Instructions for use LERKAMEN 10

pharmachologic effect

The tablets have a pronounced hypotensive effect. The mechanism of action is based on selective blocking of calcium receptors. Lercanidipine is able to slow down the flow of calcium ions in smooth muscle tissue and cardiomyocytes.

Lerkamen reduces total peripheral vascular resistance and gradually expands the lumen of blood vessels, preventing the development of reflex tachycardia and collapse . The medication does not have a negative inotropic effect.

Pharmacodynamics and pharmacokinetics

The medicine Lerkamen is well absorbed from the digestive system. The maximum plasma concentration is recorded after 1.5-3 hours. Up to 98% of the active substance binds to plasma proteins.

The bioavailability of the drug increases after eating, which is why it is recommended to take the tablets on an empty stomach. As the dose increases, bioavailability increases. Initially, the drug is metabolized in the hepatic system, which explains the low absolute bioavailability of 10%.

The hypotensive effect is observed throughout the day. The active component is excreted through the renal system; the half-life is 10 hours.

Contraindications

• heart failure;
• obstruction of the vessels leaving the left ventricle;
• individual hypersensitivity to lercanidipine ;
• lactase deficiency;
• pregnancy;
• unstable form of angina ;
• acute myocardial infarction ;
• sick sinus syndrome (in patients without a pacemaker);
• lactation;
• age limit – 18 years.

Contraindications to the use of the drug Lerkamen

Hypersensitivity to dihydropyridines or other components of the drug; severe stenosis of the mitral or aortic valve; hypertrophic cardiomyopathy with obstruction of the left ventricular outflow tract; decompensated congestive heart failure, unstable angina; within 1 month after myocardial infarction; severe liver and kidney dysfunction (creatinine clearance ≤10 ml/min); During pregnancy and breastfeeding; women of childbearing age (in the absence of adequate contraception), children and adolescents under the age of 18; simultaneous use with CYP3A4 inhibitors (for example, cyclosporine) and grapefruit juice.

Side effects

Nervous system:

• migraine;
• dizziness;
• sleep and wakefulness disorders.

Digestive tract:

• stool disorders;
• gastralgia;
• dyspepsia (vomiting, nausea);
• increased ALT, AST;
• disruption of food digestion.

The cardiovascular system:

• discomfort behind the sternum;
• increased heart rate;
• increase in angina ;
• drop in blood pressure;
• chest pain.

Allergic responses, frequent urination , development of polyuria , swelling, hyperemia , gum hyperplasia , and muscle pain are also possible.

Side effects of the drug Lerkamen

Those registered during clinical studies are shown in the following table:

In isolated cases (≤1/10,000), gingival hyperplasia and a reversible increase in the activity of liver transaminases in the blood plasma are detected (no other clinically significant deviations in laboratory tests of liver function were detected). There have been reports of increased urinary frequency. In isolated cases, the use of some dihydropyridines leads to angina attacks. Very rarely, unstable progressive angina may develop, in some cases even leading to the development of myocardial infarction. Lercanidipine does not significantly affect the levels of glucose and lipids in the blood plasma.

Instructions for use of Lerkamen (Method and dosage)

The tablets are intended for oral administration. It is not allowed to crush the drug or damage the protective shell. The effectiveness of the drug increases when lercanidipine is taken on an empty stomach. The duration of therapy is determined by the doctor.

1 tablet of 10 mg is taken 1 time every 24 hours. If there is insufficient reduction in blood pressure, after 14 days you can switch to a single dose of 20 mg.

Take the tablets with water on an empty stomach. When the dose of the drug is increased (more than 20 mg per day), an increase in the hypotensive effect is not observed, but an increase in the frequency and severity of undesirable side reactions is recorded.

If the medication is ineffective in the treatment of arterial hypertension, it is recommended to prescribe additional antihypertensive drugs from other pharmacological groups.

Use of the drug Lerkamen

The recommended dose for adults is 10 mg 1 time per day, at least 15 minutes before meals. Depending on the individual sensitivity of the patient and the effect achieved, the dose may be increased to 20 mg. The maximum antihypertensive effect develops within 2 weeks of treatment. Lerkamen can be taken simultaneously with beta-adrenergic blockers, diuretics or ACE inhibitors. It is unlikely that the effectiveness of the drug will increase with increasing dose, but at the same time, an increase in side effects is possible.

