Enzix tabs 10mg/2.5mg #15 + #15

Enzix user manual

Reed more and buy Enzix tablets

Composition

The preparation Enzix is issued in the form of two tablets of different sizes, one contains 10 mg of enalapril maleate + gelatin, magnesium stearate, lactose monohydrate, crospovidone, magnesium carbonate. The second (smaller) contains 2.5 mg of indapamide + crospovidone, lactose monohydrate, sodium lauryl sulfate, hypromellose, titanium dioxide, macrogol 6000, povidone K30, magnesium stearate, talc.
Enzyme Duo a large tablet contains: 10 mg enalapril maleate, gelatin, lactose monohydrate, magnesium stearate, crospovidone, magnesium carbonate. In a small tablet is 2.5 mg indapamide, povidone K30, magnesium talc stearate, macrogol 6000, titanium dioxide, lactose monohydrate, hypromellose, crospovidone.
Duo Forte Enzyme is also produced as a large tablet containing enalapril maleate 20 mg + excipients. And small, with an indapamide content of 2.5 milligrams + additional ingredients.

Form of issue

The medicine is sold in cardboard packs, in blisters:
    5 tablets of two kinds (Enzix);
    10 large and 5 small (Enzix Duo);
    for 10 large doses of 20 mg and 5 small (Enzix Duo Forte).
Large tablets are white, round, biconvex, with a risk.
Small tablets are covered with a white film shell, convex, round.

pharmachologic effect

Antihypertensive.

Pharmacodynamics and pharmacokinetics

The drug is sold in a set of two different tablets - an ACE inhibitor and a diuretic.
Enalapril maleate is a maleic acid salt, a derivative of two amino acids of L-alanine and L-proline. The substance interferes with hydrolysis reactions, resulting in the formation of enalaprilate, an ACE inhibitor.
The angiotensin-converting enzyme, in turn, acts as a catalyst for the conversion of angiotensin-1 into angiotensin-2, which is responsible for reducing the concentration of aldosterone and retin in the blood. And aldosterone with retinoma, as is known, leads to an increase in blood pressure.
It is also assumed that enalapril is able to inhibit the process of decreasing the concentration of bradykinin acting as a vasopressor.
The substance retains its pharmacodynamic activity even in the treatment of patients with a low level of retinin. The drug reduces blood pressure, both in the recumbent and in a standing position, without significantly increasing the chss.
After a sharp discontinuation of medication with prolonged therapy, a sharp increase in blood pressure was not observed.
The duration of action of the substance depends on the dose taken. The first effects are observed for an hour, reaching its peak within 2-4 hours and disappearing in a day. The degree of systemic absorption reaches 60%. Pharmacokinetic parameters do not depend on food intake and slightly on age. Reactions of metabolism (except for conversion into enalaprilat) the agent is not exposed. It is excreted through the kidneys with urine, 20% - unchanged. In persons suffering from kidney failure, these indicators can increase up to 2-fold.
Indapamide is a strong diuretic, thiazide sulfonamide with indole calcium. When taking 2.5 mg of substance per day, it permanently lowers blood pressure.
Initially, indapamide reduces the current of calcium through the cell membranes and prevents vascular spasm. Then the substance stimulates the synthesis of prostaglandins PGE2 and PGI2 and the vessels reflexively expand. Also, this active ingredient is able to enhance the action of bradykinin. Thus, the agent weakens the increased vascular response to a change in the concentration of norepinephrine in the blood and reduces the overall peripheral pressure.
In the long term, the substance reduces hypertrophy of the left ventricle of the heart muscle, reduces the amount of protein in the urine and normalizes blood pressure. The agent does not change the metabolism of triglycerides, cholesterol and glucose (even in diabetics).
The drug is well suited for treatment of arterial hypertension when combined with calcium channel blockers, beta-blockers, angiotensin-converting enzyme inhibitors.
Indapamide is fully absorbed into the systemic circulation through the gastrointestinal tract, reaching its maximum level in the blood after 60-120 minutes. The equilibrium concentration in the blood is observed after a week of daily intake. The degree of binding to plasma proteins is more than 80%. The half-life is from 14 hours to 24 hours.
The drug undergoes metabolic reactions in the liver, its inactive metabolites are excreted mainly by the kidneys and about 20% with feces.

Indications for use

The medicine is prescribed for arterial hypertension.

Contraindications

Enalapril can not be taken:
    if there is an allergy to the components of the agent or other ACE inhibitors;
    if the patient previously developed Quincke's edema as a reaction to taking any medications;
    pregnant and lactating women;
    with serious kidney disease (if creatinine clearance is less than 30 milliliters per minute);
    children under 18;
    with porphyria.
Contraindications to ingestion of indapamide:
    allergy to the drug;
    age to 18 years;
    serious kidney or liver disease;
    hypokalemia;
    disorders in the circulation of the brain;
    anuria;
    Combinations with means extending the QT interval;
    pregnancy and lactation.

