Lisinopril 10 mg tablets number 30

Lisinopril (Lisinopril) Instructions for use

Composition:

active ingredient : lisinopril; 1 tablet contains lysinopril dihydrate, based on 5 mg, or 10 mg or 20 mg;
auxiliary substances: calcium hydrogen phosphate, mannitol (E 421), starch corn, magnesium stearate, silicon dioxide, colloidal anhydrous.

Dosage form

Tablets: 5 mg №20, 10 mg №20, 10 mg №30, 20 mg №20.

Pharmacotherapeutic group

Angiotensin converting enzyme (ACE) inhibitors. Code АТС С09А А03.

Clinical characteristics

Indications

Arterial hypertension.

Chronic heart failure.

Acute myocardial infarction in patients with stable hemodynamic parameters (systolic blood pressure> 100 mm Hg).

Diabetic nephropathy with diabetes mellitus (in patients with insulin-dependent diabetes mellitus type II).

Contraindications

Hypersensitivity to lysinopril, to other components of the drug or to other ACE inhibitors.

Angioneurotic edema in the history (including after the use of ACE inhibitors, idiopathic and hereditary edema).

Aortic or mitral stenosis or hypertrophic cardiomyopathy with marked hemodynamic disturbances.

Bilateral stenosis of the renal artery or stenosis of the artery of a single kidney; acute myocardial infarction with unstable hemodynamics; cardiogenic shock; simultaneous application of the drug and high-pass membranes from polyacrylonitrile-2-methylalyl sulfonate (eg, AN 96) for urgent dialysis; Patients with serum creatinine levels ≥ 220 μmol / L.

Pregnant women or women who are planning to become pregnant (see section "Use during pregnancy or breast-feeding").

Method of administration and dose

Lysinopril-Astrafarm tablets are taken inward once a day, preferably at the same time, regardless of food. The daily dose is individually selected, depending on the patient's reaction and blood pressure.

Arterial hypertension.

The drug is used as a monotherapy or in combination with other classes of antihypertensive drugs.

Initial dose.

With arterial hypertension, the recommended starting dose is 10 mg per day. In patients with elevated renin-angiotensin-aldosterone system activity (in particular with renovascular hypertension, excessive sodium chloride excretion from the body and / or dehydration, cardiac decompensation, or severe hypertension), an excessive reduction in blood pressure after the initial dose may occur. The recommended starting dose in these patients is 2.5-5 mg and the start of treatment should be under the supervision of a physician. To obtain a dose of 2.5 mg, use the drug with the appropriate active ingredient content.

For patients with renal insufficiency, the dose should be reduced (see Table 1).

Supportive dose.

The usual effective maintenance dose is 20 mg per day. If the drug at the indicated dose does not provide the proper therapeutic effect within 2-4 weeks, the dose can be further increased. The maximum daily dose is 80 mg per day.

Patients taking diuretics.

In patients undergoing diuretic therapy, after the first dose of Lisinopril-Astrapharm, symptomatic arterial hypotension may occur. Treatment with diuretics should be stopped 2-3 days before the treatment with Lisinopril-Astrapharm. If it is not possible to stop treatment with diuretics, lysinopril is prescribed at an initial dose of 5 mg. It is necessary to control the function of the kidneys and the level of potassium in the serum. A further dose should be selected depending on the blood pressure. If necessary, treatment with diuretics can be resumed.

Patients with renal insufficiency.

In patients with renal insufficiency, the dose is determined according to the creatinine clearance, as shown in Table 1:

Creatinine clearance (ml / min)	Initial dose (mg / day)
<10 (including patients on hemodialysis)	2.5 *
10-30	2.5-5
31-80	5-10

* The dose and / or dosage regimen is set according to blood pressure values. The dose can be raised to no more than 40 mg per day with blood pressure monitoring.

Chronic heart failure.

Patients with symptomatic heart failure Lisinopril-Astrapharm can be used as an adjunct to diuretics, digitalis or b-blockers. Lisinopril-Astrafarm is prescribed in the initial dose of 2.5 mg per day under the supervision of a physician to determine the primary effect on arterial pressure. The dose should be increased by no more than 10 mg, with a time interval of at least 2 weeks and up to a maximum dose of 35 mg per day.

The determination of the dose should be based on the clinical observation of each patient.