Overdose

There is a drop in blood pressure, drowsiness , ischemic changes in myocardial tissue, nausea, and the development of cardiogenic shock . Induction of vomiting, administration of laxatives and enterosorbents are recommended.

In case of severe intoxication, Dopamine , catecholamines , and diuretics are prescribed. It is possible to administer Atropine bradycardia develops , a drop in blood pressure and loss of consciousness. Treatment is carried out in a hospital. Hemodialysis has not proven effective.

Interaction

Absorption of the drug is enhanced during treatment with midazolam . Inducers of CYP3A4, ethanol, Cyclosporine and grapefruit juice are strictly contraindicated when taking Lerkamen.

Caution is required when taking high doses of cimetidine (more than 800 mg).

The bioavailability of the active substance increases simultaneously with an increase in the negative inotropic effect during therapy with beta-blockers.

A mandatory dose adjustment of Digoxin after starting lercanidipine therapy.

To reduce the risk of negative interactions, it is necessary to maintain a 10-hour window when taking Simvastatin and lercanidipine.

Drug interactions Lerkamen

The simultaneous use of Lerkamen with inhibitors of CYP 3A4 (for example, ketoconazole, itraconazole, ritonavir, erythromycin or troleandomycin) should be avoided. Research results indicate that the simultaneous use of ketoconazole and lercanidipine leads to a significant increase in the plasma concentration of the latter. The combined use of lercanidipine with cyclosporine leads to an increase in the concentration of both drugs in the blood plasma, therefore lercanidipine and cyclosporine should not be used simultaneously. The metabolism of lercanidipine, like other dihydropyridines, slows down when combined with grapefruit juice, which leads to an increase in its systemic bioavailability and antihypertensive effect, so you should not take lecarnidipine with grapefruit juice. Caution is required when combining lercanidipine with terfenadine, astemizole, amiodarone, or quinidine. The simultaneous use of midazolam and lercanidipine at a dose of 20 mg led to an increase in the absorption of lercanidipine by 40% and a decrease in the rate of its absorption (3 hours instead of 1.75 hours). Lerkamen can be prescribed together with diuretics and ACE inhibitors. Cimetidine in a daily dose of up to 800 mg does not cause significant changes in lercanidipine in blood plasma, but caution is required when increasing the dose, since the bioavailability and antihypertensive effect of lercanidipine may increase. The simultaneous use of lercanidipine with inducers of CYP 3A4, such as anticonvulsants (for example, phenytoin, carbamazepine), and with rifampicin may lead to a decrease in the severity of its antihypertensive effect, in which case it is necessary to monitor blood pressure more often. It should be borne in mind that the combined use of Lerkamen with metoprolol (or other β-adrenergic receptor blockers) leads to a decrease in its bioavailability by 50% due to a decrease in hepatic blood flow, so dose adjustment of the drug may be necessary. With simultaneous use of lercanidipine with beta-adrenergic receptor blockers, the negative inotropic effect may be potentiated. The combined administration of lercanidipine at a dose of 20 mg and β-methyldigoxin does not lead to their pharmacokinetic interaction. The simultaneous use of digoxin and lercanidipine at a dose of 20 mg leads to an increase in the concentration of digoxin in the blood plasma by 33%, so monitoring is necessary for the possible manifestation of digoxin intoxication. There were no clinically significant interactions between lercanidipine and fluoxetine. When lercanidipine 20 mg was co-administered with simvastatin 40 mg, the AUC for lercanidipine changed little, whereas the AUC for simvasantine increased by 56% and its active hydroxy acid metabolite increased by 28%. It is unlikely that such changes are clinically significant. Interactions can be avoided if lercanidipine is taken in the morning and simvastatin in the evening. With simultaneous use of lercanidipine and warfarin, no changes in the pharmacokinetics of warfarin were observed. When used in combination with MAO inhibitors, the hypotensive effect of lercanidipine may be enhanced, and with nitrates - an additional decrease in blood pressure and an increase in heart rate. When taking alcohol and antihypertensive drugs simultaneously, the vasodilating effect of the latter increases.

