Composition, form of production and packaging
The tablets covered with a film cover of white color, round, biconcave; on the cross section - the core is light yellow.
1 tab.
lercanidipine hydrochloride 10 mg
enalapril maleate 10 mg
Excipients: lactose monohydrate 102 mg, microcrystalline cellulose 40 mg, sodium carboxymethyl starch 20 mg, povidone K30 8 mg, sodium hydrogen carbonate 8 mg, magnesium stearate 2 mg.
The composition of the shell: opadrai white (02F29056) - 6 mg (hypromellose 5cP - 3.825 mg, titanium dioxide (E171) - 1.275 mg, talc - 300 Ојg, macrogol 6000 - 600 Ојg).
7 pcs. - blisters (1, 2, 3, 4, 5, 6, 7, 8, 9, 10) - packs of cardboard.
10 pieces. - blisters (1, 2, 3, 4, 5, 6, 7, 8, 9, 10) - packs of cardboard.
14 pcs. - blisters (1, 2, 3, 4, 5, 6, 7, 8, 9, 10) - packs of cardboard.
28 pcs. - blisters (1, 2, 3, 4, 5, 6, 7, 8, 9, 10) - packs of cardboard.
30 pcs. - blisters (1, 2, 3, 4, 5, 6, 7, 8, 9, 10) - packs of cardboard.
35 pcs. - blisters (1, 2, 3, 4, 5, 6, 7, 8, 9, 10) - packs of cardboard.
42 pcs. - blisters (1, 2, 3, 4, 5, 6, 7, 8, 9, 10) - packs of cardboard.
50 pcs. - blisters (1, 2, 3, 4, 5, 6, 7, 8, 9, 10) - packs of cardboard.
56 pcs. - blisters (1, 2, 3, 4, 5, 6, 7, 8, 9, 10) - packs of cardboard.
The tablets covered with a film cover of yellow color, round, biconcave; on the cross section - the core is light yellow.
1 tab.
lercanidipine hydrochloride 10 mg
enalapril maleate 20 mg
Excipients: lactose monohydrate - 92 mg, microcrystalline cellulose - 40 mg, sodium carboxymethyl starch - 20 mg, povidone K30 - 8 mg, sodium hydrogen carbonate - 8 mg, magnesium stearate - 2 mg.
The composition of the shell: opadray yellow (02F22330) - 6 mg (hypromellose 5cP - 3.825 mg, titanium dioxide (E171) - 1.139 mg, talc - 300 Ојg, macrogol 6000 - 600 Ојg, dye quinoline yellow (E104) - 121 Ојg, iron dye oxide yellow (E172) - 15 Ојg).
7 pcs. - blisters (1, 2, 3, 4, 5, 6, 7, 8, 9, 10) - packs of cardboard.
10 pieces. - blisters (1, 2, 3, 4, 5, 6, 7, 8, 9, 10) - packs of cardboard.
14 pcs. - blisters (1, 2, 3, 4, 5, 6, 7, 8, 9, 10) - packs of cardboard.
28 pcs. - blisters (1, 2, 3, 4, 5, 6, 7, 8, 9, 10) - packs of cardboard.
30 pcs. - blisters (1, 2, 3, 4, 5, 6, 7, 8, 9, 10) - packs of cardboard.
35 pcs. - blisters (1, 2, 3, 4, 5, 6, 7, 8, 9, 10) - packs of cardboard.
42 pcs. - blisters (1, 2, 3, 4, 5, 6, 7, 8, 9, 10) - packs of cardboard.
50 pcs. - blisters (1, 2, 3, 4, 5, 6, 7, 8, 9, 10) - packs of cardboard.
56 pcs. - blisters (1, 2, 3, 4, 5, 6, 7, 8, 9, 10) - packs of cardboard.
INSTRUCTION FOR THE SPECIALIST.
Description of the drug approved by the manufacturer for the printed edition of 2013.
PHARMACHOLOGIC EFFECT
The drug is a combination of an ACE inhibitor and a blocker of slow calcium channels.
Lercanidipine
Lercanidipine, a dihydropyridine derivative, inhibits the transmembrane flow of calcium into cardiac cells and smooth muscle cells. The mechanism of antihypertensive action is due to a direct relaxing action on the smooth muscle of the vessels, resulting in a decreased OPSS. Has a prolonged antihypertensive effect.Due to the high selectivity to the smooth muscle cells of the vessels, a negative inotropic effect is absent.
