It is not an acute reaction to stress. Stress: symptoms, causes, body reaction to emotional stress. Key Points to Observe

Pills round, biconvex, with beveled edge, white.

Excipients:

Pills round, flat, with a beveled edge and a notch on one side, white.

Excipients: sodium bicarbonate, lactose monohydrate, corn starch, hyprolose (hydroxypropylcellulose), talc (magnesium hydrosilicate), magnesium stearate.

10 pieces. - blisters (2) - cardboard packs.

Pills round, flat, with a beveled edge and a notch on one side, red-brown in color with splashes of white on the surface and in the tablet mass.

Excipients: sodium bicarbonate, lactose monohydrate, corn starch, talc (magnesium hydrosilicate), magnesium stearate, red iron oxide (dye Sicopharm red 30, E172).

10 pieces. - blisters (2) - cardboard packs.

Pills round, flat, with a beveled edge and a notch on one side, light orange in color with splashes of white on the surface and in the tablet mass.

Excipients: sodium bicarbonate, lactose monohydrate, corn starch, talc (magnesium hydrosilicate), magnesium stearate, yellow iron oxide (dye Sicopharm yellow 10, E172).

10 pieces. - blisters (2) - cardboard packs.

Clinical and pharmacological group

ACE inhibitor

pharmachologic effect

Antihypertensive drug, ACE inhibitor. Enalapril is a “prodrug”: as a result of its hydrolysis, enalaprilat is formed. The mechanism of action is associated with inhibition of ACE activity under the influence of enalaprilat. This leads to a decrease in the formation of angiotensin II, which causes a direct decrease in aldosterone secretion. As a result, there is a decrease in peripheral vascular resistance, a decrease in systolic and diastolic blood pressure, and post- and preload on the myocardium.

Dilates arteries in to a greater extent than veins, while no reflex increase in heart rate is observed.

The hypotensive effect is more pronounced when high level plasma renin than with normal or reduced. A decrease in blood pressure within therapeutic limits does not affect cerebral circulation; blood flow in the vessels of the brain is maintained at a sufficient level even against the background of reduced blood pressure. Strengthens coronary and renal blood flow.

With long-term use, hypertrophy of the left ventricle of the myocardium and myocytes of the walls of resistive arteries decreases, prevents the progression of heart failure and slows down the development of left ventricular dilatation. Improves blood supply to ischemic myocardium.

Inhibits platelet aggregation.

Has some diuretic effect.

When taking the drug orally, the hypotensive effect develops after 1 hour, reaches a maximum after 4-6 hours and lasts up to 24 hours. In some patients, to achieve optimal level AD requires therapy for several weeks. In heart failure, a noticeable clinical effect is observed with long-term use - 6 months or more.

Pharmacokinetics

Suction

After taking the drug orally, about 60% of enalapril is absorbed. Cmax of enalapril in blood plasma is achieved after 1 hour. Food intake does not affect absorption.

Distribution and metabolism

In the liver, enalapril is metabolized to form the active metabolite enalaprilat, which is a more active ACE inhibitor than enalapril. C max of enalaprilat in blood serum is observed after 3-4 hours, C ss - after 4 days.

Enalaprilat binding to plasma proteins is 50-60%.

Enalaprilat easily penetrates histohematic barriers, with the exception of the BBB. A small amount penetrates the placental barrier and is excreted in breast milk.

Removal

T1/2 enalaprilat - 11 hours. Excreted mainly by the kidneys - 60% (20% - in the form of enalapril and 40% - in the form of enalaprilat), through the intestines - 33% (6% - in the form of enalapril and 27% - in the form of enalaprilat ).

It is removed by hemodialysis (rate 62 ml/min) and peritoneal dialysis.

Indications for use of the drug

- arterial hypertension;

— chronic heart failure (as part of combination therapy);

- asymptomatic left ventricular dysfunction (as part of combination therapy).

Dosage regimen

The drug is taken orally, regardless of food intake, at the same time of day. If you miss a dose of the drug, it should be taken as soon as possible. If there are only a few hours left before the next dose, then you need to take only the next dose according to the schedule and not take the missed dose. The dose should never be doubled. The dose of the drug should be adjusted depending on the patient's condition.

At treatment of arterial hypertension The recommended starting dose is 5 mg 1 time/day. After taking the initial dose, patients require medical monitoring for 2 hours and an additional 1 hour until blood pressure stabilizes.

Dose adjustment is carried out depending on the achievement of a therapeutic effect (lowering blood pressure). If there is no clinical effect, the dose is increased after 1-2 weeks by 5 mg. Typically, the maintenance dose ranges from 10 mg to 20 mg; if necessary and if well tolerated, the dose can be increased to 40 mg/day. Maximum daily dose is 40 mg. It is advisable to divide the high dose into 2 doses.

For patients who continue to take diuretics The initial dose of the drug is 2.5 mg 1 time / day.

For patients with hyponatremia (concentration of sodium ions in the blood serum less than 130 mmol/l) or serum creatinine more than 140 µmol/l, the initial dose is 2.5 mg 1 time/day.

For patients with kidney disease The dose of Enap is determined depending on renal function and/or CC. At CC more than 30 ml/min the initial dose is 5 mg/day; at CC less than 30 ml/min The initial dose is 2.5 mg/day and is gradually increased until a clinical effect is achieved.

on the day of the procedure, the drug is prescribed at a dose of 2.5 mg; on the remaining days, the doctor adjusts the dose in accordance with blood pressure levels.

U elderly patients More often, a more pronounced hypotensive effect and a prolongation of the duration of action of the drug are observed, which is associated with a decrease in the rate of elimination of enalapril, therefore the recommended initial dose is 1.25 mg.

At treatment of chronic heart failure The recommended starting dose is 2.5 mg 1 time/day. The dose of Enap should be increased gradually until the maximum clinical effect is achieved, usually after 2-4 weeks. The usual maintenance dose is from 2.5 mg to 10 mg 1 time / day; the maximum maintenance dose is 20 mg 2 times a day.

At treatment of asymptomatic left ventricular dysfunction The recommended initial dose is 2.5 mg 2 times a day. Dose adjustment depends on tolerability of the drug. Usually the maintenance dose is 10 mg 2 times a day.

Treatment with Enap is long-term, usually throughout life, unless circumstances arise that require its cancellation.

The tablets should be swallowed whole with a small amount of liquid.

Side effect

From the outside of cardio-vascular system: excessive decrease in blood pressure, orthostatic collapse, rarely - chest pain, angina pectoris, myocardial infarction (usually associated with a pronounced decrease in blood pressure), arrhythmias (brady- or tachycardia, atrial fibrillation), palpitations, thromboembolism of the branches of the pulmonary artery, pain in the heart, fainting, Raynaud's syndrome.

From the central nervous system and peripheral nervous system: dizziness, headache, insomnia, weakness, increased fatigue, drowsiness (2-3%), very rarely confusion, increased fatigue, very rarely when used in high doses - increased excitability, depression, paresthesia.

From the senses: vestibular apparatus disorder, hearing and vision impairment, tinnitus.

From the outside respiratory system: nonproductive dry cough, interstitial pneumonitis, bronchospasm/asthma, shortness of breath, rhinorrhea, pharyngitis, sore throat, hoarseness.

From the digestive system: dry mouth, anorexia, dyspeptic disorders (nausea, diarrhea or constipation, vomiting, abdominal pain), intestinal obstruction, pancreatitis, impaired liver function and biliary excretion, hepatitis (hepatocellular or cholestatic), jaundice, increased activity of liver transaminases, hyperbilirubinemia.

From the urinary system: renal dysfunction, proteinuria, hypercreatininemia.

From the side of metabolism: increased urea content, hyperkalemia, hyponatremia.

From the hematopoietic system: decreased concentration of hemoglobin and hematocrit, thrombocytopenia, neutropenia, agranulocytosis (in patients with autoimmune diseases), eosinophilia.

Dermatological reactions: photosensitivity, pemphigus, alopecia.

Allergic reactions: skin rash, angioedema of the face, extremities, lips, tongue, glottis and/or larynx, dysphonia, erythema multiforme, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, itching, urticaria, photosensitivity, serositis, vasculitis, myositis, arthralgia , arthritis, stomatitis, glossitis, increased sweating.

Other: decreased libido, hot flashes, decreased potency, increased ESR.

A complex symptom complex may develop, which may include all or some of the following symptoms: fever, serositis, vasculitis, myalgia/myositis, arthralgia/arthritis, positive test for antinuclear antibodies, increased ESR, eosinophilia, leukocytosis.

Side effects observed when using Enap are usually mild, transient and do not require discontinuation of the drug.

Contraindications to the use of the drug

- history of angioedema (including those associated with the use of ACE inhibitors);

- porphyria;

- pregnancy;

- lactation (breastfeeding);

- hypersensitivity to enalapril and other components of the drug;

- increased sensitivity to other ACE inhibitors.

