Enzix Duo tabs 10mg/2.5mg #30 + #15

Enzix Duo instruction

You can buy Enzix Duo here

Enzix Duo is a combined antihypertensive agent.

Release form and composition

Release form - a set of tablets 10 mg + 2.5 mg: tablets containing enalapril - round, biconvex, with a risk on one side; film-coated tablets containing indapamide are round, biconvex, white (in a blister there are 10 enalapril tablets and 5 indapamide tablets, in a cardboard box 3 blisters and instructions for use of Enzix Duo).
Composition of 1 tablet of enalapril:
    active substance: enalapril maleate - 10 mg;
    auxiliary components: gelatin, magnesium stearate, magnesium carbonate, crospovidone, lactose monohydrate.
Composition of 1 tablet of indapamide:
    active substance: indapamide - 2.5 mg;
    auxiliary components: sodium lauryl sulfate, crospovidone, povidone-K30, talc, magnesium stearate, lactose monohydrate;
    film shell: talc, macrogol-6000, hypromellose, titanium dioxide E 171.

Pharmacodynamics

Enzix duo is a combined preparation containing two separate drugs in one package - an angiotensin-converting enzyme (ACE) inhibitor enalapril maleate and a diuretic indapamide.

Enalapril

An antihypertensive agent, the mechanism of action of which is due to the ability to reduce the formation of angiotensin II from angiotensin I, as a result of which the release of aldosterone decreases, accompanied by a decrease in systolic and diastolic blood pressure (BP), total peripheral vascular resistance (OPSS), pre- and afterload on the myocardium. Enalapril dilates arteries (than veins) to a greater extent, and this does not lead to an increase in heart rate (HR). Enzix Duo also increases the synthesis of prostaglandin, reduces the degradation of bradykinin.
The antihypertensive effect of enalapril is more pronounced in patients with high plasma renin concentrations than in those with normal or reduced levels.
With a decrease in blood pressure within the therapeutic range, there is no effect of Enzix Duo on cerebral circulation. The blood flow in the vessels of the brain remains at a sufficient level even against the background of reduced blood pressure.
Enalapril increases renal and coronary blood flow. With prolonged use, it helps to reduce left ventricular hypertrophy of the myocardium and myocytes of the walls of resistant arteries, slows down the development of left ventricular dilatation, and prevents the progression of heart failure. Improves blood circulation in the ischemic myocardium.
The substance reduces platelet aggregation. Has some diuretic effect.
Enalapril maleate is a prodrug that is inactive in its original form, but after entering the body by hydrolysis, it is biotransformed into its active metabolite - enalaprilat, which inhibits ACE.
The antihypertensive effect develops within 1 hour after taking Enzix duo, reaches a maximum after 4-6 hours, lasts up to 24 hours.

Indapamide

Derivative of benzamides, thiazide-like diuretic with moderate potency and long duration.
Reduces the tone of the smooth muscles of the arteries and OPSS. It has a moderate saluretic and diuretic activity, which are due to the blockade of reabsorption of mainly chlorine, sodium and hydrogen ions, to a lesser extent - potassium ions in the proximal tubules and the cortical segment of the distal nephron tubule.
The mechanisms of vasoconstrictor action and a decrease in OPSS are based on:
    decreased reactivity of the vascular wall to angiotensin II and norepinephrine;
    inhibition of calcium flow into vascular smooth muscle cells;
    an increase in the synthesis of prostaglandins with vasodilating activity.
Indapamide helps to reduce left ventricular hypertrophy. When used in therapeutic doses, it does not have any effect on carbohydrate and lipid metabolism, including in patients with diabetes mellitus.
A stable hypotensive effect develops by the end of the first - beginning of the second week of regular use. After a single dose, it lasts for 24 hours.
The simultaneous administration of enalapril and indapamide enhances the antihypertensive effect of Enzix Duo.

