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- Pharmacology For Enalapril + Hydrochlorothiazide
Enalapril + Hydrochlorothiazide Pharmacology
Enalapril + Hydrochlorothiazide
About Enalapril + HydrochlorothiazideN/AMechanism of Action of Enalapril + HydrochlorothiazideN/APharmacokinets of Enalapril + HydrochlorothiazideN/AOnset of Action for Enalapril + HydrochlorothiazideN/ADuration of Action for Enalapril + HydrochlorothiazideN/AHalf Life of Enalapril + HydrochlorothiazideN/ASide Effects of Enalapril + HydrochlorothiazideN/AContra-indications of Enalapril + HydrochlorothiazideN/ASpecial Precautions while taking Enalapril + HydrochlorothiazideN/APregnancy Related InformationContraindicated since Enalapril and Hydrochlorthiazide are contraindicated during pregnancyOld Age Related InformationN/ABreast Feeding Related InformationContraindicated since Hydrochlorothiazide is contraindicated in pregnancyChildren Related InformationN/AIndications for Enalapril + HydrochlorothiazideHypertensionInteractions for Enalapril + HydrochlorothiazideN/ATypical Dosage for Enalapril + HydrochlorothiazideAdult: ? to 1 tablet / day (Enalapril 10mg + Hydrochlorthiazide 25mg)Schedule of Enalapril + HydrochlorothiazideN/AStorage Requirements for Enalapril + HydrochlorothiazideN/AEffects of Missed Dosage of Enalapril + HydrochlorothiazideN/AEffects of Overdose of Enalapril + HydrochlorothiazideN/AEnalapril
About EnalaprilAngiotensin converting enzyme (ACE) inhibitor, Antihypertensive.Mechanism of Action of EnalaprilIt is a prodrug and converted in to active Enalaprilat; which is an angiotensin converting enzyme inhibitor prevents the conversion of angiotensin-1 to angiotensin-2 and abolishes the pressor actions of angiotensin. It decreases aldosterone secretion, sodium and water retention, and total peripheral resistance, leads to fall in BP. The arterioles dilate and the compliance of larger arteries is increased. Both systolic and diastolic BP is lowered. It has no effect on cardiac output and cardiovascular reflexes. And there is little dilatation of capacitance vessels; so postural hypotension is not a problem. The drug does not compromise renal, cerebral, and coronary blood flow. The drug also increases plasma kinin levels and potentiate the hypotensive action of exogenously administered bradykinin. It is used for treatment of systolic heart failure, because it improves symptoms, decrease mortality and reduce ventricular hypertrophy. It reduces both preload and after load and thus increasing cardiac out put in patients with heart failure.Pharmacokinets of EnalaprilAbsorption: Absorbed orally up to60%
Distribution: Widely distributed, but poor brain penetration.
Metabolism: Metabolized in to active metabolite Enalaprilat
Excretion: Excreted mainly through urine and a small amount is excreted through faeces
Onset of Action for Enalapril1 hourDuration of Action for Enalapril24 hourHalf Life of Enalapril11 hoursSide Effects of Enalapril1. Cough
2. Angioedema
3. Hypotension
4. Bradycardia
5. Hyperkalemia
6. Rashes
7. Urticaria
8. Swelling of lips, mouth, nose and larynx
9. Fetopathic in later half of pregnancy
10. Headache
11. Diarrhoea
12. Fatigue
13. Dizziness
14. Nausea
15. Acute renal failure is precipitated in renal artery stenosis
16. Transient increase in liver enzymes.
Contra-indications of Enalapril1. Hypersensitivity to the drug
2. Renal artery stenosis
3. Aortic stenosis
4. Coarctation of aorta
Special Precautions while taking Enalapril1. Renal impairment
2. Patient at high risk of cardiogenic shock, severe heart failure etc
3. Anaesthesia and surgery
4. Stops diuretics 2 to 3days before Enalapril therapy
Pregnancy Related InformationContraindicatedOld Age Related InformationUse with cautionBreast Feeding Related InformationUse with cautionChildren Related InformationUse with cautionIndications for Enalapril1. Hypertension
2. Congestive heart failure
3. Left ventricular dysfunction
Interactions for EnalaprilAntacids: Decrease effeciency of Captopril.
Indomethacin: Reduces hypotensive effect.
Digoxin: Increases plasma digoxin levels.
Potassium preparations & potassium sparing diuretics: Hyperkalaemia and increased risk of renal failure.
Lithium: Toxicity due to increased serum concentration of lithium.
Immunosuppressive Drugs : Increased risk of bone marrow depression.
Antidepressants, diuretics, Beta-blockers, Nitrates, Dopaminergics, Calcium channel blockers, Phenothiazines: Enhance hypotensive effect.
Morphine: Enhanced analgesic effect and respiratory depression.Typical Dosage for EnalaprilAdult:
5mg once daily. Increases the dose to 10 to 20mg once daily or as two divided doses depending on patient`s response if required.
Maximum dose: 40mg/day
In patient on diuretic therapy & In CHF patients starts the dosage with 2.5mg once daily dosage and increases to usual dosage.
Left ventricular dysfunction: Starts with 2.5mg orally twice daily. Increases the dosage up to 20mg/day in two divided doses.
Children : 0.1 to 0.5mg/kg/day once daily or in divided doses as suspension of crushed tablets.
Schedule of EnalaprilHStorage Requirements for EnalaprilStore at room temperature in a well closed container and protect from moisture.Effects of Missed Dosage of EnalaprilTake the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose.Do not double the dose.
