Primary arterial hypertension.
1 tablet per day, mainly in the morning (before breakfast for ≥15 minutes).
Hypersensitivity to any active pharmaceutical ingredient, any ACE inhibitor or dihydropyridine calcium antagonist, or any other component of the drug; angioedema (idiopathic, hereditary or transferred in connection with the use of ACE inhibitors); pregnancy or its planning; combined use with drugs containing aliskiren against the background of diabetes mellitus or impaired renal function (GFR 60 ml / min / 1.73 m2); obstruction of the outflow of blood from the left ventricle; heart failure in the systemic circulation (in patients who have not received treatment for this reason); angina pectoris (unstable form); previous myocardial infarction (within 1 month); severe renal dysfunction (creatinine clearance 30 ml / min), also in patients receiving hemodialysis treatment; severe liver dysfunction; combined use of cyclosporine, strong inhibitors of syp 3a4, grapefruit juice.
Decrease in the level of hemoglobin, platelets (150⋅109/l); hypersensitivity; increase in the content of potassium in the blood; anxiety; cephalgia and dizziness (including postural), tinnitus; increased heart rate (90 bpm), palpitation; decrease in blood pressure (90/60 mm Hg), insufficientia vascularis; cough, dryness, sore throat; abdominal pain, nausea, constipation, dyspeptic manifestations, swelling of the lips, speech disorders, xerostomia, diarrhea, inflammation of the gum mucosa; increased activity of aminotransferases; angioedema, facial edema, dermatitis, rashes, urticaria; arthralgia; pollakiuria, the predominance of the night part of diuresis over the day part, increased urine output; impotence; weakness, fatigue, peripheral edema, feeling of heat.
Koripren 20 mg/10 mg is not used for initial therapy of hypertension.
Therapy of elderly patients is determined by the functional state of the kidneys.
Caution is required at the start of therapy in patients with mild to moderate hepatic or renal insufficiency.
C caution is prescribed to patients with coronary artery disease or with cerebrovascular pathology (excessive decrease in blood pressure can cause stroke or myocardial infarction), as well as Short's syndrome without an implanted pacemaker and in patients with left ventricular dysfunction.
Secondary hypotension in the treatment of enalapril is possible in patients with heart failure. Medical supervision is required in patients with severe heart failure against the background of a decrease in the content of sodium in the blood, disorders of renal function, or therapy with high doses of loop diuretics (risk of secondary hypotension).
With a decrease in BCC in hypertensive patients taking enalapril, the likelihood of developing secondary hypotension increases.
If secondary hypotension develops, dose reduction or withdrawal of diuretics and/or enalapril may be required.
In patients with impaired renal function of mild or moderate degree, constant monitoring of the content of creatinine and potassium in the blood plasma is required. An increase in the content of creatinine and potassium in the blood plasma can occur in a number of patients with hypertension who do not have a history of kidney pathology, against the background of the use of a diuretic in combination with enalapril.
Against the background of taking enalapril, the development of renal failure is possible (usually in patients with kidney pathology or with severe impairment of cardiac function), which is reversible when the drug is discontinued.
Scrupulous supervision by the doctor of patients with a stenosis is required. renalis (bilateral or a single functioning kidney) treated with ACE inhibitors, due to the likelihood of impaired renal function or a decrease in blood pressure (90/60 mm Hg. Art.). Treatment begins with low doses with a gradual increase against the background of control of renal function.
Coripren should not be taken by patients after kidney transplantation.
Patients with diabetic nephropathy should not take ACE inhibitors in combination with aliskiren.
If it is necessary to use ACE inhibitors in combination with aliskiren or angiotensin II antagonists, medical supervision and rigorous monitoring of blood pressure, electrolytes in blood plasma, and renal functions are required.
It is possible to enhance the antihypertensive effect of lercanidipine in patients with hepatic impairment. The use of ACE inhibitors is stopped in patients with an increase in the activity of aminotransferases or the development of jaundice.
With caution, enalapril is prescribed to patients with collagenosis (with damage to the vascular system) receiving immunosuppressant therapy, procainamide or allopurinol (regular monitoring of the leukogram and alertness to the development of infectious diseases is required).
The likelihood of angioedema in the background of the use of an ACE inhibitor increases in patients with angioedema (not associated with the use of drugs in this group) in history.
In rare cases, it is possible to develop anaphylactoid reactions against the background of the use of ACE inhibitors in combination with desensitizing therapy (insect venom) or LDL apheresis (dextran sulfate).
Patients receiving ACE inhibitors may experience cough.
At the beginning (1st month) of therapy with ACE inhibitors in diabetic patients receiving insulin or hypoglycemic drugs per os, rigorous monitoring of glycemia is required.
In the case of a decrease in blood pressure 90/60 mm Hg. Art. when conducting a major surgical intervention or using anesthetics that reduce blood pressure, measures are taken to increase the BCC.
When using ACE inhibitors, hyperkalemia may develop. Regular monitoring of the content of potassium in the blood plasma is required if necessary, the combined use of enalapril with potassium-sparing diuretics, dietary supplements or salt substitutes containing potassium.
