Эналаприл Таблетки, 20 шт, 10 мг, для взрослых

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Усиливает коронарный и почечный кровоток."}},{"type":"paragraph","data":{"text":"При длительном применении уменьшается гипертрофия левого желудочка миокарда и миоцитов стенок артерий резистивного типа предотвращает прогрессирование сердечной недостаточности и замедляет развитие дилатации левого желудочка. Улучшает кровоснабжение ишемизированного миокарда. Снижает агрегацию тромбоцитов."}},{"type":"paragraph","data":{"text":"Обладает некоторым диуретическим эффектом."}},{"type":"paragraph","data":{"text":"Время наступления гипотензивного эффекта при приеме внутрь - 1 ч достигает максимума через 4-6 ч и сохраняется до 24 ч. У некоторых больных для достижения оптимального уровня артериального давления необходима терапия на протяжении нескольких недель. 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Выводится эналаприл преимущественно почками - 60% (20% - в виде эналаприла и 40% - в виде эналаприлата) через кишечник - 33% (6% - в виде эналаприла и 27% - в виде эналаприлата)."}},{"type":"paragraph","data":{"text":"Удаляется при гемодиализе (скорость 62 мл/мин) и перитонеальном диализе."}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"- артериальная гипертензия"}},{"type":"paragraph","data":{"text":"- при хронической сердечной недостаточности (в составе комбинированной терапии)."}}]},{"id":9,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"Повышенная чувствительность к эналаприлу и другим ингибиторам АПФ наличие в анамнезе ангионевротического отека связанного с лечением ингибиторами АПФ порфирия беременность период лактации возраст до 18 лет (эффективность и безопасность не установлены)."}}]},{"id":10,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"С осторожностью применять при первичном гиперальдостеронизме двустороннем стенозе почечных артерий стенозе артерии единственной почки гиперкалиемии состоянии после трансплантации почки; аортальном стенозе митральном стенозе (с нарушениями гемодинамики) идиопатическом гипертрофическом субаортальном стенозе системных заболеваниях соединительной ткани ишемической болезни сердца цереброваскулярных заболеваниях сахарном диабете почечной недостаточности (протеинурия более 1 г/сут.) печеночной недостаточности у пациентов соблюдающих диету с ограничением соли или находящихся на гемодиализе при одновременном приеме с иммунодепрессантами и салуретиками у пожилых людей (старше 65 лет)."}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Назначают внутрь независимо от времени приема пищи."}},{"type":"paragraph","data":{"text":"При монотерапии артериальной гипертензии - начальная доза 10 мг 1 раз в сутки."}},{"type":"paragraph","data":{"text":"При отсутствии клинического эффекта через 2 недели дозу повышают на 10 мг. Через 2 часа после приема начальной дозы больные должны находиться в горизонтальном положении в течение 3-4 часов. При необходимости и достаточно хорошей переносимости дозу можно увеличить до 40 мг/сут в 2 приема."}},{"type":"paragraph","data":{"text":"Максимальная суточная доза препарата составляет 40 мг/сут."}},{"type":"paragraph","data":{"text":"В случае назначения пациентам одновременно получающим диуретики лечение диуретиком необходимо прекратить за 2-3 дня до назначения Эналаприла. Если это невозможно то начальная доза препарата должна составлять 25 мг/сут."}},{"type":"paragraph","data":{"text":"Больным с гипонатриемией (концентрация ионов натрия в сыворотке крови менее 130 ммоль/л) или концентрацией креатинина в сыворотке крови более 014 ммоль/л начальная доза - 25 мг 1 раз в сутки."}},{"type":"paragraph","data":{"text":"При реноваскулярной гипертензии начальная доза - 25 - 5 мг/сут. Максимальная суточная доза - 20 мг."}},{"type":"paragraph","data":{"text":"При хронической сердечной недостаточности начальная доза составляет - 25 мг однократно затем дозу увеличивают на 25 - 5 мг через каждые 3-4 дня в соответствии с клинической реакцией до обычной поддерживающей суточной дозы."