Following, ratiopharm-enalapril 20 mg in combination-related applications, there are more detailed information:
- High blood pressure
- Heart muscle weakness
The following substance not effective components are part of the drug:
- Magnesium stearate
- Corn starch
- Eisen(III)-OXID red (E 172)
- Iron oxide hydrate yellow (E 172)
- Sodium hydrogen carbonate
- Talcum powder
So does enalapril-ratiopharm 20 mg
Ratiopharm-enalapril 20 mg enalapril contains the active substance. Learn more on the applications and the action of the enalapril below. Read also the information about the ACE inhibitor, to which belongs the active ingredient enalapril drug group. Note the special effect of enalapril-ratiopharm 20 mg is also
Fields of application of the active substance: enalapril
Enalapril has several areas of application:
In patients with high blood pressure of the substance can be used as individual therapy or in combination with other hypotensive means.
Heart muscle weakness and symptomloser Hyposecretion of left ventricle enalapril is given in combination with diuretics.
In severe forms of heart muscle weakness, a combination of enalapril with heart glykosiden is possible.
Also enalapril can be used type 1 conditional kidney disease also at one by diabetes. The effectiveness is however not fully secured. Therefore, not all pharmaceutical companies provide their enalapril medicines for this form of the disease.
Following applications of enalapril, in-depth information is available:
- High blood pressure
- Heart muscle weakness
- Effect of enalapril
Enalapril belongs in the Group of ACE inhibitors. The lowering of the blood pressure is ACE inhibitor in three ways:
By blocking the enzyme ACE (English: angiotensin-converting enzyme) is prevented in the kidney of the formation of the hormone Angiotensin II. Angiotensin II causes a strong contraction and to an increase in blood pressure in the blood vessels. Is blocked by the ACE inhibitors ACE, virtually no Angiotensin II more can be made. The blood vessels relax and blood pressure decreases.
Through support of renal function, salt and water are increasingly eliminated. This reduced blood volume and reduces the pressure in the blood vessels.
direct expansion of blood vessels, by the removal of tank throughout the making the body’s own substance bradykinin is hindered. Thus bradykinin can work longer, the vessels remain permanent expanded.
Enalapril is actually a prodrug: it is itself ineffective and is only converted in the liver into its active form of Enalaprilat. The gift as a prodrug has the advantage that the active substance is absorbed better into the body as his effective conversion product. However the effect of enalapril by converting occurs lazily. The effect begins approximately one to two hours after the capture, has been going on but 18 to 24 hours. Enalapril, respectively Enalaprilat is excreted mainly kidneys. Therefore, the physician must reduce the dose in patients with strong renal impairment and low urine output, because the effect is stronger and lasts.
Special features of the effect of enalapril-ratiopharm 20 mg
Notes to the dosage instructions on the packaging and in the patient information:
The medicine contains the active ingredient enalapril in the form of enalapril maleate. 15,28 Milligrams enalapril correspond to 20 milligrams of enalapril maleate.
- Areas of application according to the manufacturer’s specifications
- High blood pressure
- Weakness of the heart performance in addition to drain funds and, if necessary, also to agents of the Foxglove plant (Digitalis)
- Prevention of complaints-causing weakness of heart performance in patients with impaired function of the left ventricle
Warnings & precautions
Responsiveness can be compromised by strong blood pressure so that the use on the road or driving of machinery are dangerous.
During the treatment works without secure fit are dangerous.
In the event of angioneurotischen oedema (swelling of face, lips, tongue, larynx, mucous membranes, eyes), to cancel treatment and the doctor is to seek.
Whenever a jaundice (Icterus) must the doctor agreed and, where appropriate, terminated therapy.
Before the start of therapy, a liquid or body salt deficiency should be compensated.
During the treatment, you may not suddenly increased physical activity.
The therapy should not be interrupted without medical advice or canceled.
Duration of therapy, all the important laboratory parameters (urea, creatinine, potassium, sodium, urine protein, bilirubin, liver enzymes) must be inspected regularly by doctors.
The active ingredient can cause birth defects in pregnancy. A pregnancy is therefore reliably to prevent.
Should symptoms such as fever, Lymphadenopathy, and/or sore throat, the doctor must promptly examine the blood count.
Enalapril treatment is often less in patients of African descent. Perhaps they need therefore higher dosages of the drug.
The drug contains lactose (milk sugar) and is therefore not suited to patients with glucose utilization.
The drug should be stored not warmer than 25 degrees.
Medicines can cause allergic reactions. Evidence for this can be: redness, runny nose, itching, swelling of the mucous membrane, itching and redness of the eyes, narrowing of the Airways (asthma). In rare cases, there may be allergic shock with loss of consciousness.
Should you perceive signs of an allergic reaction, immediately inform a doctor.
What interactions of the active substance enalapril in enalapril-ratiopharm 20 mg are known? It is important to note that the interactions can be different depending on the pharmaceutical form of the drug (for example, Tablet, syringe, ointment).
