Enap - N tablets 10mg + 25 mg, No. 60

Arterial hypertension (for patients for whom combination therapy is indicated).

EnapЃ N should be taken regularly at the same time, preferably in the morning, during or after meals, without chewing, with a small amount of liquid.

The recommended dose is 1 tablet per day.

In patients on diuretic therapy, it is recommended to cancel treatment or reduce the dose of diuretics at least 3 days before starting treatment with EnapЃ N to prevent the development of symptomatic arterial hypotension.

Kidney function should be examined before starting treatment.

The duration of treatment is determined by the doctor.

Dose in case of impaired renal function
In patients with renal insufficiency with a CC of 30-75 ml / min, EnapЃ N should be used only after preliminary titration of the doses of enalapril and hydrochlorothiazide separately, according to the doses in the combined drug EnapЃ N.

(per 1 tablet):
Active ingredients:
Hydrochlorothiazide 25.00 mg
Enalapril maleate 10.00 mg
Excipients: sodium bicarbonate 5.10 mg, lactose monohydrate 120.02 mg, corn starch 29.60 mg, pregelatinized starch 6.00 mg , talc 6.00 mg, magnesium stearate 2.00 mg, quinoline yellow dye, E104 0.06 mg

- hypersensitivity (including to individual components of the drug or sulfonamide derivatives);
- anuria, severe renal dysfunction (creatinine clearance (CC) less than 30 ml / min);
- a history of angioedema associated with the use of earlier ACE inhibitors, as well as hereditary or idiopathic angioedema;
- bilateral stenosis of the renal arteries, stenosis of the artery of a single kidney;
- pregnancy and lactation period;
- age up to 18 years (efficacy and safety have not been established);
- lactose intolerance, lactase deficiency or glucose-galactose malabsorption.

Carefully:

- severe stenosis of the aortic orifice or idiopathic hypertrophic obstructive subaortic stenosis;
- ischemic heart disease and cerebrovascular diseases (including cerebral circulation insufficiency), because an excessive decrease in blood pressure can lead to the development of myocardial infarction and stroke;
- chronic heart failure; severe atherosclerosis;
- severe autoimmune systemic diseases of the connective tissue (including systemic lupus erythematosus, scleroderma);
- oppression of bone marrow hematopoiesis; diabetes mellitus, because thiazide diuretics can reduce glucose tolerance;
- hyperkalemia;
- condition after kidney transplantation;
- dysfunction of the liver and / or kidneys (CC 30-75 ml / min);
- conditions accompanied by a decrease in the BCC (as a result of diuretic therapy, with restriction of salt intake, diarrhea and vomiting);
- elderly age.

Tradename:

EnapЃ N

International name or grouping name:

hydrochlorothiazide + enalapril &

Dosage form:

pills

Composition

(per 1 tablet):
Active ingredients:
Hydrochlorothiazide 25.00 mg
Enalapril maleate 10.00 mg
Excipients: sodium bicarbonate 5.10 mg, lactose monohydrate 120.02 mg, corn starch 29.60 mg, pregelatinized starch 6.00 mg , talc 6.00 mg, magnesium stearate 2.00 mg, quinoline yellow dye, E104 0.06 mg

Description

Round, flat, yellow tablets with beveled edges and scored on one side.

Pharmacotherapeutic group:

combined antihypertensive agent (diuretic + angiotensin-converting enzyme (ACE) inhibitor)

