It is not an acute reaction to stress. Stress: symptoms, causes, reaction of the body to emotional stress. Key points to be observed

Pills round, biconvex, with a 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 (hydroxypropyl cellulose), talc (hydrogen silicate), magnesium stearate.

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

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

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

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

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

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

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

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, post- and preload on the myocardium.

It dilates the arteries to a greater extent than the veins, while there is no reflex increase in heart rate.

The hypotensive effect is more pronounced with a high level of plasma renin than with normal or reduced levels. 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. Enhances coronary and renal blood flow.

With prolonged 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, therapy for several weeks is necessary to achieve the optimal level of blood pressure. In heart failure, a noticeable clinical effect is observed with prolonged use - 6 months or more.

Pharmacokinetics

Suction

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

Distribution and metabolism

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

The binding of enalaprilat to plasma proteins is 50-60%.

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

breeding

T 1/2 of 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 during hemodialysis (speed 62 ml / min) and peritoneal dialysis.

Indications for the use of the drug

- arterial hypertension;

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

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

Dosing regimen

The drug is taken orally, regardless of food intake, at the same time of day. If a drug is missed, 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 scheme and do 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 initial dose is 5 mg 1 time / day. After taking the initial dose, patients require medical supervision 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). In the absence of a clinical effect, the dose is increased after 1-2 weeks by 5 mg. Usually the maintenance dose is from 10 mg to 20 mg, if necessary and if well tolerated, the dose can be increased to 40 mg / day. The 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 (serum sodium ion concentration less than 130 mmol / l) or serum creatinine content of 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 QC 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.

At elderly patients more often there is a more pronounced hypotensive effect and a prolongation of the duration of the drug, which is associated with a decrease in the rate of excretion of enalapril, so the recommended initial dose is 1.25 mg.

At treatment of chronic heart failure the recommended initial 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 ranges from 2.5 mg to 10 mg 1 time / day; the maximum maintenance dose is 20 mg 2 times / day.

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

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

Tablets should be swallowed whole with a small amount of liquid.

Side effect

From the side of the cardiovascular system: excessive decrease in blood pressure, orthostatic collapse, rarely - retrosternal 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 side of the central nervous system and peripheral nervous system: dizziness, headache, insomnia, weakness, fatigue, drowsiness (2-3%), very rarely confusion, fatigue, very rarely when used in high doses - irritability, depression, paresthesia.

From the sense organs: violation of the vestibular apparatus, impaired hearing and vision, tinnitus.

From the respiratory system: unproductive 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 bile secretion, hepatitis (hepatocellular or cholestatic), jaundice, increased liver transaminase activity, hyperbilirubinemia.

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

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

From the hematopoietic system: decrease in the 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, pruritus, urticaria, photosensitivity, serositis, vasculitis, myositis, arthralgia , arthritis, stomatitis, glossitis, increased sweating.

Others: 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 antinuclear antibody test, increased ESR, eosinophilia, leukocytosis.

Side effects observed with the use of Enap, as a rule, are mild, transient in nature and do not require discontinuation of the drug.

Contraindications to the use of the drug

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

- porphyria;

- pregnancy;

- lactation (breastfeeding);

- hypersensitivity to enalapril and other components of the drug;

- Hypersensitivity to other ACE inhibitors.

Do not use the drug in patients with a history of angioedema associated with previous use of ACE inhibitors (allergic reaction with a sharp swelling of the lips, face, neck and possibly hands and feet, accompanied by choking and hoarseness) or with other causes, in children and adolescents under the age of 18 years (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 of age).

The 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.

Application for violations of kidney function

The dosage regimen is set depending on the severity of renal dysfunction or on the values ​​of CC. At CC more than 30 ml / min the initial dose is 5 mg / day, with QC 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.

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 level of blood pressure.

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

special instructions

In the course of 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 a few hours after taking the first dose) in patients with severe heart failure, severe renal dysfunction, as well as in patients with impaired water and electrolyte balance due to treatment with diuretics, salt-free diet, diarrhea, vomiting, as well as in patients on hemodialysis.

A pronounced decrease in blood pressure is usually manifested by nausea, an increase in heart rate, and fainting. In the event of arterial hypotension, the patient should be transferred to a horizontal position with a low headboard, and medical supervision is necessary.

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 stabilizes, you can continue therapy with the drug at the average recommended doses. Arterial hypotension can be avoided by interrupting treatment with diuretics and giving up a salt-free diet before starting treatment with Enap, if possible. The patient should be warned that if there are relapses of arterial hypotension, accompanied by nausea, increased heart rate and fainting, then a doctor's consultation is necessary.

