DIROTON PILLS 20MG
DIROTON PILLS 20MG - 56 TABS
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One pill contains:
- Active substances
- lisinopril 20 mg.
- Excipients Magnesium stearate, talc, mannitol, corn starch, Calcium hydrophosphate dihydrate.
In the blister 14 tablets. In packing 4 blisters.
Mechanism of action
Diroton pills - an ACE inhibitor.
Reduces the formation of angiotensin II from angiotensin I. Reducing the content of angiotensin II leads to a direct reduction in the release of aldosterone. Reduces the degradation of bradykinin and increases prostaglandin synthesis. Reduces the OPSS, blood pressure, 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 the progression of left ventricular dysfunction in patientssuffered a myocardial infarction without clinical manifestations of heart failure.
The onset of action of the drug - after 1 h, reaches a maximum after 6-7 hours and lasts for 24 hours. The duration of the effect also depends on the size of the dose taken. In case of arterial hypertension, the effect is noted in the first days after the start of treatment, a stable action develops after 1-2 months. With the abrupt cancellation of the drug did not observe a pronounced increase in blood pressure.
Diroton reduces albuminuria. In patients with hyperglycemia, it helps normalize the function of the damaged glomerular endothelium. It does not affect the concentration of glucose in the blood of patients with diabetes mellitus and does not lead to an increase in cases of hypoglycemia.
Indications and usage
- Arterial hypertension (as monotherapy or in combination with other antihypertensive drugs).
- Chronic heart failure (as part of combination therapy for the treatment of patients taking digitalis and / or diuretics).
- 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 (to reduce albuminuria in patients with insulin-dependent diabetes mellitus in patients with normal blood pressure and in patients with insulin-dependent diabetes mellitus with arterial hypertension).
- Angioedema in history (including with 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.
Pregnancy and Breastfeeding
The use of Diroton in pregnancy is contraindicated. Lisinopril penetrates the placental barrier. At establishment of pregnancy reception of a preparation should be stopped as soon as possible. Acceptance of ACE inhibitors in the II and III trimesters 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 in the first trimester is not. For newborns and infants who have undergone intrauterine effects of ACE inhibitors, it is recommended to establish careful monitoring to timely detect a pronounced decrease in blood pressure, oliguria, hyperkalemia.
Data on the penetration of lisinopril into breast milk is not. If necessary, the appointment of the drug during lactation breastfeeding should be discontinued.
Dosage and administration
The drug is taken orally 1 time / day, in the morning, for all indications, before or after meals, always at about the same time of day.
- Use in essential hypertension. Patients who do not receive other antihypertensive drugs are prescribed 10 mg 1 time / day. The usual daily maintenance dose is 20 mg.The maximum daily dose is 40 mg. The full effect usually develops after 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 they should be discontinued 2-3 days before the use of Diroton. If it is impossible to cancel diuretics, then the initial dose of Diroton 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 A pronounced decrease in blood pressure may develop.
- Application in renovascular hypertension and conditions with increased activity of the renin-angiotensin-aldosterone system. It is advisable to prescribe a lower initial dose of 2.5-5 mg / day under enhanced medical control (control of blood pressure, kidney function, serum potassium concentration). Maintenance dose should be determined depending on the dynamics of blood pressure.
- Use in chronic heart failure. The initial dose is 2.5 mg 1 time / day, which can be increased to the usual maintenance daily dose of 5-20 mg. The daily dose should not exceed 20 mg.
- Use in acute myocardial infarction In the combination therapy, 5 mg is prescribed on the first day, then 5 mg every other day, 10 mg after two days and then 10 mg 1 time / day. In patients with acute myocardial infarction, the drug should be used for at least 6 weeks.At the beginning of treatment or during the first 3 days after acute myocardial infarction in patients with low systolic blood pressure (? 120 mm Hg), the drug should be administered at a dose of 2.5 mg. In the case of a decrease in blood pressure (systolic blood pressure? 100 mm Hg) while receiving Diroton, the daily dose of 5 mg can be temporarily reduced to 2.5 mg. In the case of a prolonged pronounced decrease in blood pressure (systolic blood pressure <90 mmHg more than 1 hour), treatment with diroton should be stopped.
- Use in diabetic nephropathy. In patients with insulin-dependent diabetes mellitus, Diroton is used in a dose of 10 mg 1 time / day. If necessary, the dose can be increased to 20 mg 1 time / day in order to achieve diastolic blood pressure values below 75 mm Hg. in a sitting position. In patients with non-insulin dependent diabetes mellitus, the drug is prescribed in the same dose, in order to achieve diastolic blood pressure values below 90 mm Hg. in a sitting position.