Enalapril
Enalapril - ACE inhibitor, inhibits the formation of angiotensin II and eliminates its vasoconstrictive effect. Reduces blood pressure without causing an increase in heart rate and minute volume. Reduces OPSS, reduces afterload and preload on the heart. Reduces pressure in the right atrium and a small circle of blood circulation.
Does not affect the metabolism of glucose, lipoproteins, as well as the functions of the reproductive system.
PHARMACOKINETICS
Pharmacokinetic interaction with simultaneous use of enalapril and lercanidipine was not observed.
Lercanidipine
Suction
Lercanidipine is completely absorbed into the digestive tract after ingestion. At the "first pass" through the liver, due to high metabolism, absolute bioavailability after ingestion after eating is approximately 10%, when taken on an empty stomach, bioavailability decreases by 1/3. Bioavailability after lercanidipine is increased 4-fold if the drug is taken no later than 2 hours after ingestion of fatty foods. Therefore, the drug should be taken at least 15 minutes before meals. C max in blood plasma is achieved after 1.5-3 hours. It does not cumulate with repeated application.
The duration of the therapeutic action of lercanidipine is 24 hours. The concentration of lercanidipine in blood plasma when ingested is in a non-linear dose dependence. When 10 mg, 20 mg, or 40 mg C max of lercanidipine was measured in blood plasma in a ratio of 1: 3: 8, respectively, and AUC - in a ratio of 1: 4: 18, suggesting progressive saturation during "first passage" through the liver. Accordingly, bioavailability increases with increasing dose.
Distribution
The distribution of lercanidipine from plasma to tissues and organs occurs rapidly and intensively. The binding of lercanidipine to plasma proteins exceeds 98%.
Metabolism
Lercanidipine is metabolized by the isoenzyme of the liver CYP3A4 with the formation of inactive metabolites.
Excretion
The drug remains unchanged in urine and feces. About 50% of the accepted dose of lercanidipine is excreted by the kidneys, the mean T 1/2 of lercanidipine is 8-10 hours.
Pharmacokinetics in special clinical cases
In elderly patients and patients with mild or moderate renal insufficiency or with mild or moderate hepatic insufficiency, the pharmacokinetic parameters of lercanidipine are the same as in the general group of patients.
In patients with severe renal failure or in patients on hemodialysis, lercanidipine is excreted by the kidneys in a higher quantity (about 70%).
In patients with hepatic insufficiency (from moderate to severe), the systemic bioavailability of lercanidipine is increased, the drug is metabolized predominantly in the liver.
In patients with renal and hepatic insufficiency, the plasma protein content is reduced, so the free fraction of lercanidipine can be increased.
Enalapril
Suction
The percentage of absorption of enalapril after oral administration is about 60%. C max enalapril in the blood plasma is observed after 1 h. Food intake does not affect the absorption of enalapril.
Distribution
When ingested quickly hydrolyzed to enalaprilata, which has an inhibitory effect on ACE. C max enalaprilat in the serum is observed 3-4 hours after taking the drug.The binding of enalapril to plasma proteins does not exceed 60%.
Metabolism
When ingested, it is hydrolyzed to the main metabolite, enalaprilate.
Excretion
About 40% of enalapril in the form of enalaprilat and about 20% of unaltered enalapril is excreted by the kidneys.
Pharmacokinetics in special clinical cases
In patients with renal failure, the duration of the action of enalapril and enalaprilate is increased.
In patients with mild or moderate renal insufficiency (CC 40-60 ml / min) with 5 mg enalapril 1 time / day, the plateau stage of AUC enalaprilat is doubled compared to patients with normal liver function.
In patients with severe renal failure (CK ≥ 30 ml / min), the AUC increases approximately 8-fold. In this stage of renal failure, T 1/2 enalaprilat increases with multiple enalapril maleate intake and the time to reach the AUC plateau stage slows down. Enalaprilat can be removed from the general blood flow through hemodialysis. The dialysis clearance is 62 ml / min.
INDICATIONS
- Essential hypertension (with ineffectiveness of monotherapy with lercanidipine 10 mg) - a dose of 10 mg + 10 mg;
- Essential hypertension (with inefficiency of monotherapy with enalapril 20 mg) - a dose of 10 mg + 20 mg.