In patients with a high risk of developing symptomatic arterial hypotension (with excess sodium chloride excretion) with or without hyponatriemia, with hypovolemia, and also in patients who received high doses of diuretics, the above-mentioned conditions must be compensated before the start of treatment.

Acute myocardial infarction.

Patients should simultaneously receive standard, standard therapy with thrombolytic drugs, acetylsalicylic acid and β-blockers. Lisinopril is compatible with nitroglycerin administered intravenously or transdermally.

Initial dose (in the first 3 days after an infarction).

The therapy of lisinopril should be started in the first 24 hours after the onset of symptoms of the disease. Therapy should not be started if systolic blood pressure is less than 100 mm Hg. The first dose of Lisinopril-Astrapharm is 5 mg, after 24 hours, again, a dose of 5 mg is administered, then a dose of 10 mg once daily is administered, and then the maintenance dose is 10 mg once a day.

Patients with systolic arterial pressure (120 mm Hg or lower) in the first 3 days after myocardial infarction appoint a reduced dose of lysinopril - 2.5 mg.

In renal failure (clearance of creatinine <80 ml / min), the initial dose of lisinopril-astrapharm should be adjusted depending on the patient's creatinine clearance (see Table 1).

Supportive dose.

The maintenance dose is 10 mg per day. In case of arterial hypotension (systolic blood pressure lower than or equal to 100 mm Hg), a maintenance dose of 5 mg is temporarily reduced to 2.5 mg. If there is prolonged arterial hypotension (systolic blood pressure below 90 mmHg for more than 1 hour), treatment should be stopped.

Treatment should be continued for 6 weeks, then you need to re-evaluate the condition of the patient. Patients who have symptoms of heart failure should continue treatment with lisinopril.

Diabetic nephropathy.

In the treatment of arterial hypertension in patients with type II diabetes mellitus and initial nephropathy, the dose of lisinopril-astrapharm is 10 mg per day. If necessary, the dose may be increased to 20 mg per day in order to achieve diastolic blood pressure values below 90 mmHg. sitting in position.

With renal insufficiency (clearance of creatinine <80 ml / min), the initial dose of the drug should be corrected, depending on the patient's creatinine clearance (see Table 1).

Older patients.

In clinical studies, no differences were found in the efficacy or safety of the drug due to age. The initial dose of lysinopril given to elderly persons with reduced renal function should be adjusted according to Table 1. Subsequently, the dosage is determined depending on the reaction and blood pressure.

Adverse reactions

The side effects are listed below: very common (> 1/10), common (≥ 1/100, <1/10), uncommon (≥ 1/1000, <1/100), rarely (≥ 1/10 000) , <1/1000), very rare (<1 / 10,000), not known (can not be estimated from available data).

On the part of hematopoietic and lymphatic systems: rarely common - decrease in hemoglobin and hematocrit levels;very rarely common - oppression of bone marrow activity, anemia, thrombocytopenia, leukopenia, neutropenia, agranulocytosis, hemolytic anemia, lymphadenopathy, autoimmune disease.

On the part of the metabolism: very rarely common - hypoglycemia.

From the central nervous system: common - dizziness, headache; Uncommon - mood changes, paresthesia, disturbance of taste sensations, sleep disturbances, disturbance of balance, disorientation; rarely common - confusion, disturbance of the sense of smell; unknown - symptoms of depression, fainting.

From the cardiovascular system: common - orthostatic effect (including arterial hypotension); Uncommon: myocardial infarction or cerebrovascular stroke, possibly secondary due to excessive arterial hypotension in high-risk patients, palpitations, tachycardia, Raynaud's phenomenon.

On the part of the musculoskeletal system: muscle spasms have been reported.

From the respiratory system: common - cough, bronchitis; Uncommon - rhinitis, dyspnea; rarely common - dyspnoea, angioneurotic edema; very rarely common - bronchospasm, glossitis, sinusitis, allergic alveolitis / eosinophilic pneumonia. Infections of the upper respiratory tract have been reported.

On the digestive tract: common - diarrhea, vomiting; nonsurgical - nausea, abdominal pain and dyspepsia; rarely common - dry mouth, decreased appetite, taste changes; very rarely common - pancreatitis, intestinal angioedema, constipation, hepatitis (hepatocellular or cholestatic), jaundice and hepatic insufficiency.