Effects of Overdose of EnalaprilTreatment is supportive and symptomatic. To remove drug from the body perform induced emesis and gastric lavage. Administer activated charcoal to reduce absorption. In severe cases haemodialysis is considered if required. Treatment includes I.V. infusion of normal saline solution.Hydrochlorothiazide
About HydrochlorothiazideThiazide derivatibve, Diuretic.Mechanism of Action of HydrochlorothiazideIt is thiazide diuretic which exerts its action by acting at site-3(central dilating segment of early distal tubule). It binds to Na+Cl- symporter and inhibits Na+Cl- symport at the luminal membrane. It has additional carbonic anhydrase inhibitory actions in proximal tubules. It increases natriuresis, kaliuresis and diuresis. It decreases Ca2+ excretion and increases Mg2+excretion. It also has minor carbonic anhydrase inhibitory action. It also causes direct arteriolar vasodilatation and decreases total peripheral resistance. The antihypertensive actions of the drug may be attributable to depletion of sodium and subsequent reduction in plasma volume and a decrease in peripheral resistance. Decrease in peripheral resistance is due to either the loss of sodium from the arteriolar wall or a direct action on the vascular bed. It is an effective drug in edema associated with congestive heart failure.
Vertigo: Diuretics are used in vertigo in assumption that vertigo is due to endolymphatic hydrops. They reduce labyrinthine fluid pressure
Pharmacokinets of HydrochlorothiazideAbsorption: It is absorbed after oral administration.
Metabolism: It is not metabolized in the body.
Excretion: Excreted unchanged in urine.
Onset of Action for Hydrochlorothiazide1 to 3 hoursDuration of Action for Hydrochlorothiazide12 to 16 hoursHalf Life of Hydrochlorothiazide5 to 15 hoursSide Effects of Hydrochlorothiazide1. Dizziness
2. Blurred vision
3. Confusion
4. Tingling fingers
5. Dry mouth
6. Nausea
7. Diarrhoea
8. Constipation
9. Vomiting
10. Weakness
11. Hypokalaemia
12. Hyponatraemia
13. Hyperuricaemia
14. Elevated levels of glucose, calcium and lipids
15. Gastro intestinal disturbances
16. Polyuria
17. Electrolyte imbalance
18. Jaundice
19. Rashes
20. Photosensitivity
21. Fever
22. Itching
23. Myalgia
24. Muscle cramps
25. Arthralgia
26. Blood dyscrasias
27. Ototoxicity
Contra-indications of Hydrochlorothiazide1. Hyper uricaemia
2. Hyper calcaemia
3. Renal impairment
4. Hepatic impairment
5. Anuria
6. Hypersensitivity to the drug
7. Hyper sensitivity to sulfonamides
8. Fluid and electrolyte imbalance
Special Precautions while taking Hydrochlorothiazide1. Gout
2. Diabetes mellitus
3. Renal impairment
4. Hepatic impairment
5. Monitor and correct Fluid and electrolyte imbalance
6. Hyper parathyroidism
7. Cirrhosis
Pregnancy Related InformationContraindicatedOld Age Related InformationUse with cautionBreast Feeding Related InformationContraindicatedChildren Related InformationMay be usedIndications for Hydrochlorothiazide1. Hypertension
2. Oedema associated with heart failure
3. Oedema due to renal and hepatic diseases
4. Diabetes insipidus
5. Idiopathic hypercalciurea.
6. Vertigo
Interactions for HydrochlorothiazideCholestyramine & Colestipol: decrease absorption of hydrochlorothiazide.
Diazoxide: Additive action - may cause hyperglycemia, hyperuricaemia and hypotension.
Digitalis: Diuretics induced hypokalaemia may precipitate digitalis toxicity.
Lithium: Hydrochlorothiazide potentiates therapeutic and toxic effects by increasing its renal excretion.
Frusemide: Synergy leading to profound diuresis and greater than predicted electrolyte loss.
Non-depolarizing muscle relaxants: Diuretics induced hypokalaemia enhances efficacy.
Sulfonylureas: Efficacy decreased due to hydrochlorothiazide induced glucose intolerance.
Chlorpropamide: Hypokalaemia.
Propantheline: Bioavailability of hydrochlorothiazide increased.
Metoclopramide: Bioavailability of hydrochlorothiazide decreased.
NSAIDs: Natriuretic effect of hydrochlorothiazide decreased.
Typical Dosage for HydrochlorothiazideAdults:
Hypertension: 25mg once daily or in divided doses. Increased to 50mg if required; depending up on the patient`s response.
Children: 1mg/kg single daily dose.
Oedema:
Adults:
Starts with 25 to 50mg. Increased the dose until desired response is obtained.
Maximum dose: 200mg/day
Maintenance dosage: 25 to 100mg daily or on alternate days.
Children: 1mg/kg single daily dose or 1 to 3mg/kg/day in two divided doses
Schedule of HydrochlorothiazideGStorage Requirements for HydrochlorothiazideStore at room temperature in a well closed container and protected from light.Effects of Missed Dosage of HydrochlorothiazideTake the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose.Continue the regular schedule.Do not double the dose.Effects of Overdose of HydrochlorothiazideTreatment is supportive and symptomatic. Remove drug from the body by induced emesis and gastric lavage. Monitor and assist respiratory, cardiovascular, and renal function as indicated. Monitor and support fluid and electrolyte balance.Home Delivery for Enalapril + Hydrochlorothiazide in Your City
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Enalapril + Hydrochlorothiazide is a generic medicine name and there are several brands available for it. Some of the brands for enalapril + hydrochlorothiazide might be better known than enalapril + hydrochlorothiazide itself. If the pharmacy that's willing to deliver medicines to your home doesn't have enalapril + hydrochlorothiazide in stock, you can ask for one of the branded alternatives for enalapril + hydrochlorothiazide.
