Enalapril Stella 5mg treatment for hypertension, congestive heart failure (3 blisters x 10 tablets)

Dosage form Box of 3 blisters x 10 tablets
Specifications Enalapril

Ingredient

Composition information	Content
Enalapril	5mg

Uses

Indications

enalapril 5mg Stella indicated treatment in the following cases:

Hypertension: Enalapril is used to treat mild to severe hypertension. The drug is used for monomers or in combination with other anti-hypertension drugs. The left ventricular function to reduce the incidence of coronary anemia, including myocardial infarction.

ATC code: C09AA02.

Enalapril Maleat is the precursor of enalaprilat and has little pharmacological activity until it is hydrolyzed in vivo into enalaprilate.

Medicines that reduce blood pressure in people with normal blood pressure, hypertension and have a good effect on hemodynamics in patients with congested heart failure, mainly due to inhibition of the Renin - Angiotensin - Aldosteron system.

Enalapril prevents the transformation of angiotensin I into angiotensin II (strong vascular contractions) thanks to the inhibition of angiotensin switching enzymes (ACE).

On humans hypertension, Enalapril reduces blood pressure by reducing peripheral resistance accompanied by a slight increase or no increase in heart rate, systolic volume or cardiac supply. The drug causes artery dilatation and maybe even veins. Enalapril usually reduces systolic and diastolic blood pressure by about 10-15% in both lying and sitting positions. Hypoglycemia and tachycardia rarely occur but often seen in people with hypoglycemia or hypoglycemia.

In people with congestion heart failure, enalapril often coordinates with cardiac glycosides and diuretics, reducing the total peripheral resistance, pulmonary artery pressure, heart size, average artery pressure and right atrial pressure. Heart index, cardiac supply, systolic volume and increased intense tolerance.

Renal blood flow may increase, but glomerular filtration is usually unchanged when treated with enalapril. However, in some patients, both blood flow and glomerular filtration increases. Blood urea nitrogen (bun) and serum creatinine sometimes increases when treated with enalapril for a long time, but more common in people with kidney damage before, users simultaneously with diuretics and patients with congestive heart failure.

pharmacokinetic pharmacokinetics

Absorption: Enalapril maleate absorbs well after taken. About 55 - 75% of Enalapril's oral dose is absorbed quickly after drinking in healthy people and hypertension people. Food does not affect the speed or absorption level of Enalapril. After absorption, Enalapril through initial metabolism in the liver, hydrolyzed into enalaprilate.

Enalapril peak concentration in serum 40 - 80 nanogam/ml is achieved within 0.5 - 1.5 hours after taking a single dose of 10 mg Enalapril. Enalaprilate peak concentration in serum increases in proportion to the enalapril oral dose of 2.5 to 40 mg. Enalaprilat's stable serum concentration is achieved within 30-60 hours in patients with normal kidney function to take Enalapril 10 mg daily, for 8 days without significant accumulation of metabolites.

Effects of hypotension clearly after taking a single -dose of Enalapril usually appears within 1 hour and a maximum of 4 - 8 hours. The effect of reducing the blood pressure of the dose is usually used for 12 - 24 hours, but may be reduced towards the end in some patients. Blood pressure may gradually decrease and take a few weeks of treatment before gaining full effect.

Distribution: about 50 - 60% enalaprilate attached to plasma proteins.

Elimination: About 60% of oral dose is excreted into urine in the form of enalaprilate and non -metabolic form, the rest of the drug eliminates in feces.

Before taking Enalapril Stella 5mg treatment for hypertension, congestive heart failure (3 blisters x 10 tablets)

How to use

enalapril 5mg Stella is used by oral.

Dosage

Treatment of hypertension:

The starting dose of 5 mg of Enalapril Maleat/day. Because there may be hypotension in some patients when they start treatment with ACE inhibitors, the first dose should be used at bedtime. Diuretics should be discontinued 2-3 days before the beginning of the Enalapril treatment and continue if necessary. The dose can be divided into 2 times if the single dose is not enough to control.