}},{"type":"paragraph","data":{"text":"Подбор дозы должен проводиться в течение 2-4 нед. или в более короткие сроки. Средняя поддерживающая доза - 5 -20 мг/сут. за 1-2 приема."}},{"type":"paragraph","data":{"text":"У пожилых чаще наблюдается более выраженный гипотензивный эффект и удлинение времени действия препарата что связано с уменьшением скорости выведения эналаприла поэтому рекомендуемая начальная доза пожилым - 25 мг."}},{"type":"paragraph","data":{"text":"При хронической почечной недостаточности кумуляция наступает при снижении фильтрации менее 10 мл/мин. При клиренсе креатинина (КК) 80-30 мл/мин доза обычно составляет 5-10 мг/сут при КК до 30 -10 мл/мин - 2 5 - 5 мг/сут при КК менее 10 мл/мин - 125 - 25 мг/сут только в дни диализа."}},{"type":"paragraph","data":{"text":"Препарат применяют как в монотерапии так и в сочетании с другими антигипертензивными средствами."}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Эналаприл в целом хорошо переносится и в большинстве случаев не вызывает побочных действий требующих отмены препарата."}},{"type":"paragraph","data":{"text":"Со стороны сердечно-сосудистой системы: чрезмерное снижение АД ортостатический коллапс редко - загрудинная боль стенокардия инфаркт миокарда (обычно связаны с выраженным снижением артериального давления) крайне редко аритмии (предсердная бради- или тахикардия мерцание предсердий) сердцебиение тромбоэмболия ветвей легочной артерии."}},{"type":"paragraph","data":{"text":"Со стороны центральной нервной системы: головокружение головная боль слабость бессонница тревога спутанность сознания повышенная утомляемость сонливость (2-3%) очень редко при применении высоких доз - нервозность депрессия парестезии."}},{"type":"paragraph","data":{"text":"Со стороны органов чувств: нарушения вестибулярного аппарата нарушения слуха и зрения шум в ушах."}},{"type":"paragraph","data":{"text":"Со стороны пищеварительной системы: сухость во рту анорексия диспепсические расстройства (тошнота диарея или запор рвота боль в области живота) кишечная непроходимость панкреатит нарушение функции печени и желчевыделения гепатит желтуха."}},{"type":"paragraph","data":{"text":"Со стороны дыхательной системы: непродуктивный сухой кашель интерстициальный пневмонит бронхоспазм одышка ринорея фарингит."}},{"type":"paragraph","data":{"text":"Аллергические реакции: кожная сыпь зуд крапивница ангионевротический отек"}},{"type":"paragraph","data":{"text":"полиморфная эритема эксфолиативный дерматит синдром Стивенса-Джонсона токсический эпидермальный некролиз пемфигус фотосенсибилизация серозит васкулит миозит артралгия артрит стоматит глоссит."}},{"type":"paragraph","data":{"text":"Со стороны лабораторных показателей: гиперкреатининемия повышение содержания мочевины повышение активности \"печеночных\" ферментов гипербилирубинемия гиперкалиемия гипонатриемия. Отмечаются в некоторых случаях снижение"}},{"type":"paragraph","data":{"text":"гематокрита повышение СОЭ тромбоцитопения нейтропения агранулоцитоз (у больных с аутоиммунными заболеваниями) эозинофилия."}},{"type":"paragraph","data":{"text":"Со стороны мочевыделительной системы: нарушение функции почек протеинурия."}},{"type":"paragraph","data":{"text":"Прочие: алопеция снижение либидо приливы."}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"Симптомы: выраженное снижение АД вплоть до развития коллапса инфаркта миокарда острого нарушения мозгового кровообращения или тромбоэмболических осложнений судороги ступор."}},{"type":"paragraph","data":{"text":"Лечение: больного переводят в горизонтальное положение с низким изголовьем. В легких случаях показаны промывание желудка и прием внутрь солевого раствора в более тяжелых случаях - мероприятия направленные на стабилизацию АД: внутривенное введение физиологического раствора плазмозаменителей при необходимости - введение ангиотензина II гемодиализ (скорость выведения эналаприлата - 62 мл/мин)."