- Use in renal failure Due to the fact that lisinopril is excreted by 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 kidney function, potassium concentration and serum sodium concentration: Clearance creatinine (ml / min) Initial dose 30-70 5-10 mg 10-30 2.5-5 mg Less than 10 (including patients on hemodialysis) 2.5 mg
For convenience, dosing can be used drug Diroton table. 5 mg pack. 14 Gideon Richter A or Diroton Table. 20 mg pack. 14 Gideon Richter A.
Most often, a pronounced decrease in blood pressure occurs when a decrease in the volume of fluid caused by diuretic therapy, a decrease in salt content in food, dialysis, diarrhea or vomiting.
Before starting treatment with Diroton, 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 Diroton on the patient's blood pressure.
With extensive surgical interventions, as well as with 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.
Since the potential risk of agranulocytosis cannot be excluded, periodic monitoring of the blood picture is required.
- Use in chronic heart failure In chronic heart failure with simultaneous renal failure or without it, a pronounced decrease in blood pressure is possible. A more pronounced decrease in blood pressure is detected in patients with severe stage of chronic heart failure, as a result of the use of high-dose diuretics, hyponatremia or impaired renal function. In such patients, treatment with Diroton should be started under the strict supervision of a physician (carefully select the dose of the drug and diuretics). With the use of diroton in some patients with chronic heart failure, but with normal or lowered blood pressure, there may be a decrease in blood pressure, which is usually not a reason to stop treatment. Transient hypotensive reaction is not a contraindication for taking the next dose of the drug.
- Use in ischemic heart disease and cerebrovascular insufficiency. The appointment of Diroton in patients with coronary artery disease, cerebrovascular insufficiency, can cause a sharp decrease in blood pressure, can lead to myocardial infarction or stroke. In such patients, treatment with Diroton should be started under the strict supervision of a physician (carefully select the dose of the drug and diuretics).
- Use in case of renal artery stenosis In the case of renal artery stenosis (especially in case of 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 Dyrotona may lead to impaired renal function, acute renal deficiency, which usually turns out to be irreversible after drug withdrawal.
- Use in acute myocardial infarction. The use of standard therapy (thrombolytics, Acetylsalicylic acid, beta-blockers) has been shown. It is possible to use Diroton together with IV injection or with the use of therapeutic transdermal systems of Nitroglycerin.
- Use in elderly patients In elderly patients, the use of standard doses leads to a higher concentration of the drug in the blood, therefore, special care is required in determining the dose, although there are no differences in the antihypertensive effect of Dyroton in the elderly and young patients.
- Use of the drug in dialysis conditions 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 drugs is recommended.
- Impact on the ability to drive motor vehicles and control mechanisms There is no data on the effect of lisinopril on the ability to drive vehicles and mechanisms, however, it should be borne in mind that dizziness may occur, so care should be taken.
With caution should be appointed Diroton simultaneously with potassium-sparing diuretics (spironolactone, triamterene, amiloride), potassium, potassium-containing salt substitutes, since increases the risk of hyperkalemia, especially with impaired renal function. Therefore, these combinations should be prescribed only on the basis of an individual decision of the attending physician with regular monitoring of serum potassium levels and kidney function.
With simultaneous use with diuretics and other antihypertensive drugs, an additive antihypertensive effect develops (the risk of a pronounced decrease in blood pressure).
With simultaneous use with NSAIDs (including with indomethacin), estrogen, as well as adrenostimulants, the antihypertensive effect of lisinopril is reduced.
With simultaneous use with lithium, the elimination of lithium can be reduced, therefore, the concentration of lithium in blood serum should be regularly monitored.
With simultaneous use with antacids and Kolestiramin, absorption of lisinopril from the gastrointestinal tract is reduced.
With the simultaneous use of diroton can enhance the effect of ethanol (alcohol).
With simultaneous use with diuretics lisinopril reduces the excretion of potassium.
- Symptoms: pronounced decrease in blood pressure.
- Treatment: If necessary, conduct symptomatic therapy (in / in the introduction of fluid, monitoring and normalization of blood pressure, water and electrolyte balance). Lisinopril can be eliminated from the body through dialysis.
- Store at a temperature of 15 ° to 30 ° C.