Pharmacodynamics and pharmacokinetics
This drug reduces the level of sodium ions in the vascular wall, blood pressure , arterial vascular tone, peripheral , and also increases diuresis . The hypotensive effect lasts throughout the day.
Thus, the drug is effective in cases of arterial hypertension . The hypotensive effect of the active components of the drug complements each other. Therapy with this drug is more effective in most cases for arterial hypertension than the use of enalapril maleate and hydrochlorothiazide separately.
Enalapril is an ACE inhibitor . Once absorbed it is metabolized to enalaprilat . Its action leads to a decrease in the level of angiotensin II in plasma, which increases the activity renin and decreases the secretion of aldosterone . In addition, enalapril prevents the destruction of bradykinin .
The decrease in blood pressure is accompanied by a decrease in total peripheral vascular resistance and a slight increase in cardiac output. The drug increases renal blood flow . the glomerular filtration rate does not change , unless it was initially reduced in patients.
Hydrochlorothiazide is a diuretic and antihypertensive agent that helps increase renin . Thus, when combined with enalapril , it results in a greater reduction in blood pressure . Discontinuation of the drug does not cause its sharp increase.
The maximum effect, as a rule, appears 2-4 hours after application. The hypotensive effect is noticeable within an hour. The duration of action of the medicine largely depends on the dosage. As a rule, it lasts throughout the day.
Co-renitec®
Hydrochlorothiazide
Metabolic and endocrine effects
Thiazide therapy may impair glucose tolerance. In some cases, dose adjustment of hypoglycemic agents, including insulin, may be required.
Thiazides may reduce renal excretion of calcium and cause a short-term and slight increase in serum calcium. Severe hypercalcemia may be a sign of hidden hyperparathyroidism. Due to the effect of thiazides on calcium metabolism, their use may distort the results of testing the function of the parathyroid glands, therefore, before testing the function of the parathyroid glands, the thiazide diuretic should be discontinued.
An increase in the concentration of cholesterol and triglycerides in the blood can also be associated with therapy with thiazide diuretics, however, with a dose of hydrochlorothiazide of 12.5 mg contained in 1 tablet of the drug Korenitek®, such effects were not observed or were insignificant.
In some patients, therapy with thiazide diuretics may lead to the development of hyperuricemia and/or exacerbation of gout. However, enalapril may increase renal excretion of uric acid and thereby reduce the hyperuricemic effect of hydrochlorothiazide.
Liver diseases
Thiazide diuretics should be used with caution in patients with impaired liver function or progressive liver disease, since even small changes in water and electrolyte balance can lead to hepatic coma.
Anti-doping test
Hydrochlorothiazide may cause false-positive analytical results in anti-doping tests.
Choroidal effusion, acute myopia and secondary angle-closure glaucoma
Drugs containing sulfonamide or sulfonamide derivatives may cause idiosyncratic reactions such as choroidal effusion with visual field defect, transient myopia, and acute angle-closure glaucoma. Symptoms of these disorders include a sudden decrease in visual acuity or eye pain, which typically occurs within a few hours to several weeks after starting to use the drug. If left untreated, acute angle-closure glaucoma can lead to vision loss. The main treatment is to discontinue hydrochlorothiazide as quickly as possible. It is important to keep in mind that if intraocular pressure remains uncontrolled, emergency medical or surgical treatment may be required. Risk factors for the development of acute angle-closure glaucoma include a history of allergies to sulfonamides or penicillin.
Non-melanoma skin cancer (NMSC)
In epidemiological studies, an increased risk of non-melanoma skin cancer (basal cell carcinoma and squamous cell carcinoma) was observed due to an increase in the total (cumulative) dose of hydrochlorothiazide. A possible mechanism for the development of NMSC is the photosensitizing effect of hydrochlorothiazide.
Patients taking hydrochlorothiazide should be aware of the risk of developing NMSC. Such patients should be advised to follow preventative measures such as limiting exposure to sunlight and artificial UVA rays. Patients should regularly examine their skin to identify any new suspicious lesions and report them promptly to their physician. In patients with a history of NMSC, it is recommended to reconsider the advisability of using hydrochlorothiazide (see Side effects).
Enalapril
Aortic or mitral stenosis/hypertrophic obstructive cardiomyopathy
Like all drugs that have a vasodilating effect, ACE inhibitors should be administered with caution to patients with left ventricular outflow tract obstruction.