The drug should not be used in patients with a history of angioedema associated with previous use of ACE inhibitors (an allergic reaction with severe swelling of the lips, face, neck and possibly arms and legs, accompanied by suffocation and hoarseness of the voice) or with other causes, in children and adolescents under 18 years of age (efficacy and safety have not been established).

WITH caution the drug should be used in patients with bilateral renal artery stenosis or stenosis of the artery of a single kidney; with primary hyperaldosteronism, hyperkalemia, after kidney transplantation, with aortic stenosis, mitral stenosis (with hemodynamic disorders), idiopathic hypertrophic subaortic stenosis, with systemic connective tissue diseases, coronary artery disease, cerebrovascular diseases, diabetes mellitus, with renal failure (proteinuria - more than 1 g/day), liver failure, in patients on a salt-restricted diet or on hemodialysis; simultaneously with immunosuppressants and saluretics; in elderly patients (over 65 years old).

Use of the drug during pregnancy and lactation

The drug is contraindicated for use during pregnancy and lactation ( breastfeeding). If pregnancy occurs during treatment with Enap, the drug should be discontinued immediately.

Use for renal impairment

The dosage regimen is set depending on the severity of renal dysfunction or on CC values. At CC more than 30 ml/min the initial dose is 5 mg/day, with CC less than 30 ml/min- 2.5 mg/day, the dose of the drug should be gradually increased until a satisfactory clinical effect is achieved.

For patients on hemodialysis, on the day of dialysis the drug is prescribed at a dose of 2.5 mg; on other days the dose is adjusted depending on the blood pressure level.

Avoid prescribing the drug to patients with bilateral renal artery stenosis or stenosis of the artery of a single kidney.

special instructions

During treatment with Enap, regular medical examinations are required, especially at the beginning of treatment and/or when selecting the optimal dose of the drug. The frequency of medical examinations is determined by the attending physician.

It should be borne in mind the possibility of developing arterial hypotension (even several hours after taking the first dose) in patients with severe heart failure, severe renal impairment, as well as in patients with water and electrolyte imbalance caused by treatment with diuretics, a salt-free diet, diarrhea, vomiting, as well as in patients on hemodialysis.

A pronounced decrease in blood pressure is usually manifested by nausea, increased heart rate, and fainting. If arterial hypotension develops, the patient should be transferred to horizontal position with a low headboard, requiring medical supervision.

Arterial hypotension and its severe consequences are rare and transient. Transient arterial hypotension is not a contraindication to further treatment with the drug. As soon as blood pressure has stabilized, drug therapy can be continued at the average recommended doses. Hypotension can be avoided by interrupting diuretic treatment and avoiding a salt-free diet before starting treatment with Enap, if possible. The patient should be warned that if relapses of arterial hypotension occur, accompanied by nausea, increased heart rate and fainting, then consultation with a doctor is necessary.

Renal function should be monitored before starting treatment and during therapy.

During treatment with Enap, an increase in potassium levels in the blood serum is possible, especially in patients with chronic renal failure, diabetes mellitus, while prescribing potassium-sparing diuretics (such as spironolactone, amiloride and triamterene) or potassium supplements. Such patients should be informed of the need to consult a doctor if muscle weakness and arrhythmia occur.

Patients receiving Enap ® should not drink alcohol due to the risk of developing arterial hypotension.

In case of development side effects or Quincke's edema (severe swelling of the lips, face, neck, arms and legs, accompanied by suffocation and hoarseness) Enap ® should be discontinued and appropriate treatment prescribed.

The drug should be discontinued before testing the function of the parathyroid glands.

Before carrying out a planned surgical intervention, the anesthesiologist should be informed that the patient is receiving Enap ®, since there is a risk of developing arterial hypotension during general anesthesia.

It should be borne in mind that during treatment with Enap, the development of allergic reactions is possible due to the use of certain types of filter membranes used in hemodialysis or other types of blood filtration.

During the period of treatment of allergy (desensitization) to wasp or bee venom, patients receiving Enap ® may develop a hypersensitivity reaction.

Use in pediatrics

The drug should not be prescribed to children, because the effectiveness and safety of its use in pediatrics have not been established.

Impact on the ability to drive vehicles and operate machinery

In some cases, the drug can cause severe arterial hypotension and dizziness, especially at the beginning of treatment, thus having an indirect and transient effect on the ability to control vehicles and working with machinery.

Overdose

Symptoms: excessive decrease in blood pressure up to the development of collapse, myocardial infarction, acute cerebrovascular accident or thromboembolic complications, convulsions, stupor.

Treatment: the patient should be placed in a horizontal position with a low headboard. In mild cases, gastric lavage and ingestion of saline solution are indicated; in more serious cases - measures aimed at stabilizing blood pressure, intravenous administration of saline, plasma substitutes, if necessary - intravenous administration of angiotensin II, hemodialysis (enalaprilat excretion rate - 62 ml/min).

Drug interactions

The simultaneous use of enalapril and diuretics or other antihypertensive drugs increases the effectiveness of these drugs.

Interaction medicines used to treat heart failure (cardiac glycosides) has no clinical significance.

With the simultaneous use of enalapril and NSAIDs, incl. acetylsalicylic acid may reduce the effectiveness of enalapril and increase the risk of renal dysfunction.

With the simultaneous use of certain diuretics (spironolactone, amiloride or triamterene) and/or additional administration of potassium supplements, an increase in the level of potassium in the blood serum (hyperkalemia) is possible.

Enalapril weakens the effect of products containing theophylline. Concomitant use of lithium preparations may increase side effect lithium.

Drugs containing cimetidine increase the duration of action of enalapril.

Patients receiving enalapril are at risk of developing arterial hypotension during general anesthesia.

Ethanol enhances the hypotensive effect of enalapril.

Conditions for dispensing from pharmacies

The drug is available with a prescription.

Storage conditions and periods

The drug should be stored out of the reach of children, in a dry place at a temperature not exceeding 25°C. Shelf life - 3 years.

"

Enap is an antihypertensive drug from the group of angiotensin-converting enzyme (ACE) inhibitors. This is an original drug from the Slovenian pharmaceutical company KRKA, which is based on enalapril, which is well known to specialists and patients. Enap is a so-called “prodrug”, which becomes active form after hydrolysis in the body. The mechanism of its action is associated with ACE inhibition, leading to a decrease in the production of angiotensin II from angiotensin I, and a decrease in the concentration of the first of them is known to lead to a direct decrease in the formation of the adrenal hormone aldosterone. The latter circumstance makes it possible to achieve the desired therapeutic effect: the total peripheral vascular resistance, systolic and diastolic blood pressure, post- and preload on the heart muscle decrease, and blood vessels dilate (while the expected reflex increase in heart rate in such cases is not observed). The hypotonic effect is more pronounced against the background of a high concentration of renin in the blood plasma. The decrease in blood pressure within therapeutically safe limits caused by Enap does not affect the intensity of cerebral circulation. Blood flow in the vessels of the brain is maintained at the proper level even despite a decrease in blood pressure. Another effect of Enap is the intensification of blood circulation in the myocardium and kidneys. With prolonged use, Enap reduces the enlargement of the left ventricle and muscle cells of the arterial walls, prevents the development and worsening of heart failure, slows down the pathological expansion (dilation) of the left ventricle, and improves blood supply to the ischemic area of ​​the heart muscle.

In addition, Enap reduces platelet aggregation (sticking together) and has a mild diuretic effect.

You can feel for yourself that Enap is an antihypertensive drug 1 hour after taking it. Its effect reaches its peak after 4-6 hours and lasts up to 24 hours. In some cases, to achieve the desired level of blood pressure, it is necessary to take Enap for several weeks. If we talk about severe heart failure, then noticeable positive results can be achieved only with long-term - more than 6 months - taking the drug. Enap is available only in tablet form. When taken orally, about 60% is absorbed active substance. Eating does not affect the absorption of the drug. Tablets can be taken both before and after meals, but regularly and always at the same time of the day. It happens that for a number of reasons a scheduled dose of the drug is missed. In this case, you must take the missed dose. If there are only a few hours left before taking the next scheduled dose, then the missed dose is no longer taken. The specific dose of Enap is determined by the attending physician and adjusted during the course of treatment.

Pharmacology

Antihypertensive drug, ACE inhibitor. The mechanism of action is associated with inhibition of ACE activity, which leads to a decrease in the formation of angiotensin II.

Enalapril is a derivative of two amino acids: L-alanine and L-proline. After absorption, enalapril taken orally is hydrolyzed to enalaprilat, which inhibits ACE. The mechanism of its action is associated with a decrease in the formation of angiotensin II from angiotensin I, a decrease in the content of which in the blood plasma leads to an increase in the activity of plasma renin (by eliminating the negative feedback to changes in renin production) and a decrease in aldosterone secretion. Since ACE is identical to the enzyme kininase II, enalapril can also block the destruction of bradykinin, a peptide that has a powerful vasopressor effect. The significance of this effect in the mechanism of action of enalapril has not been definitively established.

The antihypertensive effect of enalapril is associated primarily with the suppression of the activity of the RAAS, which plays an important role in the regulation of blood pressure. Despite this, enalapril has an antihypertensive effect even in patients with arterial hypertension and low renin concentrations.