Pharmacokinetics

Enalapril

Approximately 60% of an oral dose of enalapril is absorbed from the gastrointestinal tract. At the same time, food intake does not affect the degree of absorption.
Plasma proteins bind 50-60% of the dose. Enalapril is rapidly and completely hydrolyzed in the liver, resulting in the formation of an active metabolite enalaprilat, a substance that is a more active ACE inhibitor.
Bioavailability is 40%.
The maximum plasma concentration (Cmax) of enalapril is achieved within 1-2 hours, enalaprilat - 3-4 hours. The active metabolite easily penetrates the histohematogenous barriers (with the exception of the blood-brain), through the placenta and into breast milk.
The half-life (T1 / 2) is about 11 hours. Enzix Duo is excreted mainly through the kidneys (enalaprilat - 40%, enalapril - 20%) and through the intestines - (enalaprilat - 27%, enalapril - 6%). Excreted from the body during hemodialysis (at a rate of 62 ml / min) and peritoneal dialysis.

Indapamide

Once in the gastrointestinal tract, it is quickly and completely absorbed. Possesses high bioavailability - 93%. At the same time, food intake slows down the rate of absorption, but does not affect the degree of absorption.
Cmax after oral administration is noted after 1-2 hours. Equilibrium concentration is achieved after 7 days of regular use of Enzix Duo.
T1 / 2 - approximately 14-18 hours. 79% of the dose is associated with plasma proteins. Indapamide also binds to vascular smooth muscle elastin. It is characterized by a high volume of distribution, penetrates the histohematological barriers (including the placental) and into breast milk.
It is metabolized in the liver. It is excreted mainly by the kidneys (in the form of metabolites - 60-80%, unchanged - about 5%), as well as through the intestines - 20%. In renal failure, the pharmacokinetics of indapamide does not change. Enzix Duo does not accumulate in the body.

Indications for use

Enzix duo is used for arterial hypertension.

Contraindications

Both types of tablets contain lactose monohydrate, so they are contraindicated for lactose intolerance, lactase deficiency, glucose-galactose malabsorption.

Enalapril

Absolute contraindications:
    hereditary or idiopathic angioedema;
    age under 18;
    pregnancy and lactation;
    simultaneous use with aliskiren (or preparations containing it) in patients with moderate / severe renal impairment (glomerular filtration rate <60 ml / min / 1.73 m2) and / or diabetes mellitus;
    a history of angioedema associated with the use of ACE inhibitors;
    hypersensitivity to enalapril and other ACE inhibitors.
Enalapril should be used with caution in the following cases: liver failure, renal failure (proteinuria more than 1 g / day), hyperkalemia, stenosis of the artery of a single kidney, bilateral renal artery stenosis, conditions after kidney transplantation, hyperaldosteronism, conditions accompanied by a decrease in circulating blood volume ( including vomiting and diarrhea), diabetes mellitus, cerebrovascular diseases, systemic connective tissue diseases (for example, systemic lupus erythematosus or scleroderma), hypertrophic obstructive cardiomyopathy, mitral stenosis (with impaired hemodynamic parameters), aortic stenosis, ischemic heart disease, renovascular hypertension, history of angioedema or allergic history, adherence to a diet with limited salt intake or hemodialysis, dialysis behavior using high-flow membranes (such as AN 69), low-density lipoprotein apheresis (LDL apheresis) with the use of dextran sulfate, surgery or general anesthesia, old age, black race, concomitant use of drugs such as lithium preparations, potassium preparations, potassium-containing salt substitutes, potassium-sparing diuretics, immunosuppressants and saluretics, desensitization period the poison of hymenoptera insects.

Indapamide

Absolute contraindications:
    severe hepatic (including encephalopathy) and / or severe renal failure (creatinine clearance <30 ml / min);
    refractory hypokalemia;
    anuria;
    age under 18;
    pregnancy and lactation;
    hypersensitivity to indapamide or other sulfonamide derivatives.
Indapamide should be used with caution in the following cases: disturbances in water and electrolyte balance, impaired liver / kidney function, hyperuricemia (especially if it is accompanied by gout and urate nephrolithiasis), hyperparathyroidism, diabetes mellitus in the stage of decompensation, debilitated patients, concomitant use of other antiarrhythmic drugs , the combined use of drugs that prolong the QT interval.