Skin: non-common - rash, itching, hypersensitivity / angioneurotic edema of the face, extremities, lips, tongue, vocal cavity and / or pharynx, sensation of heat, skin hyperemia; rarely common - urticaria, alopecia, psoriasis; very rarely common - increased posterior distension, pemphigus, toxic epidermal necrolysis, Stevens-Johnson syndrome, polymorphic erythema, skin lymphocyte.

There was a syndrome that included one or more of the symptoms: fever, vasculitis, myalgia, arthralgia / arthritis, the appearance of positive antinuclear antibodies (ANA), rate of erythrocyte sedimentation (ESR), eosinophilia and leukocytosis, rash, photosensitization or other skin conditions.

From the kidneys and the urinary system: common - renal dysfunction; rarely common - uremia, acute renal failure; very rarely common - oliguria / anuria.

On the part of the endocrine system: unknown - inadequate secretion of the anti-diuretic hormone.

From the reproductive system and mammary glands: non-prevalent - impotence; rarely common - gynecomastia.

The body as a whole: non-prevalent - increased fatigue, weakness.

Laboratory indices: non-prevalent - elevated levels of urea in blood, creatinine in serum, hepatic enzymes, hyperkalemia; rarely common - increased bilirubin levels in serum, hyponatremia, proteinuria.

Overdose

Symptoms: arterial hypotension, circulatory shock, electrolyte disturbances, renal failure, hyperventilation, tachycardia, palpitations, bradycardia, dizziness, anxiety and coughing.

Treatment: intravenous administration of saline solutions. With arterial hypotension, you should put the patient on the back with raised legs up. If possible, administer an angiotensin II infusion and / or intravenously administer catecholamines. If the drug has recently been taken, the stomach was washed out, the use of absorbents and sodium sulfate was shown. Lisinopril is removed from the blood during hemodialysis. The use of a pacemaker is indicated for the treatment of stable bradycardia.

It is recommended that you constantly monitor laboratory parameters (determine the level of electrolytes and creatinine in the serum) and vital functions.

Use during pregnancy or breastfeeding

The drug is contraindicated during pregnancy or breast-feeding.

The drug should not be used by pregnant women or women who are planning to become pregnant. If pregnancy is confirmed during treatment with this product, its use should be discontinued immediately and, if necessary, replaced with a medicinal product authorized for use by a pregnant woman.

Where are you

The safety and efficacy of the use of lysinopril in children have not been established, therefore, it is not necessary to prescribe the drug Lisinopril-Astrafarm in this age category of patients.

Application features

Symptomatic arterial hypotension.

It is rarely seen in patients with uncomplicated arterial hypertension. In hypertensive patients taking lysinopril, the likelihood of arterial hypotension increases with decreasing circulating blood volume (for example, as a result of treatment with diuretics, limiting salt intake of food, dialysis, diarrhea or vomiting), as well as in severe forms of renin-dependent arterial hypertension.

Symptomatic arterial hypotension was observed in patients with heart failure, regardless of whether it is compatible with renal failure. This is most commonly seen in patients with severe heart failure who are forced to take large doses of loop diuretics and who have hyponatremia or functional renal failure. Patients with an increased risk of arterial hypotension need to be carefully monitored during the initial period of treatment and at the dose selection.

This also applies to patients with ischemic heart disease or vascular disease of the brain whose significant drop in blood pressure can lead to myocardial infarction or cerebrovascular accident.

In the case of development of arterial hypotension, the patient should be put on the back and, if necessary, make intravenous administration of a solution of sodium chloride. The transient hypotensive reaction is not a contraindication for the subsequent administration of the drug. After the recovery of the effective volume of blood and the disappearance of the transient hypotensive reaction, treatment with lisinopril can be continued.

In some patients with chronic heart failure who have normal or low blood pressure, an additional decrease in systemic arterial pressure may occur in the appointment of lisinopril. This effect is expected and is usually not a reason for discontinuation of therapy. In case of symptomatic hypotension, it may be necessary to reduce the dose or to stop taking lysinopril.

Arterial hypotension with acute myocardial infarction.