Before starting treatment and during therapy, renal function should be monitored.

During the period of treatment with Enap, an increase in the content of potassium 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 preparations. Such patients should be informed about the need to consult a doctor if muscle weakness and arrhythmias appear.

Patients receiving Enap ® should not drink alcohol because of the risk of arterial hypotension.

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

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

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

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

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

Pediatric use

You should not prescribe the drug to children, because. efficacy and safety of its use in pediatrics have not been established.

Influence on the ability to drive vehicles and control mechanisms

In some cases, the drug can cause severe arterial hypotension and dizziness, especially at the beginning of treatment, thus providing an indirect and transient effect on the ability to drive vehicles and work with mechanisms.

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 saline ingestion are indicated; in more serious cases - measures aimed at stabilizing blood pressure, intravenous administration of physiological saline, plasma substitutes, if necessary - intravenous administration of angiotensin II, hemodialysis (enalaprilat excretion rate - 62 ml / min).

drug interaction

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

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

With the simultaneous use of enalapril and NSAIDs, incl. acetylsalicylic acid, it is possible to reduce the effectiveness of enalapril and increase the risk of impaired renal function.

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

Enalapril weakens the effect of drugs containing theophylline. The simultaneous use of lithium preparations may increase the side effects of lithium.

Preparations containing cimetidine increase the duration of action of enalapril.

In patients receiving enalapril, there is a risk of arterial hypotension during general anesthesia.

Ethanol enhances the hypotensive effect of enalapril.

Terms of dispensing from pharmacies

The drug is dispensed by prescription.

Terms and conditions of storage

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 preparation of the Slovenian pharmaceutical company KRKA, based on enalapril, well known to specialists and patients. Enap is the so-called "prodrug", which passes into the 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, as is known, leads to a direct decrease in the formation of the adrenal cortex 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, blood vessels dilate (while the reflex increase in heart rate expected 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 of the effects of Enap is the intensification of blood circulation in the myocardium and kidneys. With prolonged use, Enap reduces the increase in the left ventricle and muscle cells of the arterial walls, prevents the development and aggravation of heart failure, slows down the pathological expansion (dilatation) of the left ventricle, and improves blood supply to the ischemic area of ​​the heart muscle.

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

You can feel for yourself that Enap is an antihypertensive agent after 1 hour from the moment of administration. Its action 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 it is possible to achieve noticeable positive results only with a long-term - more than 6 months - taking the drug. Enap is available only in tablet form. When taken orally, about 60% of the active substance is absorbed. 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 the planned intake of the drug is missed. In this case, you must take the missed dose. If there are only a few hours left before the next scheduled dose, then the missed dose is no longer taken. The specific dose of Enap is set by the attending physician and is 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 plasma content of which leads to an increase in plasma renin activity (by eliminating the negative feedback on changes in renin production) and a decrease in aldosterone secretion. Because ACE is identical to the enzyme kininase II, enalapril can also block the breakdown of bradykinin, a potent vasopressor peptide. 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 RAAS activity, 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 concentration.

Against the background of the use of enalapril, the level of blood pressure decreases regardless of the position of the body (both in the supine position and in the standing position) without a significant increase in heart rate. Symptomatic orthostatic hypotension rarely develops. In some patients, achieving optimal blood pressure reduction may require several weeks of therapy. Abrupt withdrawal of enalapril was not accompanied by a rise in blood pressure.

Effective inhibition of ACE activity usually occurs 2-4 hours after a single oral dose of enalapril. The time of onset of the antihypertensive effect when taken orally is usually 1 hour, reaching a maximum after 4-6 hours. The duration of action depends on the dose. When used at 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. The renal blood flow increases, but the rate
glomerular filtration is unchanged. However, in patients with initially low glomerular filtration rate, its level usually increased.

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

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 heart rate decreases (usually in patients with chronic heart failure, heart rate is increased). It also reduces the wedge pressure of the pulmonary capillaries. With long-term use, enalapril increases exercise tolerance and reduces the severity of heart failure (assessed according to 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. With left ventricular dysfunction, enalapril reduces the risk of developing major ischemic outcomes (including the incidence of myocardial infarction and the number of hospitalizations for unstable angina).

Pharmacokinetics

Suction

After taking the drug, about 60% of enalapril is absorbed orally. C max enalapril in serum is achieved 1 hour after ingestion. Eating does not affect absorption.

Distribution and metabolism

Enalapril is rapidly and actively hydrolyzed to form enalarylate, a potent ACE inhibitor. C max enalaprilat in serum observed 3-4 hours after ingestion. In patients with normal renal function C ss enalarylat in plasma was achieved on the 4th day of therapy.

