Lisinopril

1 tablet contains:

active substance: 

lisinopril dihydrate (lisinopril) - 10.92 mg (10.00 mg)

Inhibits ACE, prevents the transition of angiotensin I to angiotensin II, increases the concentration of endogenous vasodilating PG. Reduces the formation of arginine-vasopressin and endothelin? 1, which have vasoconstrictor properties. Reduces OPSS, systemic blood pressure, afterload on the myocardium, pressure in the pulmonary capillaries.

Increases cardiac output and myocardial load tolerance in patients with heart failure. Increases (secondary) the activity of blood plasma renin. The effect manifests itself after 1 hour, increases within 6-7 hours, lasts up to 24 hours. The antihypertensive effect reaches optimal values ​​with repeated administration over several weeks. Inhibits the tissue renin-angiotensin system of the heart, prevents the development of myocardial hypertrophy and left ventricular dilatation or promotes their reverse development (cardioprotective effect).

Reduces the number of cases of sudden death, reduces the likelihood of recurrent myocardial infarction, coronary blood flow disorders and the occurrence of myocardial ischemia. According to the ATLAS study in patients with chronic heart failure, the use of lisinopril in high doses (35 mg), compared with its use in low doses (5 mg), reduced the combined indicator: total mortality + all causes of hospitalizations by 12%, the number of hospitalizations - by 13%, the number of hospitalizations for decompensated heart failure - by 24%.

The results of the CALM study (combined therapy with candesartan and lisinopril) showed a greater severity of nephroprotective and hypotensive effects in the group of patients receiving combined treatment after 24 weeks.

Arterial hypertension (mono- and combination therapy), incl. renovascular; chronic heart failure (as part of combination therapy for the treatment of patients taking digitalis drugs and / or diuretics); acute myocardial infarction (in the first 24 hours with stable hemodynamic parameters to maintain these parameters, as well as to prevent left cardiac chamber dysfunction and heart failure); diabetic nephropathy (to reduce albuminuria in insulin-dependent patients with normal blood pressure and insulin-independent patients with arterial hypertension).

Hypersensitivity to lisinopril or other ACE inhibitors; a history of angioedema, incl. and from the use of ACE inhibitors, hereditary angioedema or idiopathic edema; pregnancy, breastfeeding, age up to 18 years (safety and efficacy have not been determined).

From the nervous system and sensory organs: headache, dizziness, increased fatigue, impaired consciousness, irritability, nervousness, transient cerebrovascular accident, fainting, ataxia, memory loss, drowsiness, insomnia, peripheral neuropathy, paresthesia, tremor, seizures, visual disturbances (diplopia, photophobia, decreased visual acuity), tinnitus.

From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): palpitations, chest pain, marked decrease in blood pressure, arrhythmia (atrial and ventricular tachycardia, atrial fibrillation, bradycardia, etc.), cardiac arrest, myocardial infarction, orthostatic reactions, vasculitis , bone marrow suppression, leukopenia, thrombocytopenia, anemia.

On the part of the respiratory system: dry cough, malignant tumors of the lungs, hemoptysis, infiltration, embolism and pulmonary infarction, bronchospasm, asthma, pleural effusion, pain when breathing, bronchitis, laryngitis, sinusitis, pharyngitis, rhinitis, nosebleeds, runny nose, paroxysmal postural ...

From the digestive tract: dry mouth, dyspepsia, heartburn, nausea, vomiting, diarrhea / constipation, flatulence, gastrointestinal cramps, abdominal pain, hepatotoxicity (hepatitis, cholestatic jaundice, fulminant liver necrosis with a possible fatal outcome), gastritis, pancreatitis.

From the genitourinary system: impaired renal function, acute renal failure, pyelonephritis, dysuria, oliguria, anuria, uremia, edema, weakening of libido, impotence.

From the musculoskeletal system: arthritis, arthralgia, myalgia, pain in the neck, back.

On the part of the skin: rash, urticaria, alopecia, photosensitivity, pemphigus, skin lesions and infections, toxic epidermal necrolysis, Stevens-Johnson syndrome.

Others: decrease (increase) in body weight, fever, sweating, allergic reactions, incl. angioedema, development of infections, incl. herpes zoster, diabetes mellitus, dehydration, gout, increased titer of antinuclear antibodies, creatinine, urea concentration, hyperkalemia, hyponatremia, hyperuricemia.

The hypotensive effect is enhanced by diuretics, and indomethacin is weakened. When combined with nitrates, propranolol and digoxin, there were no clinically significant side pharmacokinetic interactions. Increases the toxicity of lithium. Potassium-sparing diuretics, potassium supplements, and potassium-containing agents increase the risk of hyperkalemia.