Enzix duo, instructions for use: method and dosage

Enzix duo should be taken orally. Patients are prescribed 1 tablet of enalapril and 1 tablet of indapamide at the same time, in the morning. If the effect is insufficient, the dose of enalapril is increased - up to 1 tablet 2 times a day.
Maximum daily doses: enalapril - 40 mg, indapamide - 2.5 mg.
In chronic renal failure, enalapril begins to accumulate in the body in the event of a decrease in GFR (glomerular filtration rate) of less than 10 ml / min. When creatinine clearance is 30–80 ml / min, it is recommended to use enalapril in a daily dose of 5–10 mg.

Side effects

Enalapril

    on the part of the cardiovascular system: excessive decrease in blood pressure, orthostatic collapse; rarely - chest pain, palpitations, pain in the heart, arrhythmias (atrial brady- or tachycardia, atrial fibrillation), angina pectoris, pulmonary embolism, myocardial infarction, fainting;
    from the respiratory system: shortness of breath, unproductive dry cough, pharyngitis, rhinorrhea, interstitial pneumonitis, bronchospasm or bronchial asthma;
    from the urinary system: proteinuria, impaired renal function;
    from the digestive tract: stomatitis, dry mouth, dyspeptic disorders (nausea, abdominal pain, constipation / diarrhea, vomiting), intestinal obstruction, anorexia, pancreatitis, impaired bile secretion, jaundice, abnormal liver function, hepatitis (hepatocellular or cholestatic) ;
    from the central nervous system: drowsiness / insomnia, weakness, dizziness, fatigue, headache, confusion, anxiety; very rarely when taking Enzix Duo in high doses - nervousness, paresthesia, depression;
    on the part of the sense organs: tinnitus, hearing and visual impairment, impaired vestibular apparatus;
    allergic reactions: dysphonia, skin rash, itching, photosensitivity, urticaria, pemphigus, exfoliative dermatitis, serositis, polymorphic erythema, toxic epidermal necrolysis, Stevens-Johnson syndrome, edema of the extremities, lips, tongue, glottis, larynx and / or face, vasculitis , arthritis, arthralgia, myositis, glossitis, stomatitis; very rarely - intestinal angioedema;
    on the part of laboratory parameters: hyponatremia, hyperkalemia, hyperbilirubinemia, hypercreatininemia, increased activity of liver enzymes, increased urea content; rarely - eosinophilia, neutropenia, thrombocytopenia, increased ESR, decreased hematocrit and hemoglobin concentration; in patients with diabetes mellitus - hypoglycemia; in patients with autoimmune diseases - agranulocytosis;
    others: alopecia, hot flashes, decreased libido / potency.

Indapamide

    on the part of the cardiovascular system: palpitations, orthostatic hypotension, arrhythmias, changes in the electrocardiogram characteristic of hypokalemia;
    from the respiratory system: sinusitis, pharyngitis, cough; rarely - rhinitis;
    from the central nervous system: drowsiness / insomnia, dizziness, nervousness, asthenia, vertigo, headache, depression; rarely - malaise, general weakness, increased fatigue, anxiety, irritability, tension, muscle spasm;
    from the urinary system: nocturia, polyuria, an increase in the incidence of infections;
    from the gastrointestinal tract: dry mouth, abdominal discomfort, diarrhea / constipation, nausea, gastralgia, vomiting, anorexia;
    on the part of the organ of vision: conjunctivitis, visual impairment;
    laboratory parameters: hypercalcemia, hyponatremia, hypokalemia, glucosuria, hypercreatininemia, increased plasma urea nitrogen, hypochloremic alkalosis;
    allergic reactions: urticaria, skin rash, itching, hemorrhagic vasculitis;
    others: chest / back pain, paresthesias, sweating, flu-like syndrome, rhinorrhea, infections, exacerbation of systemic lupus erythematosus, pancreatitis, weight loss, decreased potency / libido.

Overdose

Enalapril

Symptoms: convulsions, stupor, excessive decrease in blood pressure, up to myocardial infarction, collapse, thromboembolic complications and acute cerebrovascular accident.
Treatment: the patient is laid horizontally with a low headboard. For minor overdose, gastric lavage and oral saline are usually sufficient. In more severe cases, the measures necessary to stabilize blood pressure are carried out: intravenous administration of plasma substitutes and saline, if necessary, inject angiotensin II, carry out hemodialysis (speed 62 ml / min).

