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Усиливает коронарный и почечный кровоток."}},{"type":"paragraph","data":{"text":"При длительном применении уменьшается гипертрофия левого желудочка миокарда и миоцитов стенок артерий резистивного типа предотвращает прогрессирование сердечной недостаточности и замедляет развитие дилатации левого желудочка. Улучшает кровоснабжение ишемизированного миокарда. Снижает агрегацию тромбоцитов."}},{"type":"paragraph","data":{"text":"Обладает некоторым диуретическим эффектом."}},{"type":"paragraph","data":{"text":"Время наступления гипотензивного эффекта при приеме внутрь - 1 ч достигает максимума через А-6 ч и сохраняется до 24 ч. У некоторых больных для достижения оптимального уровня артериального давления необходима терапия на протяжении нескольких недель. При сердечной недостаточности заметный клинический эффект наблюдается при длительном лечении - 6 месяцев и более."}},{"type":"header","data":{"text":"Фармакокинетика:","level":3}},{"type":"paragraph","data":{"text":"После приема внутрь абсорбируется 60% препарата. Прием пищи не влияет на всасывание эналаприла."}},{"type":"paragraph","data":{"text":"Эналаприл до 50 % связывается с белками плазмы крови. Эналаприл быстро метаболизируется в печени с образованием активного метаболита эналаприлата который является более активным ингибитором АПФ чем эналаприл. Био доступность препарата 40%. Максимальная концентрация эналаприла в плазме крови достигается через 1 час эналаприлата - 3-4 часа. Эналаприлат легко проходит через гистогематические барьеры исключая гематоэнцефалический небольшое количество проникает через плаценту и в грудное молоко."}},{"type":"paragraph","data":{"text":"Период полувыведения эналаприлата около 11 ч. 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После приема начальной дозы больные должны находиться под медицинским наблюдением в течение 2 ч и дополнительно 1 ч пока не стабилизируется АД. При необходимости и достаточно хорошей переносимости дозу можно увеличить до 40 мг/сут в 2 приема Через 2- 3 недели переходят на поддерживающую дозу - 10 - 40 мг/сут разделенную на 1-2 приема. При умеренной артериальной гипертензии средняя суточная доза составляет около 10 мг Максимальная суточная доза препарата составляет 40 мг/сут."}},{"type":"paragraph","data":{"text":"В случае назначения пациентам одновременно получающим диуретики лечение диуретиком необходимо прекратить за 2-3 дня до назначения Эналаприла. Если это невозможно то начальная доза препарата должна составлять 25 мг/сут."}},{"type":"paragraph","data":{"text":"Больным с гипонатриемией (концентрация ионов натрия в сыворотке крови менее 130ммоль/л) или концентрацией креатинина в сыворотке крови более 014 ммоль/л начальная доза - 25 мг 1 раз в сутки."}},{"type":"paragraph","data":{"text":"При реноваскулярной гипертензии начальная доза - 25 - 5 мг/сут. Максимальная суточная доза - 20 мг."}},{"type":"paragraph","data":{"text":"При хронической сердечной недостаточности начальная доза составляет - 25 мг однократно затем дозу увеличивают на 25 - 5 мг через каждые 3-4 дня в соответствии с клинической реакцией до максимально переносимых доз в зависимости от величины АД но не выше 40 мг/сут. однократно или в 2 приема. У больных с низким систолическим АД (менее 110 мм рт.ст.) терапию следует начинать с дозы 125 мг. Подбор дозы должен проводиться в течение 2-4 нед. или в более короткие сроки. Средняя поддерживающая доза - 5 -20 мг/сут. за 1-2 приема."}},{"type":"paragraph","data":{"text":"У пожилых чаще наблюдается более выраженный гипотензивный эффект и удлинение времени действия препарата что связано с уменьшением скорости выведения эналаприла поэтом) рекомендуемая начальная доза пожилым - 125 мг."}},{"type":"paragraph","data":{"text":"При хронической почечной недостаточности кумуляция наступает при снижении фильтрации менее 10 мл/мин. При клиренсе креатинина (КК) 80-30 мл/мин доза обычно составляет 5 - 10 мг/сут при КК до 30 -10 мл/мин - 2 5 - 5 мг/сут при КК менее 10 мл/мин - 125 - 25 мг/сут только в дни диализа."