1 таблетка содержит: активное вещество: эналаприла малеат 5 мг.
Фармакологические свойства
Эналаприл - ингибитор АПФ. Является пролекарством, из которого в организме образуется активный метаболит эналаприлат.
Полагают, что механизм антигипертензивного действия связан с конкурентным ингибированием активности АПФ, которое приводит к снижению скорости превращения ангиотензина I в ангиотензин II, являющийся мощным сосудосуживающим веществом.
В результате уменьшения концентрации ангиотензина II происходит вторичное увеличение активности ренина плазмы за счет устранения отрицательной обратной связи при высвобождении ренина и прямое снижение секреции альдостерона. Кроме того, эналаприлат, по-видимому, оказывает влияние на кинин-калликреиновую систему, препятствуя распаду брадикинина.
Благодаря сосудорасширяющему действию, уменьшает ОПСС (постнагрузку), давление заклинивания в легочных капиллярах (преднагрузку) и сопротивление в легочных сосудах; повышает минутный объем сердца и толерантность к нагрузке.
Показания к применению
Артериальная гипертония (в том числе реноваскулярная);
Хроническая сердечная недостаточность (в составе комбинированной терапии).
Противопоказания
Ангионевротический отек в анамнезе;
Прогрессирующая азотемия при двустороннем стенозе почечных артерий или стенозе почечной артерии единственной почки;
Беременность;
Лактация;
Детский возраст;
Повышенная чувствительность к ингибиторам АПФ.
Способ применения и дозы
При лечении артериальной гипертонии (эссенциальной и реноваскулярной) и хронической сердечной недостаточности средняя суточная доза препарата составляет 10-20 мг. Кратность приема 1 раз в сутки.
При необходимости доза препарата может быть увеличена до 40 мг в сутки. При отсутствии достаточного контроля за больным суточную дозу в 40 мг рекомендуется разделить на 2 приема.
Начальная доза препарата у больных с почечной недостаточностью и у больных, принимающих диуретики, составляет 2.5 мг.
За 2-3 дня до начала лечения Эналаприлом диуретики рекомендуется отменить.
Побочное действие
Большинство побочных эффектов носят временный характер и не требуют отмены препарата.
Редко: аллергические реакции в виде кожной сыпи, зуда; сухой кашель, нарушение функции печени и/или почек, гиперкалиемия, протеинурия.
Крайне редко: при использовании высоких доз возможны нарушения сна, депрессия, парестезии.
Передозировка
Симптомы: выраженное снижение АД вплоть до развития коллапса, инфаркта миокарда, острого нарушения мозгового кровообращения или тромбоэмболических осложнений, судороги, ступор.
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).
Взаимодействие с другими лекарственными средствами
При одновременном назначении эналаприла с нестероидными противовоспалительными препаратами (НПВП), включая селективные ингибиторы циклооксигеназы-2 (ингибиторы ЦОГ-2) 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).
У некоторых пациентов с нарушенной функцией почек, и принимающих НПВП, включая ингибиторы ЦОГ-2, сопутствующее применение ингибиторов АПФ может привести к дальнейшему ухудшению функции почек. Эти изменения обратимы.
Одновременный прием с жаропонижающими и болеутоляющими средствами может уменьшить эффективность препарата.
Эналаприл ослабляет действие препаратов, содержащих теофиллин.
Совместное применение ингибиторов АПФ и гипогликемических средств (инсулин, гипогликемические средства для приема внутрь) может усилить гипогликемический эффект последних с риском развития гипогликемии. Эта наиболее часто отмечается в течение первых недель совместного применения, а также у пациентов с почечной недостаточностью.
У пациентов с сахарным диабетом, получающих гипогликемические средства для приема внутрь и инсулин, необходим контроль уровня глюкозы крови, особенно в течение первого месяца совместного применения с ингибиторами АПФ.
