Renitec instructions for use, price, reviews, analogues, tablets 5 mg, 10 mg and 20 mg, Co-renitec

1 tablet contains enalapril maleate 20 mg and hydrochlorothiazide 12,5 mg; in a blister pack of 14 pcs., in a box of 1 or 2 blisters.

Co-Renitec contains such active ingredients as enalapril maleate and hydrochlorothiazide. In addition, it contains such additional components as iron oxide, yellow oxide, pregelatinized corn starch, corn starch, aqueous lactose, sodium bicarbonate, magnesium stearate.

The medicine is available in tablets, which are in the blisters contained in the package.

Renec is available in the form of tablets in dosages of 5, 10 or 20 mg. Active component: enalapril maleate – 5, 10 or 20 mg.

The drug Co-Renitec is also released. 1 tablet contains 20 mg of enalapril maleate and 12,5 mg of hydrochlorothiazide.

Each pack contains instructions for using the medication.

A more effective drug, similar in effect to Renitec, is considered a combined antihypertensive drug Co-Renitec. In its composition, in addition to elanapril 20 mg, there is a diuretic hydrochlorothiazide (12,5 mg).

The combined effect of the drug is based on a combination of a vasodilating and diuretic effect. Co-Renitec is usually prescribed for severe hypertension to reduce the burden on the heart and blood vessels.

Dosage form of release of Ranitek – tablets: triangular, on one side with a risk; 5 mg each — white, engraved on the other side of the “MSD 712”; 10 mg each — pink, engraved on the other side of the “MSD 713”; 20 mg each – light pink with a yellowish tint with blotches, engraved on the other side of the MSD 714 (7 pcs. in blisters, in a cardboard bundle of 1, 2 or 4 blisters; 100 pcs. in dark glass bottles, in cardboard pack 1 bottle).

Composition of 1 tablet:

  • active substance: enalapril maleate – 5, 10 or 20 mg;
  • auxiliary components (5/10/20 mg): sodium bicarbonate – 2,5 / 5/10 mg; lactose monohydrate – 198,1 / 164,1 / 153,9 mg; pregelatinized starch – 5,06 / 2,2 / 2,2 mg; corn starch – 22,77 / 22/22 mg; magnesium stearate – 0,9 / 1 / 1,1 mg; yellow iron oxide (E172) – 0/0 / 0,13 mg; red iron oxide (E172) – 0 / 0,5 / 0,05 mg.

Pharmacological properties

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Pharmacodynamics

Renitec is one of the inhibitors of ACE (angiotensin-converting enzyme) – drugs that affect the renin-angiotensin-aldosterone system (RAAS). The drug is used in the treatment of essential hypertension – primary hypertension (arterial hypertension) of any severity, as well as renovascular hypertension.

Enalapril is a derivative of L-proline and L-alanine (amino acids). After oral administration, the substance is rapidly absorbed, followed by hydrolysis to enalaprilat. It is a highly specific and long-acting ACE inhibitor that does not contain a sulfhydryl group.

ACE (peptidyl dipeptidase A) catalyzes the conversion of angiotensin I to the pressor peptide angiotensin II. Enalaprilat inhibits ACE, which leads to a decrease in the plasma concentration of angiotensin II in the blood and the secretion of aldosterone, as well as an increase in renin activity.

ACE is identical to the kininase II enzyme, and therefore enalapril can also block the destruction of bradykinin, a peptide that has a pronounced vasodilating effect (the value of this effect needs to be clarified).

Despite the fact that the main mechanism for lowering blood pressure (blood pressure) is the suppression of RAAS activity, Renitek also exhibits an antihypertensive effect in patients with hypertension and with reduced renin activity.

The use of enalapril in patients with hypertension leads to a decrease in blood pressure while standing and lying down without a significant increase in heart rate (heart rate).

Symptomatic postural hypotension occurs infrequently. In some patients, several weeks of use may be required to achieve optimal reduction in blood pressure. Interruption of therapy to a sharp rise Blood pressure does not lead.

Effective inhibition of ACE activity usually develops 2–4 hours after a single dose. The antihypertensive effect develops over 1 hour, the maximum decrease in blood pressure is observed 4-6 hours after taking Renitek. The duration of action depends on the dose. Hemodynamic effects and antihypertensive effect with the recommended doses are maintained for 24 hours.

Antihypertensive therapy with enalapril leads to a significant regression of left ventricular hypertrophy and contributes to the preservation of its systolic function.

When conducting clinical studies of hemodynamics in patients with essential hypertension, lowering blood pressure was accompanied by a decrease in total peripheral vascular resistance, an increase in cardiac output, and minor changes or no changes in heart rate. After taking enalapril, an increase in renal blood flow is observed.

