What are the benefits and risks of enemas for constipation? How do different types of enemas work? Get all the answers you need to manage your bowel health.

Understanding Enemas: The Basics

Enemas are rectal injections of fluid intended to cleanse or stimulate the emptying of the bowel. They have been used for centuries to treat chronic constipation and prepare patients for certain medical procedures. Enemas can be administered by a medical professional or self-administered at home.

Types of Enemas: Cleansing and Retention

There are two main categories of enemas: cleansing enemas and retention enemas. Cleansing enemas are water-based and meant to be held in the rectum for a short time to flush the colon. Retention enemas, on the other hand, are designed to be held in the bowel for an extended period, usually a minimum of 15 minutes, before being released.

Cleansing Enemas

Common types of cleansing enemas include:

• Water or saline enemas: The least irritating option, used to expand the colon and promote defecation.
• Epsom salt enemas: Magnesium-rich, said to be more effective at relaxing bowel muscles and relieving constipation.
• Sodium phosphate enemas: A common over-the-counter option that works by irritating the rectum, causing it to expand and release waste.
• Lemon juice enemas: Claimed to balance the body’s pH and cleanse the colon.
• Apple cider vinegar enemas: Believed to have antiviral and healing effects on the digestive system.
• Soap suds enemas: Mildly irritate the bowel, encouraging rapid excretion of stool.

Retention Enemas

Retention enemas are designed to be held in the bowel for an extended period. Common types include:

1. Coffee enemas: Thought to promote bile removal from the colon.
2. Mineral oil enemas: Lubricates waste and promotes its removal.
3. Probiotic enemas: May cleanse the bowel while helping colonize beneficial gut bacteria.
4. Herbal enemas: Use herbs like garlic, catnip tea, or red raspberry leaf for purported nutritional, infection-fighting, and anti-inflammatory benefits.

Enemas for Constipation: Benefits and Risks

Enemas can be an effective way to relieve constipation by mechanically promoting defecation. However, they can also have side effects, such as disturbing the gut microbiome and affecting the body’s electrolyte balance.

Benefits of Enemas for Constipation

What are the main benefits of using enemas for constipation? Enemas can:

• Expand the colon and stimulate bowel movements
• Soften and lubricate impacted stool, making it easier to pass
• Provide a quick, temporary solution for severe constipation
• Prepare the bowel for certain medical tests or procedures

Potential Risks of Enemas

What are the potential risks and side effects of using enemas? Enemas may:

• Disrupt the gut microbiome, leading to dysbiosis
• Cause electrolyte imbalances, especially with repeated use
• Lead to dehydration, bloating, cramps, or other gastrointestinal discomfort
• Potentially contribute to dependency or addiction if used excessively

When to Use Enemas: Considerations and Cautions

While enemas can provide relief for constipation, they should be used with caution and only as a short-term solution. It’s important to consider the underlying causes of constipation and address them with lifestyle changes, dietary modifications, and other treatments as needed.

Seeking Medical Advice

When should you consult a healthcare professional about using enemas? You should seek medical advice if:

• You have a history of gastrointestinal conditions or concerns
• You are experiencing severe or persistent constipation
• You are considering using enemas regularly or long-term
• You have concerns about the safety or efficacy of enemas

Alternatives to Enemas

What other options are available for managing constipation besides enemas? Alternative treatments include:

• Increasing dietary fiber intake
• Staying hydrated and drinking more water
• Engaging in regular physical activity
• Using over-the-counter laxatives or stool softeners
• Trying natural remedies like probiotic supplements or herbal teas

Conclusion

Enemas can be a useful tool for relieving constipation, but they should be used with caution and as a short-term solution. It’s important to understand the different types of enemas, their potential benefits and risks, and to seek medical advice when necessary. By exploring a range of constipation management strategies, you can find the most effective and sustainable approach for your individual needs.

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Enemas are used to relieve constipation and cleanse the colon. Water- or saline-based enemas tend to carry the least risk. However, enemas can have side effects, such as disturbing your gut bacteria and affecting your body’s electrolyte balance.

Enemas are rectal injections of fluid intended to cleanse or stimulate the emptying of your bowel.

They have been used for hundreds of years to treat chronic constipation and prepare people for certain medical tests and surgeries (1).

Enemas can be administered by a medical professional or self-administered at home.

This article reviews different types of enemas, as well as their potential benefits and health concerns.

Constipation is a condition in which the natural movement of your stool slows down, making them hard, dry, and difficult to excrete. For many people, this can be a chronic problem that requires an intervention like an enema — or a laxative inserted rectally.