}},{"type":"paragraph","data":{"text":"Длительность лечения зависит от эффективности терапии. При слишком выраженном снижении АД дозу препарата постепенно уменьшают."}},{"type":"paragraph","data":{"text":"Препарат применяют как в монотерапии так ивсочетании с другимиантигипертензивнымисредствами."}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Эналаприл в целом хорошо переносится и в большинстве случаев не вызывает побочных действий требующих отмены препарата."}},{"type":"paragraph","data":{"text":"Со стороны сердечно-сосудистой системы чрезмерное снижение АД ортостатический коллапс редко - загрудинная боль стенокардия инфаркт миокарда (обычно связаны с выраженным снижением артериального давления) крайне редко аритмии (предсердная бради- или тахикардия мерцание предсердий) сердцебиение тромбоэмболия ветвей легочной артерии."}},{"type":"paragraph","data":{"text":"Со стороны центральной нервной системы: головокружение головная боль слабость бессонница тревога спутанность сознания повышенная утомляемость сонливость (2-3%) очень редко при применении высоких доз - нервозность депрессия парестезии."}},{"type":"paragraph","data":{"text":"Со стороны органов чувств: нарушения вестибулярного аппарата нарушения слуха и зрения шум в ушах."}},{"type":"paragraph","data":{"text":"Со стороны пищеварительной системы: сухость во рту анорексия диспепсические расстройства (тошнота диарея или запор рвота боль в области живота) кишечная непроходимость панкреатит нарушение функции печени и желчевыделения гепатит желтуха."}},{"type":"paragraph","data":{"text":"Со стороны дыхательной системы: непродуктивный сухой кашель интерстициальный пневмонит бронхоспазм одышка ринорея фарингит."}},{"type":"paragraph","data":{"text":"Аллергические реакции\\ кожная сыпь зуд крапивница ангионевротический отек крайне редко дисфония полиморфная эритема эксфолиативный дерматит синдром Стивенса- Джонсона токсический эпидермальный некролиз пемфигус фотосенсибилизация серозит васкулиг миозит артралгия артрит стоматит глоссит."}},{"type":"paragraph","data":{"text":"Со стороны лабораторных показателей: гиперкреатининемия повышение содержания мочевины повышение активности \"печеночных\" ферментов гипербилирубинемия гиперкалиемия гипонатриемия. Отмечаются в некоторых случаях снижение гематокрита повышение СОЭ тромбоцитопения нейтропения агранулоцитоз (у больных с аутоиммунными заболеваниями) эозинофилия."}},{"type":"paragraph","data":{"text":"Со стороны мочевыделительной системы: нарушение функции почек редко протеинурия. Прочие: алопеция снижение либидо приливы."}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"Симптомы: выраженное снижение АД вплоть до развития коллапса инфаркта миокарда острого нарушения мозгового кровообращения или тромбоэмболических осложнений судороги ступор."}},{"type":"paragraph","data":{"text":"Лечение: больного переводят в горизонтальное положение с низким изголовьем. В легких случаях показаны промывание желудка и прием внутрь солевого раствора в более тяжелых случаях - мероприятия направленные на стабилизацию АД: внутривенное введение физиологического раствора плазмозаменителей при необходимости - введение ангиотензина II гемодиализ (скорость выведения эналаприлата - 62 мл/мин)."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"При одновременном назначении эналаприла с нестероидными противовоспалительными препаратами (НПВП) возможно снижение гипотензивного эффекта эналаприла; с калийсберегающими диуретиками (спиронолактон триамтерен амилорид) может привести к гиперкалиемии; с солями лития - к замедлению выведения лития (показан контроль концентрации лития в плазме крови)."}},{"type":"paragraph","data":{"text":"Одновременный прием с жаропонижающими и болеутоляющими средствами может уменьшить эффективность препарата."}},{"type":"paragraph","data":{"text":"Эналаприл ослабляет действие препаратов содержащих теофиллин."