DOSING MODE
Tablets are taken orally, preferably in the morning, at least 15 minutes before meals, without chewing, squeezed with enough water. You can not drink grapefruit juice.
The drug Coripren В® is not intended for the initial treatment of hypertension.
In case of ineffectiveness of monotherapy with lercanidipine 10 mg, you should start taking Coripren В® 10 mg lercanidipine + 10 mg enalapril.
If inefficiency of monotherapy with enalapril is 20 mg, you should start taking Coripren В® 10 mg of lercanidipine + 20 mg of enalapril. The dose of the drug is selected by the doctor.
SIDE EFFECT
The incidence of adverse events was classified as follows: very often (1/10), often (1/100), infrequently (1/1000), rarely (1/10 000), very rarely (<1/10 000).
Lercanidipine + enalapril
From the side of the central nervous system: often - dizziness; infrequently - a headache.
From the side of the psyche: infrequently, anxiety.
On the part of the skin: infrequently - dermatitis, edema of the lips, erythema, urticaria, rash.
From the genitourinary system: infrequently - erectile dysfunction, pollakuriya, polyuria, nocturia.
From the immune system: infrequently - hypersensitivity to one of the components of the drug, angioedema.
From the musculoskeletal system: infrequently - arthralgia.
From the digestive system: infrequently - abdominal pain, nausea, constipation, dyspepsia, glossitis.
On the part of the hematopoiesis system: infrequently - thrombocytopenia.
From the respiratory system: often - cough; infrequently - dryness in the throat, pharyngeal and throat pain.
From the cardiovascular system: often - "tides" of blood to the skin of the face; infrequent - palpitation and tachycardia, marked decrease in blood pressure, circulatory collapse, congestive heart failure.
From the side of the organ of hearing: often - vertigo, incl. positional dizziness.
Laboratory indicators: infrequent - decrease in hemoglobin level, increased activity of ALT, ACT.
Other: often - peripheral edema, infrequently - asthenia, fatigue, feeling of heat.
Enalapril
From the side of the central nervous system: very often - dizziness; often - headache; infrequently paresthesia.
From the side of the psyche: often - depression; infrequently - confusion, drowsiness, insomnia, nervousness; rarely - pathological dreams, sleep disturbance.
From the skin: often - a rash; infrequently - increased sweating, itching, hives, alopecia; rarely - erythema multiforme, exfoliative dermatitis, Stevens-Jones syndrome, Lyell syndrome, pemphigus.
From the genitourinary system: infrequently - renal failure, proteinuria, erectile dysfunction; rarely - gynecomastia, oliguria.
From the immune system: often - increased sensitivity, angioedema, swelling of the face, extremities, lips, tongue, vocal folds and / or larynx; rarely - autoimmune disorders.
From the side of metabolism: infrequently - hypoglycemia, anorexia.
From the musculoskeletal system: infrequently - muscle spasm.
From the side of the digestive system: very often - nausea; often - diarrhea, abdominal pain, impaired taste; infrequent - intestinal obstruction, pancreatitis, vomiting, dyspepsia, constipation, dryness of the oral mucosa, stomach pain, stomach or duodenal ulcer; rarely - stomatitis, aphthous stomatitis, glossitis; very rarely - intestinal angioedema.
From the liver and bile ducts: rarely - liver failure, hepatitis (cholestatic or necrotic), cholestasis.
From the hemopoietic system: infrequently - anemia, incl. aplastic and hemolytic; rarely - thrombocytopenia, neutropenia, agranulocytosis, pancytopenia, lymphadenopathy, insufficiency of bone marrow hematopoiesis.
From the respiratory system: very often - cough; often shortness of breath; infrequently - rhinorrhea, pharyngeal-laryngeal pains, dysphonia, bronchospasm, asthma;rarely - lung infiltration, rhinitis, alveolar allergic / eosinophilic pneumonia.
From the side of the organ of vision: very often - reduced visual acuity.
From the side of the organ of hearing: infrequently - ringing in the ears, vertigo.
From the cardiovascular system: often - arrhythmia, angina pectoris, tachycardia, myocardial infarction, marked decrease in blood pressure, fainting, stroke, due to excessive blood pressure lowering in patients with increased risk; infrequent - a feeling of palpitations, "hot flashes" of blood to the skin of the face, orthostatic hypotension; rarely - Raynaud's syndrome.