Enemas may also be prescribed to flush out your colon before certain diagnostic tests or surgeries. Your bowel needs to be empty before these procedures to reduce infection risk and prevent stool from getting in the way.

According to some enema advocates, when waste builds up in your colon over time, it leads to ailments like depression, fatigue, headaches, allergies, and irritability, and using enemas can provide relief.

While it’s true that many people with chronic constipation experience depression and other psychological symptoms, evidence is lacking to suggest that waste buildup directly leads to the other aforementioned effects (2, 3).

There are two main types of enemas — cleansing and retention.

Cleansing enemas

Cleansing enemas are water-based and meant to be held in the rectum for a short time to flush your colon. Once injected, they’re retained for a few minutes until your body rids itself of the fluid, along with loose matter and impacted stool in your bowel.

Some of the most common cleansing enemas include (3, 4):

• Water or saline. The least irritating of all options, water or saline — salt water that mimics your body’s sodium concentration — are used primarily for their ability to expand the colon and mechanically promote defecation.
• Epsom salt. This is similar to a water or saline enema, but magnesium-rich Epsom salt is said to be more effective at relaxing bowel muscles and relieving constipation.
• Sodium phosphate. This is a common over-the-counter enema that works by irritating your rectum, causing it to expand and release waste.
• Lemon juice. Lemon juice mixed with warm, filtered water is said to balance the pH of your body while cleansing your colon.
• Apple cider vinegar. Advocates say that mixing apple cider vinegar with warm, filtered water can quickly clear the bowel and may have other antiviral healing effects on your digestive system.
• Soap suds. Adding castile soap, or another mild soap with minimal additives, to water mildly irritates the bowel, which encourages the rapid excretion of stool.

Retention enemas

Retention enemas are designed to be held in your bowel for an extended period — usually a minimum of 15 minutes — before being released. Retention enemas may be water- or oil-based, which softens the stool and makes it easier for your body to expel.

Some of the most common retention enemas include (5, 6, 7):

• Coffee. Coffee enemas are a mixture of brewed, caffeinated coffee and water thought to promote bile removal from the colon. They were popularized by Max Gerson, a physician who used them to help treat people with cancer.
• Mineral oil. This type of enema works primarily by lubricating waste inside of your colon, sealing it with water, and promoting its removal.
• Probiotic. Mixing probiotics with water may cleanse your bowel while helping colonize your good gut bacteria. Lactobacillus reuteri enemas have been shown to reduce inflammation in children with ulcerative colitis.
• Herbal. Some people use herbs like garlic, catnip tea, or red raspberry leaf mixed with water to make herbal enemas with purported nutritional, infection-fighting, and anti-inflammatory benefits.

Summary

Enemas are rectal injections of fluid that are intended to cleanse your bowel or treat chronic constipation. The two main types — cleansing and retention enemas — come in a variety of solutions and can be injected at home.

Enemas can treat constipation and clear out your bowel. However, many people choose to use enemas for other purported health benefits (8, 9).

Some advocates claim that enemas can support weight loss, remove toxins and heavy metals from your body, and improve your skin, immunity, blood pressure, and energy levels.

Still, evidence is limited to suggest that enemas are effective for these purposes or that they benefit everyone who uses them. Most evidence in support of their effectiveness is anecdotal, despite their widespread use in modern medicine (10).

Enemas appear to be most effective when used to relieve chronic constipation in a medical setting, though they come with many risks, especially when self-administered at home (11, 12).

Summary

Enemas can be effective in cleansing the bowel and treating chronic constipation, but most evidence in their favor is anecdotal rather than science based.

Though enemas can clean out your bowel, you should consider their risks and take certain precautions before using one.

May interrupt your body’s natural balances

Enemas may disturb your gut bacteria and throw off your body’s electrolyte balance.

Research shows that enemas used in preparation for medical procedures significantly disrupt gut bacteria, though the effect appears to be temporary. However, enemas that are split and administered in two doses seem to have fewer effects on the microbiome (13, 14).

Electrolyte disturbances have been observed with various types of enemas, such as large-volume soap suds enemas and those containing minerals.

For instance, there have been reports of Epsom salt enemas causing death from magnesium overdose. In another case, an older man died from severe electrolyte disruption caused by taking two sodium phosphate enemas (3, 15, 16).

Other reports note that the overuse of enemas to flush out the colon may lead to severe dehydration, which can be fatal (17).

Enema solutions can harm your bowel

Lemon juice, apple cider vinegar, and coffee enemas are highly acidic, and scientific evidence to suggest their effectiveness or safety is lacking.