}},{"type":"paragraph","data":{"text":"Гипотензивное действие эналаприла усиливают диуретики бета-адреноблокаторы метилдола нитраты блокаторы \"медленных\" кальциевых каналов дигидропиридинового ряда гидралазин празозин."}},{"type":"paragraph","data":{"text":"Иммунодепрессанты аллопуринол цитостатики усиливают гематотоксичность. Препараты вызывающие угнетение костного мозга повышают риск развития нейтропении и/или агранулоцитоза."}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"Необходимо соблюдать осторожность при назначении пациентам со сниженным объемом циркулирующей крови (в результате терапии диуретиками при ограничении потребления поваренной соли проведении гемодиализа диарее и рвоте) - повышен риск внезапного и выраженного снижения артериального давления после применения даже начальной дозы ингибиюра АПФ. Транзиторная артериальная гипотензия не является противопоказанием для продолжения лечения препаратом после стабилизации артериального давления (АД). В случае повторного выраженного снижения АД следует уменьшить дозу или отменить препарат."}},{"type":"paragraph","data":{"text":"Применение высокопроточных диализных мембран повышает риск развития анафилактической реакции. Коррекция режима дозирования в дни свободные от диализа должна осуществляться в зависимости от уровня АД. До и во время лечения ингибиторами АПФ необходим периодический контроль АД показателей крови (гемоглобина калия креатинина мочевины активности ’’печеночных\" ферментов) белка в моче. Следует тщательно наблюдать за больными с тяжелой сердечной недостаточностью ишемической болезнью сердца и заболеваниями сосудов мозга у которых резкое снижение АД может привести к инфаркту миокарда инсульту или нарушению функции почек. Внезапная отмена лечения не приводит к развитию синдрома \"рикошета\" (резкому подъему АД)."}},{"type":"paragraph","data":{"text":"За новорожденными и грудными детьми которые подвергались внутриутробному воздействию ингибиторов АПФ рекомендуется вести тщательное наблюдение для своевременного выявления выраженного снижения АД олигурии гиперкалиемии и неврологических расстройств возможных вследствие уменьшения почечного и мозгового кровотока при снижении артериального давления вызываемого ингибиторами АПФ."}},{"type":"paragraph","data":{"text":"При олигурии необходимо поддержание АД и почечной перфузии путем введения соответствующих жидкостей и сосудосуживающих средств. Перед исследованием функций паращитовидных желез следует отменить. Алкоголь усиливает гипотензивное действие препарата."}},{"type":"paragraph","data":{"text":"Перед хирургическим вмешательством (включая стоматологию) необходимо предупредить хирурга/ анестезиолога о применении ингибиторов АПФ."}}]},{"id":17,"name":"Влияние на способность управлять автомобилем и движущимися механизмами","slug":"","body":[{"type":"paragraph","data":{"text":"В начале лечения до завершения периода подбор дозы необходимо воздерживаться от вождения автотранспорта и занятий потенциально опасными видами деятельности требующими повышенной концентрации внимания и быстроты психомоторных реакций т.к. возможно головокружение особенно после начальной дозы ингибитора АПФ у больных принимающих диуретические средства."}}]},{"id":18,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"Таблетки по 5 мг 10 мг и 20 мг."}},{"type":"header","data":{"text":"Упаковка:","level":3}},{"type":"paragraph","data":{"text":"По 10 14 20 таблеток в контурную ячейковую упаковку из пленки поливинилхлоридной и фольги алюминиевой печатной лакированной или бумаги упаковочной."}},{"type":"paragraph","data":{"text":"3 5 контурных ячейковых упаковок по 10 таблеток с маркировкой \"R\" или 2 контурные ячейковые упаковки по 14 таблеток с маркировкой \"R\" с инструкцией по применению помещают в пачку из картона 2 3 5 контурных ячейковых упаковок по 10 таблеток без маркировки \"R\" или 2 контурные ячейковые упаковки по 14 таблеток без маркировки \"R\" с инструкцией по применению помещают в пачку из картона"}},{"type":"paragraph","data":{"text":"20 контурных ячейковых упаковок по 10 таблеток без маркировки \"R\" с равным количеством инструкций по применению помещают в пачку из картона."