Korenitek tablets for normalizing blood pressure. Ko-Renitek instructions for use, contraindications, side effects, reviews

Co-Renitek refers to combination drugs, which has pronounced diuretic and antihypertensive effects.

Pharmacological action of Co-Renitec

The therapeutic effects and mechanism of action of the drug are based on pharmacological properties active ingredients Coreniteca: hydrochlorothiazide and enalapril maleate.

Enalapril - medicinal substance- angiotensin-converting enzyme inhibitor. Its action is to reduce blood pressure, resulting in increased renal blood flow. In addition, enalapril has a beneficial effect on cholesterol levels and the ratio of lipoprotein fractions. The patient’s well-being improves in any position, both lying and standing.

The Korenitek component reduces systemic blood pressure, cardiac preload and total peripheral vascular resistance, and also increases renal blood flow. The heart rate and minute blood volume almost do not increase. Under the influence of enalapril, regression of left ventricular hypertrophy occurs, which helps to preserve it systolic function.

Hydrochlorothiazide increases diuresis and a slight increase in plasma renin activity, as well as enhancing the antihypertensive effect of enalapril. Ko-Renitek is a convenient dosage form for the joint administration of hydrochlorothiazide and enalapril. If we compare the effect of Korenitek with monotherapy, the drug has a more pronounced and long-lasting effect. The effect of Co-Renitec begins within an hour after oral administration, after five to six hours the pressure drops to its maximum. The effect of the drug lasts, on average, 24 hours.

If necessary, the drug is replaced with analogues of Ko-Renitek, which have the same chemical composition. These are Lozap, Atakand, Mikardis, Aprovel, Teveten, Losartan. Losartan may have other names: Vasotens, Cozaar, Angizar, Presartan, Blocktran.

Release form and composition

Ko-Renitec is produced in the form of yellow round tablets with a grooved edge. The active substances are enalapril maleate and hydrochlorothiazide. One tablet of the drug contains 20 milligrams of enalapril maleate and 12.5 milligrams of hydrochlorothiazide.

Among the excipients: aqueous lactose, sodium bicarbonate, corn starch and pregelatinized corn starch, magnesium stearate, yellow iron oxide dye. There are seven tablets in blister packs (blister packs), and fifty-six tablets in polyethylene bottles.

Indications for use of Ko-Renitek

According to the instructions, Ko-Renitek is used in the treatment of patients with arterial hypertension requiring combination therapy.

Directions for use and dosage

Ko-Renitec is administered orally. It is not recommended to crush or chew the tablet. It is swallowed, washed down the right amount water. To achieve maximum therapeutic effect, Ko-Renitek is taken at the same time before, during or after meals. If the patient was prescribed diuretics before using the drug, they should be stopped two to three days before starting treatment with Korenitek.

The dosage of the drug and the duration of the course of treatment with Korenitek are prescribed by the attending physician individually for each patient.

For patients with creatinine clearance from 80 to 30 milliliters/min and impaired renal function, the dose of Ko-Renitec is also selected individually. As a rule, the dose of enalapril is from five to ten milligrams.

Patients with creatinine clearance less than 30 milliliters/min and impaired renal function are not prescribed the drug.

Contraindications

According to the instructions, Korenitek is prohibited in case of intolerance to the components of the drug and sulfonamide derivatives, with anuria, as well as a history of angioedema.

The drug is contraindicated in pregnant women (especially in the 2nd and 3rd trimesters) and lactating women.

Ko-Renitek is prescribed, but with caution, to elderly people and children, as well as if the patient has diabetes mellitus, heart disease chronic failure, condition after kidney transplantation, bilateral stenosis renal arteries, stenosis of the artery of a single kidney, inhibition of bone marrow hematopoiesis.

Caution must be observed when prescribing Korenitek if the patient has coronary heart disease, hepatic or renal failure, aortic stenosis, cerebrovascular diseases, including cerebral circulatory failure, hyperkalemia and severe systemic autoimmune diseases connective tissue, including systemic lupus erythematosus and scleroderma, water and electrolyte imbalance, including those caused by vomiting and diarrhea.

Ko-Renitek is prescribed with extreme caution if surgery is planned. Car drivers and patients working with potentially dangerous mechanisms warn that the drug may cause dizziness. In this case, it is better to replace it with Ko-Renitek analogues.

Side effects of Co-Renitec

According to the instructions for Korenitek, side effects of the drug are rare. These include: arterial hypotension, chest and joint pain, fainting, tachycardia, cardiac arrhythmia and renal function, acute failure renal.

In addition, you may experience: increased fatigue, cough, dizziness, convulsions, tinnitus, impotence, skin rash, urticaria, itching, photosensitivity, Stevens-Johnson syndrome, Quincke's edema. Sometimes insomnia or drowsiness, shortness of breath, arthralgia, abdominal pain, hyperhidrosis, diarrhea, constipation, gout, dry mouth, and increased sweating occur.

The use of Korenitek by pregnant women (in the 2nd and 3rd trimesters) can provoke a decrease in renal function in the fetus, the occurrence of other malformations and even intrauterine fetal death. Newborns whose mothers took Korenitek during pregnancy may experience renal failure, cranial deformities and pulmonary hypoplasia.

If the side effects are pronounced, you should stop taking the drug and consult your doctor to prescribe Korenitek analogues.

In case of overdose, Ko-Renitek can cause: nausea, vomiting, decreased blood pressure, dizziness and water-electrolyte imbalance. To eliminate symptoms, gastric lavage and the use of enterosorbents are recommended. This treatment will help if Ko-Renitek was taken no more than two hours ago. In case of development of arterial hypotension, prescribe infusion administration sodium chloride solution (0.9%). Severe arterial hypotension is relieved by administration of angiotensin II.

Conditions and shelf life

Ko-Renitek is stored in a dry place, inaccessible to direct sun rays. The shelf life of tablets depends on the packaging: in bottles - two years, in blisters - three years.

Name: Co-Renitec

Drug interactions

When prescribing enalapril in combination with other antihypertensive products the effect can be summed up. Potassium loss caused by thiazide diuretics is usually reduced by enalaprilat. Serum potassium concentrations usually remain within normal limits. The use of potassium supplements, potassium-sparing diuretics, or potassium-containing salts, especially in patients with renal failure, can lead to a significant increase in serum potassium levels.