Long-term therapy for essential hypertension and renal failure can lead to an improvement in renal function, as evidenced by an increase in GFR.

In short clinical studies in patients with renal failure with / without diabetes mellitus after enalapril administration, a decrease in albuminuria, kidney excretion of IgG, and a decrease in total protein in the urine were observed.

With the combined use of Renitek and thiazide diuretics, the antihypertensive effect is enhanced. Enalapril reduces / prevents the occurrence of hypokalemia caused by taking thiazides.

Enalapril does not have an undesirable effect on the plasma concentration of uric acid in the blood.

Renitec favorably affects the ratio of lipoprotein fractions in blood plasma. There is also a beneficial effect / no effect on the concentration of total cholesterol.

In patients with heart failure while using cardiac glycosides and diuretics, Renitek administration leads to a decrease in total peripheral resistance and blood pressure. There is an increase in cardiac output, while heart rate (usually increased in patients with heart failure) decreases. The jamming pressure in the pulmonary capillaries is also reduced.

In mild / moderate severity of HF, enalapril slows the progression of dilatation of the heart and HF (confirmed by an improvement in the ejection fraction of the left ventricle and a decrease in systolic and end-diastolic volumes of the left ventricle).

Clinical data show that enalapril reduces the frequency of ventricular arrhythmias in patients with heart failure, although the clinical significance and underlying mechanisms of this effect are not known.

Pharmacokinetics

Absorption: after oral administration, enalapril is rapidly absorbed in the gastrointestinal tract. The maximum serum concentration in the blood is reached within 1 hour. The degree of absorption of the substance is approximately 60%. Eating on the absorption of enalapril has no effect. After absorption, the substance quickly hydrolyzes, the formation of an active metabolite – enalaprilat, which is a powerful ACE inhibitor.

The maximum serum concentration of a substance in the blood is observed approximately 4 hours after oral administration. The duration of absorption and hydrolysis of enalapril is similar for the various recommended therapeutic doses. An equilibrium serum concentration of a substance in the blood is reached by the fourth day of using Renitek.

Distribution: the binding of enalaprilat to plasma proteins in the range of therapeutic doses is not higher than 60%.

Metabolism: there are no data on other significant ways of the metabolism of enalapril, in addition to hydrolysis to enalaprilat.

Excretion: excreted mainly through the kidneys. The main metabolites detected in urine are enalaprilat (about 40% of the dose) and unchanged enalapril (about 20%).

The plasma concentration curve of enalaprilat in the blood has a long final phase. The half-life of a substance with a course application is 11 hours.

AUC (area under the concentration-time curve) of enalaprilat and enalapril in patients with renal failure increases. With creatinine clearance of 40-60 ml / min after taking Renitek in a daily dose of 5 mg, the equilibrium AUC of enalaprilat is approximately 2 times higher than in patients with undisturbed renal function.

In severe renal failure (creatinine clearance is not more than 30 ml / min), the AUC value increases by about 8 times, the effective half-life after repeated administration of the drug increases, and the onset of the equilibrium state of enalaprilat concentration is delayed. Enalaprilat can be removed from the general bloodstream using the hemodialysis procedure. With hemodialysis, clearance is 62 ml / min.

The average maximum concentration of enalapril in breast milk after a single dose of 20 mg of enalapril is 1,7 mcg / l 4-6 hours after administration. The estimated maximum intake of a substance by a child who is fully breastfed is 0,16% of the dose, which is calculated taking into account the weight of the mother.

contraindications

What helps Renitek? Indications for use of the drug are as follows:

  • disruption of the left ventricle if necessary, the prevention of coronary ischemia;
  • heart failure;
  • asymptomatic disruption of the left ventricle in order to prevent the development of severe heart failure;
  • essential and renovascular hypertension.

Indications for use Renitek also include its appointment to people with unstable angina pectoris to reduce the frequency of hospitalizations and prevent the occurrence of myocardial infarction.