At acute myocardial infarction it is impossible to start the treatment of lisinopril if, because of previous treatment with vasodilators, there is a risk of further serious deterioration of hemodynamic parameters. This applies to patients with systolic arterial pressure ≤ 100 mm Hg. Art. or with cardiogenic shock. In the first 3 days after myocardial infarction, the dose should be reduced if the systolic blood pressure ≤ 120 mmHg. At systolic arterial pressure ≤ 100 mm Hg. Art. the maintenance dose should be reduced to 5 mg or temporarily to 2.5 mg. With stable hypotension (systolic blood pressure ≤ 90 mm Hg for more than 1 hour), lysinopril therapy should be discontinued.

Aortic and mitral stenosis / hypertrophic cardiomyopathy.

Like other ACE inhibitors, lysinopril should be prescribed with caution to patients with mitral stenosis or difficulty in ejection from the left ventricle (for example, with aortic stenosis or hypertrophic cardiomyopathy).

Abnormal kidney function.

In renal failure (clearance of creatinine <80 ml / min), the initial dose of lysinopril should be determined depending on the patient's creatinine clearance (see Table 1), and then - depending on the patient's response to treatment. Root control of potassium and creatinine is part of the normal medical practice of these patients.

Patients with heart failure may experience deterioration of renal function at the start of treatment with ACE inhibitors. In such situations, cases of acute renal failure, usually reversible, are described. In some patients with a narrowing of both renal arteries or with a single kidney artery stenosis, ACE inhibitors increase blood urea and creatinine levels in serum;usually these changes occur after discontinuation of drugs. The probability of this is particularly high with renal failure.

With availability renovaskulyarnoy High risk of hypertension development arteryalnoy severe hypotension and renal failure. In such patsyentov Treatment sleduet the Start tschatelnыm medical observation pod with malыh doses kotoryya dolzhnы bыt exactly podobranы. Since mogut diuretics contribute to opysannuyu Above klynycheskuyu dynamics in techenye First weeks of treatment lisinopril s pryem dolzhen bыt prekraschen and function in kidney nuzhdaetsya tschatelnom observation.

In nekotorыh patients with hypertension arteryalnoy without apparent kidney disease vessels pryem lisinopril, especially on the background of diuretics, vыzыvaet urovnja mochevynы Increase in blood and creatinine in whey; These Changed, As a rule, bыvayut neznachytelnыmy and prehodyaschymy. Above occurrence probability s in violation of the patients with kidney function. In such cases Can voznyknut Reduction in Need dozы and prekraschenyy pryema lisinopril and diuretic.

Treatment of acute myocardial lisinopril ynfarkta not shown patsyentam with signs of renal dysfunction at kotoroj otmechaetsja povыshennыy Level whey creatinine in the blood of 177 mmol / l and / or proteinuria 500 mg / day. When a kidney dysfunction DEVELOPMENT techenye lisinopril therapy (Concentration prevыshaet whey creatinine 265 umol / L or doubled povыshen Level whey creatinine in the blood compared to urovnem ego, opredelennыm to the beginning of treatment) pryem drug Nuzhny prekratyt.

Peak times chuvstvytelnost / anhyonevrotycheskyy edema.

Anhyonevrotycheskyy edema Faces, limbs, lips, language, holosovыh svyazok and larynx rarely razvyvaetsya in patsyentov, poluchayuschyh ynhybytorы inhibitors, including lisinopril. In the period of treatment anhyonevrotycheskyy edema Can razvytsya at any time. In this sluchae pryem lisinopril Nuzhny nemedlenno prekratyt, to establish sootvetstvuyuschee Treatment and observation for patsyentom; First something otpustyt patients, tired ubedytsya in volume, something is lykvydyrovanы edema symptoms.

Even in cases, when edema ohranychyvaetsya Only Language and respiratory symptom violations absent, patsyentы mogut nuzhdatsya in dlytelnom observation, because the assets and Treatment antihistamine hlyukokortykosteroydamy (ACS) may okazatsya nedostatochnыm.

In cases otdelnыh zarehystryrovan letalnыy Based in patsyentov Due anhyonevrotycheskoho laryngeal edema or language. If edema rasprostranyaetsya in language, communication holosovыe or larynx, perekrыtye Perhaps dыhatelnыh tract, especially in patsyentov, transferred earlier surgical intervention on the organs of breathing. In such cases neobhodimo Accept Measures neotlozhnoy therapy (epinephrine Introduction and / or podderzhanye prohodymosty dыhatelnыh tracks).