Diuretics and ACE inhibitors reduce the excretion of lithium by the kidneys and increase the risk of lithium toxicity. Lithium preparations, as a rule, are not prescribed concomitantly with diuretics or ACE inhibitors. NSAIDs, including selective inhibitors COX-2 may reduce the effectiveness of diuretics and other antihypertensive products. Therefore, it is possible to reduce the hypotensive effect ACE inhibitors when prescribed simultaneously with NSAIDs, including selective COX-2 inhibitors. In patients with impaired renal function receiving NSAIDs, including selective COX-2 inhibitors, further deterioration of renal function may occur with concomitant use of ACE inhibitors. These changes are usually reversible.

Thiazide diuretics may enhance the effect of tubocurarine. The hypotensive effect of the product is reduced by NSAIDs, estrogens, and ethanol. Immunosuppressants, allopurinol, and cytostatics increase the risk of developing hematotoxicity.

Storage conditions and periods

The drug should be stored out of reach of children at a temperature not exceeding 30°C. The shelf life for tablets in blisters is 3 years, for tablets in bottles high density- 2 years.

Attention!
Before using the medication "Co-Renitec" You should consult your doctor.
The instructions are provided for informational purposes only. Co-Renitec».

In this article you can find instructions for use medicinal product Renitek. Feedback from site visitors - consumers - is presented of this medicine, as well as the opinions of specialist doctors on the use of Renitec in their practice. We kindly ask you to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not stated by the manufacturer in the annotation. Analogs of Renitek if available structural analogues. Use for treatment arterial hypertension and lowering blood pressure in adults, children, as well as during pregnancy and breastfeeding.

Renitek- refers to drugs that affect the renin-angiotensin system - ACE inhibitors and is a highly specific, long-acting ACE inhibitor that does not contain a sulfhydryl group.

Renitec (active ingredient Enalapril maleate) is a derivative of two amino acids: L-alanine and L-proline. Enalapril is an ACE inhibitor, which catalyzes the conversion of angiotensin 1 into the pressor substance angiotensin 2. After absorption, enalapril taken orally is converted by hydrolysis into enalaprilat, which inhibits ACE. ACE inhibition leads to a decrease in the concentration of angiotensin 2 in the blood plasma, which entails an increase in plasma renin activity (due to the elimination of the negative feedback reaction to changes in renin production) and a decrease in aldosterone secretion.

ACE is identical to the enzyme kininase 2, so enalapril can also block the destruction of bradykinin, a peptide that has a vasodilating effect. The significance of this effect is therapeutic effect enalapril requires clarification. It is currently believed that the mechanism by which enalapril lowers blood pressure is the suppression of the renin-angiotensin-aldosterone system, which plays a role in important role in blood pressure regulation. Enalapril exhibits antihypertensive effects even in patients with reduced renin concentrations. A decrease in blood pressure is accompanied by a decrease in total peripheral vascular resistance, an increase cardiac output and no or slight changes in heart rate. As a result of taking enalapril, renal blood flow increases, but the level of glomerular filtration remains unchanged. However, in patients with initially reduced glomerular filtration, its level usually increases.

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

Enalapril therapy is accompanied by a beneficial effect on the ratio of lipoprotein fractions and no effect or a beneficial effect on concentration total cholesterol.

Taking enalapril by patients with arterial hypertension leads to a decrease in blood pressure regardless of body position: both in a standing position and in a lying position without a significant increase in heart rate.

Symptomatic postural hypotension is rare. In some patients, achieving optimal blood pressure reduction may require several weeks of therapy. Interruption of enalapril therapy does not cause a sharp rise in blood pressure.

Effective inhibition of ACE activity usually develops 2-4 hours after a single oral dose of enalapril. Start hypotensive effect occurs within 1 hour, the maximum decrease in blood pressure is observed 4-6 hours after taking the drug. The duration of action depends on the dose. However, when using recommended doses, the antihypertensive effect and hemodynamic effects are maintained for 24 hours.

Renitec reduces the loss of potassium ions caused by the use of hydrochlorothiazide.

Hydrochlorothiazide has a diuretic and antihypertensive effect and increases renin activity. Although enalapril itself exhibits an antihypertensive effect even in patients with arterial hypertension with low renin concentrations, the concomitant use of hydrochlorothiazide in such patients leads to a more pronounced decrease in blood pressure.

Compound

Enalapril maleate + Excipients.

Enalapril maleate + Hydrochlorothiazide + excipients (Co-Renitec).

Pharmacokinetics

After oral administration, Renitec is rapidly absorbed. The extent of absorption of enalapril maleate when taken orally is approximately 60%. Eating does not affect the absorption of enalapril. Enalapril is excreted primarily through the kidneys. The main metabolites detected in urine are enalaprilat, accounting for approximately 40% of the dose, and unchanged enalapril. There are no data on other metabolites of enalapril.

Indications

essential hypertension;
renovascular hypertension;
heart failure of any stage.

In patients with clinical manifestations of heart failure, the drug is also indicated for:

increasing patient survival;
slowing the progression of heart failure;

Prevention of the development of clinically significant heart failure

In patients without clinical symptoms heart failure with impaired left ventricular function, the drug is indicated for:

slowing down the development of clinical manifestations of heart failure;
reducing the frequency of hospitalizations for heart failure.

Prevention of coronary ischemia

In patients with left ventricular dysfunction, the drug is indicated for:

reducing the incidence of myocardial infarction;
reducing the frequency of hospitalizations for unstable angina.

Release forms

Tablets 5 mg, 10 mg and 20 mg.

Instructions for use and dosage

Orally, regardless of food intake, since the absorption of tablets does not depend on food intake.

Arterial hypertension

The initial dose is 10-20 mg, depending on the severity of arterial hypertension, and is prescribed once a day. For mild arterial hypertension, the recommended initial dose is 10 mg per day. For other degrees of arterial hypertension, the initial dose is 20 mg per day with a single dose. Maintenance dose - 1 tablet 20 mg 1 time per day. The dosage is selected individually for each patient, but the dose should not exceed 40 mg per day.

Renovascular hypertension

Since blood pressure and renal function may be particularly sensitive to ACE inhibition in patients in this group, therapy is started with a low initial dose of 5 mg or less. The dose is then adjusted according to the patient's needs. A dose of 20 mg per day is usually effective for daily intake. Caution should be exercised when treating patients who have recently received diuretic treatment.