ATX code : C09BA02

Pharmacological properties

Pharmacodynamics
Combined drug, the action of which is due to the components that make up its composition; has a hypotensive effect.
Enalaprilinhibits ACE, which promotes the conversion of angiotensin I into angiotensin II, reduces the concentration of aldosterone in the blood, increases the release of renin by juxtaglomerular cells in the walls of the arterioles of the renal glomeruli, improves the functioning of the kallikrein-kinin system, stimulates the release of prostaglandins and inhibits the endothelial NO (sympathetic) system, which inhibits the nerve ... Together, these effects eliminate spasm and expand peripheral arteries, reduce total peripheral vascular resistance, systolic and diastolic blood pressure (BP), post- and preload on the myocardium. Expands arteries to a greater extent than veins, while there is no reflex increase in heart rate (HR).
The hypotensive effect is more pronounced with a high concentration of renin in the blood plasma than with a normal or reduced one. A decrease in blood pressure within the therapeutic range does not affect cerebral circulation. Improves blood supply to the ischemic myocardium. Increases renal blood flow, while the glomerular filtration rate does not change. In patients with initially decreased glomerular filtration, its rate usually increases.
The maximum effect of enalapril develops after 6-8 hours and lasts up to 24 hours.
Hydrochlorothiazide- a thiazide diuretic of medium strength. Reduces the reabsorption of sodium ions at the level of the cortical segment of the loop of Henle, without affecting its section passing in the medulla of the kidney. Blocks carbonic anhydrase in the proximal section of the convoluted tubules, enhances the excretion of potassium ions, bicarbonates and phosphates by the kidneys. Virtually no effect on the acid-base state. Increases the excretion of magnesium ions. Retains calcium ions in the body. The diuretic effect develops after 1-2 hours, reaches a maximum after 4 hours, lasts 10-12 hours. The effect decreases with a decrease in the glomerular filtration rate and stops when it is less than 30 ml / min. Reduces blood pressure by reducing the volume of circulating blood (BCC), changes in the reactivity of the vascular wall.
The use of a combination of enalapril and hydrochlorothiazide leads to a more pronounced decrease in blood pressure in comparison with monotherapy with each of the drugs separately and allows you to maintain the hypotensive effect of EnapЃ N for at least 24 hours.
Pharmacokinetics of
Enalapril. After oral administration, absorption is 60%. Food intake does not affect absorption.
In the liver, it is metabolized to form the active metabolite of enalaprilat, which is a more effective ACE inhibitor than enalapril. The connection with blood plasma proteins of enalaprilat is 50-60%. The time to reach the maximum concentration (TCmax) of enalapril is 1 hour, enalaprilat is 3-4 hours. Enalaprilat easily passes through the histohematogenous barriers, excluding the blood-brain barrier, a small amount penetrates the placenta and into breast milk. Renal clearance of enalapril and enalaprilat is 0.005 ml / s (18 l / h) and 0.00225-0.00264 ml / s (8.1-9.5 l / h), respectively. The half-life (T1 / 2) of enalaprilat is 11 hours. It is 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 38-62 ml / min) and peritoneal dialysis, the serum concentration of enalaprilat after 4 hours of hemodialysis decreases by 45-57%.
In patients with reduced renal function, excretion is slowed down, which requires a dose reduction in accordance with impaired renal function, especially in patients with severe renal insufficiency.
In patients with hepatic impairment, the metabolism of enalapril can be slowed down without changing its pharmacodynamic effect.
In patients with chronic heart failure (CHF), the absorption and metabolism of enalaprilat slows down, and the volume of distribution also decreases.
Hydrochlorothiazide is absorbed mainly in the duodenum and proximal small intestine. Absorption is 70% and increases by 10% when taken with food. The maximum concentration in the blood serum is reached after 1.5-5 hours. The volume of distribution is about 3 l / kg. Communication with blood plasma proteins - 40%.
Bioavailability - 70%. In the therapeutic dose range, the average value of the area under the pharmacokinetic curve increases in direct proportion to the dose increase; when administered once a day, the cumulation is insignificant. Penetrates through the hematoplacental barrier and into breast milk. Accumulates in amniotic fluid. The serum concentration of hydrochlorothiazide in the umbilical vein blood is practically the same as in the maternal blood. The concentration in the amniotic fluid exceeds that in the serum from the umbilical vein (19 times). It is not metabolized in the liver, excreted mainly by the kidneys: 95% unchanged and about 4% as hydrolyzate-2-amino-4-chloro-m-benzenedisulfonamide by glomerular filtration and active tubular secretion in the proximal nephron.The renal clearance of hydrochlorothiazide in healthy volunteers and patients with arterial hypertension is approximately 5.58 ml / s (335 ml / min). Hydrochlorothiazide has a biphasic elimination profile. T1 / 2 in the initial phase is 2 hours, in the final phase (10-12 hours after administration) - about 10 hours.
In elderly patients, hydrochlorothiazide does not adversely affect the pharmacokinetics of enalapril, but the serum concentration of enalaprilat is higher. When prescribing hydrochlorothiazide to patients with CHF, it was found that its absorption decreases in proportion to the development of CHF - by 20-70%. T1 / 2 of hydrochlorothiazide increases to 28.9 hours; renal clearance is 0.17 - 3.12 ml / s (10-187 ml / min) (mean values ??1.28 ml / s (77 ml / min)).
In patients undergoing intestinal bypass surgery for obesity, the absorption of hydrochlorothiazide can be reduced by 30%, and the serum concentration by 50%, compared with healthy volunteers.
The simultaneous appointment of enalapril and hydrochlorothiazide does not affect the pharmacokinetics of each of them.

