Arterial hypertension is a syndrome characterized by increased blood pressure and damage to sensitive target organs. The single cause of the pathology has not been clarified, therefore, in clinical practice, drugs are used to cut off the links of pathogenesis. Enap is a modern first-line antihypertensive drug that is widely used by patients for its safety, efficacy and convenience.
Instructions for use of the drug
"Enap" is the official name of the drug, the active substance of which is enalapril, a derivative of maleic acid. The agent belongs to the group of inhibitors (slowing down the work) of the angiotensin converting enzyme (ACE inhibitors), the mechanism of action of which is presented in the table.
| Pharmacological effects | Effect on target organs |
|---|---|
| Decreased synthesis of aldosterone |
|
| Decreased production of angiotensin 2 |
|
| Bradykinin cleavage block |
|
In addition, the substance has an antifibrillatory effect and prevents remodeling (restructuring) of the myocardium after a heart attack, with congenital or acquired valvular defects.
"Enap" is produced in tablet form with various dosages of the active substance and a combination with other agents for convenient use and achievement of therapeutic goals.
Indications
The ACE inhibitor group belongs to the first line of drugs for the treatment of arterial hypertension. "Enap" is a representative of the second class with a prolonged effect (more than 24 hours) and is prescribed once a day.
The tool is used in therapy:
- essential arterial hypertension - a persistent increase in pressure indicators for no apparent reason (only risk factors are distinguished);
- Cohn's syndrome and primary hyperaldosteronism - endocrine pathologies characterized by increased synthesis of aldosterone;
- diabetic nephropathy - a violation of the filtration capacity in pathologies of carbohydrate metabolism;
- chronic heart failure - the drug increases the ejection force without affecting the frequency;
- secondary arterial hypertension with valvular defects;
- chronic kidney disease is a group of diseases characterized by a long progressive course and a decrease in the glomerular filtration rate.
"Enap" is a drug for the control of arterial hypertension, which takes effect 1 hour after administration. The drug is not used to relieve hypertensive crises.
Administration and dosage
The drug is available in the form of tablets with different concentrations of the active substance - Enalaprilat (2.5-5-10-20 mg). Excipients: magnesium stearate, corn starch, sodium bicarbonate, iron oxide yellow and red (color for tablets 20 mg), talc and lactose monohydrate.
The drug is intended for oral administration once a day without binding to food intake. The selection of the dose and the mode of use is agreed with the attending physician.
"Enap" 5 mg
Enap - 5mg tablets are flat, round, with a beveled edge. Color - white, without additional impurities, on one of the sides - a dividing strip.
The drug is available in a cardboard box: 20 tablets in blisters of 10 pieces.
The dosage regimen is presented in the table.
| Pathology | Dose of the drug "Enap" 5 mg |
|---|---|
| Arterial hypertension |
|
| Chronic circulatory failure | 4 week dose adjustment regimen:
|
| Chronic kidney disease | The selection of an effective dose depends on the filtration capacity of the kidneys (calculated by the formula):
|
The maximum therapeutic dose of 40 mg is 8 tablets, the excess of which is accompanied by signs of overdose (hyperkalemia, orthostatic hypotension, and others).
Dose 10 mg
Tablets with a dose of 10 mg enalaprilat are red-brown round with whitish blotches outside in the thickness of the product. The edges of the preparation are beveled, on one side of the surface there is a dividing notch.
The appointment of "Enap" 10 mg for various diseases are presented in the table.
| Pathology | Dose "Enap" (10 mg) |
|---|---|
| Essential arterial hypertension | Average therapeutic dosage: 1-2 tablets 1 time per day. Dose adjustment 2 weeks after prescribing or changing the regimen |
| Cohn's syndrome (in the preoperative period) | 2 tablets once a day |
| Chronic heart failure | Average therapeutic dose - ½ tablet / day |
| Chronic kidney disease | At a glomerular filtration rate of more than 30 ml / min: ½ -1 tablet per day. A lower creatinine clearance requires the selection of drugs with a lower content of enalapril |
"Enap HL" and "N"
Treatment of moderate arterial hypertension involves the selection of an effective combination of drugs. The most effective is the combination of ACE inhibitors and diuretics.
The KRKA company manufactures the drug "Enap N" and "Enap NL", which contain a fixed concentration of enalaprilat and hydrochlorothiazide (thiazide series of diuretics).
The release form is presented in the table.
| Drug name | Enalapril concentration (mg) | Hydrochlorothiazide concentration (mg) |
|---|---|---|
| "Enap N" | 10 | 25 |
| "Enap HL" | 10 | 12,5 |
| Enap HL-20 " | 10 | 12,5 |
The establishment of the regimen of admission depends on the severity of the pathology and the presence of concomitant diseases. The average therapeutic dose is 1 tablet per day.
The combination of an ACE inhibitor with a diuretic is considered the most effective in the treatment of hypertension in the elderly.
Contraindications
"Enap" refers to a group of ACE inhibitors that act on receptors located in the vessels of the entire body. The use of the drug is limited in patients with:
- allergic reactions to the active and auxiliary components of the drug (including other representatives of the group);
- anaphylactic shock or angioedema of Quincke in history;
- diabetic nephropathy (CKD stage 3 and more);
- pregnancy (active metabolites of the drug penetrate the hematoplacental barrier and disrupt the transport of blood between mother and child);
- children under 6 years old;
- liver failure;
- hyperkalemia caused by rhabdomyolysis, CKD, burn injury, or crash syndrome.
Preparations with the inclusion of hydrochlorothiazide disrupt glucose metabolism, therefore, are contraindicated in patients with diabetes mellitus.
Side effects
The undesirable consequences of taking the drug are due to the effect on the metabolism of glucose, potassium, a drop in blood pressure and a violation of the breakdown of bradykinin.
The most common side effects in the appointment of "Enap" are presented in the table.
| Reaction group | Symptoms and syndromes |
|---|---|
| Hematological (blood disorders) |
|
| The immune system |
|
| Endocrine |
|
| Cardiovascular |
|
| Respiratory |
|
| Dyspeptic |
|
Common signs include weakness, dizziness, muscle pain, and sleep disturbance. Side effects are rare (except for cough) and are leveled by dose adjustment and selection of a substitute.
Patients with significant renal dysfunction require careful monitoring of blood potassium levels due to the high risk of intoxication and cardiac arrest in diastole.
Analogues available on the Russian market
Enalapril is a popular active ingredient that is used in the treatment of hypertension and is available under various trade names.
Preparations with a similar composition, registered in Russia:
- Berlipril (Germany);
- Ednit (Hungary);
- Renitek is the original drug;
- Enam (India);
- Brumipril (Belgium) is available in capsules;
- Enalapril Hexal (Germany);
- "Enapharm" (Russia).
The choice of the remedy depends on the individual sensitivity and financial capabilities of the patient. In case of ineffectiveness of the drug, the selection of substitutes from the ACE inhibitors group or other drugs of the first line of antihypertensive therapy is recommended.
Conclusions
Treatment of arterial hypertension is an open question, in which the choice of a remedy depends on the age of the patient, the duration of the pathology and the presence of concomitant diseases. "Enap" is one of the most prescribed remedies that are used in therapeutic practice. Convenient use, duration of action, efficacy and safety are the main advantages of the drug. The appointment of the regimen and dosage of the medication is carried out by the attending physician with subsequent correction in 10-12 days.