  • hypersensitivity to the main or auxiliary components of the drug;
  • idiopathic or hereditary angioedema;
  • children and adolescents up to 18 years;
  • indications of a history of angioedema caused by previous administration of ACE inhibitors.
  • hypertrophic obstructive cardiomyopathy;
  • desensitization with allergen from Hymenoptera venom;
  • dialysis using high-flow membranes (such as AN 69);
  • hyperkalemia;
  • carrying out the apheresis procedure for low density lipoproteins (LDL apheresis) using dextran sulfate;
  • mitral / aortic stenosis;
  • oppression of bone marrow hematopoiesis;
  • belonging to the black race;
  • conditions after major surgery or general anesthesia;
  • cerebrovascular disease or coronary heart disease;
  • liver failure;
  • bilateral renal artery stenosis or single kidney artery stenosis;
  • Renovascular hypertension
  • age over 65 years;
  • systemic diseases of the connective tissue (scleroderma, systemic lupus erythematosus, etc.), therapy with procainamide or allopurinol, immunosuppressive therapy, or a combination of these complicating factors;
  • history of aggravated allergological history or angioedema;
  • conditions that are accompanied by a decrease in the volume of circulating blood (including during dialysis, diuretic therapy, a diet with restriction of salt, vomiting or diarrhea);
  • diabetes;
  • conditions after kidney transplantation;
  • kidney failure;
  • combined use with potassium-sparing diuretics, potassium preparations, potassium-containing salt substitutes and lithium preparations.

This drug is indicated for arterial hypertension, if combination therapy is considered the most effective.

You can not use Co-Renitec with increased sensitivity to its components, childhood, anuria, a history of Quincke’s edema, as well as hereditary or idiopathic Quincke’s edema.

With caution, this drug is prescribed for:

  • bilateral renal artery stenosis;
  • coronary heart disease;
  • aortic stenosis;
  • severe systemic diseases of the connective tissue;
  • diabetes mellitus;
  • condition after kidney transplantation;
  • low sodium diet
  • advanced age;
  • cerebrovascular diseases;
  • chronic heart failure;
  • renal failure;
  • oppression of bone marrow hematopoiesis;
  • conditions accompanied by a decrease in the volume of circulating blood;
  • liver failure;
  • hyperkalemia
  • stenosis of a single kidney artery.
  • Renovascular hypertension
  • essential hypertension;
  • any stage of CH.

In the presence of clinical manifestations of heart failure, Renitek is also prescribed to achieve the following goals:

  • increased patient survival;
  • a decrease in the frequency of hospitalizations associated with heart failure;
  • slowing the progression of heart failure.

In the absence of clinical symptoms of heart failure in patients with impaired left ventricular function, Renitek is prescribed to achieve the following goals (prevention of the development of clinically severe heart failure):

  • a decrease in the frequency of hospitalizations associated with heart failure;
  • slowing down the clinical manifestations of heart failure.

With left ventricular dysfunction, Renitek is prescribed to achieve the following goals (prevention of coronary ischemia):

  • a decrease in the frequency of hospitalizations associated with unstable angina pectoris;
  • decrease in the incidence of myocardial infarction.
  • idiopathic / hereditary angioedema, aggravated history of angioedema associated with the use of ACE inhibitors;
  • glucose-galactose malabsorption syndrome, lactase deficiency, hereditary lactose intolerance;
  • combination therapy with aliskiren-containing drugs or aliskiren in patients with diabetes mellitus / impaired renal function (GFR less than 60 ml / min / 1,73 m 2);
  • age of 18 years;
  • pregnancy and lactation;
  • individual intolerance of the components that make up the drug.

Relative (diseases / conditions, in the presence of which caution is required when prescribing Renitek):

  • conditions after kidney transplantation;
  • bilateral renal artery stenosis or single kidney artery stenosis;
  • mitral / aortic stenosis;
  • hypertrophic obstructive cardiomyopathy;
  • cerebrovascular disease or coronary heart disease;
  • kidney failure;
  • oppression of bone marrow hematopoiesis;
  • hyperkalemia;
  • Renovascular hypertension
  • liver failure;
  • combined use with potassium-sparing diuretics, potassium preparations, potassium-containing salt substitutes and lithium preparations;
  • carrying out the apheresis procedure for low density lipoproteins (LDL apheresis) using dextran sulfate;
  • conditions that are accompanied by a decrease in the volume of circulating blood (including during dialysis, diuretic therapy, a diet with restriction of salt, vomiting or diarrhea);
  • history of aggravated allergological history or angioedema;
  • dialysis using high-flow membranes (such as AN 69);
  • systemic diseases of the connective tissue (scleroderma, systemic lupus erythematosus, etc.), therapy with procainamide or allopurinol, immunosuppressive therapy, or a combination of these complicating factors;
  • diabetes;
  • desensitization with allergen from Hymenoptera venom;
  • belonging to the black race;
  • conditions after major surgery or general anesthesia;
  • age over 65 years.

Renec is produced in the form of tablets in different dosages of the active substance. Standard dosages are 5, 10 and 20 mg.

One of the most commonly used agents for the treatment of persistently high blood pressure is Renitek.