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"При одновременном назначении эналаприла с нестероидными противовоспалительными препаратами (НПВП) возможно снижение гипотензивного эффекта эналаприла; с калийсберегающими диуретиками (спиронолактон триамтерен амилорид) может привести к гиперкалиемии; с солями лития - к замедлению выведения лития (показан контроль концентрации лития в плазме крови)."}},{"type":"paragraph","data":{"text":"При одновременном назначении эналаприла с нестероидными противовоспалительными препаратами (НПВП) возможно снижение гипотензивного эффекта эналаприла; с калийсберегающими диуретиками (спиронолактон триамтерен амилорид) может привести к гиперкалиемии; с солями лития - к замедлению выведения лития (показан контроль концентрации лития в плазме крови)."}},{"type":"paragraph","data":{"text":"Одновременный прием с жаропонижающими и болеутоляющими средствами может уменьшить эффективность препарата."}},{"type":"paragraph","data":{"text":"Эналаприл ослабляет действие препаратов содержащих теофиллин."}},{"type":"paragraph","data":{"text":"Гипотензивное действие эналаприла усиливают диуретики бета-адреноблокаторы. Метилдопа нитраты блокаторы \"медленных\" кальциевых каналов дигидропиридинового ряда гидралазин празозин."}},{"type":"paragraph","data":{"text":"Иммунодепрессанты аллопуринол цитостатики усиливают гематотоксичность. Препараты вызывающие угнетение костного мозга повышают риск развития нейтропении и/или агранулоцитоза."}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"Необходимо соблюдать осторожность при назначении пациентам со сниженным объемом циркулирующей крови (в результате терапии диуретиками при ограничении потребления поваренной соли проведении гемодиализа диарее и рвоте) - повышен риск внезапного и выраженного снижения артериального давления после применения даже начальной дозы ингибитора АПФ. Транзиторная артериальная гипотензия не является противопоказанием для продолжения лечения препаратом после стабилизации артериального давления (АД). В случае повторного выраженного снижения АД следует уменьшить дозу или отменить препарат."}},{"type":"paragraph","data":{"text":"Применение высокопроточных диализных мембран повышает риск развития анафилактической реакции."}},{"type":"paragraph","data":{"text":"До и во время лечения ингибиторами АПФ необходим периодический контроль АД показателей крови (гемоглобина калия креатинина мочевины активности \"печеночных\" ферментов) белка в моче."}},{"type":"paragraph","data":{"text":"Следует тщательно наблюдать за больными с тяжелой сердечной недостаточностью ишемической болезнью сердца и заболеваниями сосудов мозга у которых резкое снижение АД может привести к инфаркту миокарда инсульту или нарушению функции почек."}},{"type":"paragraph","data":{"text":"Внезапная отмена лечения не приводит к развитию синдрома \" рикошета\" (резкому подъему АД)."}},{"type":"paragraph","data":{"text":"За новорожденными которые подвергались внутриутробному воздействию ингибиторов АПФ рекомендуется вести тщательное наблюдение для своевременного выявления выраженного снижения АД олигурии гиперкалиемии и неврологических расстройств возможных вследствие уменьшения почечного и мозгового кровотока при снижении артериальпо! о давления вызываемого ингибиторами АПФ."}},{"type":"paragraph","data":{"text":"При олигурии необходимо поддержание АД и почечной перфузии путем введения соответствующих жидкостей и сосудосуживающих средств."}},{"type":"paragraph","data":{"text":"Перед исследованием функций паращитовидных желез следует отменить."}},{"type":"paragraph","data":{"text":"Алкоголь усиливает гипотензивное действие препарата."}},{"type":"paragraph","data":{"text":"В начале лечения до завершения периода подбора дозы необходимо воздерживаться от вождения автотранспорта и занятий потенциально опасными видами деятельности требующими повышенной концентрации внимания и быстроты психомоторных реакций т.к. возможно головокружение особенно после начальной дозы ингибитора АПФ у больных принимающих диуретические средства."}},{"type":"paragraph","data":{"text":"Перед хирургическим вмешательством (включая стоматологию) необходимо предупредить хирурга/ анестезиолога о применении ингибиторов АПФ."