Concomitant treatment of arterial hypertension with diuretics

After the 1st dose of Renitec, arterial hypotension may develop. This effect is most likely in patients receiving diuretic treatment. It is recommended to prescribe the drug with caution, because these patients may be fluid or sodium deficient. Treatment with diuretics should be stopped 2-3 days before starting treatment with Renitec. If this is not possible, the initial dose of Renitec should be reduced (to 5 mg or less) to determine the initial effect of the drug. Further, the dosage should be selected taking into account the patient's condition.

Heart failure/asymptomatic left ventricular dysfunction

The starting dose of Renitec in patients with heart failure or asymptomatic left ventricular dysfunction is 2.5 mg, and the drug should be prescribed under careful medical supervision to establish the primary effect of the drug on blood pressure. Renitec can be used to treat heart failure with severe clinical manifestations usually together with diuretics and, when necessary, with cardiac glycosides. In the absence of symptomatic hypotension (arising as a result of treatment with Renitec) or after its appropriate correction, the dose should be gradually increased to the usual maintenance dose of 20 mg, which is prescribed either once or divided into 2 doses depending on the patient’s tolerability of the drug. Dose selection can be carried out over 2-4 weeks or more short time if there are residual signs and symptoms of heart failure. This therapeutic regimen effectively reduces mortality rates in patients with clinically significant heart failure.

Both before and after starting treatment with Renitec, careful monitoring of blood pressure and renal function should be carried out in patients with heart failure, since there have been reports of the development of arterial hypotension as a result of taking the drug, followed (which is much less common) by the occurrence of renal failure. In patients receiving diuretics, the dose of diuretics should be reduced if possible before starting treatment with Renitec. The development of arterial hypotension after taking the first dose of Renitec does not mean that arterial hypotension will persist during long-term treatment, and does not indicate the need to stop taking the drug. During treatment with Renitec, the level of potassium in the blood serum should also be monitored.

Co-Renitec

The drug is prescribed orally, regardless of food intake.

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

At the beginning of therapy with Corenitec, symptomatic arterial hypotension may develop, more often in patients with water and electrolyte imbalance due to previous treatment with diuretics. Diuretic therapy should be stopped 2-3 days before starting the use of Korenitek.

Side effect

myocardial infarction;
stroke;
chest pain;
strong heartbeat;
rhythm disturbance;
angina pectoris;
Raynaud's syndrome;
nausea, vomiting;
diarrhea;
intestinal obstruction;
liver failure;
abdominal pain;
dyspepsia;
constipation;
anorexia;
stomatitis;
dry mouth;
hypoglycemia in patients with diabetes mellitus receiving oral hypoglycemic agents or insulin;
headache;
depression;
confusion;
drowsiness;
insomnia;
increased nervousness;
paresthesia;
dizziness;
sleep disorders;
anxiety;
dyspnea;
rhinorrhea;
a sore throat;
hoarseness of voice;
increased sweating;
skin itching;
hives;
baldness;
angioedema of the face, limbs, lips, tongue, glottis and/or larynx;
impotence;
redness of the facial skin;
taste disturbance;
noise in ears;
glossitis;
blurred vision;
fever;
vasculitis;
leukocytosis;
photosensitivity and other skin reactions.

Contraindications

history of angioedema associated with previous prescription of ACE inhibitors;
hereditary or idiopathic angioedema;
age under 18 years (efficacy and safety have not been established);
hypersensitivity to any of the components of the drug.

Use during pregnancy and breastfeeding

Use of the drug during pregnancy is not recommended. If pregnancy occurs, Renitec should be stopped immediately. ACE inhibitors can cause disease or death of the fetus or newborn when prescribed to pregnant women during the 2nd and 3rd trimesters of pregnancy. The use of ACE inhibitors during these periods was accompanied by negative impact on the fetus and newborn, including the development of arterial hypotension, renal failure, hyperkalemia and/or cranial hypoplasia in the newborn. Oligohydramnios may develop, apparently due to decreased fetal renal function. This complication can lead to contracture of the limbs, deformation of the skull, including its facial part, and hypoplasia of the lungs. When prescribing Renitec, it is necessary to inform the patient about the potential risk to the fetus.

These adverse events on the embryo and fetus do not appear to be the result of in utero exposure to ACE inhibitors during the 3rd trimester of pregnancy.

Newborns whose mothers took Renitec should be closely monitored for decreased blood pressure, oliguria and hyperkalemia. Enalapril, which crosses the placenta, can be partially removed from the neonatal circulation by peritoneal dialysis; theoretically it can be removed by exchange transfusion blood.

Enalapril and enalaprilat are defined in mother's milk in trace concentrations. If the use of the drug is necessary, the patient should stop breastfeeding.

Use in elderly patients

Use caution in patients over 65 years of age.

Use in children

Contraindicated in people under 18 years of age (efficacy and safety have not been established).

special instructions

Renitec should be used with caution in the treatment of patients with bilateral renal artery stenosis or stenosis of the artery of a single kidney, with primary hyperaldosteronism, hyperkalemia, and conditions after kidney transplantation; aortic stenosis, mitral stenosis(with impaired hemodynamic parameters), idiopathic hypertrophic subaortic stenosis; systemic diseases connective tissue; coronary heart disease; cerebrovascular diseases; diabetes mellitus; renal failure (proteinuria - more than 1 g per day); liver failure; in patients on a salt-restricted diet or on hemodialysis; when taken simultaneously with immunosuppressants and diuretics, in elderly patients (over 65 years), inhibition of bone marrow hematopoiesis; conditions accompanied by a decrease in circulating blood volume (including diarrhea, vomiting).

Clinically significant arterial hypotension

Clinically significant hypotension is rarely observed in patients with uncomplicated arterial hypertension. In patients with arterial hypertension receiving Renitec, arterial hypotension develops more often against the background of hypovolemia, which occurs, for example, as a result of diuretic therapy, salt restriction, in patients on hemodialysis, and also suffering from diarrhea or vomiting. Clinically significant arterial hypotension was also observed in patients with heart failure, accompanied or not accompanied by renal failure. Arterial hypotension occurs more often in patients with more severe forms of heart failure, in whom more high doses loop diuretics, with hyponatremia or impaired renal function. In such patients, treatment with Renitec should be initiated under medical supervision, which should be especially careful when changing the dose of Renitec and/or diuretic. Similarly, patients with coronary disease heart, as well as with cerebrovascular diseases, in which a sharp decline High blood pressure can lead to myocardial infarction or stroke. If arterial hypotension develops, the patient should be laid down and, if necessary, saline sodium chloride solution should be administered intravenously.

