Is a combination drug containing the active substance: enalapril and hydrochlorothiazide, which is due the properties of the components included in its composition. Enalapril – an ACE inhibitor, a “prodrug”: as a result of hydrolysis formed enalaprilat, which inhibits .
Hydrochlorothiazide proviron for women – a thiazide diuretic. It acts at distal renal tubules, increasing the excretion of sodium and chloride ions.
Early treatment hydrochlorothiazide fluid volume in the vessels is reduced resulting in increase sodium and fluid excretion, leading to a decrease in blood pressure (BP) and a decrease in cardiac output. Consequently and hyponatremia reducing body fluids, activated renin-angiotensin-aldosterone system. Reactive increase in the concentration of angiotensin II partially limits the reduction in blood pressure. With continued therapy, antihypertensive effect of hydrochlorothiazide is based on reducing the total peripheral vascular resistance. The result of the activation of the renin-angiotensin-aldosterone system are metabolic effects on the electrolyte balance of the blood, uric acid, glucose and lipids, which partially neutralizes the effectiveness of antihypertensive treatment. In spite of the effective reduction of blood pressure, thiazide diuretics do not reduce the structural changes in the heart and blood vessels. Enalapril increases the antihypertensive effect – inhibits the renin-angiotensin-aldosterone system, ie, production of angiotensin II and its effects. In addition, it reduces the production of aldosterone and increases the effects of bradykinin and the release of prostaglandins. As he often has its own diuretic effect, it can increase the effects of hydrochlorothiazide.
Enalapril reduces pre- and afterload, which unloads the left ventricle, reduces regression of hypertrophy and proliferation of collagen, prevents damage to the myocardial cells. As a result, the heart rate slows down and reduces the load on the heart (chronic heart failure), improves coronary blood flow and oxygen consumption decreases cardiomyocytes. Thus, reduced sensitivity to ischemia of the heart. It has a beneficial effect on cerebral blood flow in patients with hypertension and chronic cardiovascular diseases. Prevents the development of glomerulosclerosis, maintains and improves the function of the kidneys and slows down even in those patients who have not yet developed hypertension. For chronic kidney disease
is well known that the antihypertensive effect proviron for women of inhibitors is higher in patients with hyponatremia, hypovolemia and increased serum levels of renin, whereas the effect of hydrochlorothiazide is not dependent on the level of renin in the blood serum. Therefore, co-administration of enalapril and hydrochlorothiazide has additional antihypertensive effect. Moreover, enalapril prevents or reduces the metabolic effects of diuretic therapy, and has a favorable effect on the structural changes in the heart and vessels. Co-administration of an ACE inhibitor and hydrochlorothiazide is used when each drug alone is insufficiently effective or monotherapy is carried out using the maximum dose of the drug, which increases the frequency of adverse effects. The antihypertensive effect of the combination is usually maintained for 24 hours.
of enalapril is rapidly absorbed from the gastrointestinal tract. Suction volume is 60%. Food does not affect the absorption of enalapril. The maximum plasma concentration is reached within 1 hour. In the liver, enalapril is hydrolyzed to the active metabolite -. Enalaprilat, which is the carrier of the pharmacological effect
maximum concentration in serum enalaprilat is achieved in 3-6 hours. Enalapril urine output (60%) and the feces (33%), mainly in the form enalaprilat. Enalaprilat penetrates in most tissues of the body, mainly in the lungs, kidneys and blood vessels. Contact with blood plasma proteins – 50 – 60%. Enalaprilat does not undergo further metabolism, and 100% excreted in the urine. Excretion – a combination of glomerular filtration and tubular secretion. Renal clearance of enalapril and enalaprilat make 0,005 ml / s (18 l / h) and 0.00225 – 0.00264 ml / sec (8.1 – 9.5 liter / hr), respectively. Displayed in several stages.When assigning multiple doses of enalapril enalaprilat half-life of blood serum is approximately 11 hours. Enalapril and enalaprilat penetrate through the placental barrier and are excreted in breast milk.
In patients with impaired renal function excretion slows down, which requires a change in dosage according to renal function, especially in patients with severe renal insufficiency. Patients with liver failure enalapril metabolism can be slowed down without damaging its pharmacodynamic effect.
Patients with heart failure enalaprilat absorption and metabolism slows down, the volume of distribution is also reduced. Since these patients proviron for women can renal failure, they may slow down the excretion of enalapril.
Pharmacokinetics enalapril can also vary in elderly patients, mostly due to comorbidities than the elderly.