Indications for use

Arterial hypertension (for patients for whom combination therapy is indicated).

Contraindications

- hypersensitivity (including to individual components of the drug or sulfonamide derivatives);
- anuria, severe renal dysfunction (creatinine clearance (CC) less than 30 ml / min);
- a history of angioedema associated with the use of earlier ACE inhibitors, as well as hereditary or idiopathic angioedema;
- bilateral stenosis of the renal arteries, stenosis of the artery of a single kidney;
- pregnancy and lactation period;
- age up to 18 years (efficacy and safety have not been established);
- lactose intolerance, lactase deficiency or glucose-galactose malabsorption.

Carefully:

- severe stenosis of the aortic orifice or idiopathic hypertrophic obstructive subaortic stenosis;
- ischemic heart disease and cerebrovascular diseases (including cerebral circulation insufficiency), because an excessive decrease in blood pressure can lead to the development of myocardial infarction and stroke;
- chronic heart failure; severe atherosclerosis;
- severe autoimmune systemic diseases of the connective tissue (including systemic lupus erythematosus, scleroderma);
- oppression of bone marrow hematopoiesis; diabetes mellitus, because thiazide diuretics can reduce glucose tolerance;
- hyperkalemia;
- condition after kidney transplantation;
- dysfunction of the liver and / or kidneys (CC 30-75 ml / min);
- conditions accompanied by a decrease in the BCC (as a result of diuretic therapy, with restriction of salt intake, diarrhea and vomiting);
- elderly age.

Pregnancy and lactation

EnapЃ N is contraindicated in pregnancy.
The effect of ACE inhibitors on the fetus in the first trimester of pregnancy has not been established. The use of ACE inhibitors in the second and third trimesters of pregnancy was accompanied by a negative effect on the fetus and newborn.
The newborns developed arterial hypotension, renal failure, hyperkalemia, and / or hypoplasia of the skull bones. Perhaps the development of oligohydramnios, apparently due to impaired renal function of the fetus. This can lead to contracture of the limbs, deformation of the bones of the skull, including its facial part, and hypoplasia of the lungs.
The use of diuretics during pregnancy is not recommended because it can cause fetal and newborn jaundice, thrombocytopenia, and possibly other adverse reactions seen in adults.
Enalapril and hydrochlorothiazide pass into breast milk. Therefore, when prescribing the drug EnapЃ N during lactation, it is necessary to abandon breastfeeding.

Method of administration and dosage

EnapЃ N should be taken regularly at the same time, preferably in the morning, during or after meals, without chewing, with a small amount of liquid. The recommended dose is 1 tablet per day.
In patients on diuretic therapy, it is recommended to cancel treatment or reduce the dose of diuretics at least 3 days before starting treatment with EnapЃ N to prevent the development of symptomatic arterial hypotension.
Kidney function should be examined before starting treatment.
The duration of treatment is determined by the doctor.
Dose for impaired renal function
In patients with renal insufficiency with a CC of 30-75 ml / min, EnapЃ N should be used only after preliminary titration of the doses of enalapril and hydrochlorothiazide separately, according to the doses in the combined drug EnapЃ N.