Following interactions with enalapril in terms of its effect and side effects can occur:
Salt, non-opioid analgesics and non-steroidal anti-inflammatory drugs reduce the blood pressure reduction.
Anaesthetic, sleeping tablets and remedy for high blood pressure increase the blood pressure reduction.
Immunosuppressive drugs increase the risk of the occurrence of changes in blood count. Allopurinol (combat gout attacks), cytotoxic drugs, glucocorticoids, and procainamide (means against cardiac arrhythmia) step up possible changes in blood count.
Potassium and potassium-sparing Entwässerungsmittel (such as spironolactone, amiloride, triamterene), as well as excess of potassium-causing drugs (E.g. heparin) increase the potassium levels. Thus the effect of heart glykosiden can weaken.
Acrylic fiber methallylsulfonat-high-flux membranes (used in the Blutwäsche), Dextransulfat (inserted at the Blutwäsche in strongly increased lipids) and insecticides in the context of a Desensibilisierungs therapy increase the risk for the occurrence of allergic reactions to the shock.
Oral antidiabetic drugs and insulin amplify a possible reduction in blood glucose.
Enalapril changed but also the effects of other active substances:
The effect of alcohol is increased when simultaneous administration of enalapril.
A combination with lithium (mean in manic depression) is not recommended, since delayed excretion of lithium and thus increased its toxicity.
The tablets are available with 2.5 milligrams, five, ten and 20 milligrams of the active substance enalapril maleate. To achieve the desired dosage, conquered several lower-dose pills together or split stronger (from five milligrams).
The dosage of the drug depends on the nature of the disease, the age of the patient and its Comorbidities. In General, the following dosages are prescribed:
In hypertension, adults begin with a starting dose of five and a maximum of 20 milligrams of enalapril maleate once daily treatment.
In patients with severely faulty blood pressure regulation (RAAS), salt or fluid deficiency or previous therapy with drainage means the treatment under medical supervision must be started daily 2.5 to 5 milligrams of enalapril maleate. The doctor will terminate if possible, two or three days before the start of enalapril therapy a therapy with draining medications, to avoid an excessive drop in blood pressure.
In the initial phase following permanent treatment of high blood pressure the so-called maintenance dose is 20 milligrams of enalapril maleate to not more than 40 mg of enalapril maleate per day.
Heart muscle weakness and Hyposecretion of left cardiac unit without significant complaints at the beginning of the treatment, the dose is 2.5 milligrams of enalapril maleate daily. Duration of treatment, the doctor increases this dose over a period of two to four weeks gradually on day 20 milligrams of enalapril maleate. This dose can be distributed to one or two gifts. The maximum dose of 40 mg of enalapril maleate is necessary per day, she should be administered only in two Einzelgaben.
In older patients and in patients with impaired renal function the doctor is basically reduce the dose and reduce the gaps between the individual doses of the drug. When a creatinine clearance of 30 to 80 milliliters per minute, the initial dose is five to ten milligrams enalapril maleate per day. When a creatinine clearance of ten to 30 milliliters per minute, the initial dose is 2.5 mg of enalapril maleate per day. In dialysis patients with a creatinine clearance of under ten milliliters per minute at Blutwäsche days, the starting dose is 2.5 mg of enalapril maleate and otherwise depends on the level of blood pressure.
Children need to be treated with heart failure or high blood pressure the starting dose for the treatment entry depends on the weight:
Children with a body weight of 20 to 50 kg daily receive 2.5 to not more than 20 mg of enalapril maleate. Children about 50 kg body weight received five and not more than 40 mg of enalapril maleate on this date. These doses are administered in a gift.
Regardless, occupy the drug with sufficient liquid (for example, a glass of water) of the meals. Taking the prescribed daily amount is usually in the morning at once, can be distributed but also on two gifts in the morning and in the evening.
The following information on contra-indications for the purposes of ratiopharm-enalapril 20 mg in General, pregnancy & breast-feeding and children. It is important to note that the contra-indications can be different depending on the pharmaceutical form of the drug (for example, Tablet, syringe, ointment).
When cannot ratiopharm-enalapril 20 mg be used?
- Enalapril should not be given at
- Hypersensitivity to enalapril or an other ACE inhibitors
- angioneurotischem edema (Quincke’s oedema) with swelling of face, lips, tongue, larynx, mucous membranes and eyes
- following kidney disease: bilateral renal artery reduction (renal artery stenosis) or unilateral reduction of renal artery in a single kidney after a kidney transplant
- following heart disease: heart-related shock, heart valve reduction (mitral or aortic) influence on the circulation in pathological enlargement of the heart with closing the flow of blood out of the hear primary hyperaldosteronism (here ACE inhibitors are ineffective).
- Only after strict medical risk benefit and under regular control enalapril must be given in
- severe renal impairment (creatinine clearance below 30 ml per minute, an elevated urine protein of over 1 gram per day) and in patients who get a Blutwäsche (dialysis). The simultaneous application of enalapril and Poly(acrylnitril,_natrium-2-methallylsulfonat) high-flux membranes (during dialysis used) is strictly prohibited.