The main active ingredient is enalapril maleate:

  1. When ingested, the substance is converted into an effective ACE inhibitor – enalaprilat.
  2. Under its influence, blood pressure decreases.
  3. A decrease in vascular resistance is also noted.
  4. In some patients, increased cardiac output.
  5. In parallel, under the influence of enalaprilat, the state of the muscle tissue of the left ventricle improves, and ventricular arrhythmia also decreases.
  6. The effect occurs 1-3 hours after the patient drinks “Renitek”. The duration of the effect is about a day.

Along with the usual “Renitek”, doctors can prescribe tablets for pressure “Ko-Renitek”.

This is a combined pair, the effect of which is provided by the synergistic action of two main components:

  • enalapril maleate, which provides a decrease in blood pressure;
  • hydrochlorothiazide (diuretic), which potentiates the hypotensive effect.

The composition of both drugs along with the main components also includes auxiliary substances, which include lactose (aqueous / anhydrous), talc, starch, dyes, etc.

The main indications for the appointment and administration of Renitek are as follows: arterial hypertension

“Renitek” is used in therapy:

  • hypertension (both essential and renovascular) as a single drug;
  • dysfunctions of the heart muscle.

As a prophylactic drug, Renec is used to prevent the development of heart failure, dysfunction of the left ventricle (both severe and asymptomatic), coronary heart disease, angina pectoris and heart attack.

At the same time, regular intake of “Renitek”, according to the instructions of a specialist, can increase patient survival, reduce the risk of exacerbations and reduce the frequency of hospitalizations.

Hypersensitivity (including to other ACE inhibitors and sulfanilamide derivatives), anuria, children’s age.

At a temperature not higher than 30 ° C.

Keep out of the reach of children.

Do not use after the expiry date printed on the package.

Synonyms of nosological groups

Heading ICD-10ICD-10 disease synonyms
I10 Essential (primary) hypertensionHypertension
Arterial hypertension
Crisis arterial hypertension
Arterial hypertension complicated by diabetes
Hypertension
Sudden increase in blood pressure
Hypertensive circulatory disorders
Hypertensive state
Hypertensive crises
Hypertension
Arterial hypertension
Malignant hypertension
Essential hypertension
Hypertonic disease
Hypertensive crises
Hypertensive crisis
Hypertension
Malignant hypertension
Malignant hypertension
Isolated systolic hypertension
Hypertensive crisis
Exacerbation of hypertension
Primary arterial hypertension
Transient arterial hypertension
Essential arterial hypertension
Essential arterial hypertension
Essential hypertension
Essential hypertension
I15 Secondary hypertensionHypertension
Arterial hypertension
Crisis arterial hypertension
Arterial hypertension complicated by diabetes
Hypertension
Vasorenal hypertension
Sudden increase in blood pressure
Hypertensive circulatory disorders
Hypertensive state
Hypertensive crises
Hypertension
Arterial hypertension
Malignant hypertension
Symptomatic hypertension
Hypertensive crises
Hypertensive crisis
Hypertension
Malignant hypertension
Malignant hypertension
Hypertensive crisis
Exacerbation of hypertension
Renal hypertension
Renovascular arterial hypertension
Renovascular hypertension
Symptomatic arterial hypertension
Transient arterial hypertension

Pharmacodynamics and pharmacokinetics

This drug reduces the level of sodium ions in the vascular wall, blood pressure, tone of arterial vessels, OPSS, and also increases diuresis. Antihypertensive effect lasts throughout the day.

Thus, the drug is effective in case of arterial hypertension. The antihypertensive effect of the active components of the drug is complementary. Therapy with this tool is more effective in most cases with arterial hypertension than the use of enalapril maleate and hydrochlorothiazide separately.

Enalapril is an ACE inhibitor. After absorption, it is metabolized to enalaprilat. Its action leads to a decrease in the level of angiotensin II in plasma, due to which the activity of blood plasma renin increases and secretion of aldosterone decreases. In addition, enalapril inhibits the destruction of bradykinin.

A decrease in blood pressure is accompanied by a decrease in the total peripheral vascular resistance and a slight increase in cardiac output. The drug increases renal blood flow. At the same time, the glomerular filtration rate does not change, unless it was initially reduced in patients.

Hydrochlorothiazide is a diuretic and antihypertensive agent that helps increase renin activity. Thus, in combination with enalapril, it leads to a more significant decrease in blood pressure. Cancellation of the drug does not cause a sharp increase.

The maximum effect, as a rule, appears 2-4 hours after application. The antihypertensive effect is noticeable after an hour. The duration of the drug depends on the dosage. As a rule, it lasts throughout the day.

Instructions for use Renitek: method and dosage

Renitek tablets are taken orally. The effectiveness of therapy does not depend on food intake.

The drug is prescribed in an initial dose of 10 (with a mild degree of the disease) to 20 mg (in other cases) per day in 1 dose, but not more than 40 mg per day. Maintenance dose – 20 mg once a day.