Transient arterial hypotension when taking Renitec is not a contraindication to further treatment drug, which can be continued after fluid replenishment and blood pressure normalization. In some patients with heart failure and with normal or low blood pressure, Renitec may cause an additional decrease in blood pressure. This reaction to the drug can be expected and should not be regarded as a reason to discontinue treatment. In cases where arterial hypotension becomes stable, the dose should be reduced and/or treatment with a diuretic and/or Renitec should be discontinued.

Aortic stenosis/hypertrophic cardiomyopathy

As with all vasodilators, patients with obstruction aortic orifice left ventricular ACE inhibitors should be prescribed with caution.

Renal dysfunction

In some patients, hypotension that develops after initiation of treatment with ACE inhibitors may lead to deterioration of renal function. In some cases, the development of acute renal failure, usually reversible, has been reported.

In patients with renal failure, it may be necessary to reduce the dose and/or frequency of dosing. In some patients with bilateral renal artery stenosis or arterial stenosis of a solitary kidney, increases in blood urea and serum creatinine were observed. The changes were usually reversible and the values returned to normal after cessation of treatment. This pattern of changes is most likely in patients with renal failure. In some patients who did not have renal disease before treatment, Renitec in combination with diuretics usually caused a slight and transient increase in blood urea and serum creatinine. In such cases, it may be necessary to reduce the dose and/or discontinue the diuretic and/or Renitec.

Hypersensitivity/Angioedema

Rare cases have been reported when prescribing ACE inhibitors, including Renitec. angioedema face, limbs, lips, tongue, glottis and/or larynx, arising in different periods treatment. In such cases, treatment with Renitec should be stopped immediately and constant surveillance follow the patient to ensure complete resolution of symptoms. Even in cases where there is only difficulty swallowing without breathing problems, patients should long time be under medical supervision, because therapy antihistamines and corticosteroids may not be sufficient. Angioedema of the larynx or tongue can lead to fatal outcome. In cases where the swelling is localized to the tongue, glottis or larynx and may cause obstruction respiratory tract, appropriate therapy should be promptly initiated, which may include subcutaneous administration of a solution of epinephrine (adrenaline) 0.1% (0.3-0.5 ml) and/or Urgent measures to ensure airway patency.

Patients with a history of angioedema not associated with the use of ACE inhibitors may have increased risk its occurrence and during treatment with an ACE inhibitor. In patients of the Negroid race, the incidence of angioedema when taking ACE inhibitors is higher than in representatives of other races.

Anaphylactic reactions during hyposensitization with an allergen from Hymenoptera venom

IN in rare cases Patients receiving ACE inhibitors during hyposensitization with an allergen from Hymenoptera venom developed anaphylactic reactions that were life-threatening. Such reactions can be avoided if you temporarily stop taking the ACE inhibitor before the onset of hyposensitization.

Patients on hemodialysis

Patients on dialysis using high-flow membranes (eg, AN69) and concomitantly receiving an ACE inhibitor have experienced anaphylactic reactions in some cases. Therefore, for such patients, it is recommended to use a different type of dialysis membrane or a different group of antihypertensive agents.

Cough

There are reports of cough occurring during treatment with ACE inhibitors. Usually the cough is non-productive, persistent and stops after discontinuation of the drug. Cough due to treatment with an ACE inhibitor should be taken into account when differential diagnosis cough.

Surgery/General anesthesia

During big surgical operations or during general anesthesia With the use of agents that cause a hypotensive effect, enalapril blocks the formation of angiotensin 2 secondary to the compensatory release of renin. If a pronounced decrease in blood pressure develops, explained by a similar mechanism, it can be corrected by increasing the volume of fluid administered.

Hyperkalemia

The use of potassium supplements, potassium-sparing diuretics, or potassium-containing salts, especially in patients with renal failure, can lead to a significant increase in serum potassium levels. Hyperkalemia can cause serious, and in some cases fatal, cardiac arrhythmias.

If concomitant administration of the above potassium-containing or potassium-increasing drugs is necessary, caution should be exercised and regular monitoring of potassium levels in the blood serum.

Hypoglycemia

Patients with diabetes mellitus receiving oral hypoglycemic agents or insulin should be informed before starting the use of ACE inhibitors of the need to carefully monitor blood glucose levels (hypoglycemia), especially during the first month of co-administration of these drugs.

Impact on the ability to drive a car and/or operate machinery

During the treatment period, care must be taken when driving vehicles and engaging in other potentially dangerous species activities that require increased concentration and speed of psychomotor reactions (dizziness is possible, especially after taking the initial dose of an ACE inhibitor in patients taking diuretic drugs).

Drug interactions

When prescribing Renitec in combination with other antihypertensive drugs a cumulative effect may be observed.

Serum potassium concentrations usually remain within normal limits. In patients with arterial hypertension treated with Renitec for more than 48 weeks, an increase in serum potassium of up to 0.2 mEq/L is observed.

At joint use Reniteca with diuretics, causing loss potassium, hypokalemia caused by the action of diuretics is usually weakened by the effect of enalapril.

Risk factors for the development of hyperkalemia include renal failure, diabetes mellitus, concomitant use of potassium-sparing diuretics (spironolactone, triamterene or amiloride), as well as the use of potassium supplements and salts. The use of potassium supplements, potassium-sparing diuretics, or potassium-containing salts, especially in patients with renal failure, can lead to a significant increase in serum potassium levels. If concomitant administration of the above potassium-containing or potassium-increasing drugs is necessary, caution should be exercised and regular monitoring of potassium levels in the blood serum.

The combined use of ACE inhibitors and hypoglycemic agents (insulin, oral hypoglycemic agents) may enhance the hypoglycemic effect of the latter with the risk of developing hypoglycemia. This phenomenon was generally observed most frequently during the first weeks of their combined use, as well as in patients with renal failure. In patients with diabetes mellitus receiving oral hypoglycemic agents or insulin, blood glucose levels should be carefully monitored, especially during the first month of co-administration with ACE inhibitors.