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

In addition to being converted to enalaprilat, enalapril does not undergo significant biotransformation.

breeding

T 1/2 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 determined in the urine.

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

Pharmacokinetics in special groups of patients

In patients with mild to moderate renal insufficiency (CC 30-60 ml / min (0.6-1 ml / sec)) after taking enalapril at a dose of 5 mg 1 time / day, the AUC of enalarylat is approximately 2 times greater than in patients with normal kidney function. In severe renal failure (CC ≤30 ml / min), the AUC increased by about 8 times. 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 of white or almost white color, ploskotsilindrichesky, with risk and a facet.

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

Dosage

The drug is taken orally, regardless of food intake, preferably at the same time of day. 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. With mild hypertension, the recommended initial dose is 5-10 mg / day.

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

Prior therapy with diuretics in high doses can lead to dehydration and an increased risk of arterial hypotension at the beginning of therapy with Enap ® ; the recommended starting dose is 5 mg/day. Treatment with diuretics should be discontinued 2-3 days before the start of the use of the drug Enap ® . Caution should be exercised when using the drug Enap ®, monitor kidney function and serum potassium levels.

The usual maintenance dose is 20 mg once daily.

The dose is selected individually, if necessary, 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 close medical supervision.

The drug Enap ® for the treatment of heart failure can be used simultaneously with diuretics and / or beta-blockers, 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 within 2-4 weeks. The maximum daily dose is 40 mg in 2 divided doses.

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

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

Impaired kidney function

Elderly patients

In elderly patients, a more pronounced antihypertensive effect and an increase in the time of action of the drug are more often observed, which is associated with a decrease in the rate of excretion of enalapril, so the recommended initial dose is 1.25 mg.

In elderly patients, the dose is selected depending on the function of the kidneys.

Overdose

Symptoms: about 6 hours after ingestion - a pronounced decrease in blood pressure up to the development of collapse, water and 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 ingestion of activated charcoal are indicated; in more serious cases - intravenous infusion of 0.9% sodium chloride solution, plasma substitutes, if necessary - intravenous administration of catecholamines. It is possible to remove enalaprilat by hemodialysis, the excretion rate is 62 ml / min. Patients with bradycardia resistant to therapy are shown setting a pacemaker. Serum electrolytes and serum creatinine should be closely monitored.

Interaction

The risk of developing arterial hypotension, hyperkalemia and renal dysfunction (including acute renal failure) is higher in the case of a double blockade of the RAAS, i.e. with the 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 necessary, the simultaneous use of drugs is recommended to control blood pressure, kidney function and water and electrolyte balance.

Simultaneous use of enalapril with aliskiren in patients with diabetes mellitus or impaired renal function (CC<60 мл/мин) противопоказано.

ACE inhibitors reduce potassium loss due to diuretics. The simultaneous use of enalapril and potassium-sparing diuretics (such as spironolactone, eplerenone, triamterene, amiloride), potassium preparations 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 necessary, simultaneous use should be careful and regularly monitor the serum potassium content.

Prior high-dose diuretic therapy may lead to a decrease in BCC and an increased risk of arterial hypotension during the initiation of enalapril therapy. Excessive antihypertensive effect can be reduced by discontinuing the diuretic, increasing the intake of water or sodium chloride, as well as by starting treatment with enalapril at a low dose.

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

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

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

The simultaneous 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 the increase in serum potassium, which can lead to a reversible deterioration in 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 against the background of the use of diuretics). Before starting therapy, it is necessary to replenish the BCC. During treatment, it is recommended to monitor kidney function.

Epidemiological studies suggest that the simultaneous use of ACE inhibitors and hypoglycemic agents (insulin and oral hypoglycemic drugs) may lead to an increase in the hypoglycemic effect with a risk of 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 effect of ACE inhibitors.

The simultaneous use of enalapril with acetylsalicylic acid (as an antiplatelet agent), thrombolytics and beta-blockers is safe.

Weakens the effect of drugs containing theophylline.

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

The simultaneous use of cyclosporine with ACE inhibitors may increase the risk of 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 flushing of the skin of the face, nausea, vomiting, arterial hypotension.

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

With simultaneous use with propranolol, the concentration of enalaprilat in the blood serum decreases, but this effect is clinically insignificant.

Side effects

Classification of the incidence 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.

On the part of 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, irritability, vertigo; rarely - a change in the nature of dreams, sleep disturbances.

