Enalapril

Pharmacological effect of Enalapril

Enalapril is inhibitor of an angiotensin-converting enzyme. Enalapril has the expanding effect on arteries and to a lesser extent on veins. Hypotensive effect of Enalapril is more obviously shown at the increased concentration of a renin in a blood plasma. At use of Enalapril the renal and coronary blood stream improves. Prolonged use of Enalapril reduces a hypertrophy of a left ventricle of a myocardium and prevents development of chronic heart failure. Enalapril has a promoting effect on blood supply of a myocardium. Lowers aggregation of thrombocytes. Enalapril is shown for delay of development of dysfunction of a left ventricle in the patients who had a myocardial infarction. According to the received comments Enalapril has some diuretic effect.

Enalapril – "pro-medicine" which making hydrolysis, forms enalaprilat which in turn inhibits an angiotensin-converting enzyme. The hypotensive effect occurs in 1 hour after reception of Enalapril and proceeds within 24 hours. Some patients need therapy within several weeks for achievement of optimum indications of arterial pressure. Patients with chronic heart failure for obtaining noticeable clinical effect need a course of treatment not less than 6 months.

Indications to Enalapril use

• prevention of coronary ischemia;
• arterial hypertension;
• to patients with dysfunction of a left ventricle of a myocardium.

Contraindications

• pregnancy;
• hypersensitivity to Enalapril and analogs from among inhibitors of an angiotensin-converting enzyme;
• lactation;
• Quincke's disease;
• cerebrovascular diseases;
• coronary insufficiency;
• aortal stenosis;
• to patients after transplantation of a kidney;
• liver or renal failure;
• coronary heart disease;
• the lowered volume of the circulating blood;
• to patients of advanced age;
• to patients up to 18 years.

Side effects of Enalapril

• orthostatic collapse, it is rare – heartbeat, a retrosternal pain, a thromboembolism of a pulmonary artery, arrhythmia (fibrillation of auricles, atrial bradi-or tachycardia), stenocardia, a myocardial infarction;
• unconscious states, dizziness, weakness, headache, paresthesias, sleeplessness, depression, uneasiness, confusion of consciousness, drowsiness (2-3%), increased fatigue, it is very rare at exceeding of a dosage – a depression, nervousness;
• dryness in a mouth, dysfunction of a zhelchevydeleniye, dispepsichesky frustration (diarrhea or locks, nausea, vomiting), intestinal impassability, pains in a stomach, pancreatitis, jaundice, hepatitis;
• pharyngitis, rhinorrhea, asthma, bronchospasm, intersticial pneumonitis, unproductive cough;
• glossitis, stomatitis, arthritis, arthralgia, miositis, vasculitis, serositis, photosensitization, urticaria, skin itch, epidermal necrolysis, pemphigus (pempigus), multiformny exudative erythema, exfoliative dermatitis, dysphonia, Quincke's diseases, skin rash of the person;
• eosinophilia, agranulocytosis, thrombocytopenia, neutropenia, increase in SOE, decrease in Hb and hematocrit, hyponatremia, hyperpotassemia, increase in activity of transaminases, giperkreatininemiya, hyperbilirubinemia, increase in concentration of urea, proteinuria;
• decrease in a libido, alopecia.

Overdose by Enalapril

At overdose by Enalapril responses showed the possible expressed lowering of arterial pressure, up to a collapse, a myocardial infarction, acute disorders of cerebral circulation, a spasm, a stupor.

Treatment: the patient needs to give horizontal position. In not hard cases the gastric lavage with reception of saline solution is recommended. In especially hard cases the therapy directed to stabilization of arterial pressure including intravenous administration of plasma substitutes, solution of 0,9% NaCl is carried out. If necessary – a hemodialysis.

Dosage of Enalapril and application instruction

Is accepted orally, irrespective of meal. An initial dosage at arterial hypertension – 5mg/days. If the expected effect does not occur it is possible to raise a dose to 10 mg. At good tolerance of drug increase in a dose up to 40 mg/days, divided into 1-2 receptions is admissible. On incident of 2-3 weeks it is possible to lower a dose to the supporting level of 10-40 mg/days. The dosage recommended at moderate hypertensia makes 10 mg/days.

To patients with a hyponatremia the initial daily dose recommended by the instruction of Enalapril makes 2,5 mg.

The initial dose at renovascular hypertensia makes 2,5-5 mg/days. In case of arterial hypertension in a severe form intravenous administration of drug in the conditions of a hospital is admissible.

The initial dosage at chronic heart failure makes 2,5 mg. Further each 3-4 days increase a dose by 2,5-5 mg of drug of Enalapril according to indications of clinical reaction, but no more than 40 mg/days, single or double daily introduction.

The dose recommended by the instruction of Enalapril for elderly patients makes 1,25 mg.

At asymptomatic dysfunctions of a left ventricle of a myocardium the recommended dosage makes 5 mg/days divided into two equal receptions on 2,5 mg.

The maximum dose of Enalapril – 40 mg/days.

Interaction with other drugs

Slows down lithium removal, strengthens effect of ethanol. Weakens effect of the drugs containing theophylline. The comments received at a clinical use of Enalapril showed that its hypotensive action can be reduced by non-steroidal anti-inflammatory drugs and vice versa it is strengthened – diuretics, ethanol, drugs of the general anesthesia.