The hypotensive effect of enalapril is reduced in representatives of the Negroid race compared to Caucasians.
Due to the content of lactose, the drug is contraindicated in patients with galactosemia, lactase deficiency or glucose-galactose malabsorption syndrome.
The use of calcium antagonists can cause reversible changes in spermatozoa and, accordingly, disruption of the fertilization process.
With the development of pregnancy in patients receiving Koripren, the drug is immediately canceled.
Coripren is not used during breastfeeding.
Persons driving vehicles or operating other mechanisms while taking Coripren should take into account the likelihood of fatigue, weakness, dizziness, drowsiness.
Interactions
Only studied in adults.
It is possible to enhance the antihypertensive effect of the drug when combined with other antihypertensive drugs.
The combined use of enalapril maleate with other ACE inhibitors, aliskiren, angiotensin II receptor antagonists increases the likelihood of side effects (decrease in blood pressure 90/60 mm Hg, increased levels of potassium in the blood, impaired renal function).
The excretion of potassium from the body, caused by the use of diuretics, is reduced by the use of ACE inhibitors. The use of potassium-sparing diuretics, dietary supplements with potassium or substances containing salts of this macronutrient in combination with enalapril maleate can lead to hyperkalemia.
The combined use of diuretics (loop or thiazide series) at the beginning of enalapril therapy can cause a decrease in BCC and increase the likelihood of a decrease in blood pressure (90/60 mm Hg. Art.).
The combined use of enalapril maleate with vasodilators (including nitroglycerin preparations, other nitrates) may enhance the hypotensive effect.
Enalapril maleate should not be used in combination with lithium preparations due to an increase in blood levels and, accordingly, the toxicity of the latter. If necessary, the use of this combination requires rigorous monitoring of the content of lithium in the blood plasma.
In rare cases, patients who received sodium aurothiomalate injections and concomitant treatment with ACE inhibitors (including enalapril) experienced vasomotor reactions.
Combined use with inhibitors of the mTOR kinase enzyme may increase the likelihood of developing angioedema.
The antihypertensive effect of ACE inhibitors is potentiated by alcohol, antipsychotics, as well as drugs used for anesthesia, and tricyclic antidepressants.
The antihypertensive effect of ACE inhibitors is reduced when combined with indirect agonists, NSAIDs.
The combination with NSAIDs also contributes to an increase in the content of potassium in the blood and possible impaired renal function (rarely - AKI).
The likelihood of hyperglycemia increases when ACE inhibitors are combined with hypoglycemic drugs, especially at the start of such therapy and in patients with impaired renal function.
Do not use lercanidipine in combination with strong CYP3A4 inhibitors, cyclosporine, or grapefruit juice.
Lercanidipine should be used with caution in combination with other CYP3A4 substrates.
In view of the possible decrease in the hypotensive effect when lercanidipine is combined with CYP 3A4 inducers (rifampicin, anticonvulsants), their simultaneous use requires more frequent monitoring of the patient's blood pressure.
Due to the increased hypotensive effect, the combined use of lercanidipine with alcohol is not recommended; for the same reason, caution is required when combined with cimetidine at a dose of 800 mg / day (the bioavailability of lercanidipine increases).
The absorption of lercanidipine is increased (with a simultaneous slowdown in its rate) when combined with midazolam at a dose of 20 mg in the elderly.
In the case of simultaneous use of lercanidipine with digoxin, rigorous monitoring of the clinical manifestations of the toxic effect of digoxin is necessary.
Overdose
Excessive use of enalapril is manifested by a decrease in blood pressure (90/60 mm Hg. Art.) Approximately 6 hours after administration and the development of stupor. when taking an excessive dose of ACE inhibitors, vascular shock, electrolyte imbalance, kidney function, hyperventilation, increased heart rate (90 beats / min) or a decrease in heart rate (60 beats / min), palpitations, dizziness, anxiety and cough can be noted.
An intravenous infusion of 0.9% NaCl solution is carried out. In the case of a decrease in blood pressure (90/60 mm Hg), give the patient an anti-shock position of the body; administered intravenously catecholamines or angiotensin II. With a recent intake, artificial vomiting is induced, gastric lavage is performed, adsorbents and Na2SO4 are prescribed. In the case of a treatment-resistant decrease in heart rate (60 bpm), a pacemaker is used. Effective hemodialysis. It is necessary to constantly monitor the content of creatinine and electrolytes in the blood plasma, indicators of the functions of vital organs and systems.
Excessive use of lercanidipine may manifest as an excessive vasodilating effect in the peripheral vasculature with a significant decrease in blood pressure (90/60 mm Hg) and a reflex increase in heart rate (90 bpm).
It is advisable to use intravenous atropine. Dialysis is ineffective. It is recommended to monitor the patient's condition for 1 day.
Storage conditions
In a place inaccessible to children, at a temperature of ≤25 ° C in the original packaging.