With the use of enalapril, blood pressure levels decrease regardless of body position (both in a supine and standing position) without a significant increase in heart rate. Symptomatic orthostatic hypotension is rare. In some patients, achieving optimal blood pressure reduction may require several weeks of therapy. Abrupt withdrawal of enalapril was not accompanied by an increase in blood pressure.

Effective inhibition of ACE activity usually occurs 2-4 hours after a single oral dose of enalapril. The onset of antihypertensive action when taken orally is usually 1 hour, reaching a maximum after 4-6 hours. The duration of action depends on the dose. When used in recommended doses, the antihypertensive effect and hemodynamic effects are maintained for at least 24 hours.

In patients with essential hypertension, a decrease in blood pressure is accompanied by a decrease in peripheral vascular resistance and an increase in cardiac output.
ejection, while the heart rate does not change or changes slightly. Renal blood flow increases, but the speed
glomerular filtration rate does not change. However, in patients with an initially low glomerular filtration rate, its level usually increased.

In patients with diabetic/nondiabetic nephropathy, albuminuria/proteinuria and renal excretion of IgG decreased while taking enalapril.

In patients with chronic heart failure (CHF) during therapy with cardiac glycosides and diuretics
the use of enalapril is accompanied by a decrease in peripheral vascular resistance and blood pressure, an increase in cardiac output, while the heart rate decreases (usually in patients with chronic heart failure, the heart rate is increased). The pulmonary capillary wedge pressure is also reduced. With long-term use, enalapril increases exercise tolerance and reduces the severity of heart failure (assessed by NYHA criteria). Enalapril in patients with mild to moderate heart failure slows down its progression, and also slows down the development of left ventricular dilatation. In case of left ventricular dysfunction, enalapril reduces the risk of major ischemic outcomes (including the incidence of myocardial infarction and the number of hospitalizations for unstable angina).

Pharmacokinetics

Suction

After taking the drug orally, about 60% of enalapril is absorbed. Cmax of enalapril in blood serum is achieved 1 hour after oral administration. Eating does not affect absorption.

Distribution and metabolism

Enalapril is rapidly and actively hydrolyzed to form enalalrylate, a powerful ACE inhibitor. Cmax of enalaprilat in the blood serum is observed 3-4 hours after oral administration. In patients with normal renal function, C ss of enalalrylate in blood plasma was achieved on the 4th day of therapy.

The binding of enalaprilat to plasma proteins in the range of therapeutic doses is 60%.

Apart from conversion to enalaprilat, enalapril does not undergo significant biotransformation.

Removal

T1/2 of enalapril with repeated use is 11 hours. Enalaprilat is excreted mainly by the kidneys. Enalaprilat (about 40% of the dose) and unchanged enalapril (about 20%) are predominantly detected in urine.

Enalaprilat is removed by hemodialysis, the elimination rate is 1.03 ml/s (62 ml/min).

Pharmacokinetics in special groups of patients

In patients with mild to moderate renal failure (creatinine clearance 30-60 ml/min (0.6-1 ml/sec)) after taking enalapril at a dose of 5 mg 1 time/day, the AUC of enalalrylate is approximately 2 times greater than in patients with normal kidney function. In severe renal failure (creatinine clearance ≤30 ml/min), the AUC increased approximately 8-fold. T 1/2 of enalaprilat after repeated use in severe renal failure is prolonged, and the time to reach C ss is delayed.

Release form

Tablets are white or almost white, flat-cylindrical, scored and chamfered.

Excipients: sodium bicarbonate - 2.6 mg, lactose monohydrate - 129.8 mg, corn starch - 22.4 mg, hyprolose - 2.5 mg, talc - 6 mg, magnesium stearate - 1.7 mg.

10 pieces. - blisters (2) - cardboard packs.
10 pieces. - blisters (6) - cardboard packs.

Dosage

The drug is taken orally, regardless of food intake, preferably at the same time of day. The tablets should be taken with a small amount of liquid.

Arterial hypertension

The initial dose is from 5 to 20 mg 1 time / day, depending on the severity of arterial hypertension. For mild arterial hypertension, the recommended initial dose is 5-10 mg/day.

In patients with severe activation of the RAAS (for example, with renovascular hypertension, electrolyte loss and/or dehydration, decompensated heart failure or severe arterial hypertension), an excessive decrease in blood pressure may occur at the beginning of treatment. In such situations, it is recommended to begin therapy with a low initial dose of 5 mg/day or less, under the supervision of a physician.

Previous therapy with diuretics in high doses may lead to dehydration and an increased risk of developing arterial hypotension at the beginning of therapy with Enap ®; The recommended initial dose is 5 mg/day. Treatment with diuretics should be stopped 2-3 days before starting use of the drug Enap ® . Caution should be exercised when using the drug Enap ® , monitoring kidney function and potassium levels in the blood serum.

Typically the maintenance dose is 20 mg 1 time/day.

The dose is selected individually; if necessary, it can be increased to a maximum daily dose of 40 mg.

Chronic heart failure and left ventricular dysfunction

The initial dose is 2.5 mg 1 time / day, treatment should be started under the close supervision of a physician.

The drug Enap ® for the treatment of heart failure can be used simultaneously with diuretics and/or beta-blockers, and, if necessary, with cardiac glycosides. In the absence of symptomatic arterial hypotension at the beginning of therapy or after its correction, the dose should be increased gradually (by 2.5-5 mg every 3-4 days) to the usual maintenance dose of 20 mg / day, which is prescribed either once or in 2 doses, in depending on drug tolerance. Dose selection is carried out over 2-4 weeks. The maximum daily dose is 40 mg in 2 divided doses.

*Special precautions should be taken in patients with impaired renal function taking diuretics.

Given the risk of arterial hypotension and renal failure (observed much less frequently), blood pressure and renal function should be carefully monitored before and after starting the use of Enap ® . In patients taking diuretics, the dose of the latter should, if possible, be reduced before starting Enap ® . The development of arterial hypotension after taking the first dose does not mean that arterial hypotension will persist with long-term use, and does not indicate the need to discontinue use of the drug.

Renal dysfunction

Elderly patients

Elderly patients often experience a more pronounced antihypertensive effect and a longer duration of action of the drug, which is associated with a decrease in the rate of elimination of enalapril, so the recommended initial dose is 1.25 mg.

In elderly patients, the dose is adjusted depending on renal function.

Overdose

Symptoms: approximately 6 hours after ingestion - a pronounced decrease in blood pressure until the development of collapse, water-electrolyte imbalance, renal failure, hyperventilation, tachycardia, palpitations, bradycardia, dizziness, anxiety, cough, convulsions, stupor. After oral administration of enalapril at a dose of 300 and 440 mg, serum concentrations of enalaprilat in blood plasma exceeded the usual therapeutic concentrations by 100 and 200 times, respectively.

Treatment: the patient should be placed in a horizontal position with a low headboard. In mild cases, gastric lavage and oral administration are indicated. activated carbon; in more serious cases - intravenous infusion of 0.9% sodium chloride solution, plasma expanders, and, if necessary, intravenous administration of catecholamines. It is possible to remove enalaprilat by hemodialysis, the elimination rate is 62 ml/min. In patients with bradycardia that is resistant to therapy, pacemaker placement is indicated. Serum electrolytes and serum creatinine concentrations should be carefully monitored.

Interaction

The risk of developing arterial hypotension, hyperkalemia and renal dysfunction (including acute renal failure) is higher in the case of double blockade of the RAAS, i.e. with simultaneous use of angiotensin II receptor antagonists, ACE inhibitors or aliskiren, compared with the use of a drug from one of the listed groups. If simultaneous use of drugs is necessary, it is recommended to monitor blood pressure, renal function and water and electrolyte balance.

Concomitant use of enalapril with aliskiren in patients with diabetes mellitus or renal impairment (KR<60 мл/мин) противопоказано.

ACE inhibitors reduce potassium loss caused by diuretics. The simultaneous use of enalapril and potassium-sparing diuretics (such as spironolactone, eplerenone, triamterene, amiloride), potassium supplements or potassium-containing salt substitutes, as well as the use of other drugs that increase the content of potassium in the blood plasma (for example, heparin) can lead to hyperkalemia. If concomitant use is necessary, use caution and regularly monitor serum potassium levels.

Previous therapy with diuretics in high doses may lead to a decrease in blood volume and an increased risk of developing arterial hypotension during the initiation of enalapril therapy. Excessive antihypertensive effects can be reduced by discontinuing the diuretic, increasing water or table salt intake, and by starting treatment with enalapril at a low dose.

Concomitant use of beta-blockers, alpha-blockers, ganglion-blocking agents, methyldopa, slow calcium channel blockers, nitroglycerin or other nitrates with enalapril can further reduce blood pressure.

With the simultaneous use of ACE inhibitors with lithium preparations, a transient increase in serum lithium concentration and the development of lithium intoxication were observed. The use of thiazide diuretics may lead to an additional increase in serum lithium concentrations and the risk of lithium toxicity with simultaneous use of ACE inhibitors. Concomitant use of enalapril with lithium is not recommended. If this combination is necessary, serum lithium concentrations should be carefully monitored.