Ингибиторы АПФ уменьшают выведение лития почками, и усиливают риск развития литиевой интоксикации. При необходимости назначения солей лития необходим контроль уровня лития в сыворотке крови.
Симптомокомплекс, включающий покраснение лица, тошноту, рвоту и артериальную гипотензию, описан в редких случаях при совместном применении препаратов золота для парентерального использования (натрия ауротиомалат) и ингибиторов АПФ (эналаприл).
Особые указания
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 ингибитора 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.
Применение высокопрочных 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 хронической 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).
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. 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.
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.
Перед хирургическим вмешательством (включая стоматологию) необходимо предупредить хирурга/анестезиолога о применении ингибиторов АПФ.
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таблетка содержит: \u003c/i\u003e\u003ci\u003e активное вещество: \u003c/i\u003eэналаприла малеат 5 мг.\n\n"}}]},{"id":9,"name":"Фармакологические свойства","slug":"pharmacologic_effects","body":[{"type":"paragraph","data":{"text":"Эналаприл - ингибитор АПФ. Является пролекарством, из которого в организме образуется активный метаболит эналаприлат."}},{"type":"paragraph","data":{"text":"Полагают, что механизм антигипертензивного действия связан с конкурентным ингибированием активности АПФ, которое приводит к снижению скорости превращения ангиотензина I в ангиотензин II, являющийся мощным сосудосуживающим веществом."}},{"type":"paragraph","data":{"text":"В результате уменьшения концентрации ангиотензина II происходит вторичное увеличение активности ренина плазмы за счет устранения отрицательной обратной связи при высвобождении ренина и прямое снижение секреции альдостерона. Кроме того, эналаприлат, по-видимому, оказывает влияние на кинин-калликреиновую систему, препятствуя распаду брадикинина."}},{"type":"paragraph","data":{"text":"Благодаря сосудорасширяющему действию, уменьшает ОПСС (постнагрузку), давление заклинивания в легочных капиллярах (преднагрузку) и сопротивление в легочных сосудах; повышает минутный объем сердца и толерантность к нагрузке.\n\n"}}]},{"id":10,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"\n\nАртериальная гипертония (в том числе реноваскулярная);"}},{"type":"paragraph","data":{"text":"Хроническая сердечная недостаточность (в составе комбинированной терапии).\n\n"}}]},{"id":11,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"\n\nАнгионевротический отек в анамнезе;"}},{"type":"paragraph","data":{"text":"Прогрессирующая азотемия при двустороннем стенозе почечных артерий или стенозе почечной артерии единственной почки;"}},{"type":"paragraph","data":{"text":"Беременность;"}},{"type":"paragraph","data":{"text":"Лактация;"}},{"type":"paragraph","data":{"text":"Детский возраст;"}},{"type":"paragraph","data":{"text":"Повышенная чувствительность к ингибиторам АПФ.\n\n"}}]},{"id":14,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"При лечении артериальной гипертонии (эссенциальной и реноваскулярной) и хронической сердечной недостаточности средняя суточная доза препарата составляет 10-20 мг. Кратность приема 1 раз в сутки."}},{"type":"paragraph","data":{"text":"При необходимости доза препарата может быть увеличена до 40 мг в сутки. При отсутствии достаточного контроля за больным суточную дозу в 40 мг рекомендуется разделить на 2 приема."}},{"type":"paragraph","data":{"text":"Начальная доза препарата у больных с почечной недостаточностью и у больных, принимающих диуретики, составляет 2.5 мг."}},{"type":"paragraph","data":{"text":"За 2-3 дня до начала лечения Эналаприлом диуретики рекомендуется отменить."}}]},{"id":15,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Большинство побочных эффектов носят временный характер и не требуют отмены препарата."}},{"type":"paragraph","data":{"text":"Возможны: головная боль, головокружение, чувство усталости, повышенная утомляемость, тошнота, ортостатическая гипотония, сердцебиение, тахикардия."