Liver failure
The use of ACE inhibitors has rarely been associated with the development of a syndrome starting with cholestatic jaundice or hepatitis and progressing to fulminant hepatic necrosis, sometimes fatal. The mechanism of this syndrome has not been studied. If jaundice appears or a significant increase in the activity of hepatic transaminases during the use of ACE inhibitors, the ACE inhibitor should be discontinued and appropriate auxiliary therapy should be prescribed. The patient should be under appropriate supervision.
Surgical interventions / general anesthesia
During major surgery or general anesthesia with the use of drugs that cause an antihypertensive effect, enalaprilat blocks the formation of angiotensin II caused by the compensatory release of renin. If a pronounced decrease in blood pressure develops, explained by a similar mechanism, it can be corrected by increasing the volume of circulating blood.
Hypersensitivity reactions/angioedema
When using ACE inhibitors, including enalapril, rare cases of angioedema of the face, extremities, lips, tongue, vocal folds and/or larynx have been observed, occurring at different periods of treatment. In very rare cases, the development of intestinal edema has been reported. In such cases, you should immediately stop taking enalapril and carefully monitor the patient's condition in order to monitor and correct clinical symptoms. Even in cases where only swelling of the tongue is observed without the development of respiratory distress syndrome, patients may require long-term observation, since therapy with antihistamines and corticosteroids may not be sufficient.
Death due to angioedema associated with laryngeal edema or tongue edema has been very rarely reported. Swelling of the tongue, vocal folds, or larynx can lead to airway obstruction, especially in patients who have undergone respiratory surgery. In cases where swelling is localized in the area of the tongue, vocal folds or larynx and can cause airway obstruction, appropriate treatment should be immediately prescribed, which may include subcutaneous injection of 0.1% epinephrine (adrenaline) solution (0.3-0.5 ml) and/or ensure airway patency.
In rare cases, intestinal edema (angioedema of the intestine) develops during therapy with ACE inhibitors. Symptoms disappeared after stopping the ACE inhibitors. The possibility of developing intestinal edema must be taken into account when carrying out the differential diagnosis of abdominal pain in patients taking ACE inhibitors.
In black patients taking ACE inhibitors, angioedema was observed more often than in patients of other races.
Patients with a history of angioedema not associated with taking ACE inhibitors may be at greater risk of developing angioedema during therapy with ACE inhibitors (see Contraindications). An increased risk of developing angioedema was observed in patients taking ACE inhibitors and mTOR inhibitors concomitantly.
In patients taking ACE inhibitors and neprilysin inhibitors simultaneously, an increased risk of developing angioedema was observed (see Contraindications, Interactions with other drugs).
In patients taking thiazide diuretics, hypersensitivity reactions may occur even in the absence of a history of allergic reactions or bronchial asthma. Relapses or worsening of the severity of systemic lupus erythematosus have been reported in patients taking thiazide diuretics.
Anaphylactoid reactions during desensitization with an allergen from Hymenoptera venom
In rare cases, patients taking ACE inhibitors have developed life-threatening anaphylactoid reactions during desensitization with hymenoptera venom allergen. Adverse reactions can be avoided if you temporarily stop taking the ACE inhibitor before starting desensitization.
Anaphylactoid reactions during LDL apheresis
Life-threatening anaphylactoid reactions have rarely been observed in patients taking ACE inhibitors during LDL apheresis using dextran sulfate. The development of these reactions can be avoided if the ACE inhibitor is temporarily discontinued before each LDL apheresis procedure.
Patients on hemodialysis
The use of Korenitek® is not recommended for patients with renal failure undergoing hemodialysis. Anaphylactoid reactions have been observed in patients on dialysis using high-flux membranes (such as AN 69®) and concomitantly receiving ACE inhibitor therapy. In these patients, it is necessary to use a different type of dialysis membrane or other classes of antihypertensive agents.
Kidney transplant
There is no experience with the use of enalapril in patients after kidney transplantation. Treatment with enalapril in patients after kidney transplantation is not recommended.
Neutropenia/agranulocytosis
Neutropenia/agranulocytosis, thrombocytopenia and anemia have been observed in patients taking ACE inhibitors. In patients with normal renal function and in the absence of other complicating factors, neutropenia rarely develops. Enalapril should be used with extreme caution in patients with systemic connective tissue diseases, those receiving immunosuppressive therapy, allopurinol or procainamide therapy, or a combination of these complicating factors, especially if there is a history of impaired renal function. Some of these patients developed serious infections, which in some cases did not respond to intensive antibiotic therapy. If enalapril is used in such patients, periodic monitoring of the white blood cell count is recommended and patients should be warned to report any signs of infection.
