Kapoten pills 25mg №40

Indications

- arterial hypertension, incl. renovascular;

- chronic heart failure (as part of combination therapy);

- dysfunction of the left ventricle after myocardial infarction in a clinically stable state;

- diabetic nephropathy on the background of type 1 diabetes mellitus (with albuminuria> 30 mg / day).

Dosage and administration

Capoten^® administered orally for 1 hour before meals. The dosage regimen is set individually.

At hypertension the initial dose is 12.5 mg 2 times / day. If necessary, increase the dose gradually (with an interval of 2-4 weeks) until the optimum effect is achieved. At mild to moderate hypertension the average therapeutic dose is 25 mg 2 times / day; the maximum dose is 50 mg 2 times / day. At severe hypertension the initial dose is 12.5 mg 2 times / day. The dose is gradually increased to a maximum daily dose of 150 mg (50 mg 3 times / day).

At chronic heart failure Capoten^® prescribed in cases where the use of diuretics does not provide an adequate effect. The initial dose is 6.25 mg 3 times / day. If necessary, increase the dose every 2 weeks. Maintenance dose - 25 mg 2-3 times / day. The maximum daily dose is 150 mg.

At left ventricular dysfunction after myocardial infarction in patients in a clinically stable state, the use of Capoten can begin as early as 3 days after myocardial infarction. The initial dose is 6.25 mg / day, then the daily dose can be increased to 37.5-75 mg in 2-3 doses (depending on the tolerance of the drug) up to the maximum - 150 mg / day.

At diabetic nephropathy daily dose ranges from 75 mg to 100 mg, divided into 2-3 doses. At insulin-dependent diabetes mellitus with microalbuminuria (albumin clearance 30-300 mg / day) dose of the drug is 50 mg 2 times / day. With a total protein clearance of more than 500 mg / day, the drug is effective at a dose of 25 mg 3 times / day.

Patients with impaired renal function of mild or moderate degree (CC ≥ 30 ml / min / 1.73 m²) Capoten^® prescribed in a daily dose of 75-100 mg. At severe renal impairment (CC <30 ml / min / 1.73 m²) the initial dose is not more than 12.5 mg 2 times / day. In the future, if necessary, the dose is gradually increased (with fairly large intervals), but use a smaller than usual daily dose of the drug.

Elderly patients the dose is selected individually. Treatment is recommended to start with the smallest therapeutic dose of 6.25 mg 2 times / day and, if possible, to maintain it at this level.

If necessary, additional designate "loop" diuretics, and not the diuretics of the thiazide series.

Adverse effects

Cardiovascular: orthostatic hypotension, tachycardia, peripheral edema, decrease in blood pressure.

Respiratory: dry cough (usually passing after drug withdrawal), bronchospasm, pulmonary edema.

Allergic reactions: angioedema of the extremities, face, lips, mucous membranes, tongue, pharynx or larynx.

Nervous system: headache, dizziness, ataxia, paresthesias, drowsiness, visual disturbances.

Fluid and electrolyte balance: hyperkalemia, hyponatremia.

Urogenital: proteinuria, an increase in the content of urea nitrogen and creatinine in the blood plasma, acidosis.

Hemic and lymphatic: neutropenia, agranulocytosis, thrombocytopenia, anemia; rarely, a positive antibody test for a nuclear antigen.

Gastrointestinal: taste impairment, dry mouth, stomatitis, gingival hyperplasia, abdominal pain, diarrhea, hepatitis, increased levels of liver transaminases in blood plasma, hyperbilirubinemia.

Contraindications

- angioedema (hereditary or associated with the use of ACE inhibitors in history);

- pronounced renal dysfunction;

- severe liver dysfunction;

- hyperkalemia;

- bilateral renal artery stenosis or arterial stenosis of a single kidney with progressive azotemia;

- condition after kidney transplantation;

- Aortic stenosis and similar obstructive changes that impede the flow of blood from the left ventricle;

- pregnancy;

- lactation period (breastfeeding);

- age up to 18 years (efficiency and safety have not been established);

- hypersensitivity to the drug and other ACE inhibitors.

WITH caution should be prescribed for severe autoimmune diseases of the connective tissue (including SLE, scleroderma), inhibition of bone marrow hematopoiesis (risk of neutropenia and agranulocytosis), cerebral ischemia, diabetes mellitus (increased risk of hyperkalemia), patients undergoing hemodialysis, patients on a sodium-restricted diet, with primary hyperaldosteronism, ischemic heart disease, conditions accompanied by a decrease in BCC (including vomiting, diarrhea), elderly patients (dose adjustment is required).