Liver disease or liver dysfunction
- Blood salt disorders (electrolyte disorders)
- impaired immune response or collagen diseases (as for example with Lupus Erythematosus and Scleroderma)
- untreatable, serious heart muscle weakness
- LDL Apheresis with Dextransulfat in the context of a blood cleansing of cholesterol and other therapies, which can cause blood in contact with negatively charged surfaces
- at the same time importance Desensibilisierungs therapy with insecticides.
- Circulatory disorders of the brain and heart.
- Under medical control of blood pressure and the relevant laboratory values, enalapril can be applied in severe hypertension and in patients over 65 years of age.
What must you consider when pregnancy and breast-feeding?
Taking enalapril is strictly prohibited during pregnancy and lactation.
If a pregnancy is planned or established, the treatment must be made by the physician to other active ingredients.
When the unborn child could be through the intake of enalapril to a reduction in kidney function and delayed formation of the skull. A reduction of the foetus may occur. In neonates, low blood pressure and an increased concentration of blood potassium can be caused by the active substance of kidney failure. With regard to these side effects, all children, whose Mütter enalapril have taken, must be monitored carefully by doctors. Is a pregnant women during or after the second third of the pregnancy treated with enalapril been, the doctor at the child using ultrasound to examine kidney function and the skull.
Enalapril is transferred into breast milk. The doctor thinks a treatment with enalapril during breastfeeding, must be breastfed off.
What is taken into account in children?
Children enalapril may not be in General, because there are too few experiences with the application of the active substance in this age group. Yet at least dosage instructions for the treatment of children can be found by some manufacturers.
What side effects can the active substance enalapril in enalapril-ratiopharm 20 mg have? Below, learn the most important thing to possible, well-known side effects of enalapril in enalapril ratiopharm 20 mg. These side effects should not occur, but can. Because everyone reacts differently to medications. Please also note that the side effects in type and frequency can vary depending on the drug form of the drug (for example, Tablet, syringe, ointment).
Common side effects: dizziness, weakness, visual disturbances (rarely with loss of consciousness without apparent cause), renal impairment (rarely up to renal failure), dry tickly, bronchitis, nausea, upper abdomen pains, indigestion, headache, fatigue, sleepiness, reducing the concentration of Red hemoglobin.
Uncommon side effects: excessive lowering of blood pressure, lack of blood cells (reduced hematocrit), reduction of white blood cells, reduction of blood platelets, conduction abnormalities of the heart (AV block II. and III. degree), shortness of breath, runny nose, sinus infection, vomiting, diarrhea, constipation, loss of appetite, pancreatitis, allergic skin reactions with rashes, redness and itching.
Rare side effects: loss of consciousness, swoon without apparent cause, Nasenschleimhautentzündung, swelling of the vessel (with the participation of the lips, face, larynx or arms and legs), drowsiness, depression, sleep disorders, nervous abnormal sensations, loss of balance, confusion, ringing in the ears, Visual impairment, taste changes, temporary loss of taste, anemia, decreased number of platelets, reduced number of polymorphonuclear and Eosinophilic granulocytes (special cells of the body defense), elevated blood urea value, increase of blood creatinine and/or blood potassium value, reduced blood sodium value, heart-related shock States, increased blistering, beginning jaundice (bile accumulation) until the death of liver cells may be fatal (unclear relation to taking enalapril), Hives, skin rash with severe disorder of Allgemeinbefindens.
Very rare side effects and individual cases: heart palpitations, medical…, chest pain, cardiac arrhythmia, angina pectoris, heart attack, noticeable heart activity, precursors of stroke, stroke, acute renal failure, spasm of the respiratory tract muscles, pneumonia, inflammation of the tongue, dry mouth, inflammation of the liver, liver dysfunction, bowel obstruction, serious drug-related skin lesions, fever, muscle pain, joint pain, arthritis, possibility, increase in the number of white blood cells, high ANA titre, psoriasis-like lesions, bubble-like skin lesions, skin reactions such as redness, swelling, itching; Rash skin separation, light sensitivity, hair loss, nail separation by Gefäßkrämpfe conditional attacks reduced supply of the fingers (Raynaud’s syndrome), increased blood concentration of bilirubin, increase in the value of the liver enzyme, liver dysfunction, liver inflammation, decreased number of granulocytes (special cells of the body defense), increase in the value of blood potassium when diabetes, destruction of red blood cells with anemia, increased erythrocyte sedimentation rate, resolution/breakdown of red blood cells, increased sweating.
Side effects without frequency indication: dizziness when body position changes, weakness, chest pain, sore throat, hoarseness, asthma, water retention in the lungs, inflammation of the mucous membrane of the mouth, liver failure, skin irritation with upper skin separation, Stevens-Johnson Syndrome, skin resolution, muscle inflammation, abdominal, or Pleurisy, erythrocyte sedimentation rate, hot Flash, increased sweating, muscle spasms, nervousness, haemolytic anaemia, increase of blood urea and/or blood creatinine in value, increased protein excretion, increased blood bilirubin value, increase in the blood liver enzyme value increased.