Heart failure treatment:

Patients with heart failure or asymptomatic left ventricular disorders: Oral starting dose is 2.5 mg/day.

Patients use 2.5 mg x 2 times/day and increase gradually until the tolerance to the daily maintenance dose of 20 mg (divided into several times).

Adjust the dose in patients with heart failure and kidney failure or hypoglycemia:

In patients with heart failure (sodium sodium 1.6 mg/dL, the starting dose of 2.5 mg/day should be under close medical monitoring. The dose may be increased to 2.5 mg x 2 times/day, 5 mg x 2 times/day and higher if necessary, usually the adjustment of this dose may be conducted for 4 days or longer if there is no excessive hypotension or severe impaired kidney function. The maximum dose is 40 mg/day.

Children:

Clinical test data on the use of enalapril in hypertension is limited. The initial recommended dose is 2.5 mg for children from 20 kg to ≤ 50 kg and 5 mg for children with severe children ≥ 50 kg. Enalapril drink once a day. Dosage should be adjusted according to the response of children to a maximum of 20 mg daily for children from 20 kg to What to do when overdose?

Enalaprilat is eliminated from the general circulatory system by hemolysis.

What to do when you forget the dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Do not drink twice as prescribed.

Side Effects

Side effects are usually mild and transient, but about 3% -6% of drug users have to stop treatment.

There was a sign that hypotension is quite severe after taking the first Enalapril dose; Up to 2–3% of people in clinical trials have to stop treatment, especially for people with heart failure, sodium hypoglycemia, and for the elderly treated simultaneously with diuretics.

In people with congestion often appears symptomatic blood pressure, bad kidney function and increases the concentration of serum potassium, especially during the first time using Enalapril in the person treated simultaneously with diuretics.

Satisfactory kidney function (hyperemia and increased serum creatinine levels) have occurred in about 20% of people with hypertension due to kidney disease, especially in people on both sides of the kidney artery or kidney stenosis in people with single kidneys (one kidney).

Common (1/100

Neurological: headache, dizziness, fatigue, insomnia, abnormalities, sympathy. In tissue or prostaglandin in the lungs, other

: Renal failure.

Hematology: Hemoglobin and hematocrite, granulocytes, neutrophils.

digestive: gastrointestinal obstruction, pancreatitis, cholestatic hepatitis, increased oral leprol.

When starting treatment, low -dose drugs should be used and checked serum sodium levels. Evaluation may occur, especially after the first enalapril dose, and if there is an additional laryngeal edema can be fatal.

It is necessary to notify the patient about the signs and symptoms of the angioedema (edema, lip eyes or half or shortness of breath) when this symptom must stop taking the drug and immediately notify the doctor. Treatment of angioedema in the tongue, bar or larynx, including the following measures:

stop using enalapril and give patients admitted to the subcutaneous adrenalin injection hospital, intravenously diphendramin hydrochloride; Hydrocortison intravenous injection. Other. Enalapril usually does not affect serum potassium concentration. If using enalapril along with the diuretic may reduce the risk of secondary release of aldosteron along with hypotension in kidney failure, enalapril can cause increased serum potassium level.

Therefore, it is not recommended to use potassium diuretics and potassium supplements for patients with impaired renal function because it can increase potassium. If you still need to be treated simultaneously with the diuretic, it is very careful and regularly measuring potassium. It is necessary to measure blood creatinine before starting medication treatment for patients with suspected kidney stenosis.

In major surgery or during drug anesthesia, which has the effect of lowering blood pressure, Enalapril can prevent Angiotensin II, causing release of clearing renin leading to hypotension, which should be adjusted by increasing volume of circulatory (by infusion).

Warnings

Before using Enalapril 5mg Stella you need to read the instructions carefully and refer to the information below.

Contraindicated

Enalapril 5mg Stella is contraindicated in the following cases:

Hypersensitivity to the drug or any ingredient in the formula. pregnancy 3 months and last 3 months of pregnancy.