What’s more, the evidence shows that their acidity and makeup can harm your bowel and lead to rectal burns, inflammation, infections, and even death (1).

Similarly, there are reports of children being given acidic hydrogen peroxide enemas, which resulted in an inflamed colon, bloody diarrhea, vomiting, and long-term complications (18).

Furthermore, in some people, herbal enemas have caused internal bleeding that required a blood transfusion and removal of the colon (1).

Dirty or improperly used tools can cause infection and damage

If you self-administer an enema at home, it’s critical to make sure that the tools you use are sterile, meaning they’re free of harmful germs. The use of dirty tools increases your risk of contracting a potentially dangerous infection.

Improper tool use may also cause physical damage to your rectum, anus, or colon. Studies indicate that perforation of the bowel is not a rare complication of frequent enema use that could put your internal organs at risk of infection (3, 12, 19).

Sterile enema injection kits, which usually include a bucket, tubing, solution, and sometimes a bulb, can be found online or at many local drug stores. They come with directions for cleaning and safe use.

Summary

Though enemas can be safe and effective, they come with many risks, especially when administered at home. Improperly used enemas can cause potentially life-threatening physical and chemical damage to your rectum or colon.

If you’re mainly considering an enema to stimulate and clean out your digestive system, there may be other, less invasive options.

Some potential alternatives to enemas, which can promote waste excretion and bowel regularity, include (20, 21, 22, 23):

• drinking caffeinated coffee, which is known to stimulate defecation
• staying well hydrated with water
• getting regular exercise like walking, running, biking, or aerobics
• trying an over-the-counter oral laxative like magnesium
• increasing your fiber intake by eating whole plant foods like fruits, vegetables, whole grains, nuts, and seeds.

If you have severe constipation or other medical issues, speak to your medical provider to determine whether an enema would be a safe and appropriate treatment.

Summary

Less risky alternatives to enemas that can help stimulate bowel movements include staying hydrated, getting regular exercise, and following a healthy, high-fiber diet.

Enemas are used to relieve constipation and cleanse the colon. Water- or oil-based solutions are injected into the bowel through your rectum to expel impacted waste.

Mild enemas like water or saline carry the least risk, but you should consult your healthcare provider before using one at home. Furthermore, ensuring the proper use of sterile injection tools is very important for safety.

Many people swear by enemas to promote regularity and prevent constipation, but evidence of their effectiveness is limited.

Other, less risky alternatives may be a better option in most cases.

Should You Use An Enema for Constipation Relief?

Having been used for thousands of years, enemas are one of the oldest methods of getting the bowels moving again if you’re suffering from constipation. Historically, the use of enemas makes sense, developing before the invention of oral and intravenous medication, notes the Canadian Society of Intestinal research.

In recent years, some celebrities have touted enemas as a way to “flush out” the digestive system and detoxify the body. However, this advice is a load of nonsense, and the regular use of enemas can actually be dangerous.

Today, better and safer treatment options, including laxatives, suppositories, and a high-fiber diet, mean enemas are typically recommended as a last resort for constipation because of possible side effects.

The Back Story: How Does an Enema Treat Constipation?

Treating constipation with an enema involves introducing fluid into the intestines via the rectum. This helps soften and break up the stool, says Bryan Curtin, MD, a gastroenterologist and director of the Center for Neurogastroenterology and GI Motility at the Melissa L. Posner Institute for Digestive Health and Liver Disease at Mercy in Baltimore.

There are several types of enemas, including tap water, sodium phosphate (such as Fleet enemas), saline, glycerin, soap suds, and mineral oils.

“While phosphorus-based enemas are traditionally considered the most potent, I find that any enema can be effective if done correctly,” Dr. Curtin says. “The oil-based enemas are fairly messy and I typically avoid those.”

How to Administer an Enema

To administer an enema, follow the instructions on the box or leaflet closely.

Bharat Pothuri, MD, a gastroenterologist at Memorial Hermann in Houston, offers the following tips for using an enema safely and effectively:

• Drink 16 ounces of water (two glasses) prior to the enema, as an enema can cause you to become dehydrated.
• Lie on your stomach with your knees pulled to your chest. If you are unable to, lie on your left side with both knees bent and your arms resting comfortably.
• Lubricate the enema tube and gently insert it into your rectum, squeezing the enema so that the contents can enter your rectum.
• Wait in that position until you feel the need to move your bowels. Try to hold the enema in for at least five minutes to achieve maximum benefit.

