ENAHEXAL 5 mg. 30 tablets

What is Enahexal tablets 5 mg?
- High blood pressure (hypertension)
- Heart failure (in combination with drainage Medicinal Products diuretics), especially in cases of severe heart failure (in combination with digitalis)
- Dysfunction of the left ventricle of the heart, without overt symptoms (eg. Difficulty breathing load) (asymptomatic left ventricular dysfunction)

When you should not take Enahexal tablets 5 mg?
Enahexal should not be applied:
- In hypersensitivity to enalapril maleate to other ACE inhibitors or any of the other ingredients of the product.
- With a tendency to swelling of tissues (angioedema hereditary angioedema or another as a result of previous therapy with ACE inhibitors
- In the narrowing of the renal arteries (bilateral or unilateral in the case of one kidney)
- After kidney transplant
- In a narrowing of the aortic or mitral valve or difficulty swelling of the left ventricle (hypertrophic cardiomyopathy)
- In primary liver disease or liver failure
- During pregnancy (pre-should be ruled out pregnancy and to take appropriate measures against becoming pregnant during treatment) and karmenePri during dialysis of kidney patients and concomitant Enahexal® with high flux membranes "AN 69" there is a risk of hypersensitivity reactions to shock. This combination should be avoided by use of other drugs (other ACE-inhibitors) used to treat high blood pressure, heart failure, or by the administration of other membranes dializa.Pri patients with elevated cholesterol receiving ACE inhibitors may arise life-threatening hypersensitivity reactions. If necessary, study of low density lipoproteins, Enahexal® must be changed temporarily to another medicine used for high blood pressure or heart nedostatachnost.Pri patients exhibiting hypersensitivity to poison insect (bees, wasps) and in patients in whom a conducted desensitization therapy, concomitant administration of Enahexal® can lead to severe hypersensitivity reactions related to low blood pressure, impaired breathing, vomiting and / or allergic skin reactions. Therefore Enahexal® treatment should be discontinued prior to desensitization therapy.

In which case you can use Enahexal tablets of 5 mg only after consulting a doctor?
Enahexal® can be applied only after careful evaluation of the risk / benefit ratio and tracking of certain clinical and laboratory chemical parameters at regular intervals at:
- Severe renal impairment (creatinine clearance below 30 ml / min)
- Dialysis patients
- Increased excretion of urinary protein (greater than 1 g / day)
- Severe electrolyte disturbances
- Impaired immune response or existing collagen disease (eg. Lupus erythematosus, scleroderma)
- Concomitant treatment with drugs that suppress the immune system (eg. With corticoids, cytostatics, antimetabolites), allopurinol, procainamide or lithium (see also Precautions)