The initial dose of Renitek is 5 mg or less (due to the fact that blood pressure and renal function in this group of patients may be especially sensitive to ACE inhibition). Then the dose is selected in accordance with the needs of the patient.

As a rule, with a daily intake, the effective dose is 20 mg per day.

Patients who, shortly before the start of taking Renitek received diuretic treatment, should be careful.

After taking the first dose of Renitek, the development of arterial hypotension is possible. This effect is most likely in patients who use diuretics.

The purpose of the drug requires caution, since such patients may experience a deficiency of sodium / fluid. Diuretics must be canceled 2-3 days before the start of the use of Renitek. If this is not possible, the drug should be prescribed in a reduced dose (5 mg or less) to determine the primary effect. In the future, the dosage is selected taking into account the patient’s condition.

In renal failure, you need to increase the interval between doses of the drug and / or reduce the dose.

The initial daily dose of Renitek depending on creatinine clearance:

  • 30–80 ml / min (minor disturbances): 5–10 mg;
  • 10-30 ml / min (moderate disturbances): 2,5-5 mg;

The appointment of Renitek should be carried out under close medical supervision in order to establish the primary effect of the drug on blood pressure. The initial dose is 2,5 mg. The drug can be used to treat heart failure with severe clinical manifestations together with diuretics and, if necessary, with cardiac glycosides.

In the absence of symptomatic hypotension (associated with taking Renitek) or after appropriate correction, the dose is gradually increased to the usual maintenance dose – 20 mg in 1 or 2 doses (depending on tolerance).

Dose selection can be carried out for 2-4 weeks or faster (in the presence of residual signs and symptoms of heart failure). Such a therapeutic regimen is effective in decreasing mortality rates in patients with clinically severe HF.

Before and after the start of therapy, it is necessary to carefully monitor blood pressure and renal function in patients with heart failure, since there is information about the occurrence of arterial hypotension as a result of taking Renitek, followed by (more rarely) the occurrence of renal failure. In patients receiving diuretics, their dose, if possible, should be reduced before taking the drug.

Overdose data is limited.

The main symptoms: a marked decrease in blood pressure, which usually begins about 6 hours after taking the drug, stupor. The plasma concentration of enalaprilat in the blood, exceeding 100-200 times the concentration observed with the use of therapeutic doses, is observed after taking 300 and 440 mg of enalapril (respectively).

Therapy: intravenous infusion with an isotonic sodium chloride solution, if possible – with angiotensin II infusion; provoking vomiting. Excretion of enalaprilat is possible with hemodialysis.

The use of Renitec may vary depending on the specific condition of the patient and other factors. In most cases, the drug is taken orally, 10-20 mg once. The maximum dose is 40 mg.

In the presence of renovascular hypertension, a single dose is from 2,5 to 5 mg. If there is congestive heart failure, the dose usually starts with 2,5 mg, then it can be increased to 20 mg.

If there is renal failure, then the dose can also be further reduced at the discretion of the attending physician.

In hypertension, the initial dose depends on the severity of the disease and usually ranges from 10 to 20 mg once a day. If the patient has a mild degree of hypertension, it is recommended to start treatment with 10 mg per day. Therapy for more severe conditions should begin with a dose of 20 mg per day once. The maintenance dose is also 20 mg once a day. The maximum daily dose is 40 mg.

Adult patients with heart failure and asymptomatic left ventricular dysfunction are given 2,5 mg / day. This medicine can be used as part of a comprehensive treatment of heart failure. If it is well tolerated or after symptomatic hypotension, the initial dosage can be gradually increased. In this case, you need to constantly monitor blood pressure, kidney function and potassium concentration in blood plasma.

The recommended maintenance daily dose is 20 mg. It is taken once or divided into two.

The drug is prescribed orally, regardless of the meal.

With arterial hypertension, the initial dose is 1 tablet 1 time per day. If necessary, the dose can be increased to 2 tablets 1 time per day.

At the beginning of Corenitec therapy, symptomatic arterial hypotension may develop, more often in patients with impaired water-electrolyte balance due to previous treatment with diuretics. Diuretic therapy should be discontinued 2-3 days before the start of Corenitec.

Inside – 1 table. Once a day; if necessary – 1 tablets. Once a day. In renal failure (with Cl creatinine less than 2-1 ml / min), it is prescribed after preliminary selection of doses of each component.

This drug is administered orally on a tablet once a day. If necessary, the dosage can be increased to two tablets per day.

Instructions for use Ko-Renitek recommends monitoring the data of water-electrolyte balance. If the patient has previously taken diuretics, it is necessary to wait 2-3 days before consuming Co-Renitec tablets. In cases where there is an increase in urea and creatinine in the blood, the use of the drug should be stopped.