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

From the side of the cardiovascular system: often - a pronounced decrease in blood pressure (including orthostatic hypotension), syncope, chest pain, heart rhythm disturbances, angina pectoris; infrequently - 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; infrequently - rhinorrhea, sore throat and hoarseness, bronchospasm / bronchial asthma; rarely - shortness of breath, infiltrates in the lungs, rhinitis, allergic alveolitis / eosinophilic pneumonia.

From the digestive system: very often - nausea; often - diarrhea, abdominal pain, flatulence; infrequently - ileitis, intestinal obstruction, pancreatitis, vomiting, constipation, anorexia, dryness of the 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 side of the skin: often - skin rash; infrequently - increased sweating, pruritus, alopecia; rarely - erythema multiforme, Stevens-Johnson syndrome, exfoliative dermatitis, toxic epidermal necrolysis, pemphigus, erythroderma.

A symptom complex is described, which 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 - a decrease in potency; rarely - gynecomastia.

From the musculoskeletal system: infrequently - muscle cramps.

On the part of laboratory parameters: often - hyperkalemia, increased serum creatinine concentration; infrequently - hyponatremia, an increase in the concentration of urea in the blood serum; rarely - an increase in the activity of hepatic transaminases and the concentration of bilirubin.

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

Other: the frequency is unknown - the syndrome of inappropriate ADH secretion.

Adverse events identified during the post-marketing use of the drug Enap ® , however, a causal relationship with taking the drug has not been established: urinary tract infections, upper respiratory tract infections, bronchitis, cardiac arrest, atrial fibrillation, herpes zoster, melena, ataxia, thromboembolism of the pulmonary branches arteries 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

• angioedema in history associated with the use of ACE inhibitors;
• hereditary angioedema or idiopathic angioedema;
• concomitant use with aliskiren in patients with diabetes mellitus or impaired renal function (QC<60 мл/мин);
• porphyria;
• pregnancy;
• lactation period (breastfeeding);
• age up to 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 transplant; with aortic stenosis and / or mitral stenosis (with hemodynamic disorders); hypertrophic obstructive cardiomyopathy (GOKMP); with reduced BCC (including with diarrhea, vomiting); with systemic connective tissue diseases (including scleroderma, systemic lupus erythematosus); ischemic heart disease; with oppression of bone marrow hematopoiesis; cerebrovascular diseases (including cerebrovascular insufficiency); with diabetes; 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 of age).

Application features

Use during pregnancy and lactation

The use of the drug Enap ®, as well as other ACE inhibitors, in the first trimester of pregnancy is not recommended. The use of ACE inhibitors, incl. the drug Enap ® is contraindicated in the II and III trimesters of pregnancy.

Epidemiological data on the risk of teratogenic effects of ACE inhibitors during pregnancy do not allow definitive conclusions to be drawn. However, the possibility of teratogenic effects cannot be ruled out. If ACE inhibitors are required, the patient should be switched to another antihypertensive drug with a proven safety profile for pregnant women.

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

Taking ACE inhibitors in the II and III trimesters of pregnancy can cause fetotoxic effects (impaired kidney 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 II and III trimesters of pregnancy, it is recommended to perform an ultrasound scan of the kidneys and bones of the fetal skull.

In those rare cases where the use of an ACE inhibitor during pregnancy is considered necessary, periodic ultrasonography 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 develops when there is irreversible damage to the fetus. If ACE inhibitors are used during pregnancy and oligohydramnios develops, then, depending on the gestational age, a stress test, a non-stress test, or a biophysical profile of the fetus may be required to assess the functional state of the fetus.

Newborns whose mothers took ACE inhibitors during pregnancy should be monitored due to possible arterial 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 determined in breast milk in trace concentrations, therefore, if it is necessary to use the drug Enap ® during lactation, breastfeeding should be discontinued.

Application for violations of liver function

The drug should be used with caution in patients with hepatic insufficiency.

Application for violations of kidney function

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

* Enalaprilat is excreted by hemodialysis. In the interval between sessions of hemodialysis, the dose of the drug should be selected under the control of blood pressure.

With caution, the drug should be used 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 arterial hypotension rarely develops in patients with uncomplicated arterial hypertension. Arterial hypotension with all clinical manifestations can be observed after the first intake of Enap ® in patients with hypovolemia, as a result of diuretic therapy, salt-free diet, diarrhea, vomiting or hemodialysis. The development of symptomatic arterial 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 be started under the supervision of a physician until the optimal dose adjustment of the drug Enap ® and / or diuretic. Similar tactics can be applied to patients with coronary artery disease or cerebrovascular disease, in whom a sharp excessive decrease in blood pressure can lead to the development of myocardial infarction or cerebrovascular accident.