}}]},{"id":18,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"Таблетки."}}]},{"id":19,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"В сухом защищенном от света месте при температуре не выше 25°С."}},{"type":"paragraph","data":{"text":"Хранить в месте недоступном для детей."}}]},{"id":20,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"2 года."}},{"type":"paragraph","data":{"text":"Не использовать позже даты указанной на упаковке."}}]},{"id":21,"name":"Условия отпуска","slug":"release_condition","body":[{"type":"paragraph","data":{"text":"По рецепту"}}]}],"source":null},"description_toggle":false,"short_description":"Эналаприл - антигипертензивный препарат из группы ингибиторов АПФ. Эналаприл является \"пролекарством\": в результате его гидролиза образуется эналаприлат который и ингибирует АПФ. Механизм его действия связан с уменьшением образования из ангиотензина I ангиотензина II снижение содержания которого ведет к прямому уменьшению выделения альдостерона. При этом понижается общее периферическое сосудистое сопротивление систолическое и диастолическое артериальное давление (АД) пост - и преднагрузка на миокард. Расширяет артерии в большей степени чем вены при этом рефлекторного повышения частоты сердечных сокращений не отмечается. Гипотензивный эффект более выражен при высоком уровне ренина плазмы крови чем при нормальном или сниженном его уровне. Снижение АД в терапевтических пределах не оказывает влияния на мозговое кровообращение кровоток в сосудах мозга поддерживается на достаточном уровне и на фоне сниженного артериального давления. Усиливает коронарный и почечный кровоток. При длительном применении уменьшается гипертрофия левого желудочка миокарда и миоцитов стенок артерий резистивного типа предотвращает прогрессирование сердечной недостаточности и замедляет развитие дилатации левого желудочка. Улучшает кровоснабжение ишемизированного миокарда. Снижает агрегацию тромбоцитов. Обладает некоторым диуретическим эффектом. Время наступления гипотензивного эффекта при приеме внутрь - 1 ч достигает максимума через 4-6 ч и сохраняется до 24 ч. У некоторых больных для достижения оптимального уровня артериального давления необходима терапия на протяжении нескольких недель. При сердечной недостаточности заметный клинический эффект наблюдается при длительном лечении - 6 месяцев и более. После приема внутрь абсорбируется 60% препарата. Прием пищи не влияет на всасывание эналаприла. Эналаприл до 50 % связывается с белками плазмы крови. Эналаприл быстро метаболизируется в печени с образованием активного метаболита эналаприлата который является более активным ингибитором АПФ чем эналаприл. Биодоступность препарата 40%. Максимальная концентрация эналаприла в плазме крови достигается через 1 час эналаприлата - 3-4 часа. Эналаприлат легко проходит через гистогематические барьеры исключая гематоэнцефалический небольшое количество проникает через плаценту и в грудное молоко. Период полувыведения эналаприлата около 11 ч. Выводится эналаприл преимущественно почками - 60% (20% - в виде эналаприла и 40% - в виде эналаприлата) через кишечник - 33% (6% - в виде эналаприла и 27% - в виде эналаприлата). Удаляется при гемодиализе (скорость 62 мл/мин) и перитонеальном диализе.","substance":[{"id":207,"title":"Эналаприл","title_latin":"Enalaprilum","slug":"enalapril_207"}],"branding":null,"valid_for_quick_buy":true,"is_available_to_delivery":false,"comments":null,"image_alt":"Эналаприл - фото упаковки","image_share":{"isTouch":{"default":"https://vseapteki.ru/cropping/thumbnails/101/86319/share_default/"},"isFromTablet":{"default":"https://vseapteki.ru/cropping/thumbnails/101/86319/share_default/"}},"diseases":[],"other_packages":[{"id":95925,"title":"Эналаприл","subtitle":{"full":"Таблетки, 28 шт, 20 мг, для приема внутрь","short":"Таблетки, 28 шт, 20 мг","package":"28 шт, 20 мг"},"prescription":true,"catalog_section_id":117,"manufacturer":{"id":2502,"title":"Обновление 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