Co-Diroton

1 tablet contains lisinopril dihydrate 

hydrochlorothiazide 

Co-Diroton has antihypertensive and diuretic effects.

Arterial hypertension (in patients for whom combination therapy is indicated).

The use of lisinopril during pregnancy is contraindicated. When pregnancy is established, the drug should be discontinued as early as possible.

Taking ACE inhibitors in the II and III trimesters of pregnancy has an adverse effect on the fetus (a pronounced decrease in blood pressure, renal failure, hyperkalemia, hypoplasia of the skull bones, intrauterine death are possible). There is no data on the negative effects of the drug on the fetus when used during the first trimester.

For newborns and infants who have been exposed to intrauterine exposure to ACE inhibitors, it is recommended to monitor them for the timely detection of a pronounced decrease in blood pressure, oliguria, hyperkalemia.

During the period of drug treatment, breastfeeding must be canceled.

Hypersensitivity (including to other ACE inhibitors and sulfonamide derivatives), anuria, angioedema (including a history of the use of ACE inhibitors), hemodialysis using high-flow membranes, hypercalcemia, hyponatremia, porphyria, precoma, hepatic coma, diabetes mellitus (severe forms), pregnancy, lactation, age up to 18 years (efficacy and safety have not been established).

With care. Aortic stenosis, hypertrophic cardiomyopathy, bilateral stenosis of the renal arteries, stenosis of the artery of a solitary kidney with progressive azotemia, condition after renal transplantation, chronic renal failure (CC more than 30 ml / min.), Severe CRF (CC less than 30 ml / min), primary hyperaldosteronism, arterial hypotension, bone marrow hypoplasia, hyponatremia (increased risk of arterial hypotension in patients on a low-salt or salt-free diet), conditions accompanied by a decrease in BCC (including diarrhea, vomiting), connective tissue diseases (SLE, scleroderma), sugar diabetes, gout, hyperuricemia, hyperkalemia, hepatic failure, cerebrovascular failure, severe CHF, old age.

Frequent: dizziness, headache.

Less frequent. From the CVS: a pronounced decrease in blood pressure, chest pain, rarely - orthostatic hypotension, tachycardia, bradycardia, the appearance of symptoms of heart failure, impaired AV conduction, myocardial infarction.

From the digestive system: nausea, vomiting, abdominal pain, dry mouth, diarrhea, dyspepsia, anorexia, taste changes, pancreatitis, hepatitis (hepatocellular and cholestatic), jaundice.

From the nervous system: mood lability, impaired concentration, paresthesia, increased fatigue, drowsiness, convulsive twitching of the muscles of the limbs and lips, rarely - asthenic syndrome, confusion.

From the respiratory system: dyspnea, bronchospasm, apnea.

From the side of the skin: urticaria, sweating, alopecia, photosensitivity.

Allergic reactions: angioedema of the face, extremities, lips, tongue, epiglottis and / or larynx, skin rash, itching, fever, vasculitis, positive results for antinuclear antibodies, increased ESR, eosinophilia.

From the side of hematopoiesis: leukopenia, thrombocytopenia, neutropenia, agranulocytosis, anemia (decrease in Hb, hematocrit, erythropenia).

From the genitourinary system: uremia, oliguria / anuria, impaired renal function, acute renal failure, decreased potency.

Laboratory indicators: hyperkalemia and / or hypokalemia, hyponatremia, hypomagnesemia, hypochloremia, hypercalcemia, hyperuricemia, hyperglycemia, increased urea and creatinine in the blood plasma, rarely - an increase in the activity of "hepatic" transaminases, hyperbilirubinemia, hypercholesterolemia, hypertrietriolemia, decreased glucose tolerance.

Others: dry cough, arthralgia / arthritis, myalgia, impaired fetal kidney development, exacerbation of gout, vasculitis.

With simultaneous use with potassium-sparing diuretics (spironolactone, triamterene, amiloride), potassium preparations, salt substitutes containing potassium, the risk of hyperkalemia increases, especially in patients with impaired renal function. Therefore, they can be co-administered only on the basis of an individual decision of the physician with regular monitoring of serum potassium and renal function.
With simultaneous use with vasodilators, barbiturates, phenothiazines, tricyclic antidepressants, ethanol, an increase in the hypotensive effect is noted.

With simultaneous use with NSAIDs (indomethacin and others), estrogens, a decrease in the antihypertensive effect of lisinopril is noted.

With simultaneous use with lithium preparations, the elimination of lithium from the body slows down (increased cardiotoxic and neurotoxic effects of lithium).

With simultaneous use with antacids and cholestyramine, absorption in the gastrointestinal tract decreases.

The drug enhances the neurotoxicity of salicylates, weakens the effect of hypoglycemic drugs for oral administration, norepinephrine, epinephrine and anti-gout drugs, enhances the effects (including side effects) of cardiac glycosides, the effect of peripheral muscle relaxants, and reduces the excretion of quinidine.

Reduces the effect of oral contraceptives.

Ethanol enhances the hypotensive effect of the drug.
With the simultaneous administration of methyldopa, the risk of hemolysis increases.