“It’s important to make sure you hold onto the enema until the urge to defecate is strong,” Curtin says.

Possible Side Effects of Enemas

While enemas can be a useful tool for treating severe constipation, they do come with some risks and are not meant for frequent use.

“Like any other medication, enemas can be abused,” Curtin says. “Too much enema use can lead to anorectal pain disorders. Generally, you should avoid using enemas regularly unless instructed to by your doctor.”

Enemas that are administered incorrectly can damage the tissue in the large intestine and cause bowel perforation, research such as a case report published in 2020 in SAGE Open, has shown. If an enema is not sterile, it can put you at risk of an infection, including sepsis, Dr. Pothuri notes.

One study notes that perforation, hyperphosphatemia (a condition characterized by too much phosphate in the blood), and sepsis following enema use may cause death in up to 4 percent of cases.

Long-term use of enemas can lead to electrolyte imbalances, which can cause uncomfortable symptoms like fatigue, headache, muscle cramping, nausea and vomiting, per the Cleveland Clinic.

People with colorectal cancer, an enlarged distended colon which may be more prone to perforation, and people who have active inflammatory bowel disease should avoid using enemas, Pothuri says.

If you have any questions about the safety of enemas, talk to your doctor. It’s best to consult your healthcare provider before using an enema and to exhaust all other ways of treating constipation first.

Safer Options for Constipation Relief

Because of the possible side effects of enemas, it’s usually only advised as a last-resort option to treat constipation.

Before considering an enema, make sure you’ve tried the following options:

High-Fiber Diet “Generally, your doctor will first start by recommending dietary changes,” Curtin says. Adding fiber to your diet increases the bulk of your stool, speeding up its passage through the digestive system. Curtin says patients who are constipated should aim for 20 to 30 grams of daily fiber. A good starting point is to add more fruits and vegetables into your diet, as well as whole grains. A sharp increase in fiber can cause bloating and gas, per the Mayo Clinic, so aim to gradually increase the amount over a few weeks. Over-the-counter supplemental fiber, such as Metamucil, is also available. Talk to your doctor to learn if this is a good option for you.

Stay hydrated. Drinking enough water is important for overall health, including digestion. “The main purpose of the colon is to reabsorb water from the stool, and if you are dehydrated more water will be taken in, leading to harder to pass stools,” Curtin says. The National Academies of Sciences, Engineering, and Medicine suggests that women get a total of about 2.7 liters (11 cups) of fluid per day and that men get about 3.7 liters (16 cups) per day. Note that not all of this fluid has to be water; it can also include nutrient-rich foods and beverages like fruit, vegetables, juice, and tea. Also, it’s important to spread out the fluids over the day. Alcohol and caffeinated drinks can cause dehydration, so you’ll want to avoid those if you’re constipated.

Laxatives Laxatives, or stool softeners, such as docusate or milk of magnesia, are available over the counter. Talk to your doctor or pharmacist if you have any questions about these medications. Overusing laxatives can lead to worsening symptoms, per the Cleveland Clinic, so you should not use the treatment for more than two weeks without talking to your healthcare provider.

Other lifestyle changes like exercise can help get things moving in your digestive tract. It’s also smart to keep a food journal so you can see which foods trigger your constipation. Certain medications and supplements may also cause constipation, so if that is a concern, talk to your doctor, who may adjust your dose or switch your prescription.

Some prescription drugs are also available to treat chronic constipation. Your healthcare provider will work with you to decide on which one is best for you. If there’s a structural problem in your colon that’s causing your constipation, your doctor might recommend surgery.

Call your doctor to talk through options if constipation is a new issue for you or you’ve been constipated for more than a few weeks.

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Enam instructions, price in pharmacies of Ukraine

There are no products on the site with the trade name “Enam”

Editorial team

Creation date: 04/27/2021
Update date: 07/04/2023

Warehouse and release form

warehouse:

1 tablet of Enam 2. 5 tablet:

Enalapril maleate – 2.5 mg;

Additive ingredients including lactose.

1 tablet of Enam 5 medicine:

Enalapril maleate – 5 mg;

Additive ingredients including lactose.

1 tablet of Enam 10 medicine:

Enalapril maleate – 10 mg;

Additive ingredients including lactose.

Release form:

Tablets in blister packs of 10 pieces, 2 pods in a carton pack.

Pharmacological treatment

Enam – antihypertensive drug. Enalapril, which in the body is rapidly metabolized to the approved pharmacologically active speech, enalaprilat, enters the drug warehouse. The drug inhibits angiotensin-converting enzyme, converting angiotensin I into angiotensin II – speech, which manifests a vasoconstrictor effect. Enalaprilat is used to reduce the peripheral support of the vessels, to change aldosterone, to increase bradykinin, to activate depressor systems and to suppress pressure systems.

