LISINOPRIL PILLS 20MG
LISINOPRIL PILLS 20MG - 20 tabs
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1 pill contains: lisinopril dihydrate, corresponding to 20 mg of lisinopril.
Excipients: milk sugar (lactose), microcrystalline cellulose, starch 1500 (pro-gelled), aerosil (colloidal silicon dioxide), talc, Magnesium stearate.
In the package 20 pcs.
Mechanism of action
Lisinopril is an ACE inhibitor that reduces the formation of angiotensin II from angiotensin I. A decrease in the content of angiotensin II leads to a direct decrease in the release of aldosterone. Reduces the degradation of bradykinin and increases prostaglandin synthesis. Reduces the total peripheral vascular resistance, blood pressure (BP), preload, pressure in the pulmonary capillaries, causes an increase in the minute volume of blood and an increase in myocardial tolerance to stress in patients with chronic heart failure. Expands arteries to a greater extent than veins. Some effects are attributed to effects on tissue renin-angiotensin systems. With prolonged use, hypertrophy of the myocardium and the walls of resistive arteries is reduced. Improves blood supply to ischemic myocardium.
ACE inhibitors prolong life expectancy in patients with chronic heart failure, slow down the progression of left ventricular dysfunction in patients who have had a myocardial infarction without clinical manifestations of heart failure. The antihypertensive effect begins after about 6 hours and persists for 24 hours. The duration of the effect also depends on the dose. Onset of action - after 1 h. The maximum effect is determined after 6-7 hours. In case of arterial hypertension, the effect is noted in the first days after the start of treatment, a stable action develops in 1-2 months. With the abrupt cancellation of the drug did not observe a pronounced increase in blood pressure.
In addition to lowering blood pressure, Lisinopril reduces albuminuria. In patients with hyperglycemia, it helps normalize the function of the damaged glomerular endothelium.
Lisinopril does not affect the concentration of glucose in the blood in patients with diabetes mellitus and does not lead to an increase in hypoglycemia.
Indications and usage
- Arterial hypertension (in monotherapy or in combination with other antihypertensive drugs).
- Chronic heart failure (as part of combination therapy for the treatment of patients taking thim ples and / or diuretics).
- Early treatment of acute myocardial infarction (in the first 24 hours with stable hemodynamic parameters to maintain these indicators and prevent left ventricular dysfunction and heart failure).
- Diabetic nephropathy (reducing albuminuria in insulin-dependent patients with normal blood pressure and insulin-independent patients with arterial hypertension).
- Angioedema in history, including and from the use of ACE inhibitors.
- Hereditary angioedema.
- Age up to 18 years (efficacy and safety have not been established).
- Hypersensitivity to lisinopril or other ACE inhibitors.
- Severe renal dysfunction.
- Bilateral renal artery stenosis or arterial stenosis of a single kidney with progressive azotemia.
- Condition after kidney transplantation.
- Renal failure.
- Stenosis of the mouth of the aorta.
- Hypertrophic obstructive cardiomyopathy.
- Primary hyper aldosteronism.
- Arterial hypotension.
- Cerebrovascular diseases (including cerebrovascular insufficiency).
- Coronary heart disease.
- Coronary insufficiency.
- Autoimmune systemic diseases of the connective tissue, including: scleroderma, systemic lupus erythematosus.
- Inhibition of bone marrow hematopoiesis.
- Diet with sodium restriction: hypovolemic states (including as a result of diarrhea, vomiting).
- Elderly age.
Pregnancy and Breastfeeding
The use of lisinopril during pregnancy is contraindicated. When establishing pregnancy, the drug should be stopped as soon as possible.Acceptance of ACE inhibitors in the II and III trimester of pregnancy has an adverse effect on the fetus (pronounced decrease in blood pressure, renal failure, hyperkalemia, hypoplasia of the skull, fetal death) are possible. Data on the negative effects of the drug on the fetus in the case of use during the first trimester is not. For newborns and infants who have been exposed to intrauterine effects of ACE inhibitors, it is recommended to conduct careful monitoring to timely detect a pronounced decrease in blood pressure, oliguria, hyperkalemia.
Lisinopril penetrates through the placenta. No data on the penetration of lysinopril into breast milk. For the period of drug treatment, it is necessary to cancel breastfeeding.
Dosage and administration
Inside, regardless of the meal.
With hypertension: patients who do not receive other antihypertensive drugs, 5 mg 1 time per day. In the absence of an effect, the dose is increased by 5 mg to the average therapeutic dose - 20–40 mg / day every 2–3 days (increasing the dose over 40 mg / day usually does not lead to a further decrease in blood pressure). The usual daily maintenance dose is 20 mg, the maximum daily dose is 40 mg. The full effect usually develops 2–4 weeks from the start of treatment, which should be considered when increasing the dose. With insufficient clinical effect, it is possible to combine the drug with other antihypertensive drugs. If the patient has received prior treatment with diuretics, then the use of such drugs should be stopped 2-3 days before starting to use Lisinopril. If this is not feasible, then the initial dose of Lisinopril should not exceed 5 mg / day.In this case, after taking the first dose, medical control is recommended for several hours (the maximum effect is reached after about 6 hours), because there may be a pronounced decrease in blood pressure.
In case of renovascular hypertension or other conditions with increased activity of the renin-angiotensin-aldosterone system: It is advisable to prescribe a low initial dose of 2.5–5 mg per day, under enhanced medical control (control of blood pressure, kidney function, serum potassium concentration). Maintenance dose, continuing strict medical supervision, should be determined depending on the dynamics of blood pressure.
For renal failure: Due to the fact that lisinopril is excreted through the kidneys, the initial dose should be determined depending on creatinine clearance, then a maintenance dose should be established in accordance with the reaction under conditions of frequent monitoring of renal function, serum potassium, sodium levels.