Indapamide

Symptoms: dysfunction of the gastrointestinal tract, nausea, water-electrolyte disturbances, vomiting, weakness; in some patients - a marked decrease in blood pressure, drowsiness, dizziness, confusion, respiratory depression. Hepatic coma may develop in patients with cirrhosis.
Treatment: gastric lavage and / or intake of activated charcoal, correction of water-electrolyte imbalance, symptomatic therapy. The specific antidote is unknown.

Special instructions for Enzix Duo

Enalapril

Symptomatic arterial hypotension is possible with uncomplicated arterial hypertension (usually against the background of dehydration due to taking a diuretic, restriction in the diet of sodium chloride, vomiting or diarrhea, dialysis), heart failure (including accompanied by renal failure). In patients with heart failure, arterial hypotension is more likely to develop with concomitant renal impairment or hyponatremia and concomitant use of high-dose loop diuretics. For such patients, treatment should be carried out under the special supervision of a physician, after careful selection of the dose of enalapril and / or a diuretic. The same measures are recommended for patients with cerebrovascular diseases and ischemic heart disease, since an excessive decrease in blood pressure in them can cause the development of a stroke or myocardial infarction. In the event of arterial hypotension, the patient is given a horizontal position and, if required, a 0.9% sodium chloride solution is injected.
The development of transient arterial hypotension is not a reason for canceling enalapril or increasing its dose, which can be continued after normalization of blood pressure and fluid volume replacement.
In heart failure in some patients with normal and even low blood pressure, Enzix Duo can cause an additional decrease in blood pressure. This phenomenon is predictable and is not a reason for discontinuation of therapy. If arterial hypotension becomes stable, the dose is reduced and / or the diuretic and / or enalapril are canceled.
The appointment of ACE inhibitors is advisable for patients with renovascular hypertension who are planned for surgery or are unable to undergo surgery. Therapy is carried out in a hospital setting, in low doses of the drug Enzix Duo, under the control of plasma potassium levels and renal function. In some cases, the development of functional renal failure is possible, it usually quickly passes after Enzix Duo is discontinued.
In some patients without comorbid kidney disease, enalapril, used in combination with a diuretic, caused an increase in blood urea and serum creatinine, usually insignificant and temporary. In this case, a dose reduction and / or withdrawal of the diuretic and / or enalapril may be required.
ACE inhibitors in rare cases cause the development of a syndrome that begins with cholestatic jaundice or hepatitis and progresses to fulminant liver necrosis, up to death. In this regard, when jaundice appears or a slight increase in the activity of liver enzymes is diagnosed, enalapril should be discontinued and appropriate therapy should be carried out under the control of the patient's condition.
ACE inhibitors can cause anemia, thrombocytopenia, neutropenia / agranulocytosis. Rarely, neutropenia occurs in patients with normal renal function and no other risk factors. For this reason, enalapril should be used with extreme caution in patients with systemic connective tissue diseases receiving immunosuppressive therapy, procainamide / allopurinol, or with concomitant risk factors, especially renal impairment. There are reports of the occurrence of serious infectious diseases that do not respond to intensive antibiotic therapy. In this regard, during the period of application of enalapril, the number of lymphocytes and leukocytes in the blood should be regularly monitored. Patients should be warned about the need to immediately consult a doctor if any signs appear that suggest the development of an infectious disease.
In rare cases, ACE inhibitors at different periods of treatment cause angioedema of the extremities, lips, tongue, larynx, vocal folds and / or face. There are rare reports of the development of intestinal edema. In this case, Enalapril is immediately canceled and symptomatic therapy is performed. Even with swelling of only the tongue (without respiratory distress syndrome), long-term medical supervision may be required, since the use of corticosteroids and antihistamines is not always sufficient.
In very rare cases, death is possible due to angioedema of the tongue, vocal folds or larynx, as it can lead to airway obstruction, especially in patients after surgery on the respiratory organs. With these localizations of angioedema, immediate adequate therapy is indicated, which may include ensuring airway patency and / or subcutaneous administration of 0.1 epinephrine solution (0.3-0.5 ml).
In patients of the Negroid race, angioedema with the use of ACE inhibitors was observed more often than in representatives of other races.
The risk of developing angioedema is increased in patients with a history of angioedema, even if it is not associated with the use of ACE inhibitors.
During desensitizing therapy with hymenoptera venom (bees, wasps), patients receiving ACE inhibitors are at risk of developing life-threatening anaphylactoid reactions. To prevent their development, you should stop taking Enzix Duo before the onset of desensitization.
During LDL apheresis using dextran sulfate in patients receiving ACE inhibitors, there is a possibility of life-threatening anaphylactoid reactions. To avoid the development of complications, it is recommended to temporarily cancel the drug before each apheresis procedure.
Anaphylactoid reactions are also possible in patients undergoing dialysis using high-flow membranes. In this case, either an antihypertensive drug of a different class should be prescribed, or a different type of dialysis membrane should be used.
During therapy, there have been cases of coughing. Usually it is of a permanent unproductive nature, after Enzix Duo is discontinued, it passes. Taking enalapril should be considered in the differential diagnosis of cough.
With general anesthesia with antihypertensive agents and extensive surgical interventions, enalaprilat blocks the formation of angiotensin II caused by compensatory renin release. A pronounced decrease in blood pressure in this case can be corrected by increasing the volume of circulating blood.

