Indapamide + Enalapril - instructions for use, dose, side effects, contraindications

Clinical and pharmacological group: & nbsp

ACE Inhibitors

Diuretics

Included in the formulation

Enzyme

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Enzyx duo

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Enziks duo forte

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АТХ:

C.09.B.A.02 Enalapril in combination with diuretics

Pharmacodynamics:

Indapamide

Diuretic, a derivative of sulfonamide. Inhibits the reabsorption of sodium in the renal tubules, increases the excretion of sodium and chlorine, enhancing diuresis. Selectively blocks "slow" calcium channels, reduces the overall peripheral resistance of blood vessels, increases the elasticity of the walls of the arteries. Has no effect on lipid metabolism (Lipoproteins of low density, high-density lipoproteins, triglycerides) and carbohydrates.

Enalapril

Angiotensin-converting enzyme (ACE) inhibitor. Prodrug: active metabolite - enalaprilate. Blocking the conversion of angiotensin I in angiotensin II, resulting in a decrease in the release of norepinephrine from the endings of sympathetic fibers, the vasoconstrictor effect, the secretion of aldosterone by the adrenal cortex and increases the bradykinin content by reducing its inactivation by the angiotensin-converting enzyme.

Bradykinin stimulates B₂-cinin receptors of the vascular endothelium, which leads to the rapid release of prostacyclin and other vasodilating substances that cause relaxation of smooth muscles.

Reduces the overall peripheral resistance of blood vessels, without affecting the heart rate. Reduces the aggregation of platelets, improves blood flow of ischemic areas of the heart muscle. With prolonged use there is a decrease in hypertrophy of the left ventricle of the heart.

Pharmacokinetics:

Indapamide

After oral administration, the empty stomach is completely absorbed in the gastrointestinal tract. The maximum concentration in the blood plasma is reached after 1 hour. The connection with plasma proteins is 79%. Therapeutic effect develops 1-2 hours after the start of the procedure.

Penetrates through the blood-brain and placental barrier, excreted in breast milk. Do not cumulate.

Metabolism in the liver.

The half-life is 18 hours. Elimination by the kidneys and with feces in the form of metabolites.

Enalapril

After oral administration, fasted to 60% is absorbed in the gastrointestinal tract. The maximum concentration in the blood plasma is achieved in 1-2 hours.The connection with plasma proteins is 50-60%.

Therapeutic effect develops 1 hour after the start of the treatment, reaches a maximum after 4-6 hours and persists for 24 hours. Metabolism in the liver, hydrolyzed to the active metabolite enalaprilata.

The half-life of enalaprilate is 11 hours. Elimination by the kidneys and with feces.

Removed during hemodialysis.

Indications:

It is used for the treatment of arterial hypertension.

ICD-10

IX.I10-I15.I15 Secondary Hypertension

IX.I10-I15.I10 Essential [primary] hypertension

Contraindications:

Indapamide

Hypokalemia, anuria, severe renal and hepatic insufficiency, acute disturbance of cerebral circulation, individual intolerance, children under 18 years of age.

Enalapril

Porphyria, individual intolerance, children under 18 years of age.

Carefully:

Systemic diseases of connective tissue, stenocardia, renovascular hypertension, advanced age, hypersensitivity.

Pregnancy and lactation:

Recommendations for FDA - Category C. Contraindicated in pregnancy and lactation.

Dosing and Administration:

Inside for 1 tablet (indapamide: 2.5 mg, enalapril: 20 mg) in the morning.

The highest daily dose: for enalapril - 40 mg; for indapamide - 2.5 mg.

The highest single dose: for enalapril - 20 mg; for indapamide - 2.5 mg.

Side effects:

Indapamide

Central and peripheral nervous system: headache, asthenia, nervousness, depression, irritability, anxiety, paresthesia.

Respiratory system: pharyngitis, sinusitis, cough, sometimes - rhinitis.

The cardiovascular system: arrhythmias, orthostatic hypotension, palpitation.

Digestive system: anorexia, dry mouth, gastralgia, vomiting, constipation, diarrhea, pancreatitis.

Dermatological reactions: hemorrhagic vasculitis.

Sense organs: visual disturbances, conjunctivitis.

urinary system: nocturia, polyuria.

Reproductive system: decreased potency and libido.

Allergic reactions.

Enalapril

Central and peripheral nervous system: cerebral ischemia, headache, dizziness, anxiety, confusion, paresthesia.

Hemopoietic system: anemia, leukopenia, thrombocytopenia, rarely - eosinophilia.

Respiratory system: dry cough, bronchospasm, dyspnea, rhinorrhea, pharyngitis, dysphonia.

The cardiovascular system: hyperkalemia, hyponatremia, orthostatic hypotension, syncope, tachycardia, angina pectoris, myocardial infarction.

Digestive system: nausea, cholestatic jaundice, constipation, dry mouth.

urinary system: hypercreatininaemia, proteinuria, increased urea levels, development or progression of chronic renal failure.

Dermatological reactions: onycholysis, alopecia.

Reproductive system: decreased potency.

Allergic reactions.

Overdose:

Indapamide

Drowsiness, dizziness, confusion, respiratory depression. In patients with cirrhosis - the development of hepatic coma.

Treatment is symptomatic.

Enalapril

Pronounced decrease in blood pressure, electrolyte imbalance, bradycardia, cardiovascular shock, renal failure.

Treatment: intravenous epinephrine, blood substitution solutions, hydrocortisone, angiotensin injection II, hemodialysis.

Interaction:

Indapamide

By reducing the excretion in the urine increases the concentration of lithium ions, which increases the risk of developing nephrotoxic action.

Cardiac glycosides, saluretics, mineralo- and glucocorticoids, amphotericin B (with intravenous administration), tetracosactide, laxatives increase the state of acidosis.

With simultaneous use with calcium preparations, hypercalcemia develops.

Reduces the hypotensive effect of glucocorticosteroids, non-steroidal anti-inflammatory drugs, sympathomimetics, tetracosactide.

Strengthens the hypotensive effect baclofen.

With the simultaneous use of iodine-containing contrast agents, dehydration develops.

Antipsychotic drugs and antidepressants strengthen the hypotensive effect, which can lead to orthostatic collapse.

Reduces the effect of indirect anticoagulants by increasing the concentration of clotting factors, due to increased production of liver and reducing the volume of circulating blood.

Strengthens the effect of nondepolarizing muscle relaxants.

Enalapril

Strengthens the hypoglycemic action of insulin and oral hypoglycemic drugs.

Enhances the toxic effects of lithium preparations.

Sodium chloride, non-steroidal anti-inflammatory drugs reduce the hypotensive effect of perindopril.

With simultaneous use with potassium-sparing diuretics (amiloride, triamterene, spironolactone), products with a high content of potassium develops hyperkalemia.

When used simultaneously with cytostatics, allopurinol, systemic glucocorticosteroids, procainamide, immunosuppressants increase the risk of developing leukopenia.

With simultaneous use with drugs for general anesthesia and for local anesthesia, it is possible to develop arterial hypotension.

Special instructions:

During surgical interventions during the treatment with enalapril, it is possible to develop arterial hypotension, which should be corrected by the introduction of a sufficient amount of fluid.

Indapamide can give a positive result in the conduct of doping control.

In the treatment it is not recommended to drive vehicles and work with moving mechanisms.

Instructions

Indapamide + Enalapril (Indapamidum + Enalaprilum)