ACE inhibitors reduce the excretion of lithium by the kidneys and increase the risk of developing lithium intoxication. If it is necessary to prescribe lithium salts, it is necessary to monitor the level of lithium in the blood serum.

NSAIDs, including selective COX-2 inhibitors, may reduce the effect of diuretics and other antihypertensive drugs. Thus, the antihypertensive effect of ACE inhibitors may be attenuated by NSAIDs, including COX-2 inhibitors.

In some patients with impaired renal function and taking nonsteroidal anti-inflammatory drugs (NSAIDs), including COX-2 inhibitors, concomitant use of ACE inhibitors may lead to a further deterioration of renal function. These changes are usually reversible.

A complex of symptoms, including facial flushing, nausea, vomiting and hypotension, has been described in rare cases with the combined use of gold preparations for parenteral use (sodium aurothiomalate) and ACE inhibitors (enalapril).

Analogs of the drug Renitek and Ko-renitek

Structural analogues according to active substance:

Bagopril;
Berlipril;
Vazolapril;
Vero-Enalapril;
Invoril;
Corandil;
Miopril;
Renipril;
Ednit;
Enazil 10;
Enalacor;
Enalapril;
Enalapril maleate;
Enam;
Enap;
Enarenal;
Enafarm;
Envas;
Envipril.

If there are no analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps, and look at the available analogues for the therapeutic effect.

Latest update of the description by the manufacturer 31.07.1998

Filterable list

Active substance:

ATX

Pharmacological group

Nosological classification (ICD-10)

Composition and release form

1 tablet contains enalapril maleate 20 mg and hydrochlorothiazide 12.5 mg; 14 pcs in a blister, 1 or 2 blisters in a box.

pharmachologic effect

pharmachologic effect- diuretic, hypotensive.

Inhibits ACE, reduces the reabsorption of ions and water in convoluted tubules.

Clinical pharmacology

Indications of the drug Ko-renitek ®

Arterial hypertension.

Contraindications

Hypersensitivity (including to other ACE inhibitors and sulfonamide derivatives), anuria, childhood.

Use during pregnancy and breastfeeding

It is not recommended to prescribe during pregnancy, especially in the II-III trimester (due to the risk of developmental defects or fetal death). If pregnancy occurs, use should be discontinued. At the same time, it is permissible to use the drug in pregnant women for health reasons, but it is necessary to inform the patient about possible consequences and perform periodic ultrasound (to assess the intra-amniotic space). Lactating women should suspend treatment for the duration of treatment. breast-feeding.

Side effects

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

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 in renal failure). Increases the likelihood of lithium intoxication.

Directions for use and doses

Inside - 1 tablet. 1 time per day; if necessary - 2 tables. 1 time per day. In case of renal failure (with creatinine Cl less than 30-80 ml/min) it is prescribed after preliminary selection of doses of each component.

Precautionary measures

To avoid symptomatic hypotension, preliminary (before treatment) and periodic (during treatment) monitoring of water and electrolyte balance is necessary, especially in patients with concomitant cerebrovascular diseases and ischemic heart disease. If used after diuretic therapy, an interval of 2-3 days is recommended. If the levels of urea and creatinine in the blood increase, use should be discontinued. Prescribed with caution to patients with liver failure, during major surgical operations, incl. using anesthetics and other drugs that lower blood pressure.

Storage conditions for the drug Ko-renitek ®

At a temperature not exceeding 30 °C.

Keep out of the reach of children.

Shelf life of the drug Ko-renitek ®

3 years.

Do not use after the expiration date stated on the package.

Synonyms of nosological groups

Category ICD-10	Synonyms of diseases according to ICD-10
I10 Essential (primary) hypertension	Arterial hypertension
	Arterial hypertension


	Arterial hypertension
	Sudden increase in blood pressure

	Hypertensive state
	Hypertensive crises
	Hypertension
	Arterial hypertension
	Hypertension is malignant
	Essential hypertension
	Hypertonic disease
	Hypertensive crises
	Hypertensive crisis
	Hypertension
	Malignant hypertension
	Malignant hypertension
	Isolated systolic hypertension
	Hypertensive crisis

	Primary arterial hypertension

	Essential arterial hypertension
	Essential arterial hypertension
	Essential hypertension
	Essential hypertension
I15 Secondary hypertension	Arterial hypertension
	Arterial hypertension
	Arterial hypertension of crisis course
	Arterial hypertension complicated by diabetes mellitus
	Arterial hypertension
	Vasorenal hypertension
	Sudden increase in blood pressure
	Hypertensive circulatory disorder
	Hypertensive state
	Hypertensive crises
	Hypertension
	Arterial hypertension
	Hypertension is malignant
	Hypertension, symptomatic
	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

The drug Korenitec is a combination of the angiotensin-converting enzyme (ACE) inhibitor enalapril and the diuretic hydrochlorothiazide. This original drug from the Dutch branch of the global pharmaceutical concern Merck Sharp & Dome, whose headquarters are located in the USA. Combined pharmacological effect the drug - antihypertensive and diuretic - is due to the substances included in its composition. Enalapril, which is converted in the body into active enalaprilat, is an ACE inhibitor, which is known to promote the transformation of angiotensin I into a powerful pressor substance and the main regulatory instrument of the renin-angiotensin-aldosterone system (RAAS) - angiotensin II. Suppression of the RAAS, in turn, leads to a decrease in blood pressure, which is accompanied by a decrease in total peripheral vascular resistance and a slight increase in minute blood volume. Against this background, the heart rate remains virtually unchanged. Renal blood circulation under the influence of enalapril becomes more intense. Long-term use enalapril leads to a decrease in left ventricular hypertrophy, while contractility the left ventricle does not suffer from this. At the same time, the drug has positive influence on the ratio of lipoprotein fractions and the concentration of total cholesterol. In patients with arterial hypertension, a decrease in blood pressure under the influence of enalapril occurs both while standing and lying down, and the heart rate increases, if at all, only slightly. Symptomatic orthostatic decrease in pressure rarely develops. In some cases, several weeks of pharmacotherapy are required to achieve the desired blood pressure level. Rebound syndrome (a sharp rise in blood pressure) does not develop when enalapril is discontinued. “To the fullest,” the inhibitory effect of enalapril on ACE develops 2-4 hours after taking the drug, reaching its maximum at 4-6 hours.