In case of development of severe arterial hypotension, it is necessary to transfer the patient to a horizontal position with a low headboard and, if necessary, inject 0.9% sodium chloride solution intravenously.

Transient arterial hypotension is not a contraindication for further treatment with Enap ® . After stabilization of blood pressure and BCC, 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 stop therapy. If arterial hypotension is accompanied by clinical symptoms, doses should be reduced and / or the diuretic and / or Enap should be discontinued.

Aortic or mitral stenosis, HOCM

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

Impaired kidney function

In patients with renal insufficiency (CK<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 during treatment with Enap ®. Changes were usually reversible after discontinuation of the drug Enap ® .

In some patients with arterial hypertension, in whom no kidney disease was detected before the start of treatment, a slight and transient increase in the concentration of urea and creatinine in the blood serum was observed when using the drug Enap ®. In such cases, it may be necessary to reduce the dose of the drug Enap ® and / or cancel the diuretic. This situation indicates the possibility of latent stenosis of the renal artery.

Renovascular hypertension

Patients with bilateral renal artery stenosis or stenosis of the artery of the only functioning kidney when treated with ACE inhibitors have an increased risk of arterial hypotension and renal failure. Only minor changes in serum creatinine concentration can indicate a decrease in kidney function. In such patients, treatment should be initiated at low doses under close medical supervision. It is necessary to carefully titrate the dose and monitor renal function.

kidney transplant

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

Impaired liver function

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

Neutropenia/agranulocytosis

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

Hypersensitivity/angioedema

In patients treated with ACE inhibitors, including the drug Enap ®, there have been reports of the development of angioedema of the face, extremities, lips, vocal cords and / or larynx at any time after the start of treatment. You should immediately stop the drug Enap ® and observe the patient until the symptoms disappear completely. Even in the presence of tongue edema, when there is only difficulty in swallowing without respiratory distress syndrome, patients may require long-term observation, because. the use of antihistamines and corticosteroids may not be sufficient.

Angioedema of the larynx or tongue can be fatal in very rare cases. Swelling of the tongue, vocal cords, or larynx can lead to airway obstruction, especially after a history of airway surgery. In the presence of swelling of the tongue, vocal cords or larynx, appropriate therapy is indicated, which may include: s / c injection 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 therapy with an ACE inhibitor, the incidence of angioedema is higher than among patients of other races.

Patients with a history of angioedema not associated with ACE inhibitors have an increased risk of developing angioedema with any ACE inhibitor.

Anaphylactoid reactions during desensitization with hymenoptera (hymenoptera) venom

Patients treated with ACE inhibitors during desensitization with hymenoptera venom 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

Patients treated with ACE inhibitors during LDL apheresis with dextran sulfate have rarely developed life-threatening anaphylactoid reactions. The drug should be temporarily replaced with drugs of another group.

Hemodialysis

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

hypoglycemia

In diabetic patients receiving oral hypoglycemic drugs or insulin, during the first month of treatment with an ACE inhibitor, blood glucose levels should be carefully monitored.

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

Surgery/general anesthesia

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

Hyperkalemia

May develop during treatment with ACE inhibitors, incl. drug Enap ® . Risk factors for the development of hyperkalemia are renal failure, advanced age (over 70 years), diabetes mellitus, some concomitant conditions (decrease in BCC, 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 salt substitutes containing potassium can lead to a significant increase in serum potassium, especially in patients with impaired renal function. Hyperkalemia can lead to serious heart rhythm disturbances, sometimes fatal. The simultaneous use of the above drugs should be carried out with caution under the control of potassium in the blood serum.

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

Ethnic features

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, so the drug is contraindicated in patients with lactase deficiency, lactose intolerance, glucose-galactose malabsorption syndrome.

Influence on the ability to drive vehicles and control mechanisms

When using the drug Enap ®, care must be taken when driving vehicles and performing other potentially hazardous types of work that require increased concentration of attention 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 does not control himself. He is confused and lost, his speech is disturbed, confusion appears, anxiety develops.

Acute reaction to stress

An acute reaction to stress occurs in people who do not care about their own mental health. They work hard, have 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 hard to miss. A person is in constant anxiety: he is scared, it is hard, he cannot concentrate, he cannot fall asleep normally. His whole body is in constant tension. This condition does not go away for weeks and results in a number of symptoms.

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

A stress-resistant person easily experiences problems

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

Symptoms

Where does the acute reaction to stress come from? It stems from the causes of the nervous state, which determine the general symptomatology. If a person experiences problems at work, then his aggression and internal tension are completely directed to work affairs. Disturbances at home provoke changes in the behavior of the victim of stress that affect the household.