Cough
Cases of cough occurring during therapy with ACE inhibitors have been observed. As a rule, the cough is non-productive, persistent and stops after discontinuation of therapy. Cough associated with the use of ACE inhibitors should be considered in the differential diagnosis of cough.
Combination of hydrochlorothiazide and enalapril
Arterial hypotension and water-electrolyte imbalance
When using antihypertensive drugs, some patients may develop symptomatic arterial hypotension. Patients should be monitored for clinical signs of fluid and electrolyte imbalance, such as dehydration, hyponatremia, hypochloremic alkalosis, hypomagnesemia, or hypokalemia, which may occur with concomitant diarrhea or vomiting. In such patients, monitoring of serum electrolytes is necessary.
The drug should be prescribed with extreme caution to patients with coronary heart disease or cerebrovascular diseases, in whom an excessive decrease in blood pressure can lead to the development of myocardial infarction or stroke.
If arterial hypotension develops, the patient should be laid down and, if necessary, a 0.9% sodium chloride solution should be administered. Transient arterial hypotension when taking the drug Ko-Renitek® is not a contraindication to its further use. After normalization of blood pressure and replenishment of circulating blood volume, therapy can be resumed in lower doses or each of the components of the drug can be used in monotherapy.
Renal dysfunction
Thiazide diuretics may not be effective enough in patients with impaired renal function and are ineffective when CC is 30 ml/min or lower (i.e., with moderate or severe renal failure).
The drug Korenitek® should not be prescribed to patients with renal failure (creatinine clearance less than 80 ml/min) until the selection of individual active components of the drug shows that the required doses are contained in one tablet of the combined drug.
In some patients with arterial hypertension without any evidence of a history of renal disease, when treated with enalapril in combination with a diuretic, there was usually a slight and transient increase in the concentration of urea in the blood and creatinine in the serum. In such cases, treatment with Corenitek should be discontinued. In the future, it is possible to resume therapy in lower doses or each of the components of the drug can be used in monotherapy.
In some patients with bilateral renal artery stenosis or arterial stenosis of a solitary kidney, increases in blood urea and serum creatinine concentrations were observed when treated with ACE inhibitors. The changes were usually reversible, and indicators returned to baseline values after cessation of treatment. This pattern of changes is most likely in patients with renal failure.
Lithium preparations
The simultaneous use of lithium, enalapril and diuretics is not recommended (see Interaction with other drugs).
Hyperkalemia
(see Interactions with other drugs, Potassium-sparing diuretics, potassium-containing dietary supplements, or other drugs that may increase serum potassium levels)
The risk of developing hyperkalemia occurs with renal failure, diabetes mellitus, and with concomitant use of potassium-sparing diuretics (for example, spironolactone, eplerenone, triamterene or amiloride), potassium-containing dietary supplements, potassium-containing table salt substitutes, or other drugs that can increase serum potassium levels blood (for example, drugs containing trimethoprim).
The use of potassium-containing dietary supplements, potassium-sparing diuretics, potassium-containing table salt substitutes, or other drugs that can increase serum potassium levels (for example, drugs containing trimethoprim), especially in patients with impaired renal function, may lead to a significant increase in serum potassium levels. blood serum. Hyperkalemia can lead to serious, sometimes fatal, arrhythmias.
If it is necessary to simultaneously use the drug Ko-Renitek® and the drugs listed above, you should be careful and regularly monitor the potassium content in the blood serum.
Contraindications
Co-Renitec should not be used in case of hypersensitivity to its components, childhood , anuria , history of angioedema , as well as hereditary or idiopathic angioedema .
This drug is prescribed with caution for:
- bilateral renal artery stenosis ;
- coronary heart disease;
- aortic stenosis;
- severe systemic connective tissue diseases;
- diabetes mellitus;
- condition after kidney transplantation;
- a diet with limited sodium content;
- old age;
- cerebrovascular diseases;
- chronic heart failure ;
- renal failure;
- inhibition of bone marrow hematopoiesis;
- conditions accompanied by a decrease in circulating blood volume;
- liver failure;
- hyperkalemia;
- stenosis of the artery of a single kidney.
