Eneas 30 tablets — Made in Spain — Free Delivery
(Eneas )
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Description Eneas 30 tablets — Made in Spain — Free Delivery
Indications
Treatment of hypertension in patients requiring combination therapy.
Application
The recommended dose for adults and elderly patients is 1 tablet per day. Swallow the tablets whole, without breaking or chewing, with plenty of water.
The duration of treatment is determined individually by the doctor, depending on the indications and the severity of the disease.
Contraindications
Hypersensitivity to the components of the preparation; a history of angioedema caused by any ACE inhibitor; hereditary or idiopathic angioedema; ii-iii trimester of pregnancy; a state with unstable hemodynamics after acute cerebrovascular accident and acute myocardial infarction; renal artery stenosis (bilateral or unilateral); stenosis of the aorta or mitral valve with severe hemodynamic disturbance, hypertrophic cardiomyopathy; severe violations of the liver and / or kidneys (creatinine clearance 10 ml / min), during hemodialysis; childhood.
Side effects
The following adverse reactions have occurred due to the use of Eneas. often (1-10%) - hot flashes, swelling, headache, cough. infrequently (0.1-1%) - dizziness, tachycardia, skin rash, nausea, dyspepsia, arterial hypotension. very rarely (0.01%), including isolated cases - asthenia, hypothermia, palpitation, peripheral ischemia, hematuria, pharyngitis, tracheitis, dyspnea, bloating, elevated liver enzymes, hypokalemia, drowsiness, paresthesia, tremor and convulsions.
The following are the side effects that may occur as a result of monotherapy with one of the active substances
Enalapril
From the side of the cardiovascular system. Infrequently - arterial or orthostatic hypotension with such symptoms: dizziness, weakness, blurred vision. Rarely - syncope (especially at the beginning of treatment, in patients with heart failure, severe renal failure and with increasing doses). Very rarely - in isolated cases due to a sudden drop in blood pressure - tachycardia, palpitation, arrhythmia, bradycardia, atrial fibrillation, chest pain, angina pectoris, myocardial infarction, stroke, pulmonary embolism, pulmonary infarction, pulmonary edema.
From the side of the kidneys and urinary system. Infrequently - the occurrence or exacerbation of impaired renal function. Rarely - oliguria, proteinuria, in patients with impaired renal function, pain in the lumbar region may occur. Very rarely - OPN.
From the respiratory system. Infrequently - dry cough, sore throat, hoarseness, bronchitis. Rarely - dyspnea, sinusitis, rhinitis. Very rarely - in isolated cases, bronchospasm / asthma, pulmonary infiltrates, stomatitis, glossitis, dry mouth, pneumonia, angioedema involving the pharynx, larynx or tongue, which in some cases can cause airway obstruction (risk group - patients of the Negroid race) .
From the digestive tract. Infrequently - nausea, abdominal pain, indigestion. Rarely - vomiting, diarrhea, constipation, dyspepsia, loss of appetite. Very rarely - in isolated cases, liver dysfunction, hepatitis, liver failure, intestinal obstruction, stomatitis, glossitis, symptoms of cholestatic jaundice with the possibility of progression, up to the development of hepatonecrosis.
From the endocrine system. Very rarely - gynecomastia.
From the side of the nervous system. Infrequently - headache, fatigue. Rarely - dizziness, sleep disturbance, depression, impotence, peripheral neuropathy with paresthesia, imbalance, muscle cramps, nervousness, confusion.
From vessels and skin. Infrequently - allergic skin reactions (exanthema). Rarely - itching, skin rash, urticaria, angioedema, spreading to the lips, face and limbs. Very rarely - severe forms of skin reactions (pemphigus, erythema multiforme, exfoliative dermatitis, malignant exudative erythema or toxic epidermal necrosis), photosensitivity, increased sweating, alopecia, onycholysis and exacerbation of Raynaud's disease. Skin disorders may be accompanied by fever, myalgia, arthritis, vasculitis, serositis, eosinophilia, leukocytosis, elevated ESR and antinuclear bodies.
From the sense organs. Rarely - ringing in the ears, blurred vision, change in taste sensations or short-term loss of taste, loss of smell, dry eyes, tearing.
Changes in laboratory parameters. Infrequently - a decrease in hemoglobin, hematocrit, a decrease in the number of leukocytes and platelets. Rarely - in patients with impaired renal function, collagenosis or receiving allopurinol, procainamide or immunosuppressants: anemia, thrombocytopenia, neutropenia, eosinophilia (in isolated cases - agranulocytosis, pancytopenia); in patients with impaired renal function, severe heart failure, renovascular hypertension: an increase in the concentration of urea, creatinine, potassium in the blood plasma, a decrease in the concentration of sodium, hyperkalemia (in patients with diabetes mellitus), increased excretion of albumin in the urine. In isolated cases, hemolytic anemia, an increase in the concentration of liver enzymes and bilirubin were recorded.