Creatinine clearance, ml / min - Initial dose, mg / day:
30-70 - 5-10
10-30 - 2,5-5
less than 10 - 2.5
(including hemodialysis patients)
With persistent hypertension, long-term maintenance therapy is indicated - 10-15 mg / day.
In chronic heart failure: the initial dose is 2.5 mg once a day, with a subsequent increase of 2.5 mg in 3-5 days to the usual, supporting daily 5–20 mg. The dose should not exceed 20 mg / day.
In elderly people, a more pronounced long-term hypotensive effect is often observed, which is associated with a decrease in the rate of elimination of lisinopril (it is recommended to begin treatment with 2.5 mg / day).
Acute myocardial infarction (as part of combination therapy): on the first day - inside 5 mg, then 5 mg every other day, 10 mg after 2 days and then 10 mg once a day. Course - at least 6 weeks.
At the beginning of treatment or during the first 3 days after an acute myocardial infarction, patients with a low BAP (120 mmHg or less) are prescribed a lower dose of 2.5 mg. In the case of lowering blood pressure (SBP below or equal to 100 mmHg), the daily dose of 5 mg, if necessary, is temporarily reduced to 2.5 mg. In the case of a prolonged marked decrease in blood pressure (SBP below 90 mm Hg. Art. More than 1 hour), treatment with Lisinopril should be stopped.
Diabetic nephropathy: in patients with non-insulin dependent diabetes mellitus - 10 mg 1 time per day. If necessary, you can increase the dose to 20 mg 1 time per day in order to achieve values of DBP below 75 mm Hg. st. in the sitting position. In patients with insulin-dependent diabetes mellitus, in order to achieve values of DBP below 90 mm Hg. st. in the sitting position, the dosage is the same.
Most often, a pronounced decrease in blood pressure occurs when a decrease in the volume of fluid caused by diuretic therapy, a decrease in the amount of salt in food, dialysis, diarrhea or vomiting. In patients with chronic heart failure with simultaneous renal failure or without it, a pronounced decrease in blood pressure is possible. It is more often detected in patients with severe stage of chronic heart failure, as a result of the use of large doses of diuretics, hyponatremia or impaired renal function. In such patients, treatment with Lisinopril should begin under the strict supervision of a physician (with careful selection of the dose of the drug and diuretics).
Similar rules should be followed when prescribing patients with coronary heart disease, cerebrovascular insufficiency, in which there is a dramatic: decrease in blood pressure can lead to myocardial infarction or stroke.
Transient hypotensive reaction is not a contraindication for taking the next dose of the drug.
When Lisinopril is used in some patients with chronic heart failure, but with normal or lowered BP, there may be a decrease in BP, which is usually not a reason to stop treatment.
Before starting treatment with Lisinopril, if possible, normalize the concentration of sodium and / or fill up the lost volume of fluid, carefully monitor the effect of the initial dose of Lisinopril on the patient.
In case of stenosis of the renal artery (especially in bilateral stenosis, or in the presence of stenosis of the artery of a single kidney), as well as circulatory failure due to lack of sodium and / or fluid, the use of Lisinopril can lead to impaired renal function, acute renal failure , which is usually turns out to be irreversible after drug withdrawal.
In acute myocardial infarction, the use of standard therapy (thrombolytics, Acetylsalicylic acid , beta-blockers) is indicated. Lisinopril may be used in conjunction with intravenous administration or with the use of therapeutic transdermal systems Nitroglycerin.
With extensive surgical interventions, as well as the use of other drugs that cause a decrease in blood pressure, Lisinopril, blocking the formation of angiotensin II, can cause a pronounced unpredictable decrease in blood pressure.
In elderly patients, the same dose leads to a higher concentration of the drug in the blood, so special care is required when determining the dose. Since the potential risk of agranulocytosis cannot be excluded, periodic monitoring of the blood picture is required. When using the drug in dialysis conditions with a polyacryl-nitrile membrane, anaphylactic shock may occur, therefore either a different type of dialysis membrane or the appointment of other antihypertensive agents is recommended.
Influence on the ability to drive vehicles and control mechanisms: there is no data on the effect of Lisinopril on the ability to drive vehicles and mechanisms used in therapeutic doses, however, it must be borne in mind that dizziness may occur, so care should be taken.
Lisinopril reduces the excretion of potassium from the body during treatment with diuretics.
Particular caution is required with simultaneous use of the drug with: potassium-sparing diuretics (spironolactone, triamterene, amiloride), potassium, potassium containing salt substitutes (the risk of hyperkalemia increases,especially with impaired renal function), so they can be jointly prescribed only on the basis of an individual decision of the attending physician with regular monitoring of serum potassium and renal function.
Caution can be applied together:
- With diuretics: with the additional administration of a diuretic to a patient taking Lisinopril, as a rule, an additive antihypertensive effect occurs - the risk of a pronounced decrease in blood pressure.
- With other antihypertensive drugs (additive effect).
- With nonsteroidal anti-inflammatory drugs (indomethacin, etc.), estrogens, as well as adrenostimulants - a decrease in the antihypertensive effect of Lisinopril.
- With lithium (lithium secretion may decrease, so you should regularly monitor the concentration of lithium in the serum).
- With antacids and Kolestiramine - reduce absorption in the gastrointestinal tract.
- Alcohol enhances the effect of the drug.
Symptoms (occur when taking a single dose of 50 mg and above): pronounced decrease in blood pressure, dry mouth, drowsiness, urinary retention, constipation, anxiety, irritability.
Treatment: symptomatic therapy, intravenous fluids, control of blood pressure, water and electrolyte balance and normalization of the latter.
Store in a dry, dark place at a temperature not exceeding 25 ° C.