Instructions for use CO-RENITEC® (CO-RENITEC)
Hypotension and electrolyte/water imbalance
As with other antihypertensive drugs, some patients may develop symptomatic hypotension. Patients should be monitored for clinical signs of fluid or electrolyte imbalance, such as dehydration, hyponatremia, hypochloremic alkalosis, hypomagnesemia, or hypokalemia, which may occur as a result of diarrhea or vomiting. Serum electrolyte levels should be checked periodically in such patients. A particularly careful approach should be taken to the treatment of patients with coronary heart disease or cerebrovascular diseases, since excessive lowering of blood pressure can lead to myocardial infarction or stroke. If arterial hypotension develops, the patient should be placed on his back and, if necessary, saline sodium chloride solution should be administered intravenously. Temporary hypotension is not a contraindication to the use of subsequent doses of the drug. After normalization of circulating blood volume and blood pressure, therapy can be resumed in reduced doses or using each component of the drug separately.
Aortic stenosis/hypertrophic cardiomyopathy
Like all other vasodilators, ACE inhibitors should be administered with caution to patients with left ventricular outflow tract obstruction.
Renal dysfunction
Thiazides may be inappropriate for use in patients with renal impairment and may not be effective when creatinine clearance is 30 mL/min or lower (i.e., moderate to severe renal impairment). Korenitec should not be administered to patients with impaired renal function (creatinine clearance <80 ml/min) until the dose titration of each component of the drug reaches the dose of this combination drug.
In some patients with arterial hypertension without evidence of existing kidney disease, concomitant use of enalapril and a diuretic usually results in a slight and temporary increase in blood urea and serum creatinine levels. If this phenomenon occurs during use of the drug Korenitek, this combination drug should be discontinued. Treatment with the drug can be resumed in reduced doses or using each of the components of the drug separately.
In some patients with bilateral renal artery stenosis or solitary renal artery stenosis, increases in blood urea and serum creatinine have been observed when using ACE inhibitors, which are usually reversible when the drug is discontinued.
Liver diseases
Thiazides should be used with caution in patients with impaired liver function or progressive liver disease, since minimal changes in fluid or electrolyte balance may lead to the development of hepatic coma.
Surgery/anesthesia
In patients undergoing major surgery or anesthesia using agents that cause hypotension, enalapril may block the formation of angiotensin II as a result of compensatory release of renin. If arterial hypotension occurs, which is explained by a similar mechanism, it can be corrected by increasing the volume of circulating blood.
Metabolic and endocrine effects
Thiazide therapy may lead to deterioration of glucose tolerance. Dosage adjustments of antidiabetic agents, including insulin, may be necessary. Thiazides may reduce urinary calcium excretion and may also cause intermittent and slight increases in serum calcium levels. Severe hypercalcemia may indicate latent hyperparathyroidism. The use of thiazides should be discontinued before testing the function of the parathyroid glands.
Elevations in cholesterol and triglyceride levels may be associated with treatment with thiazide diuretics; however, minimal or no effects were reported with the 12.5 mg dose of Corenitec. Thiazide therapy may lead to the development of hyperuricemia and/or gout in certain patients. However, enalapril may increase urinary excretion of uric acid and thus reduce the hyperuricemic effect of hydrochlorothiazide.
Hypersensitivity/angioedema
Angioedema of the face, extremities, lips, tongue, glottis and/or larynx has rarely been reported in patients receiving ACE inhibitors, including enalapril maleate. These reactions may occur at any time during treatment. In such cases, enalapril maleate should be discontinued immediately and the patient should be monitored appropriately to ensure complete resolution of symptoms before the patient is discharged. Even in cases where there is only swelling of the tongue without respiratory distress, long-term monitoring of the patient's condition is necessary, since treatment with antihistamines and corticosteroids may not be sufficient. Very rarely, fatal cases have been reported due to angioedema, which was accompanied by swelling of the larynx or tongue. Patients with swelling of the tongue, glottis, or larynx are more likely to develop airway obstruction, especially in patients with a history of airway surgery. In cases where swelling of the tongue, glottis or larynx may lead to airway obstruction, appropriate therapy should be administered immediately, which may include subcutaneous administration of epinephrine solution 1:
- 1000 (0.3-0.5 ml) and/or measures to maintain airway patency.
The development of angioedema was more often reported in patients of the Black race than in patients of other races.
Patients with a history of angioedema that is not associated with the use of an ACE inhibitor may be at higher risk of developing angioedema while using an ACE inhibitor.
In patients using thiazides, sensitivity reactions may occur regardless of a history of allergies or bronchial asthma. Exacerbation or activation of systemic lupus erythematosus has been reported with the use of thiazides.