Indapamide

Diuretics can cause photosensitivity reactions. With their development, Enzix Duo should be canceled. If treatment is necessary to continue, it is recommended to carefully protect the skin from exposure to rays, both solar and artificial ultraviolet.
Before taking a diuretic, the sodium content in the blood plasma is determined (since the initial decrease in the sodium level may not be accompanied by appropriate symptoms), this indicator is regularly monitored during therapy, especially in the elderly and patients with liver cirrhosis. The need for monitoring is due to the fact that diuretics can cause hyponatremia, which in some cases leads to very serious consequences.
Indapamide can cause a sharp decrease in the plasma level of potassium and the development of hypokalemia. The following groups of patients should be constantly monitored for this indicator: the elderly, debilitated patients, patients with heart failure, ischemic heart disease, peripheral edema, ascites or cirrhosis of the liver, patients with an increased QT interval (regardless of the cause), as well as patients, who are receiving drugs that can increase the QT interval, or antiarrhythmics. Hypokalemia, like bradycardia, can contribute to the development of severe arrhythmias (including pirouette-type arrhythmias) that can lead to death. In this regard, patients from the risk group require particularly careful monitoring of the level of potassium in the blood, especially at the beginning of treatment. With the development of hypokalemia, indapamide is canceled and appropriate corrective therapy is prescribed.
Thiazide-like diuretics reduce the excretion of calcium by the kidneys, which can cause transient moderate hypercalcemia. Also, the development of hypercalcemia may indicate the presence of hyperparathyroidism, which was not previously diagnosed. Before examining the function of the parathyroid glands, indapamide should be discontinued.
Patients with diabetes mellitus should constantly monitor blood glucose levels, especially with concomitant hypokalemia.
With gout, indapamide increases the risk of exacerbation of the course of gout or an increase in the frequency of attacks.
Thiazide-like diuretics have a pronounced effect only with normal or slightly impaired renal function (in adults, plasma creatinine concentration is <25 mg / l or 220 μmol / l). In older people, the concentration of creatinine is calculated taking into account age, sex and body weight.
Diuretics can cause fluid and sodium loss, increasing the likelihood of hypovolemia, which in turn can lead to decreased glomerular filtration rate. As a result, in the blood plasma, an increase in the level of urea and creatinine is possible. With normal kidney function, temporary renal failure usually resolves without complications. However, in patients with pre-existing renal failure, the condition may worsen.
With the use of sulfonamide derivatives, an exacerbation of the course of systemic lupus erythematosus is possible, which must also be taken into account when prescribing indapamide.
Athletes receiving this diuretic may have a positive result during doping control.

Influence on the ability to drive vehicles and complex mechanisms

At the initial stage of therapy (before the end of dose titration), Enzix Duo may cause dizziness, so patients are advised to refrain from engaging in potentially hazardous activities, including driving.