Be cautious when taking drugs

Dual inhibitors of the renin-Anotensin-aldosteron (RAA):

There is evidence that the simultaneous use of ACE inhibitors, Angiotensin II or Aliskiren receptor blockers increases the risk of hypotension, hyperkalemia and impaired renal function (including acute renal failure). Double inhibition of Raa system by using a combination of ACE inhibitors, Angiotensin II receptor blockers or Aliskiren junior high schools are not recommended.

If this treatment is necessary, when treatment must regularly monitor kidney function, electrolyte and blood pressure closely. ACE inhibitors, hoto receptor blockers Angiotensin II should not be used simultaneously on patients with diabetes kidney disease.

Hypotension with symptoms: Hypotension has very rare symptoms in patients with uncomplicated hypertension.

In patients with enalapril hypertension, it is easy to tend to have symptoms of hypotension if the patient has a decrease in a circulatory volume, such as diuretics, a diet that limits salt, fertilizer, diarrhea or vomiting. Symptoms of blood pressure have been seen in patients with heart failure with or without kidney failure.

This is more likely to occur in patients with worse heart failure, due to high doses of dosage, reduced blood sodium or kidney failure. These patients should start treatment under medical monitoring and patients must be monitored to adjust the enalapril dose and or diuretics. Similar notes can be applied to patients with myocardial ischemia or cerebrovascular disease, because of excessive lower blood pressure on these patients can lead to myocardial infarction or stroke.

If hypotension occurs, patients should lie on their backs and if necessary, intravenously salted salt solution. A transient hypotension is not contraindicated for continuing treatment and there is often no problem when using the next dose once the blood pressure has increased after adequate compensation.

Some patients with heart failure have normal blood pressure or low blood pressure, when using enalapril may cause blood pressure to lower. This effect is known and often not the reason for stopping treatment. If the hypotension has symptoms, the dose can be reduced and/or stop diuretics and/or enalapril.

Aortic stenosis or myocardial micro -valve: Like other vasodilators, caution should be used with ACE inhibitors for patients with valve obstruction and output of left ventricular ventricular and avoiding use in case of cardiova shock and significant hemorrhagic obstruction.

Renal failure: In case of patients with renal failure (creatinine clearance

There has been a report on renal failure when taking enalapril in patients with severe heart failure or kidney disease, including kidney artery stenosis. If detected and adjusted promptly, the renal failure due to the use of Enalapril can be restored.

Some patients with hypertension without the manifestation of kidney disease have progressed to increased urea and blood creatinin when taking enalapril with diuretics. Reduce Enalapril and/or diuretics. This condition may be worse if the patient has renal artery stenosis.

Hypergank hypertension due to kidney blood vessels: For patients with kidney stenosis on both sides or one side, there is only one kidney, the risk of hypotension and renal failure when treated with a higher ACE inhibitors. Loss of kidney function can occur with only small changes in serum creatinine.

In these patients, it is recommended to start treatment under close medical supervision with low doses, careful dose adjustments and kidney function monitoring.

Kidney transplantation: Inexperienced in using enalapril for new kidney transplant patients. Therefore, it is not recommended to use Enalapril 5mg Stella for kidney transplants.

Hepatic failure: Rarely treat ACE inhibitors causing jaundice syndrome or hepatitis and progress to liver necrosis, sometimes death. The mechanism of the above syndrome has not been clarified. While treating with this group of drugs, if there is an increased jaundice or liver enzyme, it is advisable to stop the drug and have appropriate medical monitoring.

Neutral leukemia/ grain leukemia: neutropenia, grain leukemia, platelet reduction, anemia that has been reported in patients treated with ACE inhibitors. In patients with normal renal function and no other complex factors, neutrophils rarely occur.

Enalapril is used cautiously in patients with vascular collagen, immunosuppressive treatment, Allopurinol or Procainamid treatment, or combining these factors, especially for patients with previous impaired renal function. In a HPE in several cases that do not respond to the treatment of antibiotics, some patients have progressed serious infections. When using Enalapril for these patients, they should monitor the amount of leukocytes periodically and guide patients to recognize infections early.

