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Enalapril, hydrochlorothiazide (Enap-HL) 10 mg + 12.5 mg – [20 tablets]


Combined hypotensive agent (diuretic + ace inhibitor)

SKU: 63411 Category:


Enap-NL Pharmacodynamics
A combination drug, the action of which is due to the properties of its constituent components.
Enalapril is an ACE inhibitor and is a prodrug: as a result of its hydrolysis, enalaprilate is formed, which inhibits ACE.
Hydrochlorothiazide is a thiazide diuretic. It acts at the level of the distal renal tubules, increasing the excretion of sodium and chlorine ions.
At the beginning of treatment with hydrochlorothiazide, the volume of fluid in the vessels is reduced as a result of increased sodium and fluid excretion, which leads to a decrease in BP and cardiac output.
Due to hyponatremia and decreased body fluid, the RAAS is activated. Reactive increase of angiotensin II concentration partially limits BP reduction. If therapy is continued, the hypotensive effect of hydrochlorothiazide is based on the reduction of RAS. The result of activation of renin-angiotensin-aldosterone system is metabolic effects on blood electrolyte balance, uric acid, glucose and lipids, which partially neutralizes the effectiveness of antihypertensive treatment.
Despite effective BP reduction, thiazide diuretics do not reduce structural changes in the heart and vessels. Enalapril enhances antihypertensive effect: it inhibits RAAS, i.e. angiotensin II production and its effects. Additionally, it reduces the production of aldosterone and enhances the effects of bradykinin and the release of prostaglandins. Since it often has its own diuretic effect, it may enhance the effect of hydrochlorothiazide.
Enalapril reduces pre- and post-load, which unloads the left ventricle, reduces regression of hypertrophy and collagen overgrowth, and prevents myocardial cell damage. As a result, the heart rhythm slows down and the load on the heart (in chronic heart failure) decreases, coronary blood flow improves and oxygen consumption by cardiomyocytes decreases. Thus, the sensitivity of the heart to ischemia is reduced, and the number of dangerous ventricular arrhythmias is reduced. It has a favorable effect on cerebral blood flow in patients with arterial hypertension and chronic cardiovascular disease. It prevents the development of glomerulosclerosis, maintains and improves kidney function and slows the course of chronic kidney disease even in patients who have not yet developed arterial hypertension.
Arterial hypertension (patients who are indicated for combination therapy).
– anuria;
– Severe renal dysfunction (CKD <30 ml/min);
– hereditary or idiopathic angioedema;
– Angioneurotic edema associated with the use of ACE inhibitors (history);
– primary hyperaldosteronism;
– Addison’s disease;
– porphyria;
– childhood and adolescence under 18 years of age (efficacy and safety have not been established);
– Hypersensitivity to the components of the drug;
– hypersensitivity to sulfonamides.
Dosage and administration regimen
  • Treatment of arterial hypertension should not be started with a combination of drugs. Initially, adequate doses of individual components should be determined. The dose should always be selected individually for each patient.
  • The drug should be taken regularly at the same time (preferably in the morning). Tablets should be swallowed in whole during or after meals, washed down with a small amount of liquid.
  • The usual dose is 1 tablet/.
  • If a dose is missed, it should be taken as soon as possible, if there is a long enough time left until the next dose. If it is a few hours before the next dose, you should wait and take only the next dose. Do not double the dose.
  • If satisfactory therapeutic effect is not achieved, it is recommended to add another drug or change therapy.
  • In patients on therapy with diuretics, it is recommended to cancel the treatment or reduce the dose of diuretics at least 3 days before treatment with Enap-NL to prevent the development of symptomatic hypotension. Renal function should be investigated before starting treatment.
  • The duration of treatment is not limited.
  • Patients with CKG > 30 ml/min or serum creatinine <265 μmol/L (3 mg/dL) may be prescribed the usual dose of Enap-NL.