The duration of action is determined accepted dose. If the doses recommended in the instructions for use are followed, the antihypertensive effect and hemodynamic effect persist throughout the day.

Hydrochlorothiazide has antihypertensive and diuretic effects. Since this thiazide diuretic increases renin activity, in patients with arterial hypertension and low renin concentrations, blood pressure decreases even more significantly. Enalapril allows you to neutralize the decrease in the concentration of potassium ions that occurs under the influence of hydrochlorothiazide. The dosage regimen for these two substances does not have significant differences. In this regard, the drug Korenitek is a successful combination of two effective components, allowing the patient not to be “loaded” with a bunch of pills, but to carry out combination therapy by taking just one drug. The use of a combination of enalapril and hydrochlorothiazide allows you to achieve more rapid decline blood pressure and maintain it stably at a given level throughout the course of treatment. Interestingly, taking these drugs separately does not achieve the same pronounced and sustainable effect.

Korenitek is an original drug, so its cost does not always correspond to the financial capabilities of patients. In this case, generic drugs can be a salvation. An example of this medicine is the drug renipril GT from the Russian pharmaceutical company Pharmstandard. According to comparative research co-renitec and renipril, conducted on the basis of the State Research Center preventive medicine Ministry of Health, the effectiveness of these two drugs is almost identical. True, the safety profile of renipril GT is somewhat worse, which is reflected in more side effects weak and medium degree expressiveness.

Pharmacology

Combined antihypertensive drug, which contains an ACE inhibitor (enalapril maleate) and a thiazide diuretic (hydrochlorothiazide). Has antihypertensive and diuretic effects.

Enalapril is an ACE inhibitor, which catalyzes the conversion of angiotensin I into the pressor substance angiotensin II. After absorption, enalapril is converted by hydrolysis to enalaprilat, which inhibits ACE. ACE inhibition leads to a decrease in the concentration of angiotensin II in the blood plasma, which entails an increase in plasma renin activity (due to the elimination of the negative feedback reaction to changes in renin production) and a decrease in aldosterone secretion.

ACE is identical to the enzyme kininase II, so enalapril can also block the destruction of bradykinin, a peptide that has a vasodilating effect. The significance of this mechanism in the therapeutic effect of enalapril requires clarification. Although enalapril lowers blood pressure by suppressing the renin-angiotensin-aldosterone system, which plays an important role in blood pressure regulation, the drug lowers blood pressure even in patients with low-renin hypertension.

A decrease in blood pressure is accompanied by a decrease in peripheral vascular resistance, a slight increase in cardiac output and no changes or minor changes in heart rate. As a result of taking enalapril, renal blood flow increases, glomerular filtration rate remains unchanged. However, in patients with initially reduced glomerular filtration rate, its rate usually increases.

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

Enalapril therapy is accompanied by a beneficial effect on the ratio of lipoprotein fractions and no effect or a beneficial effect on the content of total cholesterol.

Taking enalapril in patients with arterial hypertension leads to a decrease in blood pressure both in a standing and lying position without a significant increase in heart rate.

Effective inhibition of ACE activity usually develops 2-4 hours after a single oral dose of enalapril. The onset of antihypertensive action occurs within 1 hour, the maximum decrease in blood pressure is observed 4-6 hours after taking the drug. The duration of action depends on the dose. However, when used in recommended doses, the antihypertensive effect and hemodynamic effects persist for 24 hours.

Enalapril reduces the loss of potassium ions caused by the use of hydrochlorothiazide. Enalapril and hydrochlorothiazide have similar dosing regimens. Therefore, Ko-Renitek is a convenient dosage form for the joint administration of enalapril and hydrochlorothiazide.

The use of a combination of enalapril and hydrochlorothiazide leads to a more pronounced decrease in blood pressure compared to monotherapy with each drug separately and allows the antihypertensive effect of Korenitec to be maintained for at least 24 hours.

Pharmacokinetics

Enalapril

Suction

After oral administration, enalapril maleate is rapidly absorbed. Cmax of enalapril in blood serum is observed within 1 hour after administration. After oral administration, absorption is approximately 60%.

Eating does not affect the absorption of enalapril. The duration of absorption and hydrolysis of enalapril is similar for various recommended therapeutic doses.

After absorption, enalapril is rapidly hydrolyzed to form active substance enalaprilat, a powerful ACE inhibitor. Cmax of enalaprilat in the blood serum is observed 3-4 hours after taking a dose of enalapril orally.

Removal

Enalapril is excreted primarily by the kidneys. The main metabolites detected in urine are enalaprilat, accounting for approximately 40% of the dose, and unchanged enalapril. There are no data on other significant metabolic pathways of enalapril, with the exception of hydrolysis to enalaprilat. The plasma concentration curve of enalaprilat has a long final phase, apparently due to its binding to ACE. In persons with normal function kidneys, a stable concentration of enalaprilat is achieved on the 4th day from the start of taking enalapril. T1/2 of enalaprilat at course application of the drug orally is 11 hours.

Hydrochlorothiazide

Metabolism and distribution

Not metabolized. Hydrochlorothiazide penetrates the placental barrier, but does not penetrate the BBB.

Removal

T 1/2 of hydrochlorothiazide from 5.6 to 14.8 hours. It is quickly excreted by the kidneys. At least 61% of the dose taken orally is excreted unchanged within 24 hours.

Combination of enalaprilat maleate and hydrochlorothiazide

Regular use of a combination of enalapril and hydrochlorothiazide does not affect or slightly affects the bioavailability of each component of the drug. Application combination tablet the drug Ko-renitek is bioequivalent simultaneous administration its ingredients in separate dosage forms.

Release form

Pills yellow color, round, biconvex, with a grooved edge, with an engraving "MSD 718" on one side and a notch on the other.

Excipients: sodium bicarbonate, lactose monohydrate (lactose aqueous), corn starch, pregelatinized corn starch, yellow iron oxide dye, magnesium stearate.

7 pcs. - blisters (2) - cardboard packs.
7 pcs. - blisters (4) - cardboard packs.
56 pcs. - polyethylene bottles (1) - cardboard packs.

