Enalapril, indapamide (Enzix Duo) 10 mg + 2.5 mg – [45 tablets]

Enzix Duo contains two separate medications in one package: the diuretic indapamide and the angiotensin-converting enzyme (ACE) inhibitor enalapril.

Indapamide

Hypotensive drug, thiazide-like diuretic of moderate potency and long duration, benzamide derivative. Reduces arterial smooth muscle tone, reduces total peripheral vascular resistance. It has moderate saluretic and diuretic effects, which are associated with blockade of reabsorption of sodium, chloride, hydrogen and, to a lesser extent, potassium ions in proximal tubules and cortical segment of distal tubule of nephron. The vasodilatory effects and reduction of total peripheral vascular resistance have in their basis the following mechanisms: reduction of reactivity of the vascular wall to noradrenaline and angiotensin II; increased synthesis of prostaglandins, which have vasodilatory activity; inhibition of calcium flow in vascular smooth muscle cells. It promotes reduction of left ventricular hypertrophy. In therapeutic doses does not affect lipid and carbohydrate metabolism (including in patients with concomitant diabetes mellitus).

Antihypertensive effect develops at the end of the first/beginning of the second week when taking the drug continuously and persists for 24 hours after a single dose.

Concomitant use of Enalapril and Indapamide will enhance the antihypertensive effect of Enalapril

Enalapril

Antihypertensive drug, its mechanism of action is related to the reduction of angiotensin I angiotensin II, the reduction of which leads to a direct reduction of aldosterone secretion. This reduces total peripheral vascular resistance, systolic and diastolic blood pressure (BP), post- and preload on myocardium. Dilates arteries to a greater extent than veins, while there is no reflex increase in heart rate. Reduces bradykinin degradation, increases prostaglandin synthesis.

Hypotensive effect is more pronounced at high plasma renin levels than at normal or reduced levels.

Decrease of BP within therapeutic limits has no effect on the cerebral blood flow, the blood flow in the cerebral vessels is maintained at a sufficient level even against the background of reduced blood pressure. It enhances coronary and renal blood flow. Long-term use reduces hypertrophy of the left ventricular myocardium and myocytes of the resistant arterial walls, prevents the progression of heart failure and slows the development of left ventricular dilatation. Improves blood supply to ischemic myocardium.

Reduces platelet aggregation. Has some diuretic effect. Enalapril is a “prodrug”: as a result of its hydrolysis enalaprilat is formed, which inhibits angiotensin-converting enzyme (ACE).

Time of onset of hypotensive effect when taken orally is 1 hour, it reaches a maximum after 4-6 hours and lasts up to 24 hours.

Arterial hypertension.

– Hypersensitivity to enalapril and other ACE inhibitors or other components of the drug;

– History of angioedema associated with treatment with ACE inhibitors, hereditary or idiopathic angioedema;

– concomitant use with aliskiren and/or aliskiren-containing drugs in patients with diabetes mellitus and/or moderate or severe renal impairment (glomerular filtration rate (GFR) less than 60 ml/min/1.73 m2 body surface area);

– concomitant use with angiotensin II receptor antagonists (ARA II) in patients with diabetic nephropathy;

– concomitant use with neutral endopeptidase inhibitors (e.g., with drugs containing Sacubitril) due to the high risk of angioedema;

– hypersensitivity to indapamide, other sulfonamide derivatives or other drug components;

– severe hepatic insufficiency or hepatic encephalopathy;

– severe renal insufficiency (creatinine clearance less than 30 ml/min);

– hypokalemia;

– pregnancy, breastfeeding;

– under 18 years of age (efficacy and safety have not been established);

– lactose intolerance, lactase deficiency, glucose-galactose malabsorption.

• Enzix Duo: 1 tablet of Enalapril (10 mg) and 1 film-coated tablet of Indapamide (2.5 mg) are taken orally in the morning at the same time. Depending on the dynamics of blood pressure values, the dosage of Enalapril may be increased up to twice a day.
• Maximum daily dose of enalapril is 40 mg, indapamide 2.5 mg
• Patients with impaired renal function
• In chronic renal failure, cumulation of enalapril occurs when filtration is less than 10 ml/min. If creatinine clearance is 80-30 ml/min, the dose of enalapril should be 5-10 mg/day. Enzix Duo is contraindicated in patients with severe renal insufficiency (creatinine clearance less than 30 ml/min).
• Elderly patients
• Dose adjustment is not required in elderly patients with normal renal function.