Analogues of Lerkamen

Level 4 ATC code matches:
Lacipil

Cordafen

Azomex

Nimodipine

Felodipin

Nifedipine

Farmadipin

Amlotop

Nimotop

Tenox

Nifecard HL

Cordipin

Felodip

Normodipine

Phenigidine

Norvask

Cordaflex

Corinfar

Vero-Amlodipine

Amlodipine

Analogues of Lerkamen, produced and prescribed in Russia and other countries:

• Zanidip-Recordati
• Lercanorm
• Lernikor
• Lerkaton
• Lervask
• Zanikor

Reviews of analogues are positive and indicate the high effectiveness of the drugs in the treatment of hypertension.

Note!

The description of the drug Lerkamen on this page is a simplified author’s version of the apteka911 website, created on the basis of the instructions for use.
Before purchasing or using the drug, you should consult your doctor and read the manufacturer's original instructions (attached to each package of the drug). Information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. Only a doctor can decide to prescribe the drug, as well as determine the dose and methods of its use.

Reviews about Lerkamen

Thematic portals and medical forums, where patients share their impressions of taking medications, contain only positive reviews.

The drug is well tolerated and stabilizes blood pressure after 2 weeks of regular use in patients with stage 1 arterial hypertension.

The incidence of adverse reactions is low; the drug is considered highly effective in the treatment of grade 2.3 hypertension in combination with other antihypertensive drugs.

Special instructions for the use of the drug Lerkamen

In patients with sick sinus syndrome, Lerkamen should be used with extreme caution (unless a pacemaker is implanted). Although hemodynamic studies have not revealed a deterioration in ventricular function, with its initial dysfunction, special care is required, as with ischemic heart disease. Some dihydropyridines may in some cases cause anginal attacks. Lercanidipine does not affect blood sugar and lipid levels. One tablet contains 30 mg of lactose, so the drug is not recommended for use in cases of lactase deficiency, galactosemia and glucose/galactose malabsorption. Use in elderly patients. Pharmacokinetic data and clinical experience indicate that there is no need to adjust the daily dose, but caution must be exercised when using the drug in elderly patients. Use for impaired renal or liver function. Lercanidipine can be prescribed to patients with mild to moderate renal and hepatic dysfunction, but caution is required if their daily dose exceeds 20 mg. The antihypertensive effect of the drug may be enhanced by impaired liver function, so dose adjustment may be necessary. Use during pregnancy and lactation. Not recommended due to lack of clinical experience. Use in children. Not recommended due to lack of clinical experience. The ability to influence reaction speed when driving vehicles or operating machinery. The risk of dizziness, drowsiness and fatigue caused by taking Lerkamen is low, but it should be taken into account when driving or operating machinery.

Lerkamen price, where to buy

The cost varies depending on the region and pharmacy network. The price of Lerkamen 10 mg is about 400 rubles. for 28 tablets. The price of Lerkamen 20 mg is about 700 rubles. for 28 tablets.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine
• Online pharmacies in KazakhstanKazakhstan

ZdravCity

• Lerkamen 10 tablets p.p.o.
  28 pcs.Berlin-Chemie AG/Menarini Group RUR 392 order
• Lerkamen 20 tablets p.p.o. 60 pcs.Berlin-Chemie AG/Menarini Group

  1106 rub. order

• Lerkamen 20 tablets p.p.o. 28 pcs.Berlin-Chemie AG/Menarini Group

  RUR 665 order

• Lerkamen Duo tab. p/o captivity. 10mg + 10mg No. 28Recordati Chemical and Pharmaceutical Industry S.p.A.