When taking enalaprilav at higher doses, a significant decrease in blood pressure (approximately 6 hours after use) and stupor are possible. An overdose of hydrochlorothiazide can lead to an imbalance of electrolytes and dehydration due to excessive diuresis.

Adverse Events

The following negative consequences of taking the drug can be distinguished:

  • allergic manifestations in the form of angioedema;
  • decrease in blood sugar;
  • feeling of anxiety, increased nervous excitability;
  • bronchial cramps, profuse mucous discharge from the nose, hoarseness of the voice;
  • dry mouth, constipation, inflammation of the oral mucosa, lack of appetite, nausea, vomiting;
  • increased sweating, skin rash;
  • visual impairment, a change in taste, the appearance of tinnitus;
  • a strong decrease in blood pressure, a disturbance in the rhythm of heart contractions, poor circulation, a spasm of peripheral arteries;
  • impotence development;
  • dizziness, confusion, sleep disturbances, decreased mood.

If there are individual manifestations or a complex of negative reactions, you must urgently consult a doctor to resolve the issue of further continuation of treatment with this drug.

Dizziness, headache, insomnia or drowsiness, convulsions, paresthesias, nervousness, tinnitus, fatigue, asthenia; orthostatic hypotension, fainting, tachycardia, palpitations, chest pain, nausea, vomiting, dry mouth, dyspepsia, flatulence, abdominal pain, diarrhea or constipation, cough, shortness of breath, kidney and liver failure, pancreatitis, decreased libido, impotence, exacerbation of gout, arthralgia, photosensitivity, allergic reactions (rash, itching, angioedema of the face, lips, tongue, larynx, etc.).

Negative adverse reactions, according to studies, are usually mild. Usually they do not need to cancel therapy. Side effects may be as follows:

  • respiratory system – the appearance of shortness of breath, cough;
  • ССС – palpitations, orthostatic effects, fainting, arterial hypotension, chest pain, tachycardia;
  • musculoskeletal system – the appearance of muscle cramps, pain in the joints;
  • kidneys – the development of renal failure, problems with the work of the kidneys;
  • laboratory parameters – hyperglycemia, hyperkalemia, hypokalemia, hyperuricemia, decreased hematocrit and hemoglobin;
  • CNS – dizziness, irritability, asthenia, paresthesia, fatigue, drowsiness, headache, sleep disturbances;
  • digestive system – dyspepsia, diarrhea, nausea, flatulence, dry mouth, vomiting, abdominal pain, constipation, pancreatitis;
  • allergy – itching, rash;
  • reproductive system – development of impotence, decreased libido;
  • others – tinnitus, gout.

In addition, in rare cases, when taking the medicine, such undesirable manifestations as angioedema of the glottis, extremities, tongue, face, larynx, lips, Stevens-Johnson syndrome, intestinal Quincke edema, hyperhidrosis are possible.

In general, Renitek is well tolerated. The total frequency of adverse reactions when using the drug does not exceed that when using a placebo. Usually adverse reactions are minor, temporary and do not lead to the abolition of therapy.

Headache and dizziness are most common. In 2-3% of patients, asthenia and increased fatigue are observed. The development of arterial hypotension, orthostatic hypotension, syncope, nausea, diarrhea, muscle cramps, skin rash and cough are found in less than 2% of patients. There are rare reports of side effects such as renal failure, oliguria, proteinuria, impaired renal function.

Hypersensitivity reactions are manifested in rare cases in the form of angioedema of the tongue, face, lips, limbs, larynx and / or glottis, in very rare cases – as intestinal angioedema.

Other adverse reactions (in very rare cases):

  • digestive system: pancreatitis, intestinal obstruction, liver failure, dry mouth, vomiting, constipation, dyspepsia, stomatitis, anorexia, cholestatic / hepatocellular hepatitis, jaundice, abdominal pain;
  • cardiovascular system: stroke or myocardial infarction, possibly secondary to severe arterial hypotension in patients at risk, Raynaud’s syndrome, palpitations, chest pain, angina pectoris, rhythm disturbance;
  • respiratory system: rhinorrhea, hoarseness, sore throat, pulmonary infiltrates, bronchial asthma / bronchospasm, shortness of breath;
  • central nervous system: anxiety, sleep disturbances, increased nervousness, depression, dizziness, confusion, insomnia, drowsiness, paresthesia;
  • skin: pemphigus, toxic epidermal necrolysis, urticaria, pruritus, baldness, increased sweating, exfoliative dermatitis, polymorphic erythema, Stevens-Johnson syndrome;
  • metabolism: hypoglycemia (with diabetes mellitus during therapy with oral hypoglycemic agents or insulin);
  • others: blurred vision, redness of the skin of the face, impotence, impaired taste, glossitis, tinnitus.