Side effect

Classification of the incidence of side effects of the World Health Organization (WHO):
- very often (> 1/10)
- often (> 1/100 and - infrequently (> 1/1000 and - rarely (> 1/10000 and - very rarely ( Co sides of the hematopoietic and lymphatic system:
- rarely: neutropenia, decreased hemoglobin and hematocrit, thrombocytopenia, leukopenia, inhibition of bone marrow function;
Metabolic and nutritional disorders
- infrequently: gout;
From the central nervous system:
- very often: dizziness, weakness;
- often: headache, asthenia;
- infrequently: insomnia, drowsiness, paresthesia, increased excitability;
From the senses:
- infrequently: tinnitus;
From the side of the cardiovascular system
- often: orthostatic hypotension;
- infrequently: fainting, marked decrease in blood pressure, palpitations, tachycardia, chest pain;
From the respiratory system:
- often: cough;
- infrequently: shortness of breath;
From the digestive system:
- often: nausea;
- infrequently: diarrhea, vomiting, dyspepsia, abdominal pain, flatulence, constipation, dry mouth;
- rarely: cholestatic jaundice, fulminant necrosis;
Allergic reactions:
- infrequently: Stevens-Johnson syndrome;
- rarely: angioedema;
- very rarely: intestinal angioedema;
From the side of the skin:
- infrequently: skin rash, itching, increased sweating, skin necrosis, alopecia;
From the genitourinary system:
- infrequently: impaired renal function, acute renal failure, impotence, decreased libido;
From the side of the musculoskeletal system:
- often: muscle spasms;
- infrequently: arthralgia;
Laboratory indicators:
- rarely: hyperglycemia, hyperuricemia, hypokalemia, hyperkalemia, hyponatremia, increased concentration of urea and creatinine in the blood serum, increased activity of 'hepatic' transaminases and bilirubin;
Others:
- a symptom complex is described, which may include fever, myalgia and arthralgia, serositis, vasculitis, increased erythrocyte sedimentation rate, leukocytosis and eosinophilia, skin rash, positive test for antinuclear antibodies.

Overdose

Symptoms: increased diuresis, a marked decrease in blood pressure with bradycardia or other heart rhythm disturbances, convulsions, impaired consciousness (including coma), acute renal failure, a violation of the acid-base state and water-electrolyte balance of the blood.
Treatment:the patient is transferred to a horizontal position with raised legs. In mild cases, gastric lavage and ingestion of activated carbon are shown, in more serious cases, measures aimed at stabilizing blood pressure - intravenous administration of plasma substitutes, infusion of 0.9% sodium chloride solution. The patient needs to control the blood pressure, heart rate, respiratory rate, serum concentration of urea, creatinine, electrolytes and diuresis, if necessary - intravenous administration of angiotensin II, hemodialysis (the rate of elimination of enalaprilat is 62 ml / min).

Interaction with other medicinal products

Serum Potassium The
use of potassium supplements, potassium sparing agents or potassium-containing salt substitutes, especially in patients with renal insufficiency, can lead to a significant increase in serum potassium. Potassium loss while taking thiazide diuretics is usually reduced by enalapril. Serum potassium usually remains within the normal range.
Lithium
With simultaneous use with lithium preparations - slowing down the excretion of lithium (increasing the cardiotoxic and neurotoxic effects of lithium).
Non-depolarizing muscle relaxants
Thiazide diuretics may enhance the effect of tubocurarine chloride.
Narcotic analgesics / antipsychotics
The simultaneous use of thiazide diuretics, narcotic analgesics or phenothiazine derivatives can lead to orthostatic hypotension.
Other antihypertensive agents
Concomitant use of beta-blockers, alpha-blockers, ganglion blockers, methyldopa or slow calcium channel blockers with enalapril can further lower blood pressure.
Allopurinol, cytostatics and immunosuppressants
Concomitant use with ACE inhibitors may increase the risk of leukopenia.
Glucocorticosteroids, calcitonin
Concomitant use of thiazide diuretics can lead to the development of hypokalemia.
Cyclosporine
Concomitant use with ACE inhibitors may increase the risk of hyperkalemia.
Non-steroidal anti-inflammatory drugs The
simultaneous use of non-steroidal anti-inflammatory drugs (NSAIDs) (including selective inhibitors of cyclooxygenase-2) can weaken the antihypertensive effect of ACE inhibitors.
NSAIDs and ACE inhibitors have an additive effect on increasing serum potassium levels, which can lead to impaired renal function, especially in patients with impaired renal function. This effect is reversible.
NSAIDs can reduce the diuretic and antihypertensive effects of diuretics.
Antacids
Antacids may decrease the bioavailability of ACE inhibitors.
Sympathomimetics may reduce the antihypertensive effect of ACE inhibitors.
Thiazide diuretics can reduce the effects of adrenergic agonists (epinephrine).
Ethanol enhances the hypotensive effect of ACE inhibitors and thiazide diuretics, which can cause orthostatic hypotension.
Oral hypoglycemic agents and insulin
Epidemiological studies suggest that the simultaneous use of ACE inhibitors and hypoglycemic agents may lead to hypoglycemia. Most often, hypoglycemia develops in the first weeks of therapy in patients with impaired renal function. Long-term and controlled clinical studies of enalapril do not confirm these data and do not limit the use of enalapril in patients with diabetes mellitus. However, such patients should be monitored regularly.
The use of hypoglycemic agents for oral administration and insulin with thiazide diuretics may require dose adjustment.
Cholestyramine and Colestipol
A single dose of cholestyramine or colestipol reduces the absorption of hydrochlorothiazide in the gastrointestinal tract by 85% and 43%, respectively.
Gold preparations
With the simultaneous use of ACE inhibitors and gold preparations (sodium aurothiomalate) intravenously, a symptom complex is described, including flushing of the skin of the face, nausea, vomiting and arterial hypotension.