}},{"type":"paragraph","data":{"text":"Контурные ячейковые упаковки по 10 20 таблеток без маркировки \"R\" с равным количеством инструкций по применению помещают в групповую упаковку."}}]},{"id":19,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"В сухом защищенном от света месте при температуре не выше 30 °С."}},{"type":"paragraph","data":{"text":"Хранить в недоступном для детей месте."}}]},{"id":20,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"3 года."}},{"type":"paragraph","data":{"text":"Не использовать по истечении срока годности указанного на упаковке."}}]},{"id":21,"name":"Условия отпуска","slug":"release_condition","body":[{"type":"paragraph","data":{"text":"По рецепту"}}]},{"id":22,"name":"Производитель","slug":"","body":[{"type":"paragraph","data":{"text":"Закрытое акционерное общество \"Производственная фармацевтическая компания \"Обновление\", 633623, Новосибирская область, р.п. Сузун, ул. Комиссара Зятькова, д. 18, Россия"}}]},{"id":23,"name":"Организация, принимающая претензии потребителей","body":[{"type":"paragraph","data":{"text":"Закрытое акционерное общество \"Производственная фармацевтическая компания \"Обновление\""}}]}],"source":null},"description_toggle":false,"short_description":"Эналаприл - антигипертензивный препарат из группы ингибиторов АПФ. Эналаприл является \"пролекарством\": в результате его гидролиза образуется эналаприлаг который и ингибирует АПФ. Механизм его действия связан с уменьшением образования из ангиотензина I ангиотензина II снижение содержания которого ведет к прямому уменьшению выделения альдостерона. При этом понижается общее периферическое сосудистое сопротивление систолическое и диастолическое артериальное давление (АД) пост - и преднагрузка на миокард. Расширяет артерии в большей степени чем вены при этом рефлекторного повышения частоты сердечных сокращений не отмечается. Гипотензивный эффект более выражен при высоком уровне ренина плазмы крови чем при нормальном или сниженном его уровне. Снижение АД в терапевтических пределах не оказывает влияния на мозговое кровообращение кровоток в сосудах мозга поддерживается на достаточном уровне и на фоне сниженного артериального давления. Усиливает коронарный и почечный кровоток. При длительном применении уменьшается гипертрофия левого желудочка миокарда и миоцитов стенок артерий резистивного типа предотвращает прогрессирование сердечной недостаточности и замедляет развитие дилатации левого желудочка. Улучшает кровоснабжение ишемизированного миокарда. Снижает агрегацию тромбоцитов. Обладает некоторым диуретическим эффектом. Время наступления гипотензивного эффекта при приеме внутрь - 1 ч достигает максимума через А-6 ч и сохраняется до 24 ч. У некоторых больных для достижения оптимального уровня артериального давления необходима терапия на протяжении нескольких недель. При сердечной недостаточности заметный клинический эффект наблюдается при длительном лечении - 6 месяцев и более. После приема внутрь абсорбируется 60% препарата. Прием пищи не влияет на всасывание эналаприла. Эналаприл до 50 % связывается с белками плазмы крови. Эналаприл быстро метаболизируется в печени с образованием активного метаболита эналаприлата который является более активным ингибитором АПФ чем эналаприл. Био доступность препарата 40%. Максимальная концентрация эналаприла в плазме крови достигается через 1 час эналаприлата - 3-4 часа. Эналаприлат легко проходит через гистогематические барьеры исключая гематоэнцефалический небольшое количество проникает через плаценту и в грудное молоко. Период полувыведения эналаприлата около 11 ч. Выводится эналаприл преимущественно почками - 60% (20% - в виде эналаприла и 40% - в виде эналаприлата) через кишечник - 33% (6% - в виде эналаприла и 27% - в виде эналаприлата). 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