Антигипертензивный препарат, ингибитор АПФ. Механизм действия эналаприла связан с угнетением активности АПФ, который уменьшает образование ангиотензина II, способствующего сужению кровеносных сосудов, и одновременно активирует образование кининов и простациклина, обладающих сосудорасширяющим действием. Эналаприл относится к пролекарствам, после его гидролиза в организме образуется эналаприлат, который и ингибирует указанный фермент. Эналаприл оказывает также некоторый диуретический эффект, связанный с умеренным угнетением синтеза альдостерона. Наряду со снижением АД, препарат уменьшает пред- и постнагрузку на миокард при сердечной недостаточности, улучшает кровообращение в малом круге и функцию дыхания, снижает сопротивление в сосудах почек, что способствует нормализации в них кровообращения.
Показания к применению
Различные формы артериальной гипертензии (в т.ч. реноваскулярная)
Хроническая сердечная недостаточность (в составе комбинированной терапии)
Противопоказания
Ангионевротический отек, связанный с применением ингибиторов АПФ (в анамнезе)
Прогрессирующая азотемия при двустороннем стенозе почечных артерий или стенозе артерии единственной почки
Детский возраст
Беременность
Лактация (грудное вскармливание)
Повышенная чувствительность к эналаприлу и другим компонентам препарата
Повышенная чувствительность к другим ингибиторам АПФ
Применение при беременности и в период грудного вскармливания
Рениприл противопоказан при беременности и в период лактации.
Способ применения и дозы
Рениприл назначают внутрь независимо от приема пищи. При лечении эссенциальной артериальной гипертензии начальная доза Рениприла составляет 10-20 мг/сут. В дальнейшем дозу подбирают индивидуально. При умеренной артериальной гипертензии достаточно дозы 10 мг/сут. Максимальная суточная доза – 80 мг. При реноваскулярной гипертензии Рениприл назначают в меньших дозах. Начальная доза обычно составляет 5 мг/сут, затем дозу подбирают индивидуально. Максимальная доза составляет 20 мг/сут. При сердечной недостаточности Рениприл назначают, начиная с 2.5 мг, затем дозу постепенно увеличивают до 10-20 мг (1-2 раза/сут). Длительность лечения зависит от эффективности терапии. Во всех случаях при слишком выраженном снижении АД дозу препарата постепенно снижают. Препарат применяют как при монотерапии, так и в комбинации с другими антигипертензивными препаратами. У пациентов с нарушениями функции почек следует уменьшить разовую дозу или увеличить интервалы между приемами.
Побочное действие
Со стороны ЦНС и периферической нервной системы: 2-3% - головная боль, головокружение, повышенная утомляемость . редко (при применении в высоких дозах) – бессонница, нервозность, депрессия, нарушение равновесия, парестезии, шум в ушах. Со стороны сердечно-сосудистой системы: менее 2% - артериальная гипотензия, обмороки . редко – аритмии, стенокардия. Со стороны пищеварительной системы: менее 2% - тошнота, диарея . в отдельных случаях – панкреатит, печеночная недостаточность, диспепсия. Аллергические реакции: менее 2% - кожные высыпания . в отдельных случаях – ангионевротический отек (лица, гортани). Со стороны дыхательной системы: сухой кашель, одышка. Со стороны лабораторных показателей: менее 2% - протеинурия, гиперкалиемия, повышение активности печеночных трансаминаз, повышение концентрации билирубина в крови, нейтропения. Прочие: редко (при применении в высоких дозах) – глоссит, выпадение волос, приливы, импотенция . у пациентов с аутоиммунными заболеваниями – агранулоцитоз. Рениприл в целом хорошо переносится и в большинстве случаев не вызывает побочных реакций, требующих отмены препарата.
Особые указания
Со стороны ЦНС и периферической нервной системы: 2-3% - головная боль, головокружение, повышенная утомляемость . редко (при применении в высоких дозах) – бессонница, нервозность, депрессия, нарушение равновесия, парестезии, шум в ушах. Со стороны сердечно-сосудистой системы: менее 2% - артериальная гипотензия, обмороки . редко – аритмии, стенокардия. Со стороны пищеварительной системы: менее 2% - тошнота, диарея . в отдельных случаях – панкреатит, печеночная недостаточность, диспепсия. Аллергические реакции: менее 2% - кожные высыпания . в отдельных случаях – ангионевротический отек (лица, гортани). Со стороны дыхательной системы: сухой кашель, одышка. Со стороны лабораторных показателей: менее 2% - протеинурия, гиперкалиемия, повышение активности печеночных трансаминаз, повышение концентрации билирубина в крови, нейтропения. Прочие: редко (при применении в высоких дозах) – глоссит, выпадение волос, приливы, импотенция . у пациентов с аутоиммунными заболеваниями – агранулоцитоз. Рениприл в целом хорошо переносится и в большинстве случаев не вызывает побочных реакций, требующих отмены препарата.
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