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

• the victim gets hung up on one thought or process - this is a problem that becomes a stressor;
• an inner tension builds up around the disturbing thought;
• the victim throws all his strength into thinking about the problem, neglecting other areas of life;
• the regime of the day, sleep is disturbed, the first changes in the behavior of the victim of stress appear;
• fatigue accumulates;
• spontaneous aggression is manifested, which alternates with complete apathy;
• the person closes in on himself.

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

A personal reaction to stress depends on how self-confident a person is, how often he seeks help, what level of adaptability and receptivity he has. A dozen factors form resistance to stress and allow you to quickly overcome difficulties. If this does not happen, and a violation of adaptation or mental disorders manifests itself, 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 the behavior of the individual are barely noticeable, then after a few days they begin to catch the eye. Stress manifests itself when a person cannot cope with his emotions and obsessive thoughts.

General symptoms of severe stress:

• isolation and alienation;
• sleep disturbance: during the day a person is sleepy, and at night due to disturbing thoughts he cannot fall asleep;
• violation of the diet - the victim of stress overeats or starves;
• quick mood swings (apathy is quickly replaced by excessive activity);
• reduced work capacity;
• reduced concentration.

The severity of stress symptoms depends on the person’s openness: extroverts are ready to solve their problems, seek help, but it’s harder for introverts to talk 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 victim of stress seeks help, the easier it will be to return to a full life.

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

Causes

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

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

If problems are leveled by success in other areas of life, it is easier to survive stress. The inner tension is more difficult for adults, who from childhood did not know the support of their parents and did not see self-care. Such individuals grow up notorious and unsure of themselves: they perceive any difficulties exaggeratedly, as confirmation of internal fears. The occurrence of an overreaction to a stressful state in such cases is an inevitable process.

The greater the responsibility of the individual, the stronger the external pressure. It creates all the prerequisites for the appearance of anxiety. People in leadership positions work hard and worry a lot.

Leadership stress has a negative impact on the entire enterprise

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

Reaction forms

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

• excitation;
• braking.

The adaptive behavior of a person changes after passing through two phases, when the stressful state turns into “imaginary death”. The nervous system experiences a great load during the first phase, when all human reactions are aggravated.

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

Excitation phase

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

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

Deceleration phase

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

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

overreaction

A certain reaction occurs to a stressful state: 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 pose a threat to a person and to his close environment. Acute symptoms resemble a panic attack when the person is unconscious. She shakes, her heart rate rises and her pulse quickens. Tremor of the lower and upper extremities occurs spontaneously when a stress factor is manifested. 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 the processes of human life. Overeating or fasting affects a person's overall well-being. Hyperphagia (uncontrolled eating) is a response 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 the psychological causes of stress. A person who does not know how to let go of resentment, the past and mistakes continues to live with them. For the subconscious mind, worrying about what happened is tantamount to the stress that is happening right now. Panic attacks and fear cause thoughts, internal attitudes of the victim of stress. This process can last for years until the body is completely depleted.

The main causes of an 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 prone to nervousness and apathy, then attacks of aggression, panic and depression occur for a number of reasons:

• mental disorders;
• difficult living conditions;
• repressed fears;
• experienced trauma.

Depressive disorder develops only after a prolonged manifestation of acute symptoms: the longer a person tolerates the influence of obsessive thoughts, the more stressful he becomes. Diagnosis of a disease with an acute reaction of the body is carried out only after a visit to a psychologist who will determine the main psychological cause of stress.

deep depression

Whatever the stress factor, the event that triggers it, the cause is always born earlier. It develops in early childhood or adulthood. These are beliefs and attitudes, parts of the character of the individual and her habits. Therefore, for the treatment of stress, which ended in depression, only medications are not used - a correction of the patient's behavior is mandatory.

Low resistance to trouble

Low psychological stability depends on stress, and the behavior of the victim depends on its stability. 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 the individual's opinion about the world around him.

Mental stability is built on self-confidence: even if a person makes mistakes and has trouble, she knows that problems are not eternal. She is confident in herself, her environment, the variability of conditions. High resistance to problems in people who are not afraid of the future or the unknown: 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.

Disorders in the work of the psyche

The cause of a strong negative reaction to stress can be disorders in the work of the psyche. 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 frightened or lost. A strong experience due to stress is due to the illogicality and irrationality of a sick person. He does not perceive difficulties, he 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 in the memory and subconscious of a person can dictate a person how to live. If a victim of stress has experienced severe trauma, it is difficult for her to return to a fulfilling life. She tries to adapt, but the pressure of others does not allow her to get comfortable - in most cases, the victim hides true experiences and accumulates negativity, which becomes the basis of future stress.