By taking the Enam preparation, it can be used to induce progressive decrease in systolic and diastolic pressure without the development of reflex tachycardia. Enalapril reduces the hypertrophy of the left duct, reduces the demand of the myocardium for sourness and improves the heart rate in the mind of hypoxia. The drug subsides nirk blood flow, pereskodzha to a distant development of diabetic nephropathy. Enalapril maleate has been shown to reduce cardiac mortality. Enam does not add to lipid and carbohydrate metabolism.

When administered intravenously, enalapril is readily absorbed into the systemic circulation. The peak plasma concentration of enalaprilat is reached for 3-4 years.

Equal concentrations of active speech are reached on the 4th day of therapy with Enam.

Enalaprilat penetrates the hematoplacental barrier and is excreted in breast milk.

Enalaprilat is excreted very importantly by drugs, the period of administration reaches 11 years. In patients with reduced function, the drinking period can be extended up to 30 years.

Indications

Enam indications for therapy of patients who suffer from various forms of arterial hypertension, including Renovascular and essential arterial hypertension.

Enalapril maleate can also be used in combination with other drugs for the treatment of patients who suffer from chronic heart failure.

Enam may be victorious for the prevention of severe heart failure and coronary ischemia in patients with decreased left duct function.

Dosage

Enam for oral administration. Enalapril is taken independently from the recipient. The additional dose of enalapril is usually administered as a single dose. To achieve the maximum therapeutic effect, take Enam slid at the same hour. Doses of enalapril and the duration of therapy depend on the drug.

In adults with essential hypertension, as a rule, prescribe enalapril in a cob dose of 10-20 mg per doba. If there is sufficient control of arterial pressure, the dose is gradually increased to 40 mg of enalapril per doba.

Older adults with renovascular arterial hypertension, as a rule, prescribe 2.5-5 mg of enalapril per day. If there is sufficient control of arterial pressure, the additional dose should be incrementally increased.

The maximum recommended additional dose of enalapril maleate is 40 mg.

Patients who are taking diuretics should take diuretic drugs 2-3 days before taking enalapril on the cob. In such patients, therapy with Enam should be initiated at the lowest dose. If you do not want to take diuretic drugs, then the dose of enalapril is not guilty of overdosing 5 mg per dose.

Elderly with heart failure, as a rule, prescribe enalapril in a dose of 2.5 mg per doba. Depending on the tolerability of the drug, the dose of enalapril is progressively reduced to 20 mg per doba.

Patients with reduced function should adjust the dose of enalapril or increase the interval between taking Enam.

The maximum recommended dose of enalapril for patients with a creatinine clearance of 30 to 80 ml / min is 10 mg, for patients with a creatinine clearance of 10 to 30 mg – 5 mg, for patients with a creatinine clearance of 10 to 30 mg if you are on hemodialysis – 2.5 mg.

Intervals between dose shifts of enalapril due to become 2-4 times.

Children older than 6 years of age with arterial hypertension are usually prescribed enalapril at an oral dose of 2.5 mg per day.

The maximum recommended additional dose of enalapril maleate for children is 0.58 mg/kg body weight.

Side effects

Enalapril is generally not well tolerated by patients. At the beginning of therapy, a possible development of an epidemiological decrease in arterial pressure (including orthostatic hypotension), confusion and stiffness. In addition, it is impossible to exclude the possibility of developing such non-negligible effects during enalapril therapy:

On the side of the heart and vessels: tachycardia, bradycardia, angina attack, myocardial infarction.

From the side of the dichal system: back, glositis, rhinorrhea, pharyngitis, unproductive cough (when developing a cough, it is recommended to take an angiotensin-converting enzyme inhibitor and choose an alternative).

On the side of the mucosal tract and liver: damage to the lining, nausea, pancreatitis, damage to the etching, dryness of the mucous membrane of the mouth, pain in the epigastrium, decreased function of the liver, increased activity of the liver enzymes. In addition, a possible development of intestinal obstruction, stomatitis, changes in taste and a decrease in appetite.

From the side of the central nervous system: headache, depressive states, insomnia, judgment, impaired balance and coordination of the hands, paresthesia, noise in the ears.

On the side of laboratory findings: an increase in potassium and bilirubin in blood plasma, proteinuria, a decrease in hematocrit, hemoglobin and leukocytes, neutropenia, hypoglycemia.

