Антигипертензивный препарат, ингибитор АПФ. Механизм действия эналаприла связан с угнетением активности АПФ, который уменьшает образование ангиотензина II, способствующего сужению кровеносных сосудов, и одновременно активирует образование кининов и простациклина, обладающих сосудорасширяющим действием. Эналаприл относится к пролекарствам, после его гидролиза в организме образуется эналаприлат, который и ингибирует указанный фермент. Эналаприл оказывает также некоторый диуретический эффект, связанный с умеренным угнетением синтеза альдостерона. Наряду со снижением АД, препарат уменьшает пред- и постнагрузку на миокард при сердечной недостаточности, улучшает кровообращение в малом круге и функцию дыхания, снижает сопротивление в сосудах почек, что способствует нормализации в них кровообращения.
Показания к применению
Различные формы артериальной гипертензии (в т.ч. реноваскулярная)
Хроническая сердечная недостаточность (в составе комбинированной терапии)
Противопоказания
Ангионевротический отек, связанный с применением ингибиторов АПФ (в анамнезе)
Прогрессирующая азотемия при двустороннем стенозе почечных артерий или стенозе артерии единственной почки
Детский возраст
Беременность
Лактация (грудное вскармливание)
Повышенная чувствительность к эналаприлу и другим компонентам препарата
Повышенная чувствительность к другим ингибиторам АПФ
Применение при беременности и в период грудного вскармливания
Рениприл противопоказан при беременности и в период лактации.
Способ применения и дозы
Рениприл назначают внутрь независимо от приема пищи. При лечении эссенциальной артериальной гипертензии начальная доза Рениприла составляет 10-20 мг/сут. В дальнейшем дозу подбирают индивидуально. При умеренной артериальной гипертензии достаточно дозы 10 мг/сут. Максимальная суточная доза – 80 мг. При реноваскулярной гипертензии Рениприл назначают в меньших дозах. Начальная доза обычно составляет 5 мг/сут, затем дозу подбирают индивидуально. Максимальная доза составляет 20 мг/сут. При сердечной недостаточности Рениприл назначают, начиная с 2.5 мг, затем дозу постепенно увеличивают до 10-20 мг (1-2 раза/сут). Длительность лечения зависит от эффективности терапии. Во всех случаях при слишком выраженном снижении АД дозу препарата постепенно снижают. Препарат применяют как при монотерапии, так и в комбинации с другими антигипертензивными препаратами. У пациентов с нарушениями функции почек следует уменьшить разовую дозу или увеличить интервалы между приемами.
Побочное действие
Со стороны ЦНС и периферической нервной системы: возможны головокружение, головная боль, чувство усталости. Со стороны сердечно-сосудистой системы: возможны артериальная гипотензия, ортостатическая гипотензия. Со стороны пищеварительной системы: возможны тошнота, повышение активности печеночных трансаминаз в сыворотке; редко - рвота, диарея. Аллергические реакции: редко - кожная сыпь, ангионевротический отек. Со стороны мочевыделительной системы: повышение содержания мочевины, креатинина. Со стороны дыхательной системы: возможен сухой кашель. Со стороны системы кроветворения: редко - анемия, тромбоцитопения, лейкопения, агранулоцитоз. Прочие: возможны мышечные судороги. Побочные реакции обычно слабо выражены и имеют преходящий характер и, как правило, не требуют отмены препарата.
Передозировка
Симптомы: артериальная гипотензия. Лечение: поместить пациента в положение с приподнятыми ногами. В легких случаях назначать внутрь солевой раствор. В более тяжелых случаях в условиях стационара проводят мероприятия, направленные на стабилизацию АД: в/в введение физиологического раствора или плазмозаменителей. Возможно применение гемодиализа.
Особые указания
С особой осторожностью следует применять препарат у пациентов с аутоиммунными заболеваниями, нарушениями функции печени или почек, при потере жидкости и солей, одновременно с иммунодепрессантами и диуретиками. В случае предшествующего лечения диуретиками, в частности при хронической сердечной недостаточности, Рениприл повышает риск развития артериальной гипотензии, поэтому перед началом лечения Рениприлом необходимо компенсировать потерю жидкости и солей. В процессе длительной терапии показан контроль картины периферической крови. Перед исследованием функции паращитовидных желез Рениприл следует отменить.
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