special instructions

јртериальна¤ гипотензи¤
јртериальна¤ гипотензи¤ со всеми клиническими последстви¤ми может наблюдатьс¤ после первого приема таблеток препарата ЁнапЃ Ќ у пациентов с т¤желой ’—Ќ и гипонатриемией, выраженной почечной недостаточностью или дисфункцией левого желудочка и, в особенности, у пациентов с гиповолемией, в результате терапии диуретиками, бессолевой диеты, диареи, рвоты или гемодиализа.
¬ случае возникновени¤ артериальной гипотензии необходимо уложить пациента на спину с низким изголовьем и при необходимости скорректировать объем ќ?  путем инфузии раствора 0,9% натри¤ хлорида. јртериальна¤ гипотензи¤, возникша¤ после приема первой дозы, не ¤вл¤етс¤ противопоказанием дл¤ дальнейшего лечени¤.
“ребуетс¤ соблюдать осторожность у пациентов с ишемической болезнью сердца, выраженными цереброваскул¤рнымй заболевани¤ми, аортальным стенозом или идиопатическим гипертрофическим обструктивным субаортальным стенозом, преп¤тствующим оттоку крови из левого желудочка, выраженным атеросклерозом, у пожилых пациентов в результате риска развити¤ артериальной гипотензии и ухудшени¤ кровоснабжени¤ сердца, головного мозга и почек.
Ќарушени¤ водно-электролитного баланса
Ќеобходим регул¤рный контроль сывороточной концентрации электролитов в период лечени¤ дл¤ вы¤влени¤ возможного дисбаланса и своевременного прин¤ти¤, необходимых мер. ќпределение сывороточной концентрации электролитов об¤зательно дл¤ пациентов с длительной диареей, рвотой.
” пациентов, принимающих препарат ЁнапЃ Ќ, необходимо вы¤вл¤ть признаки нарушени¤ водно-электролитного баланса, такие как, сухость во рту, жажда, слабость, сонливость, повышенна¤ возбудимость, миалги¤ и судороги (преимущественно икроножных мышц), снижение ј?, тахикарди¤, олигури¤ и желудочно-кишечные нарушени¤ (тошнота, рвота).
Ќарушение функции почек
ѕрепарат ЁнапЃ Ќ у пациентов с почечной недостаточностью (   30-75 мл/мин) должен примен¤тьс¤ только после предварительной титрации доз эналаприла и гидрохлоротиазида в отдельности, соответственно дозам в комбинированном препарате ЁнапЃ Ќ.
Ќарушение функции печени
ѕрепарат ЁнапЃ Ќ необходимо с осторожностью примен¤ть у пациентов с печеночной недостаточностью или прогрессирующими заболевани¤ми печени, так как гидрохлоротиазид может вызвать печеночную кому даже при минимальных нарушени¤х водно-электролитных баланса. —ообщалось о нескольких случа¤х развити¤ острой печеночной недостаточности с холестатической желтухой, фульминантным некрозом печени и летальным исходом (редко) во врем¤ лечени¤ ингибиторами јѕ‘. ѕри возникновении желтухи и повышении активности Ђпеченочныхї трансаминаз лечение препаратом ЁнапЃ Ќ должно быть немедленно прекращено, пациенты должны находитьс¤ под наблюдением.
ћетаболические и эндокринные эффекты
ќсторожность необходима у всех пациентов, получающих лечение гипогликемическими средствами дл¤ приема внутрь или инсулином, так как гидрохлоротиазид может ослабл¤ть, а эналаприл усиливать их действие.
“иазидные диуретики могут уменьшать выведение кальци¤ почками и вызывать незначительное и преход¤щее повышение содержани¤ кальци¤ в сыворотке крови.
¬ыраженна¤ гиперкалышеми¤ может быть признаком скрытого гиперпаратиреоза. ѕеред проведением исследовани¤ функции паращитовидных желЄз тиазидные диуретики необходимо отменить.
Ќа фоне лечени¤ тиазидными диуретиками могут повышатьс¤ концентрации холестерина и триглицеридов в сыворотке крови.