Dosage

The drug is prescribed orally, regardless of food intake.

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

In patients with impaired renal function, thiazides may not be effective enough, and with CC ≤ 30 ml/min (i.e., with moderate to severe renal failure) they are ineffective.

For renal mild insufficiency degrees, the recommended dose of enalapril maleate taken alone is 5 mg to 10 mg.

Overdose

Symptoms: severe arterial hypotension, starting approximately 6 hours after taking the drug, and stupor. After taking enalapril maleate in doses of 330 mg and 440 mg, the concentrations of enalaprilat in the blood plasma were 100 and 200 times higher, respectively, than its concentrations at therapeutic doses.

In cases of hydrochlorothiazide overdose, the most commonly observed symptoms are those caused by hypokalemia, hypochloremia, hyponatremia, and dehydration due to excessive diuresis. If you have previously been treated with digitalis drugs, the arrhythmia may worsen due to hypokalemia.

Treatment: Ko-Renitec should be discontinued; Careful medical supervision is required. Gastric lavage is recommended if the drug has been taken recently; conducting symptomatic and supportive therapy to correct water and electrolyte imbalances and arterial hypotension. Data on specific therapy there is no overdose.

Interaction

When prescribing enalapril in combination with other antihypertensive drugs the effect can be summed up.

Potassium loss caused by thiazide diuretics is usually reduced by enalaprilat. Serum potassium concentrations usually remain within normal limits.

The use of potassium supplements, potassium-sparing diuretics, or potassium-containing salts, especially in patients with renal failure, may lead to significant increases in serum potassium levels.

NSAIDs, including selective COX-2 inhibitors, may reduce the effectiveness of diuretics and other antihypertensive drugs. Therefore, it is possible to reduce the hypotensive effect of ACE inhibitors when administered simultaneously with NSAIDs, including selective COX-2 inhibitors.

In patients with impaired renal function receiving NSAIDs, including selective COX-2 inhibitors, further deterioration of renal function may occur with concomitant use of ACE inhibitors. These changes are usually reversible.

Thiazide diuretics may enhance the effect of tubocurarine.

The hypotensive effect of the drug is reduced by NSAIDs, estrogens, and ethanol.

Immunosuppressants, allopurinol, and cytostatics increase the risk of developing hematotoxicity.

Side effects

At clinical studies side effects were usually mild, transient, and in most cases did not require interruption of treatment.

From the outside of cardio-vascular system: 1-2% - orthostatic effects, including arterial hypotension; rarely - fainting, arterial hypotension regardless of body position, palpitations, tachycardia, chest pain.

From the central nervous system and peripheral nervous system: often - dizziness, increased fatigue (usually went away when the dose was reduced and rarely required discontinuation of the drug); 1-2% - asthenia, headaches; rarely - insomnia, drowsiness, systemic dizziness, paresthesia, increased excitability.

From the outside respiratory system: 1-2% - cough; rarely - shortness of breath.

From the outside digestive system: 1-2% - nausea; rarely - pancreatitis, diarrhea, vomiting, dyspepsia, abdominal pain, flatulence, constipation, dry mouth.

From the outside musculoskeletal system: 1-2% - muscle cramps; rarely - arthralgia.

Allergic reactions: rarely - angioedema of the face, limbs, lips, tongue, glottis and/or larynx. There are rare reports of the development of angioedema of the intestine in connection with taking ACE inhibitors, including enalapril.

Dermatological reactions: rarely - Stevens-Johnson syndrome, hyperhidrosis, skin rash, itching.

From the urinary system: rarely - impaired renal function, renal failure.

From the reproductive system: 1-2% - impotence; rarely - decreased libido.

From laboratory parameters: possible hyperglycemia, hyperuricemia, hypo- or hyperkalemia, increased concentrations of urea, serum creatinine in the blood, increased activity of liver enzymes and/or increased serum bilirubin (these indicators usually returned to normal after cessation of therapy with Korenitek); in some cases - a decrease in hemoglobin and hematocrit.

Other: rarely - tinnitus, gout. A symptom complex has been described, possible manifestations which are fever, serositis, vasculitis, myalgia, myositis, arthralgia/arthritis, positive test for antinuclear antibodies, accelerated ESR, eosinophilia and leukocytosis; photosensitivity may develop.

Indications

Treatment of arterial hypertension in patients for whom combination therapy is indicated.

Contraindications

anuria;
history of angioedema associated with previous prescription of ACE inhibitors, as well as hereditary or idiopathic angioedema;
hypersensitivity to the components of the drug;
hypersensitivity to other sulfonamide derivatives.

The drug should be prescribed with caution for aortic stenosis, cerebrovascular diseases (including insufficiency cerebral circulation), coronary artery disease, chronic heart failure, severe autoimmune systemic connective tissue diseases (including systemic lupus erythematosus, scleroderma), suppression of bone marrow hematopoiesis, diabetes mellitus, hyperkalemia, bilateral renal artery stenosis, artery stenosis of a single kidney, condition after kidney transplantation , renal and/or liver failure, against the background of a sodium-restricted diet, in conditions accompanied by a decrease in blood volume (including diarrhea, vomiting), in elderly patients.

Features of application

Use during pregnancy and breastfeeding

The administration of ACE inhibitors in the second and third trimesters of pregnancy can cause illness or death of the fetus or newborn. Bad influence ACE inhibitors on the fetus and newborn are manifested by arterial hypotension, renal failure, hyperkalemia and/or cranial hypoplasia. Oligohydramnios may develop, apparently due to impaired fetal renal function. This complication can lead to contracture of the limbs, deformation of the skull, including its facial part, and hypoplasia of the lungs.

The use of diuretics in women during pregnancy is not recommended, as there is a risk of developing jaundice in the fetus and newborn, thrombocytopenia and possibly other side effects observed in adult patients.

If Korenitek is prescribed during pregnancy, the patient should be warned about the existing potential risk to the fetus. In those rare cases when the administration of the drug during pregnancy is considered necessary, periodic ultrasound examinations to assess the condition of the fetus, as well as the intra-amniotic space.