Anaphylactoid reactions during desensitization with hymenoptera venom
Life-threatening anaphylactoid reactions have rarely occurred in patients who used ACE inhibitors during hymenoptera venom desensitization. The occurrence of such reactions can be avoided by temporarily stopping the use of the ACE inhibitor before starting desensitization.
Anaphylactoid reactions during LDL apheresis
Life-threatening anaphylactoid reactions have rarely occurred in patients who used ACE inhibitors during LDL apheresis using dextran sulfate. The occurrence of such reactions can be avoided by temporarily stopping the use of the ACE inhibitor before each apheresis.
Patients undergoing hemodialysis
The use of Korenitek is contraindicated in patients who require hemodialysis for renal failure. Anaphylactic reactions have been reported in patients undergoing dialysis using high-permeability membranes (eg, AN 69®) and concomitant treatment with an ACE inhibitor. In such patients, consideration should be given to the use of a different type of dialysis membrane or a different class of antihypertensive drug.
Cough
Cough has been reported with the use of ACE inhibitors. As a rule, the cough is nonproductive, persistent and disappears after cessation of therapy. Cough that occurs as a result of the use of ACE inhibitors should be considered in the differential diagnosis of cough.
Hyperkalemia
Risk factors for the development of hyperkalemia include renal impairment, diabetes mellitus, and concomitant use of potassium-sparing diuretics (such as spironolactone, eplerenone, triamterene, or amiloride), potassium supplements, or salt substitutes containing potassium.
The use of potassium supplements, potassium-sparing drugs, or salt substitutes containing potassium, especially in patients with impaired renal function, may result in marked increases in serum potassium levels. Hyperkalemia can cause serious, sometimes fatal, arrhythmias.
If concomitant use of Corenitec and the above agents is considered necessary, they should be used with caution and frequent monitoring of serum potassium levels.
Lactose
Ko-Renitek contains less than 200 mg of lactose per tablet. Patients with rare hereditary diseases of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption should not use this medicinal product.
Kidney transplant
There is no experience with the use of enalapril in patients with recent kidney transplantation. Therefore, treatment with enalapril is not recommended.
Use in elderly patients
In clinical studies, the efficacy and tolerability of enalapril maleate and hydrochlorothiazide administered concomitantly were similar in elderly patients and in younger patients with hypertension.
Use in children
The safety and effectiveness of the drug in children have not been established.
Impact on the ability to drive vehicles and other mechanisms
When operating vehicles and machinery, it should be taken into account that dizziness or fatigue may occasionally occur.
Side effects
Negative side effects, according to research, are usually moderate in nature. They usually do not require discontinuation of therapy. Side effects may be as follows:
- respiratory system – shortness of breath, cough;
- CVS - palpitations, orthostatic effects, fainting, arterial hypotension , chest pain, tachycardia ;
- musculoskeletal system - the appearance of muscle cramps, pain in the joints;
- kidneys – development of renal failure , problems with kidney function;
- laboratory indicators – hyperglycemia , hyperkalemia , hypokalemia , hyperuricemia , decreased hematocrit and hemoglobin ;
- CNS – dizziness , increased excitability, asthenia , paresthesia , increased fatigue, drowsiness , headache , sleep disturbances ;
- digestive system - dyspepsia , diarrhea , nausea, flatulence , dry mouth, vomiting, abdominal pain, constipation , pancreatitis ;
- allergies – itching , rash;
- reproductive system – development of impotence , decreased libido;
- others – tinnitus, gout .
In addition, in rare cases, when taking the medicine, undesirable manifestations such as angioedema of the glottis, limbs, tongue, face, larynx, lips, Stevens-Johnson syndrome , intestinal Quincke's edema , hyperhidrosis .