“ерапи¤ тиазидными диуретиками у некоторых пациентов может усугубл¤ть гиперурикемию и/или обостр¤ть течение подагры. ќднако эналаприл усиливает выведение мочевой кислоты почками, тем самым, противодейству¤ гиперурикемическому эффекту гидрохлоротиазида.
јллергические реакиии/јнгионевротический отек
ѕри возникновении ангионевротического отека лица обычно бывает достаточно отмены терапии и назначение пациенту антигистаминньгх средств.
јнгионевротический отЄк ¤зыка, глотки или гортани может оказатьс¤ летальным. ѕри ангионевротическом отеке ¤зыка, глотки или гортани, который может привести к обструкции дыхательных путей, необходимо немедленно ввести эпинефрин (0,3-0,5 мл раствора эпинефрина (адреналина) подкожно в соотношении 1:1000) и поддерживать проходимость дыхательных путей (интубаци¤ или трахеостоми¤).
—реди пациентов негроидной расы, получающих терапию ингибитором јѕ‘, частота возникновени¤ ангионевротического отЄка выше, чем среди пациентов другой расовой принадлежности.
ѕациенты с ангионевротическим отЄком в анамнезе, не св¤занным с ингибиторами јѕ‘, имеют повышенный риск развити¤ ангионевротического отЄка при приЄме любого ингибитора јѕ‘.
” пациентов, принимающих тиазидные диуретики, реакции повышенной чувствительности могут развитьс¤ как при наличии, так и при отсутствии в анамнезе аллергических реакций. —ообщалось об ухудшении течени¤ системной красной волчанки.
¬следствие повышени¤ риска анафилактических реакций не следует назначать препарат ЁнапЃ Ќ пациентам, наход¤щимс¤ на гемодиализе с использованием высокопроточных полиакрилонитриловых мембран (AN69Ѓ), подвергающихс¤ аферезу липопротеинов низкой плотности с декстрансульфатом и непосредственно перед процедурой десенсибилизации к осиному или пчелиному ¤ду.
’ирургические вмешательства/ обща¤ анестези¤
ѕеред хирургическим вмешательством (включа¤ стоматологию) необходимо предупредить врача-анестезиолога о применении ингибиторов јѕ‘.
¬о врем¤ хирургических вмешательств или проведении общей анестезии с использованием средств, вызывающих артериальную гипотензию, ингибиторы јѕ‘ могут блокировать образование ангиотензина II в ответ на компенсаторное высвобождение ренина. ?сли при этом развиваетс¤ выраженное снижение ј?, объ¤сн¤емое подобным механизмом, его можно корректировать увеличением объема циркулирующей крови.
 ашель
ѕри применении ингибиторов јѕ‘ отмечалс¤ кашель.  ашель сухой, длительный, который исчезает после прекращени¤ приема ингибиторов јѕ‘. ѕри дифференциальном диагнозе кашл¤, надо учитывать и кашель, вызванный применением ингибиторов јѕ‘.

¬ли¤ние на способность управл¤ть транспортным средством и другими механическими средствами:

¬ начале лечени¤ препаратом ЁнапЃ Ќ могут возникать выраженное снижение ј?, головокружение и сонливость, что может снижать способность к управлению транспортными средствами, заниматьс¤ другими потенциально опасными видами де¤тельности, требующими повышенной концентрации внимани¤ и быстроты психомоторных реакций. ѕоэтому, в начале лечени¤, не рекомендуетс¤ управл¤ть транспортными средствами и заниматьс¤ другими потенциально опасными видами де¤тельности, требующими повышенной концентрации внимани¤ и быстроты психомоторных реакций.

‘орма выпуска

“аблетки 25 мг + 10 мг. ѕо 10 таблеток в блистер. ѕо 2 блистера помещают в пачку картонную вместе с инструкцией по применению.

”слови¤ хранени¤

¬ сухом месте, при температуре не выше 25? —.
’ранить в недоступном дл¤ детей месте.

—рок годности

5 years.
Do not use the drug after the expiration date.

Conditions of dispensing from pharmacies

On prescription.