Laboratory indicators: often - hyperkalemia, an increase in creatinine in the blood; infrequently - an increase in urea in the blood, a decrease in the sodium content in the blood; rarely - an increase in the level of hemoglobin and hematocrit, an increase in the number of hepatic enzymes and a decrease in the concentration of bilirubin in the blood.
Other: very often - asthenia; often - fatigue, chest pain; infrequently - a malaise.
A symptom complex including facial flushing, nausea, vomiting, and a marked decrease in blood pressure is also described and can develop with simultaneous use of ACE inhibitors and a gold preparation (sodium aurotyomalate) IV.
Lercanidipine
From the side of the central nervous system: infrequently - dizziness, headache.
From the side of the psyche: rarely - drowsiness.
From the skin: rarely - a rash.
From the immune system: very rarely - hypersensitivity.
From the genitourinary system: rarely - polyuria.
From the musculoskeletal system: rarely - myalgia.
From the digestive system: rarely - nausea, indigestion, diarrhea, abdominal pain, vomiting.
From the side of the cardiovascular system: infrequently - tachycardia, palpitation, "tides" of blood to the skin of the face; rarely - angina pectoris; very rarely - faint.
Other: infrequent peripheral edema; rarely - asthenia, increased fatigue.
CONTRAINDICATIONS
- violation of outflow from the left ventricle, including stenosis of the aortic valve;
- chronic heart failure in the stage of decompensation;
- hereditary and / or idiopathic angioedema (including in the anamnesis);
- angioedema due to the use of ACE inhibitors (in the anamnesis);
- unstable angina;
- the first month after the myocardial infarction (within 28 days);
- severe renal failure (CK <30 ml / min), including patients on hemodialysis;
severe hepatic impairment;
- simultaneous use with potent inhibitors of the isoenzyme CYP3A4 (ketoconazole, itraconazole, erythromycin, ritonavir, troleandomycin), cyclosporine, grapefruit juice;
- lactase deficiency, lactose intolerance, glucose / galactose malabsorption syndrome;
- children and adolescence under 18;
- hypersensitivity to lercanidipine, enalapril, or to any other ACE inhibitor and other BCCC derived dihydropyridine, as well as to any other component of the drug.
With caution
- syndrome of weakness of the sinus node (without simultaneous application of an artificial pacemaker);
- a violation of the function of the left ventricle and ischemic heart disease;
- renal failure (QC more than 30 ml / min);
- Renovascular hypertension;
- condition after kidney transplantation (experience of application is limited);
- liver failure;
- oppression of bone marrow hematopoiesis;
- severe autoimmune diseases of connective tissue (including scleroderma, systemic lupus erythematosus);
- simultaneous use with immunosuppressants, allopurinol, procainamide;
- diabetes;
- surgical interventions and general anesthesia;
- Patients who follow a diet with restricted intake of table salt;
- Hyperkalemia;
- Conditions accompanied by a decrease in bcc, incl. diarrhea, vomiting, primary aldosteronism.
PREGNANCY AND LACTATION
Use of the drug Coripren В® is not recommended for use in pregnancy.
ACE inhibitors can cause disease or death of the fetus or newborn in appointments in the second and third trimesters of pregnancy. The use of ACE inhibitors during this period was accompanied by a negative impact on the fetus and newborn, including the development of arterial hypotension, renal failure, hyperkalemia and / or hypoplasia of the skull bones in a newborn. Perhaps the development of oligohydramnion, apparently due to a decrease in the function of the kidneys of the fetus. This complication can lead to limb contracture, deformation of the skull bones, including its facial part, and lung hypoplasia. Teratogenic effect with the use of ACE inhibitors (enalapril) in the I trimester is not proved, but we should not rule out this possibility. Patients who are on therapy with ACE inhibitors when planning pregnancy should switch to alternative schemes of antihypertensive treatment.
It is not recommended to use the drug in women of childbearing age who do not use reliable contraceptives.
The use of the drug in the period of breastfeeding is not recommended, because Enalapril and its main metabolite - enalaprilat penetrate into breast milk.
APPLICATION FOR FUNCTIONS OF THE LIVER
Contraindicated in severe renal failure (CK <30 mL / min), including patients on hemodialysis.
With caution: renal failure (QC more than 30 ml / min); Renovascular hypertension; state after kidney transplantation (application experience is limited).
APPLICATION FOR VIOLATIONS OF THE FUNCTION OF KIDNEYS
Contraindicated in severe hepatic insufficiency.