Allergic reactions: kropivyanka, sverbizh shkir, bronchospasm. In a few cases, there is a possible development of an angio-neurotic swelling of the larynx, appearance, tongue and lips, which means indispensable help (including the introduction of glucocorticosteroids, tracheal intubation and mechanical ventilation may be necessary). eniv).

Others: alopecia, erectile dysfunction, hot flushes, agranulocytosis, Raynaud’s syndrome, increased urination, nirk deficiency (including deficiencies in patients with already known impairment of nirk function). In addition, a possible development of the symptomatic complex, which includes hyperthermia, vasculitis, inflammation of the mucosa, increased erythrocyte count, positive test results for antinuclear antibodies, leukocytosis and eosinophilia.

Contraindications

Enam do not prescribe to patients with intolerance to enalapril and other drugs of the angiotensin-converting enzyme inhibitor group (including history of angiotensin congestion associated with angiotensin-converting enzyme inhibitor therapy).

Enam tablets should not be taken by patients with galactosemia, glucose-galactose malabsorption syndrome and lactase deficiency.

Enalapril is not suitable for the treatment of patients with mitral and aortic stenosis, relapsing or idiopathic angioedema (including history).

We do not stop for women during pregnancy, women who have children up to 6 years of age, as well as children with reduced function of nirok (creatinine clearance less than 30 ml / min).

Care should be taken when prescribing Enam to patients who suffer from hypovolemia (including after taking diuretics), heart failure, ischemic heart disease, impaired cerebral blood flow , as well as damage to the water-salt balance (enalapril can be recognized only after correction of water-salt electrolyte balance).

Preservation should also be taken into account when enalapril is recognized in patients with reduced function of the nir, stenosis of the artery of the single nir, or bilateral stenosis of the nir’s arteries.

During enalapril therapy (especially on the cob) it is recommended to avoid driving and operating potentially unsafe mechanisms.

vacancy:

We do not prescribe vagity to women. Before the start of therapy, women of reproductive age should switch off their vaginess, and during the period of taking the Enam drug, they should switch off the need for contraception. In times of current or planning pregnancy, it is recommended to take enalapril.

It is not possible to avoid taking enalapril maleate during lactation, it is necessary to consider breastfeeding.

Interaction

There is no evidence of high permeability membrane blockage for hemodialysis during enalapril therapy.

It is possible to mutually improve hypotensive diarrhoea, with one-hour stoppage of enalapril and other antihypertensive drugs.

Non-steroidal antiseizure drugs in case of one-hour treatment with Enam reduce the hypotensive effect of enalapril. In addition, in patients with reduced function, the total accumulation of non-narcotic analgesics and enalapril can lead to a further deterioration in the function of the drugs.

In the case of one-hour congestion with diuretics, enalapril compensates for the loss of potassium caused by diuretics.

In case of one-hour congestion of enalapril with potassium sparing midiuretics, potassium preparations and other medications, which increase plasma potassium levels, a possible development of hyperkalemia.

Enam with one-hour stasis can improve hypoglycemic insulin and oral antidiabetic effects. If one-hour infusion of these drugs is necessary, then regularly monitor the level of glucose in plasma and adjust doses of hypoglycemic diseases as necessary.

Enalapril increases plasma concentrations of lithium during one-hour exposure.

In case of one-hour admission of the drug Enam with parenteral preparations of gold, arterial hypotension, vomitting and vomiting can develop.

Ethyl alcohol in case of one-hour retention of the hypotensive potency of enalapril.

One-hour exposure to the drug with cimetidine may increase the therapeutic effect of enalapril.

Enam reduces the effectiveness of theophylline.

Overdosing

Taking high doses of Enam can cause severe arterial hypotension.

There is no specific antidote. In case of an overdose of enalapril, wash the tube, take enterosorbent drugs. With the development of arterial hypotension, the patient should take a horizontal position with raised lower tips. To normalize arterial pressure, increase the volume of circulating blood (for additional infusion of physiological sodium chloride). In addition, in case of severe arterial hypotension, parenteral administration of angiotensin II is indicated.

Overdose treatment is carried out in the minds of a hospital under the supervision of medical personnel. It is recommended to control potassium, sechovin and creatinine in blood plasma.

Hemodialysis may be required to lower plasma concentrations of enalaprilat.

Clean up the savings

The drug Enam is safe in dry areas with a temperature that does not exceed 25 degrees Celsius.

Enam adventitious stretch 3 years after preparation.

instructions for use, price, analogues, composition, indications

Renal function assessment

Before and during the use of Enam, monitoring of renal function is necessary.