Patsyent dolzhen nahodytsya tschatelnыm medical observation pod to a Rack full of yscheznovenyya symptoms.

In patsyentov, ymeyuschyh in anamneze anhyonevrotycheskyy edema not related pryemom ACE inhibitors, can bыt povыshen risk anhyonevrotycheskoho edema development in response to ACE inhibitors pryem.

Hemodialysis.

With the appointment of the drug in terms dyalyza with polyakrylvynylovoy membranoy Perhaps Development anafilakticheskom reactions. Using the recommended type of membrane for conducting the second dyalyza Application lekarstvennыh assets or second groups of treatment for hypertension patsyentov with arteryalnoy.

Anafylaktoydnыe reactions during LDL-apheresis.

So As with LDL apheresis with dextran sulfate ynhybytorov ACE Application Can lead for development anafilakticheskom reactions kotoryya mogut present threats to life, Nuzhny temporarily cancel the ynhybytorы ACE kazhdыm before apheresis.

Desensitization.

In patsyentov, prynymayuschyh ynhybytorы ACE desensybylyzyruyuschey on the background therapy (for example, against Jada pereponchatokrыlыh) razvyvayutsya dlytelnыe anafylaktoydnыe reaction. If patsyentы vozderzhyvalys Such as pryema ynhybytorov ACE IN TIME desensitization, no reactions was observed, however sluchaynoe Introduction ACE provotsyrovalo anafylaktoydnuyu reaction.

Pechenochnaya failure.

C pryemom ynhybytorov ACE svyazыvayut syndrome rarely Development, kotoryya nachynaetsya with cholestatic jaundice or hepatitis and move in molnyenosnыy liver necrosis, Sometimes with letalnыm consequences. Mechanism of development эtoho not ponyaten syndrome. If in patsyentov, prynymayuschyh lisinopril, razvyvaetsya Jaundice or Significantly povыshaetsya pechenochnыh activity of enzymes, drug neobhodimo to cancel, I leave patsyenta observation pod doctor to yscheznovenyya symptoms.

Hyperkalemia.

In nekotorыh patsyentov, prynymayuschyh ynhybytorы inhibitors, including lisinopril, observed urovnja Increase potassium in blood whey. The group K line development hyperkalemia otnosjatsja patsyentы with renal insufficiency or diabetes saharnыm, prynymayuschye kalyysberehayuschye diuretics, salt substitute or kalyysoderzhaschye, as well as that patsyentы, kotoryya prynymayut others sredstva Pharmaceuticals, povыshayuschye Level potassium in whey (for example, heparin).

If pryem perechyslennыh Above drugs on the background of treatment with ACE inhibitor pryznaetsya neobhodymыm, recommended rehulyarnыy control urovnja potassium in blood whey.

Patsyentы saharnыm with diabetes.

Patsyentam saharnыm with diabetes, kotoryya prynymayut hypohlykemycheskye sredstva or insulin, it is necessary tschatelno Level kontrolyrovat glucose in the blood techenye pervogo month of treatment with ACE inhibitor.

Cast.

Usually not recommended sochetat pryem cast and lisinopril.

Neutropenia / agranulocytosis.

In patsyentov, prynymayuschyh ynhybytorы ACE mogut razvyvatsya neutropenia / agranulocytosis, thrombocytopenia and anemia. In normal renal function and absence of complications during neutropenia razvyvaetsya rare. Neutropenia and agranulocytosis obratymы after a pass prekraschenyya pryema ACE inhibitors.

It should manifest kraynyuyu ostorozhnost appointment with lisinopril patsyentam s disease soedynytelnoy fabric with sosudystыmy manifestations, transmitted course of treatment antidepressants, prynymayuschym Allopurinol or prokaynamyd, as well as at эtyh The combination of factors, especially on the background violations kidney function.

In such nekotorыh patsyentov razvyvayutsya Heavy infection, kotoryya not always poddayutsya yntensyvnoy antibiotic therapy. If in the Treatment of patsyentov prymenyayut lisinopril, recommended Provera Quantity leykotsytov Periodically, and at patsyentov It should predupredyt Need lyubыh Report signs of infection.

Rasovaya accessories.