The simultaneous use of certain anesthetics, tricyclic antidepressants and antipsychotics (neuroleptics) with ACE inhibitors may lead to an additional decrease in blood pressure.

Concomitant use of NSAIDs (including selective COX-2 inhibitors) may weaken the antihypertensive effect of ACE inhibitors or angiotensin II receptor antagonists. NSAIDs and ACE inhibitors have an additive effect on increasing serum potassium, which may lead to a reversible deterioration of renal function, especially in patients with existing renal impairment.

In rare cases, acute renal failure may develop, especially in patients with impaired renal function (for example, in elderly patients or with severe hypovolemia, including while using diuretics). Before starting therapy, it is necessary to replenish the blood volume. During treatment, it is recommended to monitor renal function.

Epidemiological studies suggest that the simultaneous use of ACE inhibitors and hypoglycemic agents (insulin and oral hypoglycemic drugs) may lead to an increased hypoglycemic effect with a risk of developing hypoglycemia. More often, hypoglycemia develops in the first weeks of therapy in patients with impaired renal function.

Ethanol enhances the antihypertensive effect of ACE inhibitors.

Sympathomimetics may reduce the antihypertensive effects of ACE inhibitors.

It is safe to use enalapril simultaneously with acetylsalicylic acid (as an antiplatelet agent), thrombolytics and beta-blockers.

Weakens the effect of medications containing theophylline.

Concomitant use of allopurinol, cytostatics and immunosuppressants (including methotrexate, cyclophosphamide) with ACE inhibitors may increase the risk of developing leukopenia. When used simultaneously with allopurinol, the risk of developing an allergic reaction increases, especially in patients with impaired renal function.

Concomitant use of cyclosporine with ACE inhibitors may increase the risk of developing hyperkalemia.

Antacids may reduce the bioavailability of ACE inhibitors.

When using ACE inhibitors, incl. enalapril, in patients receiving intravenous gold preparations (sodium aurothiomalate), a symptom complex was described, including facial flushing, nausea, vomiting, and arterial hypotension.

There were no clinically significant pharmacokinetic interactions of enalapril with hydrochlorothiazide, furosemide, digoxin, timolol, methyldopa, warfarin, indomethacin, sulindac and cimetidine.

When used simultaneously with propranolol, the concentration of enalaprilat in the blood serum decreases, but this effect is clinically insignificant.

Side effects

Classification of the frequency of side effects (WHO): very often (≥1/10), often (≥1/100 and<1/10), нечасто (≥1/1000 и <1/100), редко (≥1/10 000 и <1/1000), очень редко (<1/10 000), частота неизвестна (не может быть оценена на основании имеющихся данных). В каждой группе нежелательные эффекты представлены в порядке уменьшения их тяжести.

From the hematopoietic system: infrequently - anemia (including aplastic and hemolytic), rarely - neutropenia, decreased hemoglobin and hematocrit, thrombocytopenia, agranulocytosis, inhibition of bone marrow hematopoiesis, pancytopenia, lymphadenopathy, autoimmune diseases.

From the side of metabolism: infrequently - hypoglycemia.

From the nervous system: very often - dizziness; often - headache, depression; infrequently - confusion, insomnia, drowsiness, paresthesia, increased excitability, vertigo; rarely - changes in the nature of dreams, sleep disturbances.

From the senses: often - a change in taste perception; infrequently - tinnitus; very rarely - blurred vision.

From the cardiovascular system: often - marked decrease in blood pressure (including orthostatic hypotension), syncope, chest pain, cardiac arrhythmias, angina pectoris; uncommon - palpitations, myocardial infarction or stroke (due to a sharp decrease in blood pressure in high-risk patients); rarely - Raynaud's syndrome.

From the respiratory system: very often - cough; uncommon - rhinorrhea, sore throat and hoarseness, bronchospasm/bronchial asthma; rarely - shortness of breath, pulmonary infiltrates, rhinitis, allergic alveolitis/eosinophilic pneumonia.

From the digestive system: very often - nausea; often - diarrhea, abdominal pain, flatulence; uncommon - ileitis, intestinal obstruction, pancreatitis, vomiting, constipation, anorexia, dry oral mucosa, peptic ulcer; rarely - impaired liver function and bile secretion, hepatitis (hepatocellular or cholestatic), including liver necrosis, cholestatic jaundice, stomatitis/aphthous ulcers, glossitis; very rarely - angioedema of the intestine.

From the skin: often - skin rash; uncommon - increased sweating, itching, alopecia; rarely - erythema multiforme, Stevens-Johnson syndrome, exfoliative dermatitis, toxic epidermal necrolysis, pemphigus, erythroderma.

A symptom complex has been described that may include fever, myalgia/myositis, arthralgia/arthritis, serositis, vasculitis, increased ESR, leukocytosis and eosinophilia, and a positive test for antinuclear antibodies. Skin rash, photosensitivity reactions, or other skin manifestations may occur.

From the urinary system: infrequently - impaired renal function, proteinuria, renal failure; rarely - oliguria.

From the reproductive system: infrequently - decreased potency; rarely - gynecomastia.

From the musculoskeletal system: infrequently - muscle cramps.

From laboratory parameters: often - hyperkalemia, increased concentration of creatinine in the blood serum; infrequently - hyponatremia, increased concentration of urea in the blood serum; rarely - increased activity of liver transaminases and bilirubin concentration.

Allergic reactions: often - hypersensitivity reactions/angioedema of the face, lips, tongue, pharynx and/or larynx; infrequently - skin itching, urticaria.

Other: frequency unknown - syndrome of inappropriate ADH secretion.

Adverse events identified during post-marketing use of the drug Enap ® , but no cause-and-effect relationship with the drug was established: urinary tract infections, upper respiratory tract infections, bronchitis, cardiac arrest, atrial fibrillation, herpes zoster, melena, ataxia, thromboembolism of pulmonary branches artery and pulmonary infarction, hemolytic anemia, including cases of hemolysis in patients with glucose-6-phosphate dehydrogenase deficiency.

Indications

• essential hypertension;
• chronic heart failure (as part of combination therapy);
• prevention of the development of clinically significant heart failure in patients with asymptomatic left ventricular dysfunction (as part of combination therapy);
• prevention of coronary ischemia in patients with left ventricular dysfunction in order to reduce the incidence of myocardial infarction and reduce the frequency of hospitalizations for unstable angina.

Contraindications

• history of angioedema associated with the use of ACE inhibitors;
• hereditary angioedema or idiopathic angioedema;
• simultaneous use with aliskiren in patients with diabetes mellitus or renal impairment (KR<60 мл/мин);
• porphyria;
• pregnancy;
• lactation period (breastfeeding);
• age under 18 years (efficacy and safety have not been established);
• lactose intolerance, lactase deficiency, glucose-galactose malabsorption syndrome;
• hypersensitivity to enalapril and other components of the drug;
• hypersensitivity to other ACE inhibitors.

The drug should be used with caution in patients with bilateral renal artery stenosis or stenosis of the artery of a single kidney; with primary hyperaldosteronism; hyperkalemia; after kidney transplantation; with aortic stenosis and/or mitral stenosis (with hemodynamic disorders); hypertrophic obstructive cardiomyopathy (HOCM); with reduced blood volume (including with diarrhea, vomiting); with systemic connective tissue diseases (including scleroderma, systemic lupus erythematosus); IHD; with inhibition of bone marrow hematopoiesis; cerebrovascular diseases (including cerebrovascular insufficiency); with diabetes mellitus; renal failure (proteinuria - more than 1 g/day); liver failure; in patients on a salt-restricted diet or on hemodialysis; simultaneously with immunosuppressants and diuretics; in elderly patients (over 65 years old).

Features of application

Use during pregnancy and breastfeeding

The use of Enap ®, like other ACE inhibitors, is not recommended in the first trimester of pregnancy. The use of ACE inhibitors, incl. the drug Enap ® is contraindicated in the second and third trimesters of pregnancy.

Epidemiological data on the risk of teratogenic effects of ACE inhibitors during pregnancy do not allow us to draw definitive conclusions. However, the possibility of teratogenic effects cannot be excluded. If it is necessary to use ACE inhibitors, the patient must be transferred to therapy with another antihypertensive drug with a proven safety profile for pregnant women.

If pregnancy is confirmed, Enap ® should be discontinued as soon as possible.

Taking ACE inhibitors in the second and third trimesters of pregnancy can cause fetotoxic effects (impaired renal function, oligohydramnios, delayed ossification of the skull bones) and neonatal toxic effects (renal failure, arterial hypotension, hyperkalemia).

If the patient took an ACE inhibitor in the second and third trimesters of pregnancy, it is recommended to perform an ultrasound scan of the fetal kidneys and skull bones.