Application during pregnancy and lactation

Enzix duo is contraindicated for use by pregnant and breastfeeding women.
If treatment is required during lactation, breastfeeding should be discontinued.

Childhood use

For the treatment of children and adolescents under 18 years of age, Enzix Duo tablets are not used.

With impaired renal function

The use is contraindicated:
    enalapril: severe renal dysfunction (glomerular filtration rate less than 60 ml / min / 1.73 m2) in patients receiving drugs containing aliskiren;
    indapamide: severe renal failure (creatinine clearance less than 30 ml / min).
Carefully:
    enalapril: hyperkalemia, renal failure (proteinuria more than 1 g / day), stenosis of an artery of a single kidney or bilateral stenosis of the renal arteries, conditions after kidney transplantation;
    indapamide: impaired renal function.

For violations of liver function

Indapamide is contraindicated in severe hepatic impairment (including encephalopathy).
Carefully:
    enalapril: liver failure;
    indapamide: liver dysfunction.

Use in the elderly

Enalapril should be used with caution in patients over 65 years of age. Before its appointment, it is necessary to assess kidney function and determine the level of potassium in the blood.

Drug interactions

Enalapril

    non-steroidal anti-inflammatory drugs, including selective inhibitors of cyclooxygenase-2 (COX-2 inhibitors): it is possible to reduce the antihypertensive effect of Enzix Duo. In some patients with impaired renal function, further reversible renal impairment is likely;
    lithium salts: the excretion of lithium slows down, the risk of lithium intoxication increases, therefore careful monitoring of the plasma concentration of lithium is needed;
    potassium-sparing diuretics (triamterene, eplerenone, spironolactone, amiloride): hyperkalemia may develop;
    theophylline: its effect is weakened;
    cytostatics, immunosuppressants, allopurinol: increased hematotoxicity;
    drugs that cause bone marrow suppression: the likelihood of developing agranulocytosis and / or neutropenia increases;
    ethanol, beta-blockers, blockers of slow calcium channels of the dihydropyridine series, diuretics, nitrates, prazosin, hydralazine, methyldopa: the hypotensive effect is enhanced;
    propranolol: the concentration of enalaprilat in the blood serum decreases (however, this phenomenon has no clinical significance);
    aliskiren and preparations containing this substance: there is a risk of double blockade of the renin-angiotensin-aldosterone system. This combination is contraindicated in patients with impaired renal function and / or diabetes mellitus;
    gold preparations for parenteral use (sodium aurothiomalate): in rare cases, it is possible to develop a symptom complex, including facial flushing, arterial hypotension, nausea and vomiting;
    oral hypoglycemic agents and insulin: an increase in the hypoglycemic effect is possible, up to the development of hypoglycemia, especially in patients with renal insufficiency and in the first weeks of combination therapy. In diabetes mellitus, blood glucose levels should be monitored, especially in the first month of therapy combined with enalapril.
There were no clinically significant interactions with the simultaneous use of indomethacin, timolol, furosemide, hydrochlorothiazide, digoxin, sulindac, warfarin, methyldopa, cimetidine.
Enalapril, if necessary, can be combined with beta-blockers, thrombolytics and acetylsalicylic acid in doses that have an antiplatelet effect.