Use during pregnancy and lactation

The drug is contraindicated for use during pregnancy and lactation.

Special notes

Before beginning, and regularly in the process of treatment with Capoten, the kidney function should be monitored. In patients with chronic heart failure, Capoten^® should be used under close medical supervision.

On the background of long-term use of Capoten in approximately 20% of patients, an increase in the content of urea and creatinine in the blood serum is observed by more than 20% compared with the norm or baseline value. Less than 5% of patients, especially in severe nephropathies, require discontinuation of treatment due to an increase in creatinine concentration.

In patients with arterial hypertension when using Capoten, severehypotension is observed only in rare cases; the likelihood of developing this condition increases with increased loss of fluid and salt (for example, after intensive diuretic treatment), in patients with heart failure or being on dialysis.

The possibility of a sharp decrease in blood pressure can be minimized with a preliminary cancellation (4-7 days) of a diuretic or an increase in sodium chloride (about a week before the start of treatment), or by administering Capoten at the beginning of treatment in small doses (6.25-12.5 mg / day).

In the first 3 months of therapy, the number of blood leukocytes should be monitored monthly, then 1 time in 3 months. In patients with autoimmune diseases, the number of leukocytes in the first 3 months of treatment should be monitored every 2 weeks, then every 2 months. If the number of leukocytes is less than 4000 / μl, a general blood test is indicated, if less than 1000 / μl, the drug is discontinued.

In some cases, against the background of the use of ACE inhibitors, incl. Capoten, an increase in the concentration of potassium in the serum. The risk of developing hyperkalemia with the use of ACE inhibitors is increased in patients with renal insufficiency and diabetes mellitus, as well as receiving potassium-saving diuretics, potassium preparations or other drugs that cause an increase in the concentration of potassium in the blood (for example, heparin). It is necessary to avoid simultaneous use of potassium-saving diuretics and potassium preparations with Capoten.

When conducting hemodialysis in patients receiving capoten^®, the use of high permeability dialysis membranes (for example, AN69) should be avoided, since in such cases the risk of anaphylactoid reactions increases.

In the case of the development of angioedema, the drug is canceled and thorough medical supervision is carried out. If the edema is localized on the face, special treatment is usually not required (antihistamines can be used to reduce the severity of symptoms); If the edema spreads to the tongue, pharynx or larynx and there is a threat of airway obstruction, 0.5 ml of 0.1% solution of epinephrine (adrenaline) should be injected immediately.

When taking Capoten, a false-positive reaction may be observed in the analysis of urine on acetone.

Caution should be prescribed Kapoten ^® patients who are on a low-salt or salt-free diet, because in this case, the risk of arterial hypotension increases.

In case of symptomatic arterial hypotension after taking Capoten, the patient should assume a horizontal position with the legs elevated.

Influence on ability to drive motor transport and control mechanisms

During the period of treatment, it is necessary to refrain from driving vehicles and practicing potentially hazardous activities that require increased concentration and psychomotor speed, sincedizziness may occur, especially after taking the initial dose.

Overdose

Symptoms: a sharp decrease in blood pressure.

Treatment: the introduction of an isotonic solution of sodium chloride or other plasma-substituting drugs, hemodialysis.

Drug interaction

Diuretics, vasodilators (for example, minoxidil) potentiate the antihypertensive effect of the drug Capoten^®.

Indomethacin and other NSAIDs may reduce the antihypertensive effect of the drug Capoten^®.

Simultaneous use of Capoten with potassium-sparing diuretics (for example, triamterene, amiloride and spironolactone), potassium preparations, potassium supplements, salt substitutes (contain significant amounts of potassium) may increase the risk of hyperkalemia.

The simultaneous use of salts of lithium and Capoten can lead to an increase in the concentration of lithium in the blood serum.

Against the background of simultaneous use of Capoten with Allopurinol and procainamide, neutropenia and / or Stevens-Johnson syndrome may be observed.

With simultaneous use of immunosuppressants (eg, azathioprine and cyclophosphamide) with Capoten, the risk of hematological disorders increases.

Terms and conditions of storage

List B. The drug should be stored in a dry place inaccessible to children at a temperature not higher than 25 ° C.