Ynhybytorы ACE chashche vыzыvayut Development anhyonevrotycheskoho edema in patsyentov nehroydnoy rasы compared to patsyentamy Another rasovoy accessories. How and others ynhybytorы ACE lisinopril Can bыt less than эffektyvnыm Reduction in arterial pressure in chernokozhyh patsyentov compared to lytsamy second races Perhaps more than Due Peak Frequency persons with urovnem series of renin in populyatsyy chernokozhyh patsyentov arteryalnoy with hypertension.

Cough.

In ynhybytorov ACE Application Can neproyzvodytelnыy will appear dlytelnыy cough kotoryya yschezaet prekraschenyya after treatment. Such cough vыzvannыy Application ynhybytorov ACE uchytыvat exhausted when the differential diagnosis of cough.

Operatyvnыe intervention / anesthesia.

In patsyentov, podverhayuschyhsya Global hyrurhycheskomu intervention or anesthesia drugs snyzhayuschymy pressure of arteryalnoe, lisinopril blokyrovat Can Increase education angiotensin II Under the Influence vыbrosa compensatory renin. If predpolahaetsya, something hypotension razvyvaetsya on this mehanyzmu, ÎÍÀ bыt otkorrektyrovana Can Increase BCC.

Ability to Speed vlyyat reaction with traffic control or work with the second mechanisms.

If traffic management or working with second mechanism Nuzhny prynymat t WARNING Possibility occurrence dizziness and povыshennoy Fatigue.

Interaction with other drugs and other types of interactions

Diuretics.

When simultaneously with diuretics Application otmechaetsja summation antihypertensive effect. In patsyentov, kotoryya already prynymayut diuretics, especially to whom diuretics naznachenы recently, additions lisinopril Can Sometimes sex prychynoy chrezmernoho Reduction arterial pressure. Probability symptomov arteryalnoy Effect of lisinopril hypotension pod snyzhaetsya, prekratyt If prynymat diuretik before the beginning of treatment lisinopril.

Kalyysberyhayuschye diuretics, kalyysoderzhaschye pyschevыe solezamenytely or additives.

Although whey Level potassium in the blood at the Clinical Research ynhybytorov ACE Usually ostavalsya within the rules, the same nekotorыh patsyentov is still razvyvalas hyperkalemia. Risk factors for hyperkalemia svyazыvayut c, k kotorыm otnosjatsja Renal failure, diabetes and saharnыy odnovremennыy pryem kaliysberegayuschimi diuretics (for example, spironolactone, triamterene or amiloride), as well kalyysoderzhaschyh pyschevыh solezamenyteley or additives.

Application kalyysoderzhaschyh pyschevыh supplements, diuretics or kaliysberegayuschimi kalyysoderzhaschyh solezamenyteley Can Significantly Increase leads for urovnja whey potassium in the blood, especially in patsyentov with violation of the kidney function. Vaud TIME pryema lisinopril in the background kalyyvыvodyaschyh diuretics hypokalemia, vыzvannaya s pryemom, can bыt weakened.

Cast.

In a simultaneous cast ynhybytorov standard receiving ACE Select Level povыshaetsya cast in blood whey and razvyvayutsya toksychnыe эffektы. Application thiazide diuretics Can povыshat risk lytyevoy intoxication and usylyvat EE If ÎÍÀ already vыzvana odnovremennыm pryemom ynhybytorov ACE. Apply with lisinopril cast simultaneously is not recommended, but in technical cases, when such neobhodimo The combination, carries weary tschatelnыy control urovnja cast in blood whey.

Nesteroydnыe protyvovospalytelnыe sredstva (NSAIDs) include a atsetylsalytsylovuyu acid ≥ 3 g dose per day.

Dlytelnыy pryem Can NSAIDs weaken hypotensive effect of ACE ynhybytorov. Эffektы NSAIDs and ACE ynhybytorov urovnja to Increase potassium in blood whey summyruyutsya, Can bring something for abuse kidney function. These эffektы Usually obratymы. In cases otdelnыh Can be observed Acute Renal failure, especially when abuse kidney function, for example, the age or persons pozhyloho patsyentov with dehydration in the body.

Gold.