Side effects of the drug Ko-renitek
Co-Renitec is generally well tolerated. The most common side effects were dizziness and fatigue, which usually resolved with dose reduction and rarely required discontinuation of therapy. Other side effects (1–2%) were: muscle cramps, nausea, asthenia, orthostatic effects including hypotension, headache, cough, impotence. The following side effects were rarely noted: from the cardiovascular system - fainting, non-orthostatic hypotension, palpitations, tachycardia, chest pain; from the gastrointestinal tract - pancreatitis, diarrhea, vomiting, dyspepsia, abdominal pain, flatulence, constipation; from the nervous system and psyche - insomnia, drowsiness, paresthesia, dizziness, increased excitability; from the respiratory system - shortness of breath; on the part of the skin - Stevens-Johnson syndrome, rash, itching, increased sweating; others - impaired renal function, renal failure, decreased libido, dry mouth, tinnitus, gout, arthralgia. A constellation of symptoms has been noted that may include fever, serositis, vasculitis, myalgia and myositis, arthralgia and arthritis, positive antinuclear antibody (ANA) testing, accelerated ESR, eosinophilia and leukocytosis. May detect rash, photosensitivity and other dermatological manifestations. Hypersensitivity and angioedema Angioedema of the face, extremities, lips, tongue, glottis and/or larynx has been reported rarely (see SPECIAL INSTRUCTIONS). From the side of laboratory parameters When prescribing Ko-Renitek, clinically significant changes in laboratory parameters were rarely detected. In rare cases, hyperglycemia, hyperuricemia and hypokalemia, increased blood urea levels, serum creatinine, increased liver enzyme activity and/or increased serum bilirubin levels have been observed. After cessation of Corenitec therapy, these indicators usually returned to normal. Hyperkalemia, decreased hemoglobin levels, and decreased hematocrit levels have also been reported.
Instructions for use Co-Renitek (Method and dosage)
This medication is taken orally , one tablet once a day. If necessary, the dosage can be increased to two tablets per day.
Instructions for use Co-Renitek recommends monitoring water and electrolyte balance data. If the patient has previously taken diuretics , you must wait 2-3 days before using Co-Renitec tablets. In cases where there is an increase in urea and creatinine in the blood, the use of the drug should be discontinued.
Use of the drug Ko-Renitek
AH (arterial hypertension) Adults are usually prescribed 1 tablet once a day. If necessary, the dose can be increased to 2 tablets per day for 1 dose. Previous diuretic therapy At the beginning of treatment with Corenitec, symptomatic arterial hypotension may be noted; it is more often detected in patients in whom previous diuretic therapy has led to an imbalance of water and electrolyte balance. Diuretic therapy should be discontinued 2–3 days before starting Corenitec therapy. Dosing in Renal Impairment Thiazide diuretics may not be effective in patients with impaired renal function and may not be effective in patients with creatinine clearance of 30 mL/min or less (i.e., moderate to severe renal impairment). In patients with creatinine clearance in the range of 30–80 ml/min, Corenitec can be used only after preliminary selection of doses of each component. The recommended starting dose of enalapril maleate taken alone for moderate renal impairment is 5 to 10 mg.
Interaction
Co-Renitec can be used with other antihypertensive drugs. Then the summation of the action is observed. In combination with potassium supplements, potassium-containing salts and potassium-sparing diuretics hyperkalemia is likely .
When interacting with lithium drugs, lithium excretion through the kidneys is reduced. lithium intoxication increases .
NSAIDs reduce the effect of the drug. And if they are taken by patients with kidney function problems, this combination can lead to a deterioration in kidney function. But these changes are reversible.
The hypotensive effect of the drug is reduced by estrogens and ethanol . Immunosuppressants , cytostatics and Allopurinol increase the likelihood of hematotoxicity .
Analogues of Ko-Renitek
Level 4 ATX code matches:
Akkuzid
Enap-N
Iruzid
Co-Diroton
Enalozide
Enap NL
Enapril-N
Capozide
Tritace Plus
Enzix
Liprazid
Hartil N
Hartil D
Noliprel
Ko-Perineva
Kaptopres
The following analogues of Co-Renitek are sold in pharmacies:
- Enalapril-HL-Health;
- Berlipril Plus;
- Ena Sandoz Compositum;
- Enalapril-H-Health;
- Enalozide;
- Enalozid Forte;
- Enap-N;
- Enap-HL;
- Enapril-N.
Co-Renitek price, where to buy
The price of Co-Renitek, which contains 28 tablets per package, is on average about 340 rubles.
- Online pharmacies in RussiaRussia
- Online pharmacies in UkraineUkraine
ZdravCity
- KO-Renitek tablets 20 mg + 12.5 mg 28 pcs. Merck Sharp & Dohme BV
489 rub. order
Pharmacy Dialogue
- Co-Renitek (tab. 20/12.5 mg No. 28) Merck Sharp
RUR 538 order
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Pharmacy24
- Tablets Co-Renitek 20/12.5 mg No. 28 Merck Sharp i Dome B.V./Merck Sharp i Dome Limited, Netherlands/Great Britain
189 UAH order