In those rare cases where the use of an ACE inhibitor during pregnancy is considered necessary, periodic ultrasound should be performed to assess the amniotic fluid index. If oligohydramnios is detected during ultrasound, it is necessary to stop taking the drug. Patients and physicians should be aware that oligohydramnios occurs when there is irreversible damage to the fetus. If ACE inhibitors are used during pregnancy and the development of oligohydramnios is observed, then, depending on the stage of pregnancy, a stress test, a non-stress test or a fetal biophysical profile may be required to assess the functional status of the fetus.

Newborns whose mothers took ACE inhibitors during pregnancy should be monitored due to possible hypotension. Enalapril, which crosses the placenta, can be partially removed from the neonatal circulation by peritoneal dialysis, and theoretically it can be removed by exchange transfusion.

Enalapril and enaprilat are detected in breast milk in trace concentrations, therefore, if it is necessary to use the drug Enap ® during lactation, breastfeeding should be discontinued.

Use for liver dysfunction

The drug should be used with caution in patients with liver failure.

Use for renal impairment

In patients with impaired renal function, the intervals between doses should be increased and/or the dose of Enap ® should be reduced.

* Enalaprilat is eliminated by hemodialysis. In the interval between hemodialysis sessions, the dose of the drug should be adjusted under blood pressure monitoring.

The drug should be used with caution in patients with bilateral renal artery stenosis or stenosis of the artery of a single kidney, after kidney transplantation, renal failure (proteinuria - more than 1 g/day), in patients on hemodialysis.

Use in children

The use of the drug is contraindicated in children and adolescents under the age of 18 years (efficacy and safety have not been established).

special instructions

Arterial hypotension

Symptomatic hypotension rarely occurs in patients with uncomplicated hypertension. Arterial hypotension with all clinical manifestations can be observed after the first dose of Enap ® in patients with hypovolemia, as a result of diuretic therapy, a salt-free diet, diarrhea, vomiting or hemodialysis. The development of symptomatic hypotension is more likely in patients with severe heart failure due to the use of high doses of diuretics, hyponatremia or impaired renal function. In such patients, treatment should begin under the supervision of a physician until the optimal dose adjustment of Enap ® and/or diuretic. Similar tactics can be applied to patients with coronary artery disease or cerebrovascular diseases, in whom a sharp excessive decrease in blood pressure can lead to the development of myocardial infarction or cerebrovascular accident.

If severe arterial hypotension develops, it is necessary to transfer the patient to a horizontal position with a low head and, if necessary, administer a 0.9% sodium chloride solution intravenously.

Transient arterial hypotension is not a contraindication for further treatment with Enap ® . After stabilization of blood pressure and blood volume, therapy can be continued.

In some patients with heart failure and normal or low blood pressure, it may be further reduced when taking Enap ® . This effect is predictable and is not a reason to discontinue therapy. If arterial hypotension is accompanied by clinical symptoms, the dose should be reduced and/or the diuretic and/or Enap should be discontinued.

Aortic or mitral stenosis, HOCM

Like all vasodilators, ACE inhibitors should be used with caution in patients with valvular obstruction and left ventricular outflow tract hypertrophy. Should not be used in patients with cardiogenic shock and hemodynamically significant left ventricular obstruction.

Renal dysfunction

In patients with renal failure (KR<80 мл/мин (1.33 мл/с)) начальную дозу препарата Энап ® следует подбирать, в первую очередь, с учетом КК и, затем, клинического ответа на лечение. У таких пациентов следует регулярно контролировать содержание калия и концентрацию креатинина в сыворотке крови.

In patients with severe heart failure and kidney disease, including renal artery stenosis, renal failure may develop when treated with Enap ®. The changes were usually reversible after discontinuation of the drug Enap ® .

In some patients with arterial hypertension who did not have renal disease before treatment, there was a slight and transient increase in serum urea and creatinine concentrations when using the drug Enap ® . In such cases, it may be necessary to reduce the dose of Enap ® and/or discontinue the diuretic. This situation indicates the possibility of hidden renal artery stenosis.

Renovascular hypertension

In patients with bilateral renal artery stenosis or arterial stenosis of a single functioning kidney, when treated with ACE inhibitors, the risk of developing arterial hypotension and renal failure is increased. Only minor changes in serum creatinine concentration may indicate a decrease in renal function. In such patients, treatment should be started with small doses under close medical supervision. The dose should be titrated carefully and renal function monitored.

Kidney transplant

There is no experience with the use of Enap ® in patients who have recently undergone kidney transplantation. Therefore, treatment of such patients with Enap ® is not recommended.

Liver dysfunction

In rare cases, therapy with ACE inhibitors was accompanied by the development of a syndrome starting with cholestatic jaundice and hepatitis up to the development of fulminant liver necrosis. The mechanism of development of this syndrome is unknown. If jaundice or a significant increase in liver enzyme activity occurs, treatment with the ACE inhibitor should be stopped immediately, the patient's condition should be carefully monitored and, if necessary, treatment should be administered.

Neutropenia/agranulocytosis

Cases of neutropenia/agranulocytosis, thrombocytopenia and anemia have been described in patients using ACE inhibitors. In patients with normal renal function in the absence of other complications, neutropenia rarely develops. The drug Enap ® should be used with great caution in patients with connective tissue diseases (including systemic lupus erythematosus, scleroderma) who are simultaneously receiving immunosuppressive therapy, allopurinol or procainamide, as well as a combination of these factors, especially with existing renal dysfunction . These patients may develop severe infections that do not respond to intensive antibiotic therapy. If patients still take the drug Enap ®, it is recommended to periodically monitor the number of leukocytes in the blood. The patient should be warned that if any signs of infection appear, they should consult a doctor immediately.

Hypersensitivity/angioedema

In patients receiving ACE inhibitors, including Enap ® , there have been reports of the development of angioedema of the face, extremities, lips, vocal folds and/or larynx at any time after the start of treatment. You should immediately discontinue the drug Enap ® and monitor the patient until symptoms disappear completely. Even in the case of tongue swelling, when there is only difficulty swallowing without respiratory distress, patients may require long-term observation, because the use of antihistamines and corticosteroids may be insufficient.

Angioedema of the larynx or tongue can be fatal in very rare cases. Swelling of the tongue, vocal folds, or larynx can lead to airway obstruction, especially after a history of airway surgery. If there is swelling of the tongue, vocal folds or larynx, appropriate therapy is indicated, which may include: subcutaneous administration of a 0.1% solution of epinephrine (adrenaline) (0.3 ml-0.5 ml) and/or measures aimed at restoring airway patency (intubation or tracheostomy).

Among black patients receiving ACE inhibitor therapy, the incidence of angioedema is higher than among patients of other races.

Patients with a history of angioedema not associated with ACE inhibitors are at increased risk of developing angioedema when using any ACE inhibitor.

Anaphylactoid reactions during desensitization with Hymenoptera (Hymenoptera) venom

Patients taking ACE inhibitors during hymenoptera venom desensitization have rarely developed life-threatening anaphylactoid reactions. To prevent such reactions, it is necessary to temporarily stop taking the ACE inhibitor during desensitization procedures.

Anaphylactoid reactions during LDL apheresis

Life-threatening anaphylactoid reactions have occurred in rare cases in patients receiving ACE inhibitors during LDL apheresis with dextran sulfate. The drug should be temporarily replaced with drugs from another group.

Hemodialysis

Due to the increased risk of anaphylactoid reactions, the drug should not be used in patients undergoing hemodialysis using high-flow polyacrylonitrile membranes (AN69 ®). If hemodialysis is necessary, it is advisable to use dialysis membranes of a different type or antihypertensive drugs of a different group.

Hypoglycemia

In patients with diabetes mellitus receiving oral hypoglycemic agents or insulin, blood glucose concentrations should be carefully monitored during the first month of treatment with an ACE inhibitor.

When using the drug Enap ®, a dry, unproductive, prolonged cough may occur, which disappears after stopping the use of ACE inhibitors, which must be taken into account in the differential diagnosis of cough during the use of an ACE inhibitor.

Surgery/general anesthesia

Before surgery (including dental procedures), you must warn the surgeon/anesthesiologist about the use of the drug Enap ® . During major surgery or general anesthesia with the use of drugs that cause arterial hypotension, ACE inhibitors may block the formation of angiotensin II in response to compensatory release of renin. If a pronounced decrease in blood pressure develops, explained by a similar mechanism, it can be corrected by introducing plasma substitutes.

Hyperkalemia

May develop during treatment with ACE inhibitors, incl. with the drug Enap ®. Risk factors for the development of hyperkalemia are renal failure, old age (over 70 years), diabetes mellitus, some concomitant conditions (decrease in blood volume, acute heart failure in the stage of decompensation, metabolic acidosis), simultaneous use of potassium-sparing diuretics (spironolactone, eplerenone, triamterene, amiloride) , as well as potassium preparations or potassium-containing substitutes and the use of other drugs that increase the content of potassium in the blood plasma (for example, heparin).

The use of potassium supplements, potassium-sparing diuretics and table salt substitutes containing potassium can lead to a significant increase in serum potassium levels, especially in patients with impaired renal function. Hyperkalemia can cause serious heart rhythm problems, sometimes fatal. The simultaneous use of the above drugs should be carried out with caution under the control of potassium levels in the blood serum.

