Renitec - Dosage | Interactions | Side effects
This article was medically reviewed by M.Pharm, Marko Tanaskovic on August 12, 2018. To read more about an author, click here.
Renitec is a medicine that contains enalapril as an active substance and belongs to a family of medicines called angiotensin-converting enzyme inhibitors (ACE inhibitors). Angiotensin-converting enzyme is involved in the conversion of angiotensin I to angiotensin II which is known as a powerful vasoconstrictor substance. In addition to the vasoconstrictor effect, angiotensin II also stimulates the secretion of aldosterone - a hormone secreted by the adrenal cortex, which reabsorbs sodium and water and stimulates the secretion of potassium.
Renitec mechanism of action is shown below:
Because of these effects, Renitec is used to treat hypertension and symptomatic heart failure.
Contraindications and warnings
Renitec is contraindicated in patients who have a history of angioedema associated with previous use of ACE inhibitors as well as in patients with history of idiopathic or hereditary angioedema.
Since clinical studies have confirmed a toxic effect on the fetus (it can cause fetal death), this drug is absolutely contraindicated in pregnant women.
Its use is also contraindicated in patients with cardiogenic shock.
This medicine must be used with extra precautions in patients with left ventricular or blood flow obstruction.
Patients who have renal artery stenosis or other kidney disorders should not use this medicine without careful medical attention. Cases of renal insufficiency have been reported in patients who have renal impairment and are using this medicine.
This medicine can very rarely cause a fulminant necrosis of the liver that may have a fatal outcome.
Cases of neutropenia, thrombocytopenia, and anemia have been rarely reported. The risk of these side effects is higher in patients with impaired renal function and in patients taking medication that can also cause these side effects (e.g. immunosuppressive drugs).
Angioneurotic edema, which affects the tongue, glottis, larynx, lips and face, occurs very rare, but it may have a fatal outcome. Therefore, you should seek medical attention immediately if you notice swelling (edema).
Because it may affect blood glucose levels, diabetic patients who are taking this medicine should be closely monitored at the beginning of treatment (during the first month of treatment), in order to make necessary corrections to doses of oral anti-diabetic drugs.
Cough is the most commonly reported side effect of Renitec. Cough is usually unproductive and persistent. Do not discontinue therapy if cough stops after 15-30 days, but if cough persists after 30 days, then contact a doctor to discuss other possible treatment options.
Renitec increases blood potassium levels and high potassium levels (hyperkalaemia) can disrupt heart's muscle normal rhythm. The risk of hyperkalaemia is higher in patients:
- Who have impaired renal function
- Who have metabolic acidosis
- Suffering from diabetes
- Who have acute heart failure
- Who take potassium-sparing diuretics (e.g. aldosterone, spironolactone, and triamterene)
Renitec, pregnancy and breastfeeding
Renitec is absolutely contraindicated in pregnant women because it exhibits fetal toxicity. Studies have shown that this drug can cause a skull hypoplasia as well as renal insufficiency in the fetus.
The use of this medication during breastfeeding is not recommended.
The usual initial dose in the treatment of mild hypertension is 5-10 mg once a day. The usual maintenance dose is 20 mg once a day. The maximum daily maintenance dose for the treatment of hypertension is 40 mg.
The following dosing regimen should be used for the treatment of symptomatic heart failure:
- From first to third day of treatment: 2.5 mg once a day
- From the fourth to the seventh day of treatment: 2.5 mg twice daily
- From the seventh to the fourteenth day of treatment: 5 mg twice daily or 10 mg once a day
- After 14 days of treatment: 10 mg twice daily or 20 mg once daily
Take the tablet without regard to food.
Renitec should not be administered concurrently with the following medicines:
- Lithium (antipsychotic). Renitec increases the plasma concentration of lithium and therefore increases the risk of lithium toxicity.
- Tricyclic antidepressants (e.g. imipramine, nortriptyline, amitriptyline, and desimipramine). These medicines may enhance the antihypertensive effect of Renitec and the simultaneous use must be avoided.
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as: diclofenac, ibuprofen, ketoprofen, flurbiprofen, indomethacin and others. These medicines reduce the antihypertensive effect of Renitec.
- Oral anti-diabetics (e.g. metformin, gliclazide, glyburide, glimepiride, pioglitazone, and others). Renitec can increase the anti-hyperglycemic effect of these drugs and therefore increase the risk of hypoglycaemia.
Simultaneous use with alcoholic beverages must be avoided.
Side effects of Renitec include:
- Blurred vision
- Rapid heart rate
- Pain in the chest
- Stomach pain
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If you have any concerns or questions about your health, you should always consult with a physician or other health-care professional.