Symptomatic hypotension

Symptomatic hypotension is rarely seen in patients with uncomplicated hypertension. Among those taking Enam, symptomatic hypotension occurs more often in patients with impaired fluid balance, for example, due to diuretic therapy, a diet with limited salt intake, diarrhea or vomiting. In such patients, it is necessary to determine the levels of electrolytes in the blood serum regularly, at regular intervals. Particular care should be taken in the treatment of patients with ischemic heart disease or cerebrovascular disease, since an excessive decrease in blood pressure can lead to myocardial infarction or stroke. Symptomatic hypotension has been observed in patients with arterial hypertension and heart failure with and without impaired renal function. This condition is more likely to occur in patients with more severe heart failure due to high-dose loop diuretics, hyponatremia, or worsening renal function. In such patients, treatment should be started under the supervision of a physician, and the patient’s condition should be closely monitored when changing the dose of Enam and / or diuretic (see section “Method of application and dosage”). Similar actions should be taken in patients with ischemic heart disease or cerebrovascular disease, since an excessive decrease in blood pressure can lead to myocardial infarction or stroke.

With the development of arterial hypotension, the patient should be placed on his back and, if necessary, administered intravenously with saline sodium chloride solution. Temporary hypotension is not a contraindication to further use of the drug. If an increase in blood pressure occurs after normalization of the circulating blood volume, therapy can be resumed at the usual doses.

In some patients with heart failure and normal or low blood pressure, an additional decrease in blood pressure may occur when using Enam. This effect is predictable and is not a reason to discontinue the drug. If hypotension becomes symptomatic, dose reduction and/or discontinuation of the diuretic and/or Enam may be required.

Renal dysfunction

Enalapril-associated renal failure has been reported, predominantly in patients with severe heart failure or underlying kidney disease, including renal artery stenosis. With timely diagnosis and appropriate treatment, renal failure associated with the use of enalapril is usually reversible.

Enam should not be administered to patients with impaired renal function (creatinine clearance <80 ml/minute) until the dose titration of enalapril reaches the dosage in this drug.

In some patients with arterial hypertension without signs of existing kidney disease, while using enalapril and a diuretic, an increase in the level of blood urea and creatinine was observed. If such a phenomenon occurs, Enam should be discontinued, and possible renal artery stenosis should be considered.

Renovascular hypertension

There is an increased risk of hypotension and impaired renal function if a patient with bilateral renal artery stenosis or arterial stenosis of a solitary kidney is treated with ACE inhibitors. Weakening of kidney function can occur even with mild changes in serum creatinine levels. In such patients, treatment should be started at low doses and under medical supervision, with caution increasing the dose and monitoring renal function.

Kidney transplantation

There is no experience with the use of enalapril in patients with recent kidney transplantation. For this reason, treatment with enalapril is not recommended.

Aortic stenosis/hypertrophic cardiomyopathy

As with all other vasodilators, ACE inhibitors should be used with caution in patients with left ventricular valve and outflow tract obstruction. The use of such drugs should be avoided in case of cardiogenic shock and hemodynamically significant obstruction.

Liver failure

Rarely, the use of ACE inhibitors has been associated with a syndrome that begins with cholestatic jaundice or hepatitis and progresses to fulminant necrotizing hepatitis, sometimes fatal. The mechanism of this syndrome is not known. Patients receiving treatment with ACE inhibitors who experience jaundice or marked elevation of liver enzymes should discontinue the ACE inhibitor and establish appropriate medical supervision.

Neutropenia/agranulocytosis

Neutropenia/agranulocytosis, thrombocytopenia and anemia have been reported in patients receiving ACE inhibitors. Neutropenia occurs rarely in patients with normal renal function and no other complicating factors.

Enalapril should be used with extreme caution in patients with collagen vascular disease, in individuals receiving treatment with immunosuppressants, allopurinol or procainamide, or a combination of these complicating factors, especially in the presence of impaired renal function. Some patients have developed serious infections that have not responded to intensive antibiotic therapy. If enalapril is prescribed to such patients, it is recommended to periodically determine the level of leukocytes, and patients should be aware of the need to inform the doctor about the occurrence of any signs of infection.

Hypersensitivity/angioedema

Angioedema of the face, extremities, lips, tongue, glottis and/or larynx has been reported in patients taking ACE inhibitors, including enalapril. These reactions can occur at any time during treatment. In such cases, you should immediately stop using Enam and establish appropriate monitoring of the patient’s condition to ensure the complete disappearance of symptoms before the patient is discharged. Even in cases where there is only swelling of the tongue without respiratory distress, long-term monitoring of the patient’s condition is necessary, since treatment with antihistamines and corticosteroids may not be enough.

