Capozide pills 50mg/25mg №28

The combined drug has a hypotensive and diuretic effect. Captopril is an ACE inhibitor, reduces the formation of angiotensin II from angiotensin I, reduces the release of aldosterone, reduces OPSS, blood pressure, post-and preload. Expands arteries to a greater extent than veins. Enhances coronary and renal blood flow. With prolonged use, hypertrophy of the myocardium and the walls of resistive arteries is reduced; improves blood supply to ischemic myocardium; reduces platelet aggregation. Hydrochlorothiazide, a thiazide diuretic of moderate strength, reduces Na + reabsorption at the level of the cortical segment of the loop of Henle. Does not affect CBS. Lowers blood pressure by changing the reactivity of the vascular wall, reducing the pressure of the vasoconstrictor substances (epinephrine, norepinephrine) and increasing the depressor effect on the vegetative ganglia (to a lesser extent, by reducing the BCC). Strengthens the hypotensive effect of captopril.

Arterial hypertension.

Contraindications

Hypersensitivity to captopril, diuretic preparations of the thiazide type, sulfonamides (allergic reactions may cross), angioedema (in history with angiotensin-converting enzyme inhibitors), aortic stenosis, renal artery stenosis, bilateral health care, renal ward, renal ward, renal ward, renal ward, arthral stenosis, bilateral osteoarthritis, recurrent stenosis, miral stenosis;, kidney transplantation (in history), heart failure, cardiogenic shock, arterial hypotension, tachycardia, severe liver failure (precoma or coma); severe renal failure (serum creatinine more than 1.8 mg / 100 ml or CC less than 20-30 ml / min, anuria), primary hyperaldosteronism, pregnancy, lactation. With care (with careful control): moderate renal failure (serum creatinine up to 1.8 mg / 100 ml or with CC 30-60 ml / min), with an increase in protein excretion in the urine (more than 1 g / day), hypokalemia (not medically corrected ); hyponatremia, hypovolemia, hypercalcemia, gout, systemic diseases of the connective tissue and other immune diseases (incl.SLE, scleroderma, periarteritis nodosa), old age (over 65 years old), simultaneous prescription of drugs that suppress the body's protective reactions (GCS, cytostatics, immunosuppressants), Allopurinol, procainamide and Li + drugs.

Inside, regardless of the meal, take 1 pill 1 time per day. In the future, if necessary, the dose can be increased to 2 pills per day, or reduced to the minimum effective.

Adverse reactions

Blood flushes to the skin of the face, fever, dizziness, headache, tachycardia, palpitations, swelling of the legs, a pronounced decrease in blood pressure (including orthostatic) with symptoms of dizziness, weakness, visual disturbances, in rare cases - fainting, tachycardia, palpitations, with a sharp or prolonged excessive decrease in blood pressure - a transient violation of cerebral circulation, stroke, myocardial infarction. Disorders of water and electrolyte balance: dry mouth, thirst, fatigue, depression, drowsiness, weakness. In rare cases - reduced formation of tear fluid. Bronchospasm, dry cough, in rare cases - respiratory failure, sinusitis, rhinitis. Angioedema of the larynx, pharynx and / or tongue, angioedema, allergic reactions (up to the development of pulmonary edema), skin rash (exanthema, in rare cases, urticaria). Exfoliative dermatitis, erythema multiforme, malignant exudative erythema (Stevens-Johnson syndrome), and toxic epidermal necrolysis (Lyell's syndrome). These skin changes may be accompanied by a rise in temperature, pain in muscles and joints, and the development of vasculitis. In some cases, skin changes resembling psoriasis, photosensitivity, hair loss, nail disorders (onycholysis). Nausea, vomiting, constipation or diarrhea, stomach discomfort, abdominal pain, anorexia, acute cholecystitis (with gallstone disease), hemorrhagic pancreatitis, hepatitis, cholestatic jaundice. With prolonged use: gingival hyperplasia, asthenic syndrome, taste change, renal dysfunction, nephritis. Headache, fatigue, in rare cases - depression, depression, sleep disturbances, decrease in potency, convulsions, imbalance, dizziness, tinnitus, visual disturbances, myopia progression, tremor, paresthesia, taste disturbances.Anemia, reduced hematocrit, thrombocytopenia, leukopenia, neutropenia (up to the development of pancytopenia and agranulocytosis - especially amid simultaneous reception allopurinol, procainamide, and immunosuppressants), eosinophilia, increased titer of antinuclear antibodies, proteinuria, increased activity "liver" enzymes, hyperlipidemia, hyperbilirubinemia; hyperglycemia; hyperuricemia (up to exacerbation of gout). In rare cases, especially in patients with renal insufficiency, there may be an increase in serum concentrations of urea, creatinine and K + (the risk of developing hyperkalemia is also increased in patients with diabetes mellitus), as well as hyponatremia.