With caution for moderate and mild hepatic insufficiency.
APPLICATION FOR CHILDREN
Contraindicated in children under 18 years.
SPECIAL INSTRUCTIONS
Particular attention in the treatment of hypertension is required by patients with severe arterial hypotension with systolic blood pressure less than 90 mm Hg, as well as patients with decompensated heart failure.
Transient arterial hypotension is not a contraindication to the continuation of treatment, tk. after replenishment of bcc, an adequate response to the administration of the drug can be expected.
Particular care should be taken in the initial stages of treatment of patients with mild to moderate renal failure.
Patients with bilateral renal artery stenosis or stenosis of the artery of a single functioning kidney are particularly at risk of developing hypotension or renal failure due to the administration of ACE inhibitors. For this group of patients, treatment should be performed under the strict supervision of a physician, with careful selection of the dose and administration of low doses of the drug. Before and during the treatment it is necessary to monitor the function of the kidneys.
Particular care should be taken in the initial stages of treatment of patients with mild to moderate degree of liver function deficiency. If there is jaundice and a significant increase in the activity of liver enzymes, it is necessary to stop taking ACE inhibitors and consult a doctor.
Because of the increased risk of anaphylactic reactions should not be prescribed to patients in hemodialysis using high-strength polyacrylonitrile membranes (AN69), suffer from a low-density lipoprotein apheresis with dextran sulfate, and immediately prior to the desensitization procedures wasp or bee venom.
Like other ACE inhibitors, it has a less pronounced antihypertensive effect in blacks compared to patients with other races.
Because the application may develop enalapril angioneurotic edema of the face, limbs, tongue, pharynx, or larynx. In this case, you should immediately stop taking the drug. Angioneurotic edema of the larynx may be fatal. Angioneurotic edema tongue, pharynx or larynx can cause airway obstruction, should immediately enter 0.3-0.5 ml solution of epinephrine (adrenaline) n / a ratio of 1: 1000 and maintain airway (intubation or tracheostomy).
Among patients blacks receiving ACE inhibitor therapy, angioedema incidence higher than other accessories race among patients.
Patients with a history of angioneurotic edema, not involving the use of ACE inhibitors, are at increased risk of angioedema during application of any ACE inhibitor.
Prior to surgery (including dental), you must notify the surgeon / anesthetist on the use of ACE inhibitors. During surgical procedures and / or general anesthesia using means causing hypotension, ACE inhibitors can block the formation of angiotensin II in response to compensatory renin release. If it develops a marked reduction in blood pressure, explained by such a mechanism, it is possible to adjust the increase in BCC.
Hyperkalemia may occur during therapy with ACE inhibitors, including and enalapril. Risk factors for hyperkalemia are renal failure, advanced age, diabetes, some comorbid conditions (reduction of BCC, acute heart failure decompensation, metabolic acidosis), simultaneous reception of potassium-sparing diuretics (such as spironolactone, eplerenone, triamterene, amiloride), as well as drugs potassium or potassium-based salt substitutes and the use of other drugs that enhance the potassium content in the blood plasma (e.g., heparin). Hyperkalemia can cause serious heart rhythm disturbances, sometimes with fatal consequences. Combined use of the above formulations must be done with caution.
It is not recommended during therapy with drinking alcohol.
There is evidence of reversible biochemical changes in the sperm heads in the application of calcium channel blockers, which can disrupt their ability to fertilize.
Impact on the ability to drive vehicles and manage mechanisms
It should be borne in mind the possibility of weakness and drowsiness, so use caution when performing tasks that require special attention, especially at the beginning of treatment, at higher doses and when driving.
OVERDOSE
Information about drug overdose are not available. Presumably, in the case of overdose can cause a condition caused by an overdose of any of the active substances.
Lercanidipine
symptoms: peripheral vasodilation with marked decrease in blood pressure and reflex tachycardia, and vomiting.
Treatment: Treatment is symptomatic, the choice of treatment depends on the extent of overdose, and from the symptoms observed. The applicable methods of care: gastric lavage, high doses of catecholamines, furosemide, cardiac glycosides and plasma substitutes, activated carbon, laxatives and / introduction of dopamine. In order to prevent possible development of bradycardia in / atropine.
Enalapril
Symptoms:the main feature of overdose - marked reduction of blood pressure, which is followed by the blockade of the renin-angiotensin-aldosterone system. It can also develop collapse, electrolyte imbalance, renal failure, hyperventilation, tachycardia, palpitations, bradycardia, dizziness, anxiety and cough.