Inside, 1 time per day. The dose is determined individually, depending on the indications, the state of renal function and concomitant therapy. Usually the initial dose is 2.5–5 mg, the average maintenance dose is 5–20 mg, and the maximum daily dose is 80 mg.

Symptoms: acute arterial hypotension.

Treatment: the introduction of saline and other symptomatic therapy. It is removed by hemodialysis.

Most often, a pronounced decrease in blood pressure occurs with a decrease in the BCC caused by diuretic therapy, a decrease in the content of table salt in food, dialysis, diarrhea or vomiting. Under the supervision of a physician, it is recommended to use the drug Lisinopril-Teva in patients with coronary artery disease, cerebrovascular insufficiency, in whom a sharp decrease in blood pressure can lead to myocardial infarction or stroke. The use of the drug Lisinopril-Teva can lead to impaired renal function, acute renal failure, which is usually irreversible even after the drug is discontinued.

Transient arterial hypotension is not a contraindication for further use of the drug.

In the case of renal artery stenosis (especially with bilateral stenosis or in the presence of stenosis of an artery of a single kidney), as well as with peripheral circulatory insufficiency resulting from hyponatremia and hypovolemia, the use of Lisinopril-Teva can lead to renal dysfunction, acute renal failure, which usually irreversible after drug withdrawal.

The drug Lisinopril-Teva can be used simultaneously with standard therapy for acute myocardial infarction (thrombolytics, acetylsalicylic acid as an antiplatelet agent, beta-blockers).

The drug Lisinopril-Teva can be used simultaneously with intravenous administration of nitroglycerin or with the use of therapeutic transdermal systems of nitroglycerin.

It is not recommended to use the drug Lisinopril-Teva in patients who have had acute myocardial infarction if the systolic blood pressure does not exceed 100 mm Hg. Art. With surgical interventions, as well as with the use of other drugs that cause a decrease in blood pressure, lisinopril, by blocking the formation of angiotensin II, can cause a pronounced, unpredictable decrease in blood pressure. Before surgery (including dental surgery), the surgeon / anesthesiologist should be informed about the use of an ACE inhibitor.

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, despite the fact that there are no differences in the antihypertensive effect of the drug Lisinopril-Teva in elderly and young patients.

Since the potential risk of agranulocytosis cannot be ruled out, periodic monitoring of peripheral blood is required.

Angioneurotic edema of the face, extremities, lips, tongue, epiglottis and / or larynx, which can occur during any period of treatment, has rarely been observed in patients taking an ACE inhibitor, including lisinopril. In this case, treatment with the drug should be stopped as soon as possible, and the patient should be monitored until the symptoms completely regress. Angioedema with laryngeal edema can be fatal.

Swelling of the tongue, epiglottis or larynx can cause airway obstruction, therefore appropriate therapy (0.3-0.5 ml 1: 1000 epinephrine (adrenaline) solution subcutaneously) and / or measures to ensure airway patency should be carried out immediately. In cases where edema is localized only on the face and lips, the condition most often goes away without treatment, however, antihistamines may be used. ACE inhibitors are more likely to cause the development of angioedema in black patients than in other races.

The risk of developing angioedema is increased in patients who have a history of angioedema unrelated to previous treatment with ACE inhibitors. In patients taking ACE inhibitors during hymenoptera venom desensitization, it is extremely rare that life-threatening anaphylactoid reactions can develop. This can be avoided by temporarily stopping treatment with an ACE inhibitor before each hymenoptera desensitization procedure. Anaphylactoid reactions have also been reported in patients on hemodialysis using high-flow dialysis membranes (AN69®) who are also taking ACE inhibitors. In such cases, consider using a different type of dialysis membrane or other antihypertensive agent. In patients

Very rarely, with the use of ACE inhibitors, a syndrome was observed that began with cholestatic jaundice and progressed to fulminant liver necrosis, sometimes with a fatal outcome. The mechanism of the development of this syndrome is unknown. When jaundice appears against the background of the use of the drug Lisinopril-Teva or a pronounced increase in the activity of "hepatic" transaminases, the drug is canceled and the patient's condition is monitored.

Cough has been reported with the use of ACE inhibitors. 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.

Influence on the ability to drive vehicles and mechanisms

Caution should be exercised when taking Lisinopril-Teva due to the possible development of arterial hypotension, dizziness and drowsiness, which can affect the ability to drive vehicles and work with potentially dangerous mechanisms.

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