Assign inside 1 tab. 1 time / day If the proper therapeutic effect is not achieved within 2-4 weeks, the dose of the drug can be increased to 2 tab. 1 time / day

In patients with CC 30-80 ml / min, the drug can be used only after selecting the dose of the individual components of the drug. The recommended starting dose of lisinopril for uncomplicated renal failure is 5-10 mg.

Symptomatic hypotension may occur after taking the initial dose of the drug. Such cases are more common in patients who have had fluid and electrolyte loss due to prior diuretic treatment. Therefore, you should stop taking diuretics 2-3 days before starting drug treatment.

Symptoms: a pronounced decrease in blood pressure, dry mouth, drowsiness, urinary retention, constipation, anxiety, irritability.

Treatment: symptomatic therapy, IV fluid administration, blood pressure control; therapy aimed at correcting dehydration and violations of the water-salt balance. Control of urea, creatinine and electrolytes in serum, as well as urine output.

Most often, a pronounced decrease in blood pressure occurs with a decrease in fluid volume caused by diuretic therapy, a decrease in the amount of salt in food, dialysis, diarrhea, or vomiting.

In patients with chronic heart failure with or without concurrent renal failure, a marked decrease in blood pressure is possible. It is more common in patients with severe chronic heart failure as a result of high doses of diuretics, hyponatremia or impaired renal function. In such patients, treatment should be started under the strict supervision of a physician. Similar rules must be followed when prescribing patients with ischemic heart disease, cerebrovascular insufficiency, in which a sharp decrease in blood pressure can lead to myocardial infarction or stroke.

Transient arterial hypotension is not a contraindication for further administration of the drug.
Before starting treatment, if possible, the sodium concentration should be normalized and / or the lost volume of fluid should be replenished, the effect of the initial dose of the drug on the patient should be carefully monitored.

In patients with chronic heart failure, a pronounced decrease in blood pressure after starting treatment with ACE inhibitors can lead to a further deterioration in renal function. Cases of acute renal failure have been reported.

In patients with bilateral renal artery stenosis or stenosis of an artery of a single kidney, who received ACE inhibitors, there was an increase in urea and creatinine in serum, usually reversible after discontinuation of treatment. More common in patients with renal failure.

Angioneurotic edema of the face, extremities, lips, tongue, epiglottis and / or larynx was rarely observed in patients treated with ACE inhibitors, including lisinopril, which can occur at any time during treatment. In this case, treatment with lisinopril should be stopped as soon as possible and the patient should be monitored until the symptoms completely regress. In cases where swelling of only the face and lips has occurred, the condition most often goes away without treatment, however, antihistamines may be prescribed. Angioedema with laryngeal edema can be fatal. When the tongue, epiglottis or larynx are covered, airway obstruction may occur, therefore appropriate therapy (0.3-0.5 ml of epinephrine (adrenaline) solution 1: 1000 s / c) and / or measures to ensure airway patency should be carried out immediately.

Patients who already have a history of angioedema not associated with previous treatment with ACE inhibitors may be at increased risk of developing it during treatment with an ACE inhibitor.

A cough has been reported with an ACE inhibitor. The cough is dry, prolonged, which disappears after stopping treatment with an ACE inhibitor. In the differential diagnosis of cough, it is necessary to take into account the cough caused by the use of an ACE inhibitor.

Anaphylactic reactions have also been reported in patients undergoing hemodialysis using high permeability dialysis membranes (AN69®), who are also taking ACE inhibitors. In such cases, consideration should be given to using a different type of dialysis membrane or other antihypertensive agent.

When using drugs that lower blood pressure in patients with extensive surgery or during general anesthesia, lisinopril can block the formation of angiotensin II.

A pronounced decrease in blood pressure, which is considered a consequence of this mechanism, can be eliminated by an increase in BCC.

Before surgery (including dentistry), an anesthesiologist should be warned about the use of ACE inhibitors.
In some cases, hyperkalemia was noted. Risk factors for the development of hyperkalemia include renal failure, diabetes mellitus, taking potassium supplements or drugs that increase the concentration of potassium in the blood (eg, heparin), especially in patients with impaired renal function.

In patients who are at risk of symptomatic hypotension (on a low-salt or salt-free diet) with or without hyponatremia, as well as in patients who received high doses of diuretics, the above conditions must be compensated (loss of fluid and salts) before starting treatment.

Thiazide diuretics can affect glucose tolerance, therefore, it is necessary to adjust the dose of hypoglycemic agents for oral administration. Thiazide diuretics can reduce renal calcium excretion and cause hypercalcemia. Severe hypercalcemia may be a symptom of latent hyperparathyroidism. It is recommended that treatment with thiazide diuretics be discontinued before the test to assess the function of the parathyroid glands.

During the period of drug treatment, regular monitoring of potassium, glucose, urea, and lipids in the blood plasma is required.

During the treatment period, it is not recommended to consume alcoholic beverages, because alcohol enhances the hypotensive effect of the drug.
Caution should be exercised when exercising, in hot weather (risk of dehydration and an excessive decrease in blood pressure due to a decrease in BCC).

Influence on the ability to drive vehicles and use mechanisms

During the treatment period, one should refrain from driving vehicles and engaging in potentially hazardous activities that require increased concentration of attention and speed of psychomotor reactions, because dizziness is possible, especially at the beginning of treatment.

Pills.