Nitrendipine
From the side of the cardiovascular system. Infrequently - arrhythmia, tachycardia, palpitation, peripheral edema, hot flashes, vasodilation. Very rarely - arterial hypotension, angina pectoris, chest pain.
From the gastrointestinal tract. Infrequently - nausea, diarrhea. Rarely - abdominal pain, constipation, dyspepsia, vomiting. Very rarely - hypertrophic gingivitis.
From the endocrine system. Very rarely - gynecomastia.
From the side of blood. Very rarely - leukopenia, agranulocytosis.
From the side of the nervous system. Infrequently - headache. Rarely - nervousness, paresthesia, tremor, dizziness.
From the respiratory system. Rarely - dyspnea.
From the musculoskeletal system. Rarely - itching, skin rash, urticaria, myalgia.
From the sense organs. Rarely - visual impairment.
From the urinary system. Very rarely - increased frequency of urination, polyuria.
Changes in laboratory parameters. In isolated cases, an increase in the concentration of liver enzymes was recorded.
special instructions
During the period of use of ACE inhibitors, especially at the beginning of treatment and with long-term therapy, angioedema may occur in some cases. patients should immediately inform the doctor in case of any symptoms indicating angioedema (swelling of the face, limbs, eyes, lips, tongue, difficulty breathing or swallowing) and immediately stop taking the preparation. angioedema, accompanied by swelling of the larynx, can be fatal. careful observation of the patient's condition is necessary in order to control clinical symptoms, stopping observation only after they disappear. in patients taking ACE inhibitors, there have been cases of neutropenia, thrombocytopenia and anemia. patients at risk (renal failure, collagenosis, treatment with immunosuppressants, allopurinol, procainamide) should use the preparation with caution and monitor laboratory parameters. persons with renal insufficiency need to monitor kidney function, especially in the first weeks of taking ACE inhibitors. patients with moderate renal insufficiency (creatinine clearance 30 ml / min; plasma creatinine 3 mg / ml) do not need dose adjustment. in some patients, arterial hypotension occurs at the beginning of treatment with ACE inhibitors, which may contribute to an additional decrease in renal function. in these cases, attacks of acute renal failure are observed, which are usually reversible.
There are no data on the use of Eneas in recent kidney transplant patients. In individuals with renal insufficiency, proteinuria may occur in isolated cases. Patients with proteinuria (1 g / day) should use the preparation after a thorough assessment of the benefit / risk ratio and under the control of clinical laboratory parameters.
It is necessary to use the preparation with caution in patients with mild to moderate hepatic insufficiency, since there is not enough experience in the use of combination therapy. Patients with severe hepatic insufficiency taking the preparation is contraindicated. In the elderly, due to a decrease in liver function, the excretion of nitrendipine may slow down, which can lead to arterial hypotension. In the event of manifestations of side effects from the liver (cholestatic jaundice, increased liver enzymes), which can lead to hepatonecrosis, it is necessary to stop therapy with the preparation and consult a doctor.
When treated with ACE inhibitors in patients with renovascular hypertension and renal artery stenosis (bilateral or unilateral), the risk of arterial hypotension and renal failure is significantly increased, which can lead to impaired renal function.
ACE inhibitors can cause an increase in potassium levels, especially in patients with heart and kidney failure. Combination therapy with potassium-sparing diuretics and dietary supplements containing potassium is not recommended. If necessary, this combination therapy should monitor the concentration of potassium in the blood plasma.
Eneas can cause orthostatic hypotension in some cases. Patients should be examined to identify and eliminate clinical signs of fluid and electrolyte imbalance due to the use of diuretics, a low-salt diet, hemodialysis, diarrhea or vomiting. As with the use of other antihypertensive agents, some patients may develop symptomatic hypotension, which disappears after the patient takes a horizontal position and corrects blood pressure and bcc levels. Particular attention should be paid to the treatment of patients with coronary artery disease or cerebrovascular disease, since an excessive decrease in blood pressure can lead to the development of myocardial infarction or stroke. Rapidly passing arterial hypotension with a restored level of blood pressure and BCC is not a contraindication for treatment with Eneas. ACE inhibitors should be used with caution in patients with left ventricular outflow tract obstruction. With severe hemodynamic disorders, the preparation should not be used (see CONTRAINDICATIONS).
There have been cases of cough during therapy with ACE inhibitors. Usually, the cough is unproductive, persistent and stops after the preparation is discontinued. Patients with primary aldosteronism are usually resistant to therapy with antihypertensive agents that act on the renin-angiotensin-aldosterone system, and therefore the use of this preparation is not recommended.
Due to the increased risk of anaphylactic reactions, the preparation should not be prescribed to patients on hemodialysis using high-throughput polyacrylonitrile membranes (such as AI 69®) or plasmapheresis using dextran sulfate, as well as to patients during hyposensitization with hymenoptera venom allergen.