Side effects

When taking Enzix Duo, various side reactions may occur, due to one or another of the drugs in the kit.

Side effects of enalapril:

    nausea, headaches, decreased activity, dizziness, depression, decreased visual acuity;
    cough, dyspnea;
    change in taste, diarrhea, abdominal pain;
    rashes on the skin, hives, swelling of the face, lips, tongue, larynx;
    lowering blood pressure, loss of consciousness, chest pain, angina, violation of heart rate, tachycardia;
    Raynaud's syndrome, aplastic and hemolytic anemia;
    pharyngitis and angina, dry cough, hoarseness of voice;
    intestinal obstruction, pancreatitis, indigestion, anorexia, vomiting, gastritis, stomach ulcer and duodenal ulcer;
    diaphoresis, prurite, alopecia;
    Orthostatic hypotension, myocardial infarction, stroke, pulmonary thromboembolism, palpitations;
    reduction of hemoglobin level in blood, agranulocytosis, pancytopenia, neutropenia, thrombocytopenia, bone marrow depression, lymphadenopathy, development of various autoimmune diseases;
    hypoglycemia;
    disorders in the work of the liver, cholestasis, bile stasis, jaundice;
    stomatitis, glossitis, angioedema, intestinal edema;
    Stevens-Johnson syndrome, epidermal necrolysis, polymorphic erythema, erythroderma;
    insomnia, sleep disorders.
There were also reports of development:
    high temperature, serositis, vasculitis;
    Myositis and myalgia, arthritis, leukocytosis, photophobia;
    oliguria, impotence, gynecomastia, asthenia and increased fatigue.
After carrying out of laboratory researches it was revealed:
    Hyperkalemia, increased level of creatinine in the blood;
    increase urea levels in the blood, decrease the sodium content;
    increased levels of hepatic enzymes, bilirubin in the blood.
Reactions caused by ingestion of indapamide
This remedy is usually well tolerated by patients.
Nevertheless, in the process of laboratory and post-marketing research, it was found:
    hypokalemia, hyponatremia, hypovolemia, orthostatic hypotension;
    increased blood glucose and urea levels, compensatory metabolic alkalosis;
    hypercalcemia.
The following clinical manifestations were observed:
    dizziness, asthenia, headaches, insomnia, anxiety, fatigue and depression;
    nausea, constipation, dry mucous membranes, pancreatitis, hepatic encephalopathy;
    conjunctivitis, visual acuity;
    decreased libido and potency;
    lowering blood pressure, arrhythmia, cough, runny nose, rhinorrhea;
    polyuria, renal failure, increased levels of creatinine and nitrogen;
    sweating, weight loss, glycosuria;
    manifestations of allergies in the form of rashes on the skin, purpura, angioedema, sensitivity to light, Stevens-Johnson syndrome;
    influenza-like syndrome.

Instructions for use of Enzyme (Method and dosage)

The medicine must be prescribed by the attending physician.
Enzix and Enzix Duo appoint one large (enalapril) and one small (indapamide) tablet a day. Preparations are taken in the morning, at the same time.
According to the doctor, depending on the dynamics of changes in blood pressure during treatment, daily dosage of enalapril may be doubled.

Instruction for Enzix Duo Forte

Take one large and one small pill orally, in the morning, once a day. The dosage of enalapril is allowed to increase to 40 mg (2 tablets) per day - this is the maximum daily dosage of the substance.
With kidney disease, if creatinine clearance reaches 30-80 ml per minute, the amount of enalapril per day should be reduced to 5-10 mg.
It should be remembered that the lower the dosage, the less likely to develop any unwanted adverse reactions.

Overdose

Data on enalapril overdose are limited by insufficient number of clinical trials.
The signs of overdose are:
    a strong decrease in blood pressure, which begins 6 hours after taking the tablets, is accompanied by a stupor;
    circulatory shock;
    renal insufficiency, violation of electrolyte balance in the body;
    tachycardia, acceleration of the heart rhythm, bradycardia;
    hyperventilation, dizziness, cough;
    anxiety and a sense of fear.
As therapy:
    intravenous sodium chloride injection 0.9%;
    place the victim in the position of "leg above the head";
    injections of angiotensin, catecholamines;
    if less than 2 hours have passed, after receiving large doses of the medicine, it is necessary to rinse the stomach, prescribe enterosorbents, sodium sulfate;
    hemodialysis is effective.
If various therapeutic ways of normalizing the condition of the victim are not effective enough, heart stimulants can be used.
Indications for an overdose of indapamide:
    hyponatremia, hypokalemia, electrolyte balance disturbance;
    nausea, low blood pressure, vomiting, dizziness;
    anuria, polyuria, drowsiness.
As a therapy, wash the stomach, appoint enterosorbents, measures to normalize the water-electrolyte balance, symptomatic therapy.