Treatment: Treatment is symptomatic. In severe cases it is recommended to / in a 0.9% sodium chloride solution, and if possible, the administration of the angiotensin II infusion and / or catecholamines. If overdose developed symptoms immediately after dosing, it is necessary to induce vomiting, to gastric lavage and take drugs from the group of absorbent or sodium sulfate.
DRUG INTERACTION
Antihypertensive effect Koriprena may potentiate other drugs to lower blood pressure, such as diuretics, beta-blockers, alpha-blockers, and others.
Furthermore, while the use of other drugs may occur following interaction effects.
Lercanidipine
drug should not be taken in combination with inhibitors of CYP3A4, such as ketoconazole, itraconazole, erythromycin and others with cyclosporine and grapefruit juice (increase the concentration in the blood and lead to potentiation of the antihypertensive effect).
Care must be taken at the same time taking with drugs such as terfenadine, astemizole, antiarrhythmic drugs of class III (e.g., amiodarone), and quinidine.
Simultaneous treatment with anticonvulsant (e.g., phenytoin, carbamazepine) and rifampicin can reduce the antihypertensive effect of lercanidipine.
Acceptance of digoxin should be carefully monitored in order to detect clinical signs of digoxin toxicity.
The drug with midazolam increases the absorption of lercanidipine in the gastrointestinal tract and decrease the rate of absorption.
Metaprolol reduces bioavailability of lercanidipine 50%.
Cimetidine 800 mg / day did not lead to significant changes in contents and concentrations of lercanidipine in the serum, however, with such a combination requires special care, since at higher doses, the bioavailability of lercanidipine cimetidine and, hence, its antihypertensive effect, can be increased.
Fluoxetine has no effect on the pharmacokinetics of lercanidipine.
In the case of the drug simvastatin, the drug should be taken in the morning and simvastatin - in the evening.
Lercanidipine concurrently with warfarin did not affect the pharmacokinetics of the latter.
Enalapril
Simultaneous administration of the drug with potassium salts, with potassium-sparing diuretics (spironolactone, triamterene, eplerenone, amiloride), ACE inhibitors, angiotensin II receptor antagonists, NSAIDs, heparin (low molecular weight or nefratsionirovannye), cyclosporin, tacrolimus and trimethoprim increases the risk of hyperkalemia.
He also recommended along with lithium salts (when reception of such a combination is required, carried out careful control over the plasma concentration of lithium).
Simultaneous treatment with antidiabetic drugs (both oral and insulin) may cause hypoglycaemia in the first week of treatment.
Diuretics ( "loop" and thiazide) may cause a decrease in the BCC and thus increase the risk of significant decrease in blood pressure in the treatment agent.
Long term use of NSAIDs may reduce the antihypertensive effect of the ACE inhibitors.
As NSAIDs and ACE inhibitors (enalapril) contribute to the potassium content of the blood, which can lead to renal dysfunction.
Baclofen enhances the antihypertensive effect.
Cyclosporin increases the risk of hyperkalemia.
Ethanol enhances the antihypertensive effect of the ACE inhibitors.
Tricyclic antidepressants, antipsychotics, drugs for general anesthesia, opioid analgesics may lead to a further decrease in blood pressure.
Corticosteroids (except hydrocortisone as replacement therapy in Addison's disease) reduced antihypertensive effect (fluid retention with the subsequent increase bcc).
Combined use with other antihypertensive agents may enhance the antihypertensive effect of enalapril.
The combined use of nitroglycerine and other nitrate vasodilators and leads to even more pronounced decrease in BP.
Allopurinol, cytostatic, immunosuppressive agents, systemic corticosteroids, and procainamide may lead to an increased risk of leucopenia.
Antacids help reduce the bioavailability of ACE inhibitors.
Sympathomimetics may reduce the antihypertensive effect.
Enalapril can be applied simultaneously with acetylsalicylic acid (as an antiplatelet agent).
When applied simultaneously with the preparation of gold (sodium aurothiomalate) in / side effects may develop.
TERMS OF RELEASE FROM PHARMACY
The drug is released by prescription.
TERMS AND CONDITIONS OF STORAGE
The drug should be stored out of reach of children at a temperature of no higher than 25 В° C. Shelf life - 2 years.