Nytrytoydnыe reaction (vasodilation symptoms, vkljuchaja prylyvы, nausea, dizziness, hypotension arteryalnuyu, kotoraja Can bыt Very severe) after ynъektsyy gold (for example, sodium aurotyomalata) otmechalys chashche in patsyentov, poluchavshyh Treatment with ACE inhibitor.

Other antihypertensive funds.

In the Application simultaneously with the second antihypertensive lisinopril assets Gain observed hypotensive effect. Odnovremennыy pryem nytrohlytseryna and second nytratov Organic or vazodylatatorov Can usylyvat hypotensive effect lisinopril.

Tricyclic antydepressantы, anesthetics and antipsychotics.

Pryem nekotorыh anestetikov, tricyclic antipsychotic antydepressantov and assets in the background ynhybytorov ACE Could usylyt arteryalnuyu hypotension.

Sympathomimetic.

Country can weaken hypotensive effect of ACE ynhybytorov.

Hypohlykemycheskye means.

Эpydemyolohycheskye research showed that odnovremennыy pryem ynhybytorov ACE and hypohlykemycheskyh assets (ynsulynov and hypohlykemycheskyh funds for pryema ext) may usylyvat action poslednyh, vplot to the development of hypoglycemia. The probability of such phenomena especially in the Peak time techenye First weeks of treatment patsyentov simultaneously, as well as kidney function with abuse.

Atsetylsalytsylovaya acid, thrombolytics, b-blockers and nytratы.

Lisinopril can be assign simultaneously with atsetylsalytsylovoy kyslotoy (in doses kotoryya prymenyayut in Cardiology), thrombolytic funds, β-blockers and nitrate.

Pharmacological properties

pharmacodynamics

Lisinopril - inhibitor of ACE. ACE javljaetsja peptydyldypeptydazoy, kotoraja katalyzyruet transformation of angiotensin I in vazokonstryktornыy peptide, angiotensin II, also kotoryya stymulyruet aldosterone secretion. Inhibition of ACE Reduction for lead concentrations in blood plasma angiotensin II, bring something for Reduction vazopressorov activity and aldosterone secretion. Directory Recent Reduction Can Increase for lead concentrations of potassium in the blood whey.

Since the action mechanism with hypertension osushchestvljaetsja posredstvom oppression renin-angiotensin-aldosterone system, lisinopril okazыvaet antihypertensive action in hypertenzyvnыh patsyentov Even with a series of renin urovnem. ACE ydentychen for kynynaze-enzyme razrushayuschemu bradykinin. Role povыshennoho urovnja bradykinin (obladayuscheho vыrazhennыmy vasodilating properties) in the course of treatment is not completely vыyasnena lisinopril and trebuet dalneysheho study.

Pharmacokinetics.

Absorbtsyya.

After oral lisinopril pryema slowly and not completely vsasыvaetsya pyschevarytelnom in Truckee. Absorbtsyya drug after pryema sostavljaet Approximately 25% of a mezhyndyvydualnoy varyabelnostyu (6-60%). Odnovremennыy pryem of food vlyyaet not to vsasыvanye. Maximum Concentration in plasma dostyhaetsya Approximately 6-8 hours.

Distribution.

Equilibrium concentrations in blood whey dostyhayutsya in techenye after 2-3 days of administering a drug. In addition to ACE not svyazыvaetsya with blood plasma proteins.

Metabolism and withdrawal.

Not metabolized, vыvodytsya with urine in neyzmenennom form.

Udalyaetsya during hemodialysis.

Pharmacokinetics osobыh groups of patients.

When kidney function abuse withdrawal of lisinopril snyzhaetsya proportsyonalno degree violations funktsyonalnыh violations (This stanovytsya Clinical vazhnыm Reduction in the glomerular filtration below 30 ml / min).

In cardiac failure pochechnыy ride height lisinopril reduced.

For patsyentov pozhyloho age more than Characteristic High concentrations in plasma lisinopril and value, Square pod curve "Concentration-Time" (uvelychenы prymerno 60%), than in patsyentov Jr. age.

Pharmaceutical characteristics

Basic physicochemical properties: white-colored, flat-cylindrical tablets with beveled edges and risks.

Shelf life

3 years.

Storage conditions

Store in a dry place protected from light at a temperature not exceeding 25 ° C. Keep out of reach of children.

Packaging

10 tablets in a blister; 1 or 2 or 3 blister cards in the box.

Vacation category

By recipe