Cautions

At the beginning of treatment, an excessive decrease in blood pressure can be observed, especially in patients with heart failure, severe hypertension (including kidney origin) and / or kidney failure. Before starting treatment, it is necessary to compensate for the deficiency of Na + and BCC (reduce the dose of previously prescribed diuretics or, in some cases, completely eliminate them), as well as determine the indicators of kidney function. Requires regular monitoring of plasma K + and Ca2 + (especially in patients receiving treatment with digitalis, GCS, often using laxatives, as well as in elderly patients), glucose, uric acid, lipids (cholesterol and TG), urea and creatinine, activity " hepatic transaminases. Especially careful monitoring of blood pressure levels and laboratory parameters is necessary in the following cases: in patients with renal insufficiency, patients with severe hypertension (including kidney genesis), in elderly patients (over 65), in patients with waterborne disorders -electrolyte balance and severe heart failure, as well as receiving both allopurinol, salts of Li +, procainamide, and drugs that reduce immunity. During treatment, you should refrain from engaging in potentially hazardous activities that require increased concentration and psychomotor speed. When fever, swollen lymph nodes and / or signs of laryngitis and / or pharyngitis appear, it is necessary to immediately determine the content of leukocytes.

Drug Interactions

Increases the concentration of Digoxin in plasma by 15-20%, increases the bioavailability of propranolol. Cimetidine, slowing down the metabolism of captopril in the liver, increases its concentration in plasma. The combination with nitrates, thiazide diuretics, Verapamil, beta-blockers and other antihypertensive drugs, as well as tricyclic antidepressants, hypnotics and ethanol increases the severity of the hypotensive effect. The risk of developing an immunosuppressive effect increases with combined use with procainamide, as well as drugs that block tubular secretion (decrease in the number of leukocytes and granulocytes). If Li + is prescribed at the same time, there may be a delay in the elimination of Li + (increased damage to the heart and central nervous system). Drugs that bind intensively with proteins enhance the diuretic effect. Increases the neurotoxicity of salicylates, the effect of curare-like muscle relaxants, ethanol. Reduces the excretion of quinidine, the action of oral hypoglycemic drugs, norepinephrine, epinephrine and anti-arthritis. Strengthens the side effects of cardiac glycosides, especially when administered concurrently with drugs that increase the release of K + and Mg2 + and / or retain Ca2 + (for example, diuretics, adrenal cortex hormones, laxatives, amphotericin B, carbenoxolone, penicillin G, salicylates). At the same time taking methyldopa may develop hemolysis of red blood cells. Kolestiramin reduces absorption. Table salt and NSAIDs reduce the severity of the hypotensive effect. K + salts, potassium-sparing diuretics, and Heparin contribute to the development of hyperkalemia. Appointment against the background of hemodialysis using certain high-permeability dialysis membranes (for example, polyacrylonitrile-metalyl sulfonate membranes) increases the risk of developing hypersensitivity reactions (anaphylactoid reactions).