Hypersensitivity/ angioedema: edema on the face, limbs, lips, tongue, subjects and larynx rare in patients treated with ACE inhibitors, including Enalapril. Hypersensitivity can occur at any time during treatment. When hypersensitivity occurs during treatment, the enalapril should be stopped, monitoring until the symptoms disappear completely. Even in the case of only tongue edema, there is no sign of shortness of breath, still having to monitor carefully and long term patients because of antihistamine and corticosteroid therapy may not be effective. Patients with a history of angioedema are not related to ACE inhibitors may have a high risk of angioed with an ace inhibitor.

Anaphylaxis reactions in the process of hypersensitivity to Hymenoptera insects: Rarely patients with ACE inhibitors are threatened by anaphylaxis, while treating hypersensitivity to Hypenoptera venom. Have avoided these reactions when temporarily suspended the treatment of ACE inhibitors before each sensitivity.

Anaphylaxis reactions during the LDL classification process: Some patients who use ACE inhibitors in the process of classifying LDL with Dextran Sulfate may occur in a life -threatening response, although these cases rarely occur. It is possible to eliminate these reactions by suspending the use of ACE inhibitors before each appraisal.

Patients with hemolysis: Anaphylactic reactions have been recorded in patients who are fertilized with high absorbent filters and treated at the same time with an ACE inhibitor. In these patients, it is recommended to use another type of fertilizer membrane or another group of hypotension.

Hemorrhage reduction: When starting to use ACE inhibitors for patients with diabetes treated with an oral diabetes or insulin, it is necessary to let patients know how to closely monitor blood glucose, especially in the first month when they start using combining.

cough: cough has been recorded when using ACE inhibitors. Typically, dry cough, prolonged and will end when the drug is stopped. It should be noted to the cough reaction due to the use of ACE inhibitors when diagnosed distinct from coughing diseases.

Surgery/anesthesia: In patients undergoing a major surgery or during anesthesia with anesthesia, it has the effect of lowering blood pressure, enalapril prevents the formation of angiotensin II, causing clearing offspring. If hypotension occurs and is thought to be due to this mechanism, can be treated by increased volume.

The ability to drive and operate machinery

Use the medication cautiously when driving or operating machinery because occasionally stunned and tired.

Pregnancy

When taking drugs for pregnant women in the middle of the three months and at the end of pregnancy, ACE inhibitors can be dangerous even causing death in the growing fetus. Should stop taking the drug as soon as you find pregnancy.

Breastfeeding period

Enalapril and Enalaprilat are excreted through breast milk. Because Enalapril can cause serious reactions in breastfed babies, consider mothers to stop taking medication or stop breastfeeding.

Medicinal interaction

Interaction of drugs

Excessive hypotension may occur when used with diuretics, other anti -hypertension drugs or other hypotension agents such as alcohol.

The phenomenon of hyperkalemia can occur in patients taking ACE inhibitors with diuretics that keep potassium, potassium supplements (including salt -containing salt substitutes) or other drugs that cause hyperkalemia (such as cyclosporin or indomethacin), so monitoring of serum potassium levels.

Unwanted effects on the body of ACE inhibitors can increase when used with other drugs that affect kidney function such as nonsteroidal anti -inflammatory drugs.

Lithi: Lithi toxicity has been reported in patients using lithium simultaneously with sodium elimination drugs such as ACE inhibitors. Should monitor serum lithium concentration regularly if used enalapril with lithium.

Use Enalapril simultaneously with sympathetic bronchodilators, nonsteroidal anti -inflammatory drugs (NSAID) can reduce the hypotension effect of enalapril. Use Enalapril simultaneously with oral contraceptives that increase the risk of vascular lesions and difficult to control blood pressure.

In the cavalry of the drug

Due to the absence of studies on the correlation of the drug, not mixing this drug with other drugs.

Storage

Store in closed packaging, dry place. The temperature does not exceed 30 ° C.

To be out of reach of children.

Expiry date: 36 months from the date of manufacture.

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