The simultaneous use of lithium salts and the drug Enap ® is not recommended.

Ethnic characteristics

The drug Enap ® , like other ACE inhibitors, has a less pronounced antihypertensive effect in patients of the Negroid race compared to representatives of other races.

Special information on excipients

The drug Enap ® contains lactose, therefore the drug is contraindicated in patients with lactase deficiency, lactose intolerance, and glucose-galactose malabsorption syndrome.

Impact on the ability to drive vehicles and operate machinery

When using the drug Enap ®, care must be taken when driving vehicles and performing other potentially hazardous types of work that require increased concentration and speed of psychomotor reactions (dizziness may develop due to a sharp decrease in blood pressure, especially after taking the initial dose of the drug Enap ® in patients taking diuretics ).

Stress is a complex psycho-emotional state in which a person cannot control himself. He is confused and lost, his speech is impaired, confusion appears, and anxiety develops.

Acute reaction to stress

An acute reaction to stress occurs in people who do not take care of their own mental health. They work hard, get little rest, and worry about every little thing that doesn't matter.

Definition

An acute reaction to stress occurs as a natural phenomenon. This is a consequence of protracted experiences that are difficult to ignore. A person is in constant anxiety: he is scared, it’s hard, he cannot concentrate or sleep normally. His entire body is in constant tension. This condition does not go away for weeks and results in a number of symptoms.

The characteristics of stress directly depend on the nature of the individual, habits, and close environment. The stronger she is, the fewer negative processes occur in her life. A person has a simple reaction to stress only in cases where he has high stress resistance. He knows how to distance himself from difficulties and overcome difficulties without harming himself.

A stress-resistant person experiences problems easily

Emergency responses are abnormal reactions caused by constant internal stress. A person does not rest, does not discharge, does not calm down: due to constant stress, internal organs, nervous and cardiovascular systems suffer. Acute reactions are the result of neglect of psychological problems that are a consequence of unfavorable environmental factors.

Symptoms

Where does the acute stress response come from? It stems from the causes of the nervous condition, which determine the general symptoms. If a person experiences problems at work, then his aggression and internal tension are completely directed towards work matters. Troubles at home provoke changes in the behavior of the stress victim, which affect household members.

Changes in behavioral factors under stress occur gradually. Whatever the root cause of stress, it develops gradually:

• the victim becomes fixated on one thought or process - this is a problem that becomes a stress factor;
• internal tension grows around the disturbing thought;
• the victim throws all his energy into thinking about the problem, neglecting other areas of life;
• the daily routine and sleep are disrupted, the first changes in the behavior of the stress victim appear;
• fatigue accumulates;
• spontaneous aggression appears, which alternates with complete apathy;
• the person withdraws into himself.

The body reacts to stress, it protects itself from a difficult moral and physical situation, and signals that obsession is not beneficial. Therefore, acute symptoms are not the main problem, but only its manifestation. Psychological disturbances entail physiological changes.

A personal reaction to stress depends on how self-confident a person is, how often he seeks help, and what is his level of adaptability and receptivity. A dozen factors create resistance to stress and allow you to quickly overcome difficulties. If this does not happen, and adaptation disorder or mental disorders manifest themselves, then it will not be possible to get rid of stress without additional methods (drug and therapeutic treatment).

General signs

What does stress look like? A complex psycho-emotional state manifests itself over time in the form of a number of symptoms: if at the initial stages changes in a person’s behavior are barely noticeable, then after a few days they begin to be noticeable. Stress manifests itself when a person cannot cope with his emotions and obsessive thoughts.

General symptoms of severe stress:

• isolation and alienation;
• disturbance of sleep patterns: a person is sleepy during the day, but at night cannot fall asleep due to anxious thoughts;
• eating disorder – the victim of stress overeats or starves;
• rapid mood swings (apathy quickly gives way to excessive activity);
• reduced ability to work;
• reduced concentration.

The severity of stress symptoms depends on a person’s openness: extroverts are ready to solve their problems and seek help, but introverts have a harder time talking about the troubles that have happened. The body's response to stress is a factor that determines the treatment of a complex condition, and the sooner a stress victim seeks help, the easier it will be to return to a full life.

The general symptoms of stress depend on the accompanying conditions: a person’s standard of living, his relationships (family and professional), social status. Each stress is a unique condition that requires individual treatment.

Causes

A reaction to severe stress is built as a defense, which intensifies as the stress factor influences. The more strongly it affects a person, the less chance she has of getting rid of disturbing thoughts. Psychological reactions to stress depend on:

• from personality education;
• from her social role;
• on the standard of living (material and social living conditions);
• from harmony in other areas.

If problems are leveled out by successes in other areas of life, it is easier to survive stress. Inner tension is more difficult for adults who, since childhood, have not known their parents’ support and have not seen self-care. Such individuals grow up complex and unsure of themselves: they perceive any difficulties in an exaggerated way, as confirmation of internal fears. The occurrence of an excessive reaction to a stressful state in such cases is an inevitable process.

The more responsibility a person bears, the stronger the external pressure. It creates all the prerequisites for the emergence of anxiety. People in leadership positions work a lot and worry a lot.

Managerial stress negatively affects the entire enterprise

If you do not relieve tension in a timely manner, you can have a breakdown, because their responsibility increases stress.

Forms of reactions

The types of acute stress reactions depend on the time of their development. There are 2 phases of acute reaction:

• excitation;
• braking.

A person’s adaptive behavior changes after going through two phases, when the stressful state turns into “imaginary death.” The nervous system experiences a heavy load during the first phase, when all human reactions are exacerbated.

Forms of stress response help in diagnosing a person’s condition. If he is having an attack and needs urgent medical attention, general symptoms during excitation or inhibition (only an acute reaction to a difficult situation) will help to correctly establish the diagnosis.

Excitation phase

During the arousal phase, a person is active - his actions are spontaneous and chaotic. He gesticulates a lot, tries to explain something in a raised voice. The nervous system of the victim of a phobia is in a state of strong excitement. She is trying to relieve the load, so she takes out her aggression on the world around her.

Against the background of severe overexcitation, a person’s concentration is impaired. He does not understand what they are saying to him in response, what they are trying to convey to him. The victim's arguments seem very convincing to her, although his speech is very confused and emotionally charged. At this stage, the stress response does not allow the person to calm down until the stress factor - the situation or person that caused the acute defensive reaction - disappears.

Braking phase

The second phase is the opposite of excitement. Being in it, a person does not react to anything, he is not concerned about either the problem or its solution. The victim cannot remain in an excited state for a long time, so indifference for him is a kind of escape from reality. This is the only way she can reduce her anxiety level.

At this stage, even an acute reaction is accompanied by stupor and apathy. A person cannot quickly react to changing circumstances - everything that happens to him seems unreal and distant. Inhibition concerns facial expressions, gestures, and speech.

Overreaction

A certain reaction to a stressful state occurs: symptoms that signal a problem, but do not prevent a person from leading a full life. An acute reaction to stress occurs less frequently and is a sign of dangerous mental changes.

Mental reactions that cannot be controlled create a threat to a person and his immediate environment. Acute symptoms resemble a panic attack when the person is unconscious. She shakes, her heart rate increases and her pulse quickens. Tremor of the lower and upper extremities occurs spontaneously when a stress factor appears. The person cannot calm down. One thought about the cause of a complex psycho-emotional state causes fear and corresponding symptoms.

Problems at work - stress factor

Manifestation in everyday life

It is more difficult to cope with the symptoms that accompany all processes in a person’s life. Overeating or starving affects a person's overall well-being. Hyperphagia (uncontrolled food consumption) is a reaction to stress. This is a psychological need to find a monotonous process that will temporarily distract from disturbing stressful thoughts.

Sleep disturbances are also observed due to psychological causes of stress. A person who does not know how to let go of grievances, the past and mistakes continues to live with them. For the subconscious mind, worries about what happened are tantamount to stress that is happening right now. Panic attacks and fear are caused by thoughts and internal attitudes of the victim of stress. This process can last for years until the body is completely exhausted.

Main causes of acute reaction

The causes of stress and the reasons why an acute reaction occurs may differ. If, against the background of reduced stability, a person is susceptible to nervousness and apathy, then attacks of aggression, panic and depression arise for a number of reasons:

• mental disorders;
• difficult living conditions;
• suppressed fears;
• experienced traumas.

Depressive disorder develops only after a long period of acute symptoms: the longer a person endures the influence of obsessive thoughts, the more stressed he is. Diagnosis of a disease with an acute reaction of the body is carried out only after visiting a psychologist, who will determine the main psychological cause of stress.

Deep depression

Whatever the stress factor, the event that triggers it, the cause always originates earlier. It is formed in early childhood or adulthood. These are beliefs and attitudes, parts of a person’s character and habits. Therefore, to treat stress that results in depression, only medications are not used - correction of the patient’s behavior is mandatory.