  RUR 526 order

Pharmacy Dialogue

• Lerkamen (tab.p.pl/vol. 20mg No. 60)Berlin-Chemie AG/Menarini

  RUB 1,085 order

• Lerkamen Duo (tab.p.pl/vol.10mg+20mg No. 28)Recordati

  RUR 691 order

• Lerkamen (tab.p.pl/vol. 20mg No. 28)Berlin-Chemie AG/Menarini

  RUB 667 order

• Lerkamen Duo (tab.p.pl/vol. 10mg+10mg No. 28)Recordati

  RUR 537 order

  Read also:  Likferr 100 solution for intravenous administration 20 mg/ml 5 ml 5 pcs. in Moscow
• Lerkamen (tab.p.pl/vol. 10mg No. 28)Berlin-Chemie AG/Menarini

  RUB 388 order

show more

Pharmacy24

• Lerkamen 10 mg No. 28 tablets Berlin Chemi AG, Nimechchina
  164 UAH.order
• Lerkamen 10 mg N60 tablets Berlin Chemi AG, Nimechchina

  297 UAH order

• Lerkamen 20 mg No. 28 tablets Berlin Chemi AG, Nimechchina

  263 UAH order

PaniPharmacy

• Lerkamen tablets Lerkamen tablets. p/o 10 mg No. 60 Germany, Berlin-Chemie

  343 UAH. order

• Lerkamen tablets Lerkamen tablets. p/o 10 mg No. 28 Germany, Berlin-Chemie

  179 UAH. order

• Lerkamen tablets Lerkamen tablets. p/o 20 mg No. 28 Germany, Berlin-Chemie

  284 UAH order

• Lerkamen tablets Lerkamen tablets. p/o 20 mg No. 60 Germany, Berlin-Chemie

  509 UAH. order

show more

Lerkamen® Duo

Patients who require special attention when treating arterial hypertension:

- with severe arterial hypotension (systolic blood pressure less than 90 mm Hg);

- with decompensated heart failure.

The drug Lerkamen® Duo should not be used to relieve a hypertensive crisis.

Aortic stenosis/mitral stenosis/hypertrophic obstructive cardiomyopathy

Like all drugs that have a vasodilating effect, ACE inhibitors and BMCCs should be used with caution in patients with left ventricular outflow tract obstruction.

Lerkamen® Duo should be used with extreme caution in patients with aortic stenosis, mitral stenosis or hypertrophic obstructive cardiomyopathy. In patients with hemodynamically significant obstruction of the left ventricular outflow tract (for example, with severe aortic stenosis), the use of the drug is contraindicated.

Alcohol

During treatment, you should avoid drinking alcoholic beverages, since ethanol enhances the antihypertensive effect of vasodilating antihypertensive drugs.

Lactose

The drug Lerkamen® Duo contains lactose monohydrate, therefore its use in patients with rare hereditary lactose intolerance, lactase deficiency or glucose-galactose malabsorption syndrome is contraindicated.

Lercanidipine

Sick sinus syndrome

Lercanidipine should be used with extreme caution in patients with sick sinus syndrome (without a pacemaker).

Left ventricular dysfunction

Although controlled hemodynamic studies have not revealed any abnormalities in left ventricular function, the use of BMCC in patients with signs of left ventricular dysfunction should be carried out with extreme caution.

Cardiac ischemia

Patients with coronary heart disease receiving short-acting BMCCs, dihydropyridine derivatives, represent a high-risk group for developing complications from the cardiovascular system. Although lercanidipine is a long-acting drug, caution should be exercised when used in patients with coronary artery disease.

In rare cases, in patients with angina pectoris, when using blockers of “slow” calcium channels, an increase in the frequency, duration and/or severity of angina attacks was observed, as well as, in isolated cases, the development of myocardial infarction (see section “Side Effects”).

Chronic heart failure

In patients with chronic heart failure, lercanidipine should be used with extreme caution. Before starting to use the drug, it is necessary to achieve compensation for chronic heart failure.

Unstable angina/myocardial infarction

There is no experience with the clinical use of lercanidipine in acute myocardial infarction and unstable angina, and therefore the use of the drug in these diseases is contraindicated.

Impaired liver or kidney function

Particular caution should be exercised when initiating treatment in patients with mild or moderate renal impairment. Although the usual recommended dose of 10 mg is generally well tolerated by patients, increasing the daily dose of lercanidipine to 20 mg should be approached with caution.