During major surgery or during anesthesia with preparations that increase blood pressure, the preparation blocks the formation of angiotensin II secondary to compensatory renin release. If at the same time arterial hypotension develops, it is corrected by increasing the volume of fluid.
In isolated cases, nitrendipine can cause reversible biochemical changes in the head of spermatozoa during artificial insemination, which can affect the functional state of sperm.
The preparation is less effective in lowering blood pressure in patients of the Negroid race. Patients with rare hereditary disorders of glucose-galactose absorption, Lapp lactase deficiency should not use the preparation.
During pregnancy and breastfeeding. Experience with Eneas in the first trimester of pregnancy is limited. During pregnancy, you should stop taking the preparation, except in cases where continued use of the preparation is vital for the woman. Eneas is contraindicated in the II and III trimester of pregnancy. The use of ACE inhibitors during this period adversely affects the fetus and newborn, causing renal failure, arterial hypotension, hyperkalemia, hypoplasia of the skull bones, and the likely development of oligohydramnios. If the appointment of the preparation during pregnancy is unavoidable, it is necessary to monitor the development of the fetus using ultrasound of the function of the kidneys and bones of the skull.
Enaprilat passes into breast milk in trace amounts, therefore, during the period of breastfeeding, the child is monitored in order to identify side effects. Mothers should not use the preparation during breast-feeding of premature babies and in the first few weeks after the birth of the baby.
Children. Clinical data on the efficacy and safety of the preparation for the treatment of children are not available, so it is not prescribed to this age group of patients.
The ability to influence the reaction rate when driving vehicles or working with other mechanisms. In individual cases, at the beginning of treatment and when changing the preparation, as well as when interacting with alcohol, the ability to drive vehicles or work with complex mechanisms may be reduced.
Interactions
The hypotensive effect of Eneas is enhanced when used in combination with other antihypertensive preparations, in particular diuretics, β-adrenergic receptor blockers, α-adrenergic receptor blockers, such as prazosin.
Combinations of enalapril maleate with other agents that must be used with caution
When combined with potassium-sparing diuretics, potassium supplements and preparations that increase the level of potassium in the blood plasma (eg heparin), it is possible to increase the concentration of potassium in the blood plasma, especially in patients with impaired renal function. With the combined use of such preparations, it is necessary to control the concentration of potassium in the blood plasma.
When taken simultaneously with lithium preparations, a delay in the excretion of lithium from the body is likely and, accordingly, an increase in the risk of its side and toxic effects. In the case of such a combination, it is necessary to carefully monitor the level of lithium in the blood plasma. Therefore, their combined use is not recommended.
With simultaneous use with NSAIDs, it is possible to weaken the hypotensive effect of ACE inhibitors, an additional increase in the level of potassium in the blood plasma with a decrease in kidney function. In some patients with impaired renal function, concomitant use may lead to further deterioration of renal function. Enalapril may increase the hypoglycemic effect of oral antidiabetic agents, therefore it is necessary to control blood glucose levels.
Baclofen, amifostine enhance the hypotensive effect of the preparation. Blood pressure control and dose adjustment are necessary.
Simultaneous reception with neuroleptics or tricyclic antidepressants can lead to orthostatic arterial hypotension.
When used with allopurinol, cytostatics, immunosuppressants, systemic corticosteroids, procainamide, leukopenia may develop.
Combinations of nitrendipine with other agents that must be used with caution
Nitrendipine can increase the concentration of digoxin in the blood plasma when used concomitantly. It is necessary to control the level of digoxin in the blood plasma.
Nitrendipine may enhance the effect and duration of muscle relaxants such as pancuronium bromide.
Grapefruit juice inhibits the oxidative metabolism of nitrendipine, increasing the concentration of the latter in the blood plasma, as a result of which the hypotensive effect of Eneas is enhanced. Nitrendipine is metabolized in the intestinal mucosa and liver with the participation of the cytochrome P450 system. Preparations that stimulate this system, such as anticonvulsants (phenytoin, phenobarbital, carbamazepine) and rifampicin, can cause a significant decrease in the bioavailability of nitrendipine. Means that suppress this enzyme system, such as antifungal agents (itraconazole, etc.), increase the concentration of nitrendipine in the blood plasma. Nitrendipine and β-adrenergic blockers have a synergistic effect.
Overdose
To date, no overdose phenomena have been noted as a result of the use of Eneas. The most likely symptom of an overdose is arterial hypotension.
Treatment: primary detoxification - gastric lavage, administration of sorbents and / or sodium sulfate (during the first 30 minutes). In the case of arterial hypotension, the patient must be given a horizontal position and restore the water and electrolyte balance. With bradycardia, atropine is prescribed. In case of severe overdose, intravenous administration of catecholamines, angiotensin II and hemodialysis are possible. It is necessary to carefully monitor the concentration of creatinine and electrolytes in the blood plasma.
Storage conditions
At a temperature not higher than 25 °C.
Tags: Eneas
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