Newborns whose mothers took Corenitec should be carefully monitored for the development of arterial hypotension, oliguria and hyperkalemia. Enalapril, which crosses the placental barrier, was removed from the neonatal circulation by peritoneal dialysis with some benefit. clinical effect, theoretically it can be removed through exchange transfusion.

Enalapril and thiazides, incl. hydrochlorothiazide, secreted from breast milk. If it is necessary to use the drug during lactation, breastfeeding should be discontinued.

Use for liver dysfunction

The drug should be prescribed with caution in case of liver failure.

Use for renal impairment

In patients with impaired renal function, thiazides may not be effective enough, and with CC less than or equal to 30 ml/min (i.e. with severe renal failure) they are ineffective.

With a CC of 80-30 ml/min, Ko-Renitek should be used only after preliminary selection of doses of each component.

special instructions

During treatment with Korenitek, as with any antihypertensive therapy, it is possible to develop symptomatic hypertension. Patients should be examined to identify clinical signs disturbances in water and electrolyte balance, i.e. dehydration, hyponatremia, hypochloremic alkalosis, hypomagnesemia or hypokalemia, which may occur due to episodes of diarrhea or vomiting. In such patients, during therapy, periodic determination of the electrolyte composition of the blood should be carried out at certain intervals.

The drug should be prescribed with extreme caution to patients with ischemic heart disease or cerebrovascular diseases, because An excessive decrease in blood pressure can lead to the development of myocardial infarction or stroke.

If arterial hypotension develops, it is indicated bed rest and, if necessary, intravenous administration saline solution. Transient arterial hypotension when prescribing Korenitek is not a contraindication to its further use. After normalization of blood pressure and blood volume, therapy can be resumed either in slightly reduced doses, or each of the components of the drug can be used separately.

Korenitek should not be prescribed to patients with renal failure (KR<80 мл/мин) до тех пор, пока подбор отдельных компонентов препарата не покажет, что необходимые дозы для данного пациента присутствуют в данной лекарственной форме.

In some patients without any evidence of renal disease before treatment, usually slight and transient increases in blood urea and serum creatinine occurred when treated with enalapril in combination with a diuretic. In such cases, treatment with Corenitec should be discontinued. In the future, it is possible to resume therapy in reduced doses or prescribe each of the components of the drug separately.

Like all drugs that have a vasodilating effect, ACE inhibitors should be prescribed with caution to patients who have difficulty with the outflow of blood from the left ventricle of the heart.

In some patients with bilateral renal artery stenosis or arterial stenosis of a solitary kidney, increases in blood urea and serum creatinine were observed when treated with ACE inhibitors. These changes were reversible; as a rule, the indicators returned to normal after cessation of treatment.

Thiazide diuretics should be used with caution in patients with impaired liver function or progressive liver disease, since even minor changes in water and electrolyte balance can lead to hepatic coma.

When performing major surgical operations or during general anesthesia with the use of drugs that cause arterial hypotension, enalaprilat blocks the formation of angiotensin II caused by compensatory release of renin. If severe arterial hypotension develops, explained by a similar mechanism, it can be corrected by increasing the volume of blood volume.

Thiazide diuretics may not be effective enough in patients with impaired renal function and are ineffective when CC ≤ 30 ml/min (i.e., with moderate to severe renal failure).

Thiazide diuretics can cause impaired glucose tolerance. Dosage adjustments of hypoglycemic medications, including insulin, may be required.

Thiazide diuretics may decrease urinary calcium excretion and may also cause a slight and transient increase in serum calcium. Severe hypercalcemia may be a sign of hidden hyperparathyroidism. Thiazides should be discontinued before testing parathyroid function.

Increases in cholesterol and TG levels may also be associated with therapy with thiazide diuretics, however, with a dose of hydrochlorothiazide of 12.5 mg contained in 1 Korenitek tablet, such effects were either not observed or were insignificant.

Thiazide therapy may lead to hyperuricemia and/or gout in some patients. However, enalapril may increase uric acid levels in the urine and thereby reduce the hyperuricemic effect of hydrochlorothiazide.

Rare cases of angioedema of the face, extremities, lips, tongue, glottis and/or larynx have been described during treatment with ACE inhibitors, including enalapril maleate. These reactions can occur at any stage of therapy. In such cases, it is necessary to immediately stop taking enalapril maleate and carefully monitor the patient's condition in order to monitor and correct clinical symptoms. Even in cases where there is only swelling of the tongue without swelling of the respiratory organs, patients may require long-term observation as therapy with antihistamines and corticosteroids may not be sufficient.

There have been rare reports of death due to angioedema accompanied by laryngeal edema or tongue edema. Swelling of the tongue, glottis, or larynx can lead to airway obstruction, especially in patients who have undergone respiratory surgery.

In cases where swelling is localized in the area of the tongue, glottis or larynx, which can lead to airway obstruction, 0.3-0.5 ml of a 0.1% solution of epinephrine (adrenaline) should be immediately administered subcutaneously and quickly ensure airway patency.

In black patients taking ACE inhibitors, angioedema was observed more often than in other patients.

If there is a history of angioedema not associated with taking ACE inhibitors, the risk of developing angioedema during therapy with ACE inhibitors increases significantly.

In patients receiving thiazides, allergic reactions may occur regardless of a history of allergic conditions or bronchial asthma. Relapses or worsening severity of SLE have been reported in patients receiving thiazides.

In rare cases, patients receiving ACE inhibitors have developed life-threatening anaphylactoid reactions during hyposensitization with hymenoptera venom allergen. Such reactions can be avoided if you temporarily stop taking the ACE inhibitor before starting hyposensitization.

The use of Korenitek is contraindicated in patients with renal failure undergoing hemodialysis. Anaphylactoid reactions have been observed in patients on dialysis using high-flow membranes (such as AN69) and concomitantly treated with ACE inhibitors. In these patients, it is necessary to use a different type of dialysis membrane or different classes of antihypertensive drugs.

Cases of cough have been reported during ACE therapy. As a rule, the cough is dry, persistent and disappears after the end of therapy. Cough associated with the use of ACE inhibitors should be considered in the differential diagnosis of cough.

The results of clinical studies of the efficacy and tolerability of enalapril maleate and hydrochlorothiazide when administered concomitantly were similar in elderly and younger patients.

Use in pediatrics

The safety and effectiveness of Corenitec in children have not been established, therefore use in pediatrics is not recommended.