}},{"type":"paragraph","data":{"text":"Редко: аллергические реакции в виде кожной сыпи, зуда; сухой кашель, нарушение функции печени и/или почек, гиперкалиемия, протеинурия."}},{"type":"paragraph","data":{"text":"Крайне редко: при использовании высоких доз возможны нарушения сна, депрессия, парестезии."}}]},{"id":16,"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":17,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"При одновременном назначении эналаприла с нестероидными противовоспалительными препаратами (НПВП), включая селективные ингибиторы циклооксигеназы-2 (ингибиторы ЦОГ-2) 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":"У некоторых пациентов с нарушенной функцией почек, и принимающих НПВП, включая ингибиторы ЦОГ-2, сопутствующее применение ингибиторов АПФ может привести к дальнейшему ухудшению функции почек. Эти изменения обратимы."}},{"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, метилдопа, 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."}},{"type":"paragraph","data":{"text":"Совместное применение ингибиторов АПФ и гипогликемических средств (инсулин, гипогликемические средства для приема внутрь) может усилить гипогликемический эффект последних с риском развития гипогликемии. Эта наиболее часто отмечается в течение первых недель совместного применения, а также у пациентов с почечной недостаточностью."}},{"type":"paragraph","data":{"text":"У пациентов с сахарным диабетом, получающих гипогликемические средства для приема внутрь и инсулин, необходим контроль уровня глюкозы крови, особенно в течение первого месяца совместного применения с ингибиторами АПФ."}},{"type":"paragraph","data":{"text":"Ингибиторы АПФ уменьшают выведение лития почками, и усиливают риск развития литиевой интоксикации. При необходимости назначения солей лития необходим контроль уровня лития в сыворотке крови."}},{"type":"paragraph","data":{"text":"Симптомокомплекс, включающий покраснение лица, тошноту, рвоту и артериальную гипотензию, описан в редких случаях при совместном применении препаратов золота для парентерального использования (натрия ауротиомалат) и ингибиторов АПФ (эналаприл)."}}]},{"id":18,"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 ингибитора 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 высокопрочных диализных мембран повышает риск развития анафилактической реакции. Коррекция режима дозирования в дни, свободные от диализа, должна осуществляться в зависимости от уровня АД."}},{"type":"paragraph","data":{"text":"До и во время лечения ингибиторами АПФ необходим периодический контроль АД, показателей крови (гемоглобина, калия, креатинина, мочевины, активности «печеночных» ферментов), белка в моче."}},{"type":"paragraph","data":{"text":"Следует тщательно наблюдать за больными с тяжелой хронической сердечной недостаточностью, ишемической болезнью сердца и заболеваниями сосудов мозга, у которых резкое снижение АД может привести к инфаркту миокарда, инсульту или нарушению функции почек."}},{"type":"paragraph","data":{"text":"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. При олигурии необходимо поддержание АД и почечной перфузии путем введения соответствующих жидкостей и сосудосуживающих средств."}},{"type":"paragraph","data":{"text":"Перед исследованием функций паращитовидных желез следует отменить."}},{"type":"paragraph","data":{"text":"Алкоголь усиливает гипотензивное действие препарата."}},{"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."}},{"type":"paragraph","data":{"text":"Перед хирургическим вмешательством (включая стоматологию) необходимо предупредить хирурга/анестезиолога о применении ингибиторов АПФ."}}]},{"id":20,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"Таблетки."}}]},{"id":21,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"В сухом, защищенном от света месте, при температуре не выше 25 °C"}}]},{"id":22,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"3 года."}}]},{"id":23,"name":"Условия отпуска","slug":"release_condition","body":[{"type":"paragraph","data":{"text":"По рецепту."}}]},{"id":24,"name":"Производитель","slug":"","body":[{"type":"paragraph","data":{"text":"Озон ООО"}}]}],"source":{"title":"('Эркафарм/Столетов',)","url":"https://stoletov.ru/"}},"description_toggle":false,"short_description":"Эналаприл - ингибитор АПФ. 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