What precautions should I keep in mind?
Low blood pressure (hypotension) Enahexal can cause considerable drop in blood pressure especially after the first administration of the product. Fall in blood pressure occurs more frequently in patients with disturbances in the water and electrolyte balance (eg. In therapy with drainage means, in the case of a low-salt diet, vomiting, diarrhea or after dialysis). These are mainly patients with severe heart failure with or without renal impairment. In these patients, therapy Enahexal should be started under very close monitoring of lekar.Spetsialni care is also required in patients with reduced blood flow to the heart muscle (coronary heart disease) or stenosis of cerebral arteries. In these cases it may be a myocardial infarction or ischemic attack as a result of a sharp drop in blood pressure. Therapy should be initiated with low doses and dose be increased after careful monitoring of renal function and potassium levels. On initiation of therapy possible should be temporarily stopped existing drainage terapiya.Babrechna hypertension / stenosis of the renal arteries (also see Contraindications) in patients with high blood pressure associated with disease of the renal vessels when taking Enahexal an increased risk of sharply drop in blood pressure and kidney failure. The decline of renal function accompanied by slight changes in serum creatinine even in patients with unilateral renal artery stenosis. Treatment should start under close medical supervision in hospital with a low dose and increase the dose carefully. Ongoing treatment with drainage means must be temporarily discontinued and renal function be accurately monitored during the first weeks of terapiyata.Babrechna failure / hemodializaEnahexal should be carefully dosed in patients with impaired renal function (renal failure) as it is may require dose reduction (see Dosage and Administration). In patients with severe renal insufficiency (creatinine clearance below 30 ml / min) and in patients on dialysis (see Dosage and Administration) product can be applied only after a very critical evaluation of the benefit / risk and close monitoring of renal function before and during terapiyata.Osobeno in patients with severe heart failure, or kidney disease (incl. renal artery stenosis) is communicated renal failure associated with ACE inhibitor therapy. In some patients without any obvious presence of renal disease concomitant drainage funds were measured elevated levels of urea and creatinine in the blood. This may require reducing the dose of ACE inhibitor and / or discontinuation of the drainage means.
Patients hemodializaEdnovremennoto application Enahexal and high-permeable membranes of dialysis treatment implies the risk of hypersensitivity reactions to shock first symptoms of severe hypersensitivity reactions include swelling of the face, redness, lowering blood pressure and difficult breathing. Symptoms appear a few minutes after initiation of hemodialysis. This combination should be avoided by the application of other membrane dialysis or use of another product for the treatment of high blood pressure or heart failure.
Disorders in electrolyte balance / HiperkaliemiyaPo during treatment with Enahexal can be observed an elevated level of potassium, especially in kidney and / or heart failure. The administration of potassium-sparing 'water resources or potassium supplements as accompanying therapy is not recommended because it can lead to a significant increase potassium levels in serum. If concomitant therapy is necessary with the above products, potassium levels should be regularly prosledyavani.V cases of severe electrolyte disturbances (especially potassium and sodium) Enahexal should be used only after careful evaluation of the benefit / risk and immediately follow up regularly electrolyte levels in serum.
Primary hiperaldosteronizamPatsienti with primary aldosteronism do not respond to medications that lower blood pressure, whose effect is based on inhibition of the renin-angiotensin system. Therefore it is not recommended to use Enahexal.
Separation of protein in the urine (proteinuria) may rarely occur proteinuria in patients with pre-existing renal impairment or after administration of relatively high doses of Enahexal. In the event of clinically significant proteinuria (greater than 1 g / day) Enahexal can be applied only after very accurate assessment of the risk / benefit in regular clinical and laboratory parameters.
Swelling of the tissues! Angioneurotic edema (see also "Contraindications") in patients treated with ACE inhibitors, including Enahexal® were observed swelling of the face, extremities, lips, tongue, glottis and / or larynx. They can occur at any time during the treatment. In these cases, treatment with enalapril maleate should be discontinued immediately and the patient should be monitored. Swelling confined to the face and lips, usually disappear upon discontinuation of therapy. Antihistamines have proven their advantages in the removal of these symptoms. In patients with a history of angioedema is an increased risk of developing one, and after taking ACE inhibitori.Pri black patients were more frequently reported cases of angioedema during therapy with ACE inhibitori.Angioedem involving the tongue, glottis and / or larynx may be life-threatening. In this case it should take urgent treatment 0,3-0,5 mg epinephrine, administered subcutaneously or 0,1 mg epinephrine, administered slowly intravenously at ECG monitoring and blood pressure. Patients should be treated in a hospital setting, to be observed for at least 12-24 h, to ensure complete removal of siptomite before discharge of the patient.
Changes in blood count (neutropenia, agranulocytosis) In patients with hypertension treated with ACE inhibitors, rarely observed decrease leukocyte count (neutropenia or agranulocytosis) - mainly in patients in whom treatment of high blood pressure occurs without complications. Impaired renal function changes occur more frequently, especially if there is both a disease of vascular and connective tissue disorders (such as systemic lupus erythematosus or scleroderma) or simultaneously conducted therapy suppresses the immune system. Blood counts should be monitored in these patients at regular intervals. Neutropenia and agranulocytosis are reversible after discontinuation of treatment with an ACE inhibitor. If symptoms such as fever, swollen lymph nodes and / or sore throat in the course of therapy, you should consult a doctor and blood count monitored.


What other products influence the effect of Enahexal tablets 5 mg or can be influenced by preparation?
- Medicines that lower blood pressure, strengthen the effect of Enahexal®, especially drainage means
- Preparations for pain and inflammation (eg. Aspirin, indomethacin) weaken the effect of Enahexal
- Potassium-sparing 'water resources (such as spironolactone, amiloride, triamterene) and other medications, causing increased concentration in serum potassium (eg. Heparin)
- Lithium: Increased serum concentration of lithium - requires regular follow-up
- Hypnotics, narcotics, anesthetics cause greater drop in blood pressure (the doctor conducting anesthesia should be informed of therapy Enahexal)
- Allopurinol, medicines that suppress the protective effects (cytostatic, immunosuppressive agents, systemic corticoids, procainamide) cause reduction in the number of leukocytes in the blood
- Medicines that lower blood sugar (sulphonylureas / biguanides) or insulin administered with Enahexal, enhance the effect of lowering blood sugar