Interaction

Enalapril
The antihypertensive effect of enalapril decreases under the influence of sympathomimetics.
The combination of ACE inhibitors with lithium preparations can lead to increased toxicity and a concentration of lithium to the blood. Therefore, this combination of drugs is extremely undesirable.
The use of enalapril and NSAIDs weakens the antihypertensive effect of the drug, increases the burden on the kidneys.
The medicine should be combined with caution with diuretics (spironolactone, eplerenone, amiloride, triamterene).
If, before the beginning of the treatment, the drug was given long-term therapy with loop diuretics or thiazide, then the blood pressure is most likely to be reduced. And to compensate for fluid loss and to normalize the pressure, it is recommended that you take a saline solution or use low doses of enalapril.
When the drug is combined with other drugs that lower blood pressure, nitroglycerin, nitrates, dilating blood vessels, the risk of developing arterial hypotension is significantly increased.
A joint medication with tricyclic antidepressants, neuroleptics, narcotic analgesics and anesthetics can lead to a significant drop in blood pressure, right up to the development of orthostatic collapse.
When a combination of ACE inhibitors and preparations of gold (for example, sodium aurothiomalate), nitrite reactions were rarely observed. Symptoms of this kind of reactions are: nausea, redness of the face, vomiting and hypotension.
Special care when treating the drug should be observed for people suffering from diabetes. Since the combination of ACE inhibitors and insulin (other hypoglycemic drugs) leads to an increase in blood sugar levels. The effect is enhanced if the patient has impaired renal function.
The drug is not recommended to combine with ethanol, as this leads to an even greater reduction in blood pressure.
Indapamide
Undesirable combinations of indapamide: with astemizole, halofantrine, sultopride, vincamine, erythromycin, terfenadine (hypokalemia and bradycardia develop, the QT interval is prolonged).
The drug is not recommended to combine with lithium, due to increased concentration of lithium in the blood.
With special care are taken the drug with systemic nonsteroidal anti-inflammatory drugs, large doses of salicylates can lead to an increase in blood pressure.
When the drug is combined with estrogens, fluid retention occurs in the body and the antihypertensive effect of the drug is reduced.
Iodine-containing radiopaque agents increase the burden on the kidneys. With this combination, it is necessary to restore the water-electrolyte balance.
When co-administered with Amphotericinum, mineralocorticoids, glucocorticoids, ACE inhibitors, tetracosactide, permeating agents, with cardiac glycosides, potassium-sparing diuretics (Amiloride, Triamteren, Spironolactone), antiarrhythmics should be used with caution.
The combination of indapamide and metformin can lead to the development of lactic acidosis and renal insufficiency.
Tricyclic antidepressants increase the likelihood of developing arterial hypotension.
When taking indapamide with calcium salts, hypercalcemia develops.
Cyclosporine increases the creatinine content in the blood plasma.

Terms of sale

You can buy Enzix without a prescription.

Storage conditions

Keep the tablets in a dry, cool, dark place.
Shelf life - 3 years.

special instructions

When receiving funds above 65 years of age, special care must be taken.
In individuals with a decrease in the volume of circulating blood, the risk of a sharp decrease in blood pressure is increased.
When receiving enalapril there is no withdrawal syndrome - a sharp increase in pressure after withdrawal of the drug.
After taking the first pill, you should observe the patient's condition within 3-4 hours.
The use of high-strength membranes during dialysis promotes the development of anaphylactic shock. In those days when dialysis is not performed, the dosing regimen should be adjusted.
Before carrying out any operation using local or general anesthesia, the patient should inform the doctor that he is taking ACE inhibitors.
Before treatment and during therapy, the drug is recommended to periodically give blood to the protein in the urine, the level of hemoglobin, urea, liver enzymes and potassium.
When controlling for doping, the drug Indapamide may provoke a false positive reaction.
Persons suffering from hypertension and hyponatremia should stop taking diuretics 3 days before starting treatment with the drug.
The drug can complicate the course of systemic lupus erythematosus.
During the first week of taking the drug and choosing the optimal dosage, it is not recommended to drive a car or carry out potentially dangerous activities.

Reviews for Enzix

On the Internet about the drug respond well. However, there are often problems with the selection of the optimal dosage. It is necessary to divide the tablets into many parts, to conduct long-term experiments. Of the adverse reactions, the most common is a strong decrease in blood pressure.
Reviews about Enzix Duo:
    "... The drug helped me cope with increased blood pressure. At first there was dry mouth, and loss of appetite, but at the end of the course I noticed that for a long time the pressure was not galloping, I realized that this Enzyme helps. The doctor said to take a break in treatment, and then repeat the course. ";
    "... I drink medicine for maintenance therapy, the doctor said that taking the pill will take a long time. While the pressure did not stabilize, I am still in the stage of choosing the dosage. However, the doctor insists that it is necessary to continue treatment. ";
    "... I feel bad, I can not do anything, the pressure from this medicine is greatly lowered. How to choose a normal dose? ".