Depression after a breakup

Post-traumatic stress disorder is the cause of an acute reaction to any stressful event. The defense of the psyche of the military 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 hard to resist difficulties if a person lives in difficult conditions. If he is mired in debt, obligations, constant squabbles. Difficult living conditions are additional stress factors that do not help a person recover, but only aggravate his psycho-emotional state.

Causes of an acute reaction to difficulties:

• lack of housing - fear of the unknown, fear of being on the street;
• lack of stability;
• lack of support.

A person is a part of society, and if society repels him, he loses his role. Lost does not know how to cope with intrusive thoughts. He is withdrawn and constantly depressed.

The difficult moral conditions of life, which 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

Suppressed fears destroy mental protection. Phobias are formed either in early childhood or in adulthood. The role of irrational fear is very great. 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) makes a person fall into hysteria. He loses sleep, cannot concentrate and collect himself. Suppressed fears weaken the defense mechanisms of the psyche day by 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.

Effects

Why is stress management so important? Acute symptoms decrease over time, but the load on the human body remains the same. The more he worries about the stressor, the more he hurts himself. Anxiety, fear and internal tension accumulate, and a person gets used to the feeling that he is ill. He adapts to constant fear, the expectation of bad events. The acute reaction decreases, and under adverse conditions returns in a more acute form. With each new attack, the nervous system of the victim of stress is depleted - 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 rapidly and leads the life of a weak personality. A person who is exhausted by constant internal stress cannot be treated. He comes to terms with a new life in which stress comes first. Recognizing the symptoms and managing stress are paramount tasks for anyone who wants to take control of their own lives.

For the psyche

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

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

Attacks of aggression - a symptom of stress

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

Constant seizures affect a person's judgment. He does not know how to see his own mistakes, therefore he is aggressive, hysterical, angry. It is difficult to find a common language with such a person. Concomitant phobias make a person choose imprisonment - to escape from people who demand explanations for actions and words. Forced loneliness brings a welcome temporary relief.

For the body

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

Human immunity is depleted. Dermatitis and wounds appear if, from nervous tension, a person begins to comb his skin. Any physiological consequences must be treated in a complex, while getting rid of a stressful state.

depressive state

Depression is the most common complication of acute stress response. The person ignores the symptoms, ignores the 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 needs to be treated by 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 he realizes its destructive influence.

The onset of depression

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

depression from chronic fatigue

Associated 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, nor in what she loved before. This is due to burnout due to frequent acute reactions of the body due to a strong shock.

Prevention methods

It is impossible to ignore an acute reaction. Suppressed emotions do not disappear, but only delay the outburst of negativity. To cope with the load on the psyche, it is necessary to eradicate the reaction and rebuild your own body.

In an emergency, people with low resistance to problems will benefit from breathing exercises. This is a simple exercise system that helps to calm down. It is necessary to take a comfortable position - sitting or standing. It is better to arrange so that no one bothers to calm down. It is necessary to adjust calm breathing, 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 need to calm down urgently.

Working on thinking

Stress factors and the reaction to them directly depend on how a person perceives the world, i.e. subjectively evaluates events or people. If the stress factor originates in the human mind, then it must be eradicated by 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 the problem in an exaggerated way, it is necessary to find the reason for such an attitude to a particular trouble.

If a person can find the cause of false beliefs, he will be able to draw a new conclusion - to change the attitude. After that, the reaction to the stress factor will change. To correct thinking, auto-trainings are used: techniques that allow you to tune in a positive way. 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 to strive for. If a person reacts sharply to stress, she needs to take care of protecting her mind and body. Maintaining a good physical shape will make it easier to withstand a stressful situation. Going in for sports, especially group sports, will help you find a good company for communication and distract from problems.

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

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, i.e., improve resistance to stress. Working on yourself will give good results.

Synonyms Key words: acute stress reaction, post-traumatic stress disorder, post-traumatic stress disorder with embitterment

Acute reaction to stress:
Response to stress in the mental and social sphere with manifestations that go beyond the normal and expected response to stressful life situations
Appearing within 1 hour, disappearing 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 on the basis of the type, severity and duration of the initial load and reactive symptoms.

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

:
Stressful situation
neurobiological vulnerability
personality traits
Social factors

Important: There is a clear cause-and-effect relationship between the traumatic situation and the inadequate reaction that follows it.