Very rarely, fatal cases have been reported due to angioedema, which was accompanied by swelling of the larynx and tongue. Patients with swelling of the tongue, glottis, or larynx are more likely to develop airway obstruction, especially in patients with a history of airway surgery. In cases where swelling of the tongue, glottis, or larynx may lead to airway obstruction, appropriate therapy should be initiated immediately, which may include the administration of a 1:1000 solution of epinephrine (0.3-0.5 ml) and/or measures to maintain patency respiratory tract.

The development of angioedema was more often reported in patients of the Black race who received ACE inhibitors than in patients of other races. However, it is generally believed that blacks have an increased risk of angioedema.

Patients with a history of angioedema that is not associated with the use of ACE inhibitors may have a higher risk of angioedema during the use of an ACE inhibitor. (see section “Contraindications”)

Anaphylactoid reactions during desensitization with hymenoptera venom

Life-threatening anaphylactoid reactions have rarely occurred in patients who have used ACE inhibitors during Hymenoptera. The occurrence of such reactions can be avoided by temporarily stopping the use of the ACE inhibitor before starting desensitization.

Anaphylactoid reactions during low-density lipoprotein (LDL) apheresis

Life-threatening anaphylactic reactions have rarely occurred in patients treated with ACE inhibitors during LDL apheresis with dextran sulfate. The occurrence of such reactions can be avoided by temporarily stopping the use of the ACE inhibitor before each session of apheresis.

Hypoglycemia

Patients with diabetes mellitus treated with oral antidiabetic drugs or insulin, when prescribing an ACE inhibitor, it is necessary to carefully monitor for hypoglycemia, especially during the first month of combination therapy (see section “Interaction with other drugs”)

Cough

Cough has been reported with the use of ACE inhibitors. As a rule, the cough is unproductive, persistent and disappears after cessation of therapy. Cough that occurs as a result of the use of ACE inhibitors should be considered in the differential diagnosis of cough.

Surgery/Anesthesia

Enalapril blocks the formation of angiotensin II and therefore reduces the compensatory abilities of patients associated with the renin-angiotensin system during major surgical interventions or anesthesia using drugs that lead to arterial hypotension. If arterial hypertension occurs, which is explained by a similar mechanism, it can be corrected by increasing the volume of circulating blood.

Hyperkalemia

In some patients receiving treatment with ACE inhibitors, including enalapril, an increase in serum potassium levels was observed.

Risk factors for developing hyperkalemia include impaired renal function, impaired renal function, age (>70 years), diabetes mellitus, intercurrent conditions such as dehydration, acute cardiac decompensation, metabolic acidosis, and concomitant use of potassium-sparing diuretics (such as spironolactone, eplerenone, triamterene or amiloride), potassium supplements or salt substitutes containing potassium, as well as the use of other drugs associated with an increase in serum potassium levels (for example, heparin). The use of potassium supplements, potassium-sparing diuretics or salt substitutes containing potassium, in particular in patients with impaired renal function, can lead to a significant increase in serum potassium levels. Hyperkalemia can cause serious, sometimes fatal, arrhythmias. If the simultaneous use of enalapril and any of the above drugs is necessary, these drugs should be used with caution and frequently monitor the level of potassium in the blood serum (see section “Interaction with other drugs”).

Lithium

As a rule, it is not recommended to use lithium in combination with enalapril and diuretics (see the section “Interaction with other drugs”).

Use by children

The safety and efficacy of the drug in children have not been established (see section “Method of application and dosage”).

Ethnic differences

As with other ACE inhibitors, enalapril is less effective in lowering blood pressure in patients of the black race compared to patients of other races. This may be due to the higher prevalence of the low-active renin system among black patients with hypertension.

Lactose

Enalapril contains lactose. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not use this medicine.

Double blockade of the renin-angiotensin-aldosterone system

Dual blockade of the renin-angiotensin-aldosterone system is associated with an increased risk of hypotension, hyperkalemia, and renal dysfunction (including acute renal failure) compared with monotherapy. Dual RAAS blockade with an ACE inhibitor, ARB II, or Aliskiren cannot be recommended for any patient, especially those with diabetic nephropathy.

In some cases, when the combined use of an ACE inhibitor and ARB II is absolutely indicated, careful observation by a specialist and mandatory monitoring of kidney function, water and electrolyte balance, and blood pressure are necessary.