There is evidence of the development of a complex symptom complex, which may include some or all of the following symptoms: myositis / myalgia, vasculitis, fever, arthralgia / arthritis, serositis, increased erythrocyte sedimentation rate (ESR), a positive test for antinuclear antibodies, leukocytosis and eosinophilia. Rash, photosensitization and other skin reactions may also occur as adverse reactions.

There is evidence of an increase in serum creatinine, blood urea, the activity of liver and / or bilirubin enzymes in the blood serum (as a rule, they are reversible and after discontinuation of Renitek normalize). Sometimes there is a development of hyperkalemia and hyponatremia.

There is evidence of a decrease in the concentration of hematocrit and hemoglobin. There are separate reports of thrombocytopenia, neutropenia, suppression of bone marrow function and agranulocytosis.

Side effects, the occurrence of which was noted as a result of post-marketing observation: urological infection, pneumonia, herpes zoster, upper respiratory tract infection, cardiac arrest, bronchitis, atrial fibrillation, melena, pulmonary embolism, ataxia, hemolytic anemia, including cases of hemolysis in patients with hemolysis glucose-6-phosphate dehydrogenase deficiency. A causal relationship with taking Renitek has not been reliably established.

special instructions

Renitec should be taken with extreme caution in treating patients with bilateral renal artery stenosis or a single kidney artery stenosis. Clinically expressed arterial hypertension is rarely seen in patients with uncomplicated arterial hypertension.

In patients with arterial hypertension undergoing therapy with drugs for the treatment of arterial hypertension, it often develops against the background of hypovolemia, which is traceable as a result of taking diuretics. Clinically expressed arterial hypertension is observed in patients with heart failure, but is not accompanied by renal failure.

Arterial hypotension is more often observed in patients with severe forms of heart failure. In such patients, treatment with the drug should begin under the supervision of a physician. Similarly, patients with coronary heart disease, as well as vascular diseases, should be monitored.

The development of clinically pronounced arterial hypotension in patients with uncomplicated arterial hypertension is rare. During therapy in patients with arterial hypertension, this disease often develops against the background of hypovolemia, which is associated with diuretic therapy, restriction of salt intake, in patients on hemodialysis, as well as with diarrhea or vomiting.

When taking Renitek, transient hypotension for further treatment is not a contraindication, after replenishing the fluid volume and normalizing blood pressure, the drug can be continued. In some patients with heart failure and normal / low blood pressure, the use of Renitek may cause an additional decrease in blood pressure.

In patients with a history of angioedema that is not associated with the use of ACE inhibitors, an increase in the likelihood of its occurrence with the use of Renitek is also possible. The incidence of angioneurotic edema in patients of the Negroid race is higher than in representatives of other races.

There is information about rare cases of life-threatening anaphylactic reactions during hypersensitivity by an allergen from Hymenoptera venom. Such reactions can be avoided if Renitec is temporarily discontinued before the start of hyposensitization.

There is information about the appearance of cough during the use of the drug. In most cases, the cough is unproductive, permanent, and after the withdrawal of Renitek stops (you need to consider when conducting differential diagnosis of cough).

The main risk factors for developing hyperkalemia are renal failure, diabetes mellitus, combined use with potassium-sparing diuretics (spironolactone, triamteren or amiloride). Also, the risk increases with the use of potassium supplements and salts. It must be taken into account that hyperkalemia can lead to serious (in some cases fatal) cardiac arrhythmias.

Due to the likelihood of dizziness (especially after taking the initial dose of Renitek in patients taking diuretics), caution should be exercised during the treatment period when driving vehicles.

Application in pregnancy and lactation

The safety of the processes of using the drug by children under the age of 18 is not defined.

The medicinal composition is not used during pregnancy and breastfeeding due to the lack of data confirming the safety of this process.

Renitek is contraindicated for pregnant and lactating women.

In the event of pregnancy, the drug should be stopped immediately, since its use in the II and III trimesters of pregnancy can lead to the development of diseases or death of the fetus / newborn. Possible consequences of continued therapy during this period: arterial hypotension, renal failure, hyperkalemia / hypoplasia of the skull, oligohydramnios (can lead to skull deformation, contracture of the extremities, lung hypoplasia). These complications, apparently, are not observed in cases of using Renitek during the first trimester of pregnancy.