In patients with mild or moderate hepatic impairment, the antihypertensive effect may be enhanced, and therefore caution should be exercised and the need for dosage adjustment of lercanidipine should be considered.

Lercanidipine is contraindicated in patients with severe hepatic impairment or severe renal impairment (GFR < 30 ml/min), as well as in patients on hemodialysis (see sections "Dosage and Administration" and "Contraindications").

Peritoneal dialysis

Patients on peritoneal dialysis may experience cloudiness of the peritoneal exudate, which is due to increased concentrations of triglycerides in the exudate. Although the mechanism is unknown, exudate opacities tend to resolve soon after discontinuation of lercanidipine. This is important to remember, since cloudy peritoneal exudate can be mistakenly regarded as one of the symptoms of infectious peritonitis, followed by unnecessary hospitalization and empirical prescription of antibiotics.

CYP3A4 inducers

Inducers of CYP3A4, such as anticonvulsants (eg, phenytoin, carbamazepine) and rifampicin, may decrease plasma concentrations of lercanidipine; therefore, the effectiveness of lercanidipine may be reduced.

Enalapril

Symptomatic hypotension

Symptomatic hypotension is rarely observed in patients with uncomplicated hypertension. In patients with arterial hypertension taking enalapril, arterial hypotension develops more often against the background of dehydration, which occurs, for example, as a result of diuretic therapy, restriction of dietary salt intake, in patients on dialysis, as well as in patients with diarrhea or vomiting.

Symptomatic hypotension has been observed in patients with chronic heart failure (CHF) with or without chronic renal failure.

Arterial hypotension is more likely to develop in patients with more severe CHF with hyponatremia or impaired renal function in whom higher doses of loop diuretics are used. In such patients, treatment with enalapril should be initiated under medical supervision, which should be especially careful when changing the dose of enalapril and/or diuretic.

Similarly, patients with coronary artery disease or cerebrovascular disease, in whom an excessive decrease in blood pressure may lead to the development of myocardial infarction or stroke, should be monitored.

If arterial hypotension develops, the patient should be placed in a horizontal position and, if necessary, administered a 0.9% sodium chloride solution. Transient arterial hypotension when taking enalapril is not a contraindication to further use and increasing the dose of enalapril, which can be continued after fluid volume is replenished and blood pressure is normalized.

In some patients with CHF and normal or low blood pressure, enalapril may cause an additional decrease in blood pressure. This reaction to taking enalapril is expected and is not a reason to stop treatment. In cases where arterial hypotension becomes stable, the dose should be reduced and/or discontinued use of the diuretic and/or enalapril.

Renal dysfunction

In patients with impaired renal function (creatinine clearance <80 ml/min), the initial dose and/or frequency of enalapril should be reduced depending on the creatinine clearance. In such cases, renal function (creatinine and potassium levels in the blood) should be regularly monitored during the first few weeks of treatment.

In some patients, hypotension that develops after initiation of treatment with ACE inhibitors may lead to deterioration of renal function. Cases of the development of oliguria, progressive azotemia and acute renal failure (including fatal outcomes) have been described with the use of ACE inhibitors, mainly in patients with chronic heart failure or concomitant kidney disease (including renal artery stenosis). With timely detection and appropriate treatment, acute renal failure caused by the use of ACE inhibitors is usually reversible.

In some patients without signs of kidney disease before treatment, the use of enalapril in combination with diuretics caused an increase in the concentration of urea and creatinine in the blood serum. In such cases, it may be necessary to reduce the dose and/or discontinue the diuretic and/or enalapril. It is recommended to conduct an appropriate examination, since these abnormalities may be a sign that the patient has previously unrecognized renal artery stenosis.

Renovascular hypertension

Patients with bilateral renal artery stenosis or stenosis of the artery of a solitary kidney have an increased risk of developing arterial hypotension and renal failure when using ACE inhibitors. Renal failure may initially manifest itself as only slight changes in plasma creatinine levels. The use of enalapril in such patients should be started with low doses, under close medical supervision and monitoring of renal function.

Kidney transplant

There is no experience with the use of enalapril in patients who have recently undergone kidney transplantation. Therefore, the use of enalapril in such patients is not recommended.