Low resistance to troubles

Low psychological stability depends on stress, and the behavior of the victim depends on its resilience. These are interrelated concepts: if a person knows what events scare him, he can change his attitude towards them. Stress is helplessness, ignorance, incompetence. There is a problem (physical or psychological) that a person cannot cope with. This is not just an obstacle, but a factor that changes a person’s opinion about the world around him.

Mental stability is built on self-confidence: even if a person makes mistakes and is in trouble, she knows that problems do not last forever. She is confident in herself, her surroundings, and the variability of conditions. People who are not afraid of the future or the unknown are highly resistant to problems: if changes are coming, the personality is ready to adapt and change. This is an adaptive person, sociable and receptive. It is not difficult for him to find a new place, so difficulties do not cause much stress.

Mental disorders

The cause of a strong negative reaction to stress may be mental disorders. This is a disease that affects the perception of reality. A person does not see the objective reasons for everything that happens to him - he is scared or lost. Strong feelings due to stress are caused by the illogicality and irrationality of the sick person. He does not perceive difficulties and does not know how to solve them within the framework of social norms.

Stress, tension, aggression

Mental disorder may be accompanied by increased aggressiveness. Psychosis and hysteria are common symptoms of mental disorders, so the victim of a phobia cannot control anger or aggression.

Experienced traumas

Events that leave an imprint on a person’s memory and subconscious can dictate how a person should live. If a stress victim has experienced severe trauma, it is difficult for her to return to a full life. She tries to adapt, but the pressure of others does not allow her to get used to it - in most cases, the victim hides true experiences and accumulates negativity, which becomes the basis for future stress.

Depression after a breakup

Post-traumatic disorder is the cause of an acute reaction to any stressful event. The mental protection of military personnel or soldiers is so weakened that they cannot control their own reactions. With such patients, separate therapeutic measures are carried out to restore their skills and reactions.

Difficult living conditions

It is difficult to resist difficulties if a person lives in difficult conditions. If he is mired in debts, responsibilities, constant squabbles. Difficult living conditions are additional stress factors that do not help a person recover, but only aggravate his psycho-emotional state.

Reasons for an acute reaction to difficulties:

• lack of your own home - fear of the unknown, fear of being on the street;
• lack of stability;
• lack of support.

A person is part of society, and if society pushes him away, he loses his role. The lost person does not know how to cope with obsessive thoughts. He is withdrawn and constantly depressed.

Difficult moral living conditions that last more than one day cause an increased reaction to any difficult situation. Over time, a person gets used to experiencing constant stress and builds a kind of comfort zone around strong psycho-emotional experiences.

Phobias and repressed fears

Repressed fears destroy mental defenses. Phobias develop either in early childhood or in adulthood. The role of irrational fear is very large. Suppressed anxieties do not find a way out and, at every opportunity, result in a strong negative reaction.

Fear of the future and the unknown under the influence of a negative factor (dismissal or reprimand) causes a person to fall into hysteria. He loses sleep, cannot concentrate and collect himself. Suppressed fears weaken the defense mechanisms of the psyche day after day. As long as there is no stress, the influence of the phobia is less noticeable, but with any difficulty, all the accumulated aggression and fear manifests itself.

Consequences

Why is it so important to treat stress? Acute symptoms decrease over time, but the load on the human body remains the same. The more he worries about a stressor, the more he harms himself. Anxiety, fear and internal tension accumulate, and a person gets used to the feeling that he feels bad. He adapts to constant fear and expectation of bad events. The acute reaction decreases, and under unfavorable conditions it returns in a more acute form. With each new attack, the nervous system of the stress victim is exhausted - it cannot fight new threats.

Against the background of stress, phobias appear - natural fears. Trembling and chills, other symptoms find a logical justification: the phobia develops quickly and rules the life of a weak person. A person exhausted by constant internal tension cannot receive treatment. He comes to terms with a new life in which stress comes first. Identifying symptoms and treating stress are the primary tasks of every person who wants to manage their own life.

For the psyche

A complex psycho-emotional state threatens a person’s mental health. It changes: phobias, fears, experiences distort character and habits. Common consequences of frequent acute reactions in humans:

• psychoses;
• hysteria;
• aggressiveness and temper;
• nervousness.

Attacks of aggression are a symptom of stress

A person loses patience with everything that upsets him even more. He quarrels with close people, relatives, colleagues. Problems become the norm, and the individual does not want to fight them. It is easier for her to make excuses, relieve tension, and then ask for forgiveness, rather than find methods to deal with stress.

Constant attacks affect a person’s judgment. He does not know how to see his own mistakes, so he is aggressive, hysterical, and angry. It is difficult to find a common language with such a person. Associated phobias force a person to choose imprisonment - to escape from people who demand explanations for actions and words. Forced solitude brings welcome temporary peace.

For the body

Not only the nervous system, but also the cardiovascular system suffers from a constant acute reaction. Due to eating disorders, gastrointestinal diseases appear.

The human immune system is depleted. Dermatitis and wounds appear if a person begins to scratch his skin due to nervous tension. Any physiological consequences must be treated in a complex manner while getting rid of the stressful condition.

Depressive state

Depression is the most common complication of an acute stress response. The person ignores the symptoms, does not pay attention to depression and continues to live with the problem, constantly thinking about it. Depression manifests itself against the background of apathy, when a person is indifferent to everything that previously brought him pleasure.

Depression is a serious mental disorder that requires consultation with a doctor. This is a violation of mental functions and reactions to irritating factors of all types. The longer a person suffers from depression, the less aware he is of its destructive impact.

The onset of depression

An acute reaction appears and disappears. A person lives between mood swings, when he is happy at one moment and then sad. Over time, this leads to emotional burnout. A person cannot constantly be under tension: fatigue and apathy in such cases are a normal defensive reaction. Depression occurs due to thoughts that continue to torment a person.

Depression from chronic fatigue

Concomitant phobias and fears worsen the course of depression. It appears abruptly: the person himself does not notice the transition, but sees the consequences of depression. A person with depression feels bad and sad: she does not find joy in what she does or in what she loved before. Burnout is to blame due to frequent acute reactions of the body due to severe shock.

Prevention Methods

An acute reaction cannot be ignored. Suppressed emotions do not disappear, but only delay the outburst of negativity. To cope with the stress on the psyche, it is necessary to eradicate the reaction and rebuild your own body.

In emergency situations, people with low resistance to problems will benefit from breathing exercises. This is a simple system of exercises that helps you calm down. It is necessary to take a comfortable position - sitting or standing. It’s better to arrange yourself so that no one interferes with your calm. It is necessary to adjust your breathing calmly, then take a deep breath and hold your breath for 2-3 seconds. Then return to calm breathing. This exercise is repeated several times. It is useful only in cases where the reaction is very acute and you urgently need to calm down.

Working on thinking

Stress factors and reactions to them directly depend on how a person perceives the world, that is, subjectively evaluates events or people. If a stress factor originates in a person’s mind, then it must be eradicated using psychological methods. One of the most effective is cognitive behavioral therapy. The method is based on the search for beliefs that give rise to attitudes that develop into a defensive reaction. If a person perceives a problem in an exaggerated way, it is necessary to find the reason for such an attitude towards a specific trouble.

If a person can find the reason for false beliefs, he will be able to draw a new conclusion - change his attitude. After this, the reaction to the stress factor will change. To correct thinking, auto-trainings are used: techniques that allow you to tune into a positive mood. With their help (daily repetition of motivating phrases - affirmations) it will be possible to increase self-esteem and resistance to problems.

Body work

Harmony is a balance that we need to strive for. If a person reacts sharply to stress, she needs to take care of protecting her psyche and body. Maintaining good physical shape will make it easier to cope with stressful situations. Sports, especially group exercises, will help you find good company for communication and take your mind off problems.

Yoga classes are a combination of physical activity and relaxation techniques that will tone the body. Such exercises clear thoughts, relieve unnecessary worries and drive away negativity. Comprehensive work on the body and mind will help protect you from stress, no matter what the cause.

Conclusion

Stress is dangerous for men and women. These are complex psycho-emotional experiences due to a stress factor. They are accompanied by a violent reaction of the body; the symptoms of stress can harm a person.

To prevent the dangerous consequences of stress, it is necessary to strengthen the body's defense mechanisms, that is, improve resistance to stress. Working on yourself will give good results.

Synonyms: acute stress reaction, post-traumatic stress disorder, post-traumatic stress disorder with anger

Acute reaction to stress:
Reaction to stress in the mental and social sphere with manifestations that go beyond the normal and expected reaction to stressful life situations
Appears within 1 hour, disappears after 48 hours. Reactive changes are also possible in healthy people, for example, in an adequate form of processing (for example, loss, mourning, grief). Differentiation of these disorders is carried out based on the type, severity and duration of the initial load and reactive symptoms

Epidemiology of stress disorder. Currently, there is no reliable information on the frequency and prevalence of these disorders

:
Stressful situation
Neurobiological vulnerability
Personality characteristics
Social factors

Important: The cause-and-effect relationship between the traumatic situation and the subsequent inadequate reaction is clearly visible.