The condition of newborns whose mothers took Renitek should be closely monitored in relation to detecting a decrease in blood pressure, hyperkalemia and oliguria. Enalapril, which penetrated the placenta, can be partially removed from the blood circulation of the newborn using peritoneal dialysis; theoretically, it can be removed by exchange blood transfusion.

It is not recommended to prescribe during pregnancy, especially in the II-III trimester (due to the risk of developmental defects or fetal death). When pregnancy occurs, reception should be discontinued. However, it is permissible to use the drug in pregnant women for health reasons, however, it is necessary to inform the patient about the possible consequences and conduct a periodic ultrasound scan (to assess the intra-amniotic space). Lactating women should suspend breastfeeding during treatment.

Interaction

Compatible (additive effect) with other antihypertensive drugs. With the simultaneous use of potassium supplements, potassium-sparing diuretics and potassium-containing salts, hyperkalemia is possible (especially with renal failure). Increases the likelihood of lithium intoxication.

With the combined use of Renitek with some drugs / substances, the development of the following interactions may be observed:

  • diuretics causing potassium loss: the combination requires caution, therapy should be carried out with regular monitoring of serum potassium in the blood, which is associated with the likelihood of hypokalemia;
  • other drugs with hypotensive effect: summation of the effect;
  • lithium salts: a decrease in the excretion of lithium by the kidneys and an increase in the likelihood of lithium intoxication (monitoring of serum levels of lithium in the blood is required);
  • hypoglycemic drugs (insulin, oral hypoglycemic agents): an increase in their hypoglycemic effect and an increase in the risk of hypoglycemia (most often during the first weeks of joint use, as well as with renal failure); patients with diabetes need careful monitoring of blood glucose levels, especially during the first month of combination therapy;
  • gold preparations for parenteral use (sodium aurothiomalate): the development in rare cases of a symptom complex, including facial redness, arterial hypotension, vomiting and nausea;
  • non-steroidal anti-inflammatory drugs, including selective COX-2 inhibitors: a decrease in the renitek effect, further deterioration of renal function in patients with impaired renal function (usually, it is reversible).

Co-Renitec can be used with other antihypertensive drugs. Then there is a summation of the action. In combination with potassium supplements, potassium salts and potassium-sparing diuretics, hyperkalemia is likely.

When interacting with lithium preparations, the excretion of lithium through the kidneys is reduced. The likelihood of lithium intoxication increases.

NSAIDs reduce the effect of the drug. And if they are taken by patients with kidney function problems, such a combination can also lead to a deterioration in kidney function. But these changes are reversible.

The antihypertensive effect of the drug reduces estrogen and ethanol. Immunosuppressants, cytostatics, and allopurinol increase the likelihood of hematotoxicity.

Antihypertensive and diuretic drugs when combined with the drug Renitec enhance the hypotensive effect. With the combined use of the drug with potassium-sparing diuretics and potassium preparations, the risk of developing hyperkalemia increases.

The drug with simultaneous use reduces the excretion of lithium and increases the toxicity of lithium preparations. With the simultaneous use of the drug with non-narcotic analgesics, the risk of developing nephrotoxicity increases.

Terms of sale

Store at temperatures up to 25 ° C. Keep out of the reach of children.

Shelf life is 2,5 years.

Released by prescription.

This product is sold by prescription.

Temperature – up to 30 ° C. Store the drug in a dry place.

Store at a temperature not exceeding 25 ° C. Keep out of the reach of children. Shelf life is 2,5 years.

With abnormal liver function

In some patients, arterial hypotension that occurs after the start of the use of Renitek, can lead to deterioration of renal function. In some cases, acute renal failure, usually of a reversible nature, has been reported.

In renal failure, it may be necessary to adjust the dose and / or frequency of taking the drug. In some patients with bilateral renal artery stenosis or stenosis of a single kidney artery, an increase in blood urea and serum creatinine was noted. In most cases, the changes were reversible.

Sometimes, in the absence of kidney disease before taking the drug, therapy in combination with diuretics usually caused a transient and insignificant increase in blood urea and creatinine in the blood serum (dose reduction and / or renitek / diuretic withdrawal may be required).

In case of liver failure, Renec should be used with caution.

Detonic – a unique medicine that helps fight hypertension at all stages of its development.

Detonic for pressure normalization

The complex effect of plant components of the drug Detonic on the walls of blood vessels and the autonomic nervous system contribute to a rapid decrease in blood pressure. In addition, this drug prevents the development of atherosclerosis, thanks to the unique components that are involved in the synthesis of lecithin, an amino acid that regulates cholesterol metabolism and prevents the formation of atherosclerotic plaques.

Detonic not addictive and withdrawal syndrome, since all components of the product are natural.

Detailed information about Detonic is located on the manufacturer’s page www.detonicnd.com.

Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

Detonic