Liver dysfunction

The use of ACE inhibitors in rare cases has been accompanied by the development of a syndrome starting with cholestatic jaundice or hepatitis and progressing to fulminant liver necrosis, sometimes with death. The mechanism of development of this syndrome is unknown. If jaundice appears or a significant increase in the activity of “liver” transaminases during the use of the drug, you should stop taking enalapril and prescribe appropriate auxiliary therapy. The patient should be under appropriate supervision.

Neutropenia/agranulocytosis/thrombocytopenia/anemia

Cases of neutropenia/agranulocytosis, thrombocytopenia and anemia have been reported in patients taking ACE inhibitors. In patients with normal renal function and no other complicating factors, neutropenia rarely occurs.

Enalapril should be used with extreme caution in patients with systemic connective tissue diseases (systemic lupus erythematosus, scleroderma, etc.) taking immunosuppressive therapy, allopurinol or procainamide, or a combination of these complicating factors, especially if there are impaired renal function. Some patients developed serious infectious diseases, which in some cases did not respond to intensive antibiotic therapy. When using enalapril in patients with a high risk of neutropenia/agranulocytosis, regular monitoring of the number of leukocytes in the blood is recommended. Patients should be warned to seek immediate medical attention if any signs of an infectious disease (eg, fever, sore throat) occur.

Hypersensitivity reactions/angioedema

Rare cases of angioedema of the face, extremities, lips, tongue, vocal folds and/or larynx have been observed with the use of ACE inhibitors, including enalapril. Angioedema may develop at any time during treatment. In such cases, you should immediately stop taking enalapril and carefully monitor the patient's condition in order to monitor and correct clinical symptoms. Even in cases where only swelling of the tongue is observed without the development of respiratory distress syndrome, patients may require long-term observation, since therapy with antihistamines and corticosteroids may not be sufficient.

Angioedema, associated with swelling of the larynx and tongue, can be fatal in very rare cases. Swelling of the tongue, vocal folds, or larynx can lead to airway obstruction, especially in patients who have undergone respiratory surgery. If airway obstruction develops, appropriate treatment should be immediately prescribed, including subcutaneous administration of 0.3-0.5 ml of a 0.1% solution of epinephrine (adrenaline) and/or ensuring airway patency (intubation or tracheostomy).

In rare cases, intestinal edema (angioedema of the intestine) develops during therapy with ACE inhibitors. In this case, patients experience abdominal pain as an isolated symptom or in combination with nausea and vomiting, in some cases without previous angioedema of the face and with normal levels of C1-esterase. Diagnosis is made using abdominal computed tomography, ultrasound, or surgery. Symptoms disappeared after stopping the ACE inhibitors. The possibility of developing intestinal edema must be taken into account when carrying out the differential diagnosis of abdominal pain in patients taking ACE inhibitors.

Patients with a history of angioedema not associated with ACE inhibitors may be at greater risk of developing angioedema during ACE inhibitor therapy.

In black patients taking ACE inhibitors, angioedema was observed more often than in representatives of other races. An increased risk of angioedema was observed in patients concomitantly taking ACE inhibitors and drugs such as mTOR inhibitors (temsirolimus, sirolimus, everolimus), dipeptidyl peptidase type IV inhibitors (sitagliptin, saxagliptin, vildagliptin, linagliptin), estramustine, neutral endopeptidase inhibitors (racecadotril). ).

Anaphylactoid reactions during desensitization with an allergen from Hymenoptera venom

In rare cases, patients taking ACE inhibitors have developed life-threatening anaphylactoid reactions during desensitization with hymenoptera venom allergen. Adverse reactions can be avoided if you temporarily stop taking the ACE inhibitor before starting desensitization. The use of enalapril should be avoided in patients receiving bee venom immunotherapy.

Anaphylactoid reactions during low-density lipoprotein apheresis (LDL apheresis)

Life-threatening anaphylactoid reactions have rarely been observed in patients taking ACE inhibitors during LDL apheresis using dextran sulfate. The development of these reactions can be prevented by temporarily discontinuing the ACE inhibitor before each LDL apheresis procedure.

