the situation is critical, then first of all they try to stabilize blood pressure. Saline, plasma substitutes are administered intravenously. If necessary, apply angiotensin I or do hemodialysis.
If negative reactions and overdose symptoms appear, the patient is recommended to replace Enalapril with modern analogues of a new generation.
Cheap analogues
In case of side effects, cheap analogues will help replace Enalapril. Russian is no worse than foreign, and act quickly. The most popular are:
- "Renipril." It is made in tablets. Used to treat all forms of arterial hypertension. It costs from 40 rubles.
- Enap L Combi. Combined preparation of Russian production. It has two active ingredients: enalapril and lercanidipine. It relaxes the muscle tissue of blood vessels. It 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. It does not affect cerebral circulation. Increases coronary and renal blood flow. It is indicated for arterial hypertension. The price for 10 tablets is 20 rubles.
In addition to the above drugs, the following medicines are cheap analogues
- Enam. The drug is made in India. It costs about 30 rubles for 10 tablets.
- Renetek. It is made in the Netherlands. Five pills can be purchased for 30 rubles.
- "Ednit." Country of origin - Hungary. The cost of 10 tablets is about 30 rubles.
- Enap. It is made in Slovenia. Its cost starts from 120 rubles.
The above synonyms and analogues of Enalapril, if necessary, can serve as substitutes. They must be selected by the attending physician, individually for each patient.
Analogs of the latest generation
Can replace "Enalapril" modern analogues of a new generation. Among these drugs, it is worth noting:
- Cardosal
- "Rasilez";
- Fosinopril;
- Captopril;
- Lisinopril;
- Ramipril
- "Perindopril";
- Gopten
- "Lotensin."
The analogues of Enalapril of the latest generation continue to treat patients in the event that negative reactions of the body have occurred or clinical efficacy has not been achieved.
Which is better - Enalapril or analogues?
Some analogues of Enalapril are similar 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 a few 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, and Enalapril is drunk twice a day. It is believed that the first drug is less harmful to the body than the second.
Between Enap and Enalapril the differences are minimal. The first drug has a wider range of dosages, including 2.5 ml tablets. 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.
Captopril and Enalapril belong to the same pharmaceutical group, but their effect is different from each other. Captopril acts quickly and briefly. Only suitable for stopping a hypertensive crisis. And unlike Enalapril, it is not prescribed for continuous use, but is used from time to time.
Enalapril and Enalapril N slightly differ from each other. Their analogs and substitutes are the same. But the second drug is considered better, because it contains the diuretic component of hypothiazide. Because of what it acts faster and more efficiently.
Which is better - Enalapril or its analogues? Only the attending physician can answer this question. After all, he should be engaged in the selection of analogues after a thorough assessment of the patient's condition.
Price, user reviews
Enalapril is a drug available to everyone. Its cost is about 50 rubles for 20 tablets and in the region of 200 rubles - for 50 pills.
Analogues of "Enalapril" reviews are considered more effective. Patients note that Enap is softer, but more expensive. Some patients recommend drinking Renitec from pressure. They say that the difference between Enalapril and Renitek is colossal and the first medicine loses to the second. Many people consider Enalapril to be obsolete and recommend using it in case of emergency. According to them, the drug “Valz”, “Berlipril”, “Noliprel” can serve as a good substitute for it.
Despite the above reviews, Enalapril was ideal for many patients. It helps to keep the pressure normal. It does not cause side effects. Relieves diabetes and heart failure. It is inexpensive. Often this factor plays a decisive role in choosing Enalapril.