What foods and herbs should avoid?
- Sodium chloride (common salt) reduces the effect of lowering blood pressure, and increases the symptoms associated with heart failure
- Alcohol: increased effect of alcohol
What must comply children and elderly patients when administering Enahexal tablets 5 mg?
Children should not be treated with Enahexal, as there is insufficient data for its vazdeystvie.Patsientite elderly can respond inhibitor than younger patients. Treatment of elderly patients should be performed with caution. Patients over 65 years recommended daily dose of 2,5 mg enalapril maleate and monitoring of renal function at baseline.
What special precautions should be taken during pregnancy and lactation?
During pregnancy and breastfeeding should not use ACE inhibitors such Enahexal .For women of childbearing age before starting therapy with Enahexal should exclude pregnancy. During treatment, women should use the appropriate method to prevent pregnancy. If a woman becomes pregnant during treatment, it is necessary to consult a doctor and switched to another therapy with less risk to the fetus. Taking Enahexal® can harm the fetus and lead to death, especially during the last 6 months of bremennostta.Enahexal passes into breast milk. There are insufficient data for the reception of the product during lactation, which means that it should be administered during this period.

What should be considerate when driving or operating machinery?
Enahexal treatment requires regular medical supervision. Since individual patients respond to therapy, reactivity can be influenced so that distortions occur in the ability to drive, operate machinery or in an unstable position (eg. Climbing a ladder). This is at the beginning of treatment, at dose increase or change of the product and the use of alcohol during therapy.
Dosage, route and duration of administration:
The following dosage is recommended, unless your doctor has prescribed Enahexal® tablets of 5 mg in another dosing regimen. Please follow these instructions for use. Otherwise, it will not work pravilno.V start of therapy may occur a sharp drop in blood pressure, especially in patients suffering from a shortage of electrolytes and / or fluids (eg. Patients on dialysis drainage therapy in case of vomiting / diarrhea), heart failure, severe or renal hypertension. Shortage of electrolytes and / or liquids violations must be corrected before initiating therapy or therapy with existing drainage means to be reduced or possibly prekasnata.Pri these patients, therapy should be initiated with the lowest single dose of half a tablet Enahexal 5 mg in the morning (2,5 mg enalapril maleate). These patients should be monitored at least 8 hours after the first dose, also in enalapril maleate and / or drainage means to avoid the appearance of uncontrolled drop in blood nalyagane.Patsienti in serious condition (malignant hypertension ) or patients suffering from severe heart failure must be admitted to hospital to determine treatment Enahexal tablets 5 mg.

How much and how often you can take Enahexal tablets 5 mg?
Hypertension
The usual starting dose is 1 tablet Enahexal 5 mg in the morning (5 mg of enalapril maleate). If not achieved normalization of blood pressure during administration of this dose, the dose may be increased to 2 tablets Enahexal of 5 mg (10 mg enalaprif maleate) daily. The dose should be increased at intervals of not less than 3 sedmitsi.Po rule maintenance dose is two tablets Enahexal of 5 mg (10 mg of enalapril maleate) daily. Maximum dose of 2 x 4 tablets of Enahexal 5 mg (2 x 20 mg enalapril maleate) daily.
Heart failure / dysfunction of the left ventricle
The starting dose is 34 tablets of 5 mg in the morning Enahexal (2,5 mg enalaprilmaleat). Your doctor may increase the dose only gradually depending on individual patient tolerance to lechenieto.Po rule maintenance dose is 1-2 tablets Enahexal 5 mg per day (5-10 mg enalapril maleate). The maximum dose of 4 tablets of Enahexal 5 mg daily (20 mg of enalapril maleate) should not be exceeded.
Dosage in patients with moderate renal impairment (creatinine clearance 30-60 ml / min) and the elderly (over 65 years) starting dose is ½ tablet Enahexal® 5 mg (2,5 mg enalapril maleate) morning. As a rule, the maintenance dose is 1-2 tablets Enahexal® 5 mg (5-10 mg enalapril maleate) daily. The maximum dose of 4 tablets of Enahexal® 5 mg daily (20 mg of enalapril maleate) should not be exceeded.
Dosage in patients with severe renal impairment (creatinine clearance below 30 ml / min) and patients undergoing dialysis The starting dose is ½ tablet Enahexal® 5 mg (2,5 mg enalapril maleate) morning. Dialysis patients should not take this dose after dialysis. As a rule, the maintenance dose is 1 tablet Enahexal® of 5 mg (5 mg of enalapril maleate) daily. The maximum dose of 2 tablets Enahexal® of 5 mg (10 mg of enalapril maleate) daily should not be exceeded.

When and how you can take Enahexal tablets 5 mg?
You can take Enahexal tablets 5 mg regardless of meals. As a rule, defined daily dose is administered in the morning, but it is possible to be in 2 divided doses - in the morning and evening.