Hemodialysis using high-flow membranes

Anaphylactoid reactions have been observed in patients on dialysis using high-flux polyacrylonitrile membranes (such as AN69®) and concomitantly receiving ACE inhibitor therapy. In such cases, it is necessary to use a different type of dialysis membrane or use antihypertensive drugs of other classes.

Diabetes

When using enalapril drugs in patients with diabetes mellitus who are receiving oral hypoglycemic agents or insulin, it is necessary to regularly monitor the concentration of glucose in the blood. Patients taking oral hypoglycemic agents or insulin should be informed before starting the use of ACE inhibitors about the need for regular monitoring of blood glucose concentrations (hypoglycemia), especially during the first month of simultaneous use of these drugs (see section “Interaction with other drugs”). means").

Cough

Cases of cough occurring during therapy with ACE inhibitors have been observed. As a rule, the cough is non-productive, constant and stops after discontinuation of the drug. Cough associated with the use of ACE inhibitors should be considered in the differential diagnosis of dry cough.

Surgery/general anesthesia

During major surgical procedures or during general anesthesia with the use of agents with antihypertensive effects, enalaprilat blocks the formation of angiotensin II caused by the compensatory release of renin. If a pronounced decrease in blood pressure, explained by a similar mechanism, develops, it can be corrected by increasing the volume of circulating blood.

Hyperkalemia

Hyperkalemia may develop during therapy with ACE inhibitors, including enalapril. Risk factors for the development of hyperkalemia are renal failure, old age (over 65 years), diabetes mellitus, some concomitant conditions (decrease in blood volume, acute heart failure in the stage of decompensation, metabolic acidosis), simultaneous use of potassium-sparing diuretics (such as spironolactone, eplerenone, triamterene, amiloride), as well as potassium preparations, potassium-containing table salt substitutes and other drugs that increase the level of potassium in the blood plasma (such as heparin, tacrolimus, cyclosporine; drugs containing co-trimoxazole [trimethoprim + sulfamethoxazole]).

The use of potassium supplements, potassium-sparing diuretics, or potassium-containing table salt substitutes, especially in patients with impaired renal function, can lead to a significant increase in serum potassium levels. Hyperkalemia can cause serious heart rhythm disturbances, sometimes fatal.

If it is necessary to simultaneously use enalapril and the above potassium-containing or increasing potassium levels in the blood plasma, caution should be exercised and the potassium content in the blood serum should be regularly monitored.

Hypokalemia

When using ACE inhibitors simultaneously with thiazide diuretics, the risk of hypokalemia cannot be excluded, therefore, in such cases, regular monitoring of potassium levels in the blood during therapy should be carried out.

Dual blockade of the renin-angiotensin-aldosterone system (RAAS)

Hypotension, syncope, stroke, hyperkalemia and renal dysfunction (including acute renal failure) have been reported in susceptible patients, especially when combined therapy with drugs that affect the RAAS is used. The simultaneous use of ACE inhibitors with medicinal products containing aliskiren is contraindicated in patients with diabetes mellitus and/or with moderate or severe renal impairment (GFR less than 60 ml/min/1.73 m2 body surface area) and is not recommended in other patients.

Concomitant use of ACE inhibitors with angiotensin II receptor antagonists is contraindicated in patients with diabetic nephropathy and is not recommended in other patients.

In cases where the simultaneous administration of two drugs acting on the RAAS is necessary, their use should be carried out under the supervision of a physician with extreme caution and with regular monitoring of renal function, blood pressure and electrolyte levels in the blood plasma.

Lithium preparations

The simultaneous use of enalapril and drugs containing lithium is not recommended (see section “Interaction with other drugs”).

Use in elderly patients

Clinical studies of the efficacy and safety of enalapril were similar in older and younger patients with hypertension.

Ethnic differences

Enalapril, like other ACE inhibitors, has a less pronounced antihypertensive effect in black patients compared to representatives of other races, which may be explained by a higher prevalence of conditions with low plasma renin activity in black patients with arterial hypertension.

Discontinuation of therapy

Sudden cessation of taking enalapril, as a rule, does not lead to the development of withdrawal syndrome.