Malean

Malean - Precautions | Dosage | Interactions

Malean is a medicine that contains enalapril as an active substance and belongs to the group of ACE inhibitors (angiotensin-converting enzyme inhibitors) and is used to treat hypertension and cardiac insufficiency.

Precautions

Malean very often causes coughing as a side effect, and if the cough persists and does not disappear after 15-30 days, then you must contact your doctor. The mechanism through which Malean causes cough is based on the inhibition of the degradation of bradykinin and substance P, which are known as coughing mediators. In studies, 5 to 35% of patients had cough as an adverse effect.

Melean should not be used in patients with a history of the edema of the face, tongue, lips and throat caused by medicines, especially if caused by ACE inhibitors.

Clinical studies have confirmed that ACE inhibitors may cause major congenital malformations and may cause a number of disorders (including those that may have a fatal outcome) in the fetus. Pregnant women should not take this medicine, especially during the second and third trimester of pregnancy.

Patients undergoing dialysis or having kidney damage should cautiously use this medicine.

Patients who are taking potassium preparations or other drugs that may increase blood potassium levels, (such as Epleren) should not apply Malean concomitantly.

Caution is also required in patients who have vascular disease or cardiogenic shock.

Before starting the treatment, tell your doctor if you have liver disease because there is insufficient data on the safety of this medicine in patients with impaired liver function.

Inform your doctor if you have had a stroke or thrombotic events, because in that case extra precaution is needed.

Decrease in the number of neutrocytes and agranulocytes in the blood that lead to weakening of immune system, is rarely observed. If you notice flu-like symptoms (which are a sign of agranulocytosis or a neutropenia), you should call your physician.

Malean may increase the hypoglycemic effects of anti-diabetic agents, and caution is advised if this medicine is used in diabetics.

Dosage

The usual starting dose is 5 mg once a day, but the dose may be gradually increased to 20 mg daily. The dose is determined based on blood pressure. Patients who have abnormally active renin-angiotensin-aldosterone system, must start therapy with a lower dose (2.5 mg daily) because such patients are at higher risk of developing orthostatic hypotension and syncope.

The maximum daily dose is 40 mg.

You can take the tablet without regard to food.

The initial dose in the therapy of cardiac insufficiency is 2.5 mg daily and may be gradually increased to a 20 mg per day.

This medication can also be used in children and the dose is determined based on body weight.

The recommended dose for children who weigh 20-50 kg is 2.5 mg per day, while in children who weigh > 50 kg the initial dose is 5 mg once a day.

Interactions

Malean should not be used concurrently with the following drugs:

  • Potassium-sparing diuretics (e.g. spironolactone and triamterene).
  • Eplerenone, also known at brand name Espler (a medicine used to treat hypertension and for improving survival in patients who suffered a heart attack).
  • Aliskiren (a medicine used to treat hypertension).
  • Angiotensin-receptor antagonists, such as:
    • losartan
    • irbesartan
    • candesartan
    • olmesartan
    • valsartan
  • Medicines used in the treatment of rheumatoid arthritis, such as: teriflunomide and leflunomide. Concomitant use with these medicines increases the risk of hepatotoxicity.
  • Bactrim. Concomitant use with this medicine increases the risk of hyperkalemia.
  • Thrombolytic drugs.
  • Adrenaline, ephedrine, dopamine, naphazoline, phenylephrine and others. These medications can affect Malean's efficacy.
  • Lithium.
  • Selective cyclooxygenase-2 inhibitors, such as: etoricoxib, rofecoxib and celecoxib.
  • Non-selective cyclooxygenase inhibitors, such as:
  • Insulin and other hypoglycemic agents (e.g. metformin, empagliflozin, gliclazide and glimepiride).
  • Acetyl salicylic acid (Aspirin).
  • Gold preparations.

Side effects

The following adverse events have been reported in clinical studies:

  • Low blood sugar
  • Orthostatic hypotension and syncope
  • Depression
  • Headache
  • Dizziness
  • Raynaud phenomenon (a condition characterized by narrowing of blood vessels on the peripheral parts of body, which cause numerous muscle cramps)
  • Dyspnea
  • Muscle weakness
  • Cough
  • Tachycardia
  • Disrupted taste
  • Hyperkalemia
  • Hives
  • Ringing in the ears
  • Bone marrow depression
  • Pneumonia
  • Angioedema