Increased risk when:
Organic disorders
Accented personality traits
Neurotic personality manifestations
Severe fatigue

Protective factors:
Coping-Strategies
Stable social network
Neurobiological theory: the role of catecholamine metabolism and individual predisposition to overreactions
Learning theory: relinquishing experiential strategies is particularly important
Model of psychoanalysis: reactions to unresolved conflicts in childhood (regression)
It is important to understand the primary and secondary benefits of the disease.

Classification of stress disorder:
Acute reaction to (ICD-10 F43.0)
Post-traumatic stress disorder (ICD-10 F43.1)

Main symptoms of stress disorder. Polymorphic symptoms; at first, often “numbness”, a feeling of internal emptiness, increased alertness or excessive fearfulness, sleep disturbance, memory impairment or focus on unhappiness, the desire to avoid actions reminiscent of the traumatic situation, an increase in symptoms under the influence of factors symbolizing or reminiscent of this situation, panic fear accompanied by autonomic disorders, followed by “withdrawal”, depression or hyperactivity

Diagnostic criteria for stress disorder

Development of a state of “narrowing of consciousness” with an inability to respond to external stimuli (with “numbness”), as well as the appearance of fear, despair, excessive activity or a state of stupor in persons who do not have other mental illnesses, occurring within a few minutes (maximum 1 hour) after excessive mental or physical stress (massive traumatic events that pose a threat to life, such as natural disasters, crimes, military operations, rape). Disappearance of symptoms within 1-2 days
The most important diagnostic criterion is pathogenetic confirmation of the temporal connection between the disorder and the stressful event (substantive and emotional attitude)

Differential diagnosis of stress disorder:
Smooth transitions from normal to pathological reactions
Exclusion of organic brain disorders and other mental disorders

Treatment:
Relief of acute conditions (moving away from the scene of the incident, engaging in conversation)
Possible single/short-term use of benzodiazepines

Course and prognosis:
Symptoms of acute stress response disappear within 3 days
If symptoms persist, see Post-traumatic stress disorder, Adjustment disorders, Depression

is a mental disorder that develops as a result of significant physical or psychological stress. The main feature of this pathological condition is the fact that it usually develops in people who do not have mental illness. In the medical classification of diseases, this disorder is listed under code F43.0.

Causes of acute stress reactions

The development of the disorder occurs after a significant traumatic experience. Often acute occurs when a person witnesses or participates in such traumatic situations as:

• murder;
• rape;
• natural disasters;
• loss of loved ones;
• a sharp change in social status.

At a moment of severe stress, a fixation occurs on such protective mechanisms as repression and extreme identification. Thus, the person enters an altered state of consciousness, accompanied by disturbances in perception and behavior.

Predisposing factors for the development of such a pathological condition as an acute reaction to stress include individual characteristics and vulnerability. In addition, certain mental features can contribute to the appearance of such a mental disorder. But at the same time, it has been established that an acute reaction does not occur in all people who find themselves in such unfavorable conditions or are forced to experience strong negative emotions.

Factors that increase the risk of developing such an acute stress reaction include being elderly or.

Symptoms of an acute stress reaction

Despite the fact that the manifestations of this mental disorder begin to rapidly increase immediately after a stressful situation, an acute reaction can last for several hours or 2-3 days. After this, the intensity of symptomatic manifestations decreases. An acute reaction to stress is accompanied by the appearance of a number of mental and physical symptoms. This condition has characteristic symptoms. At first, a person may feel a certain “stupefaction” and disorientation in space.

The field of consciousness is narrowing. A person cannot adequately respond to external stimuli. After this, a withdrawal from the surrounding reality may occur. In some cases, the formation of a dissociative stupor is observed, in which a person cannot even perceive adequately speech addressed to him. In addition, often a person who has experienced extreme stress literally tries to escape from the surrounding reality. This can lead to hyperactivity.

Often such mental disorders are accompanied by an attempt to escape from the scene of the tragedy or freezing and reluctance to leave the area where the disaster occurred. In the future, the victim may exhibit behavior characterized by infantility. An acute reaction to stress may be accompanied by complete or partial amnesia of the traumatic episode. In most cases, such stress reactions become the cause of symptoms. These include:

• tachycardia;
• redness;
• increased sweating;
• fainting;
• chills or feeling hot;
• rapid breathing;
• numbness of the limbs;
• deterioration of general condition.

In severe cases, stress may cause convulsions, that is, chaotic muscle contractions, but without loss of consciousness.

In addition, a physiological reaction to stress often appears, such as a skin rash, which is very similar to hives. often accompanied by severe headaches. In most cases, such manifestations disappear within a few minutes after exposure to a traumatic factor. For several weeks after the onset of the crisis, manifestations of asthenia are observed. This condition is characterized by decreased physical and mental performance, increased fatigue, emotional instability and sleep disturbances.

Diagnosis of acute stress response

To clarify the diagnosis in the presence of such manifestations of this mental disorder, a visit to a psychiatrist is required. The specialist will not only be able to select drugs to stabilize the condition, but also drugs that will reduce the risk of complications.

To identify such a deviation, an assessment of the relationship between anamnesis and personality, as well as the form, content and severity of symptomatic manifestations, as well as the intensity of stressful events and situations causing a crisis, is required. Neurological testing and external examination will allow you to prescribe the best treatment methods.

Drug therapy for acute stress reactions

To stabilize the condition of patients experiencing acute symptoms, medications are first selected to reduce the excitability of nerve fibers. Typically, strong medications are used when symptoms persist for a long time. Depending on the severity of symptoms, neuroleptics, antidepressants and even tranquilizers are introduced into the treatment regimen.

If a person’s behavior against the background of an acute reaction to stress is inadequate and dangerous for him and others, Phenazepam is often prescribed. This is a fairly strong tranquilizing agent that can only be taken on the recommendation of a doctor. It is he who must indicate the required dosages and duration of treatment. In addition, Diazepam can also be used for acute reactions to stress. This drug belongs to the category of tranquilizers. This remedy has a pronounced calming effect.

When treating acute reactions to stress, long-term courses of antidepressants are often prescribed. There are several types of medications that are used for this pathological condition. For example, Amitriptyline is used. This drug has a sedative effect. If the body tolerates the drug well, its dose is gradually increased.

In addition, Melipramine is often used. This drug belongs to the class of antidepressants. To improve sleep, Miansan is often prescribed. This medicine should be used in dosages prescribed by your doctor.

Classic drug therapy is complemented by psychotherapy. This method of treatment is the most effective. It is aimed at changing the patient’s attitude towards the tragic event that happened in his life. In addition, psychotherapy helps to increase the patient's ability to regulate and control his more negative thoughts. With long-term work with a psychotherapist, the patient gets the opportunity to recreate new strategies for behavior in stressful situations.

Typically, if a person has had an acute stress reaction, rehabilitation will be required. To stabilize the mental state, the patient is recommended to change the environment. This will allow you to gain new positive impressions and get rid of heavy thoughts. Spa treatment can be of great benefit. A change of environment in combination with physiotherapy and relaxation allows you to stabilize your condition.

Folk remedies for acute stress reactions

If the period of crisis was short-lived and there is no opportunity to turn to specialists in the field of psychiatry, you can use some herbs. As a rule, folk remedies are used to eliminate residual effects. To normalize sleep, you can resort to baths based on herbal infusions. Water treatments with lavender have a good effect. To prepare the product, take approximately 50 g of plant flowers per 1 liter of boiling water, leave for at least 10 minutes, carefully wrapping it in a warm blanket. After this, the finished product should be filtered and poured into a hot bath. The pleasant smell coming from the water will have a relaxing effect and allow you to sleep throughout the night.

In addition, you can improve your sleep by using baths with essential oils. It is best to carry out such water procedures immediately before going to bed. It is best to use peppermint, chamomile, mint or jasmine essential oils. You need to add 5-10 drops of the selected essential oil to the bath.

You can make a “sleeping pillow” at home by filling a small rag bag with hop cones or collecting herbs such as valerian root, heather, St. John’s wort, shamrock, mint, chamomile, primrose and lavender.

To eliminate the manifestations of an acute reaction, you can use a special one. To prepare it, you will need a collection of medicinal herbs such as oregano, thyme, motherwort, valerian, and sweet clover. All plant components must be taken in equal proportions. Next 1 tbsp. l. The herbal mixture should be poured with a glass of boiling water and left to infuse for 15 minutes. Take this remedy 1/3 cup 3 times a day.

To stabilize your mental state, you can use an infusion of birch leaves. To prepare the product, take approximately 100 g of young leaves and pour 2 tbsp. boiling water The container with the composition must be carefully wrapped in a warm blanket and allowed to brew for at least 5-6 hours. The product needs to be filtered. Use the infusion ½ tbsp. 2-3 times a day 30 minutes before meals. If it is not the season for fresh birch leaves, they can be replaced with dry sweet clover grass.

It is advisable to use any folk remedies only as additional methods of treating mental disorders. In addition, it is better to use herbs after consulting a doctor.