Indapamide

Combinations requiring attention:
    antipsychotics (neuroleptics), tricyclic antidepressants: the hypotensive effect of indapamide increases, the risk of orthostatic hypotension increases (due to an additive effect);
    metformin: an increased risk of lactic acidosis in patients with functional renal failure while taking diuretics. Metformin is contraindicated in men with a creatinine concentration above 15 mg / L (135 μmol / L), in women - above 12 mg / L (110 μmol / L);
    tacrolimus, cyclosporine: plasma creatinine concentrations may increase. At the same time, the level of circulating cyclosporine does not change, even with a normal content of sodium ions and liquid;
    mineral and glucocorticosteroids, tetracosactide with systemic use: there is a retention of fluid and sodium ions, as a result of which the hypotensive effect of indapamide decreases;
    potassium-sparing diuretics: there is a risk of hypokalemia (especially with concomitant renal failure or diabetes mellitus) or hyperkalemia. It is required to monitor the indicators of the electrocardiogram (ECG) and the plasma potassium content, if necessary, adjust the therapy regimen;
    calcium salts: the excretion of calcium ions by the kidneys decreases, as a result of which the likelihood of hypercalcemia increases;
    iodine-containing contrast agents, especially in high doses: the risk of developing renal failure increases in patients with dehydration while taking a diuretic. Before the study, fluid loss should be compensated.
Combinations requiring special attention:
    cardiac glycosides: against the background of hypokalemia, their toxicity may increase. It is necessary to monitor the plasma level of potassium and ECG indicators, if necessary, adjust the therapy regimen;
    baclofen: an increase in the hypotensive effect is possible. Before the appointment of indapamide, fluid loss should be compensated, at the initial stage of combined treatment, renal function should be carefully monitored;
    non-steroidal anti-inflammatory drugs of systemic action, including salicylates in high doses (≥ 3 g / day) and selective inhibitors of COX-2: the antihypertensive effect of indapamide may decrease, in case of significant fluid loss, the risk of developing acute renal failure increases. Before the appointment of indapamide, fluid loss should be compensated, during the entire period of combination therapy, renal function should be monitored;
    class 1A antiarrhythmic drugs (disopyramide, quinidine, hydroquinidine), class III antiarrhythmics (dofetilide, amiodarone, ibutilide), sotalol, butyrophenones (haloperidol, droperidol), benzamides (sultopride, sulpiride, amisulpride, tiapperazine), fenotephromazine cyamemazine, chlorpromazine, thioridazine), halofantrine, diphemanil, moxifloxacin, pentamidine, cisapride, astemizole, mizolastine, bepridil, sparfloxacin, as well as erythromycin and vincamine when administered intravenously: the risk of developing ventricular arrhythmias increases, especially of piryrhythmias. Prior to commencing combination therapy, the plasma potassium level should be determined and, if necessary, adjusted. During the period of treatment, it is necessary to monitor the patient's clinical condition, ECG indicators and the level of electrolytes in the blood plasma. Patients with hypokalemia should be prescribed drugs that do not have the ability to cause pirouette-type arrhythmias;
    ACE inhibitors: with hyponatremia (especially in patients with renal artery stenosis), the risk of developing sudden arterial hypotension and acute renal failure increases. Patients who may have a decrease in plasma sodium concentration while taking a diuretic should discontinue the diuretic drug 3 days before prescribing an ACE inhibitor (if necessary, then taking it can be resumed) or start using an ACE inhibitor with a minimum dose, gradually increasing it by needs. In patients with chronic heart failure, the administration of ACE inhibitors is started with a low dose, having previously reduced the dose of the diuretic. In all cases described, the first week of combination therapy should be closely monitored renal function (plasma creatinine concentration);
    gluco- and mineralocorticosteroids (for systemic use), amphotericin B (intravenous), laxatives that stimulate intestinal motility, and tetracosactide: the likelihood of hypokalemia increases due to an additive effect. Need constant monitoring of plasma potassium concentration and its correction as necessary. Patients receiving cardiac glycosides should be under special supervision. If you need a laxative, it is recommended to choose drugs that do not have a stimulating effect on intestinal motility.
It is undesirable to combine the administration of indapamide with lithium preparations, since a decrease in the excretion of lithium and, as a result, an increase in its concentration in plasma, and the development of lithium intoxication are possible. If the use of such a combination is necessary, the doses of both drugs should be carefully selected, and the treatment should be carried out under regular monitoring of the plasma level of lithium.

Terms and conditions of storage

Store in a dry place, out of reach of children, at a temperature of 15-25 ° C.
Shelf life is 3 years.

Reviews about Enzix Duo

Medical specialists leave positive reviews about Enzix duo, since in clinical practice they note the effectiveness of Enzix Duo in arterial hypertension. The combination of the two active ingredients allows you to achieve the best effect. However, the remedy has many contraindications, so it should be used only as directed by a doctor.
Patients also confirm the effectiveness of Enzix Duo tablets, however, they complain that in the initial period of treatment, unwanted reactions often occurred. However, as a rule, they were mild, and therefore did not require replacement of therapy.

Terms of sell

You can buy Enzix Duo without a prescription from a doctor.