Increased risk with:
organic disorders
Accentuated personality traits
Neurotic manifestations of personality
Strong overwork

Protective factors:
Experience strategies (Coping-Strategie)
Stable social network
Neurobiological theory: the role of catecholamine metabolism and individual predisposition to overreactions
Learning Theory: Giving Up Strategies of Experience Takes Particular Importance
Psychoanalysis Model: Reactions to Unresolved Conflicts in Childhood (Regression)
It is important to recognize 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 inner emptiness, increased alertness or excessive fearfulness, sleep disturbance, memory impairment or focus on unhappiness, the desire to avoid actions resembling a traumatic situation, an increase in symptoms under the influence of factors symbolizing or resembling this situation, panic fear, accompanied by autonomic disturbances, followed by withdrawal, depression or hyperactivity

Diagnostic criteria for stress disorder

The development of a state of “constriction 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 people who do not have other mental illness, occurring within a few minutes (maximum 1 hour) after excessive mental or physical exertion (massive traumatic life-threatening events, 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 relationship between the disorder and the stressful event (meaningful and emotional attitude)

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

Treatment:
Relief of acute conditions (distance from the scene, involvement in a conversation)
Possible single/short-term use of benzodiazepines

Course and forecast:
Acute stress reaction symptoms disappear within 3 days
If symptoms persist, see PTSD, Adjustment Disorders, Depression

is a mental disorder that develops as a result of significant physical or psychological overstrain. 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 the code F43.0.

Causes of an acute reaction to stress

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

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

At the moment of severe stress, there is a fixation on such protective mechanisms as repression and extreme identification. Thus, a person enters an altered state of consciousness, accompanied by impaired 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, some features of the psyche 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 adverse conditions or are forced to experience strong negative emotions.

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

Symptoms of an acute reaction to stress

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

The field of consciousness narrows. A person cannot adequately respond to external stimuli. After that, a departure from the surrounding reality may occur. In some cases, the formation of a dissociative stupor is observed, in which a person cannot even adequately perceive the speech addressed to him. In addition, often a person who has experienced severe stress literally tries to get away 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 by freezing and unwillingness to leave the territory where the disaster occurred. In the future, the victim may exhibit behavior characterized by infantilism. 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 the inherent. These include:

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

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

In addition, there is often such a physiological reaction to stress as a skin rash, which is very reminiscent of 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 a decrease in 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 choose drugs to stabilize the condition, but also means that will reduce the risk of complications.

To identify such a deviation, an assessment of the relationship between the history data and personality, as well as the form, content and severity of symptomatic manifestations, and in addition, the intensity of stressful events and situations that cause a crisis, is required. Conducted neurological testing and external examination will allow you to prescribe the best methods of therapy.

Medical treatment of acute stress response

To stabilize the condition of patients who have acute symptoms, first of all, drugs are selected to reduce the excitability of nerve fibers. As a rule, strong medications are used when symptoms persist for a long time. Antipsychotics, antidepressants and even tranquilizers are introduced into the treatment regimen, depending on the severity of the symptoms.

If a person's behavior against the background of an acute reaction to stress is inadequate and dangerous for him and those around him, Phenazepam is often prescribed. This is a fairly strong tranquilizer that can be taken only on the recommendation of a doctor. It is he who must indicate the necessary dosages and the duration of the course 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 sedative effect.

In the treatment of acute reactions to stress, long courses of antidepressants are often prescribed. There are several types of drugs that are used in 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, Melipramin is often used. This remedy belongs to the class of antidepressants. Miansan is often prescribed to improve sleep. This drug should be used at the dosages prescribed by your doctor.

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

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

Folk remedies for an acute reaction to stress

If the period of the crisis was short-lived and there is no way to contact 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 the help of baths based on herbal decoctions. A good effect is given by water procedures with lavender. To prepare the product, you should take about 50 g of plant flowers per 1 liter of boiling water, leave for at least 10 minutes, carefully wrapped in a warm blanket. After that, 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 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, peppermint or jasmine essential oils. Add 5-10 drops of the selected essential oil to the bath.

You can make a “sleeping pillow” at home by stuffing a small rag bag with hop cones or a collection of 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 such medicinal herbs as oregano, thyme, motherwort, valerian, sweet clover. All herbal ingredients should be taken in equal proportions. Next 1 tbsp. l. herbal collection 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 the mental state, you can use an infusion of birch leaves. To prepare the product, you should take about 100 g of young leaves and pour 2 tbsp. boiling water. The container with the composition must be carefully wrapped with a warm blanket and let it brew for at least 5-6 hours. The tool must be filtered. Use infusion for ½ tbsp. 2-3 times a day 30 minutes before meals. If fresh birch foliage is out of season, 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.