Co-diroton pills 10mg + 12.5mg №10

Indications

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

Dosage and administration

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

Have patients with CC 30-80 ml / min the drug can be used only after the selection of the dose of the individual components of the drug. The recommended initial dose of lisinopril at uncomplicated renal failure makes 5-10 mg.

Symptomatic arterial hypotension may occur after taking the initial dose of the drug. Such cases are more common in patients who have had a loss of fluid and electrolytes due to previous treatment with diuretics. Therefore, you should stop taking diuretics 2-3 days before the start of treatment with the drug.

Side effect

Most often There are side effects: dizziness, headache.

Cardiovascular: pronounced decrease in blood pressure, chest pain; rarely - orthostatic hypotension, tachycardia, bradycardia, the appearance of symptoms of heart failure, impaired AV conduction, myocardial infarction.

Gastrointestinal: nausea, vomiting, abdominal pain, dry mouth, diarrhea, dyspepsia, anorexia, change in taste, pancreatitis, hepatitis (hepatocellular and cholestatic), jaundice.

From the skin: urticaria, increased sweating, photosensitivity, pruritus, hair loss.

From the side of the central nervous system: mood lability, impaired concentration, paresthesia, fatigue, drowsiness, jerky muscles of the limbs and lips; rarely - asthenic syndrome, confusion.

Respiratory: dyspnea, dry cough, bronchospasm, apnea.

Hemic and lymphatic: leukopenia, thrombocytopenia, neutropenia, agranulocytosis, anemia (decrease in the concentration of hemoglobin, hematocrit, erythrocytopenia).

Allergic reactions: angioedema of the face, limbs, lips, tongue, epiglottis and / or larynx, skin rashes, itching, fever, vasculitis, positive reactions to antinuclear antibodies, increased ESR, eosinophilia.

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

Laboratory values: hyperkalemia and / or hypokalemia, hyponatremia, hypomagnemia, hypochloremia, hypercalcemia, hyperuricemia, hyperglycemia, increased urea and creatinine levels in the blood plasma, hyperbilirubinemia, hypercholesterolemia, hypertriglyceride, reduction of tolerance diabetes and renovascular hypertension.

Other: arthralgia, arthritis, myalgia, fever, impaired fetal development, aggravation of gout.

Contraindications

- angioedema (including angioedema in history, associated with the use of ACE inhibitors);

- anuria;

- severe renal failure (CC less than 30 ml / min);

- hemodialysis using high-flow membranes;

- hypercalcemia;

- hyponatremia;

- porphyria;

- precoma;

- hepatic coma;

- severe forms of diabetes;

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

- hypersensitivity to lisinopril, other ACE inhibitors or hydrochlorothiazide, and excipients.

WITH caution: aortic stenosis / hypertrophic cardiomyopathy, bilateral renal artery stenosis, arterial stenosis of a single kidney with progressive azotemia, condition after kidney transplantation, renal failure (CC more than 30 ml / min), primary hyper aldosteronism, arterial hypotension, bone marrow hypoplasia, hyponatria, and hypotension in patients on a low-salt or salt-free diet), hypovolemic conditions (including diarrhea, vomiting), connective tissue diseases (including si dark lupus erythematosus, scleroderma), diabetes, gout, inhibition of bone marrow hematopoiesis, hyperuricemia, hyperkalemia, ischemic heart disease, cerebrovascular diseases (including cerebrovascular insufficiency), severe chronic heart failure, liver failure, advanced age.

Use during pregnancy and lactation

The use of lisinopril during pregnancy is contraindicated. When establishing pregnancy, the drug 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 reduction in blood pressure, renal failure, hyperkalemia, hypoplasia of the skull bones, 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 monitor for the timely detection of pronounced reduction in blood pressure, oliguria, hyperkalemia.

During the period of drug treatment it is necessary to cancel breastfeeding.

Application for violations of the liver

WITH caution: liver failure.

Application for violations of kidney function

Contraindicated in severe renal failure (CC less than 30 ml / min), condition after kidney transplantation.

Use in children

Contraindicated in children and adolescents under 18 years of age.

Use in elderly patients

WITH caution: elderly age.

Special notes

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

In patients with chronic heart failure with simultaneous renal failure or without it, a pronounced decrease in blood pressure is possible.It is more often detected in patients with a severe class of chronic heart failure, as a result of the use of large doses of diuretics, hyponatremia or impaired renal function. In such patients, treatment should begin under the strict supervision of a physician. Similar rules should be followed when prescribing IHD patients, 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 treatment, if possible, normalize the concentration of sodium and / or fill the lost volume of fluid, carefully monitor the effect of the initial dose of the drug on the patient.

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

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

Angioedema of the face, extremities, lips, tongue, epiglottis and / or larynx was rarely observed in patients treated with ACE inhibitors, including lisinopril, which can occur during any period of treatment.In this case, treatment with lisinopril should be stopped as soon as possible and patients should be monitored until symptoms are fully regressed. In cases where there is swelling of the face and lips, the condition most often passes without treatment, however, it is possible to prescribe antihistamines. Angioedema with laryngeal edema can be fatal. When the tongue, epiglottis, or larynx are covered, airway obstruction can occur, therefore, appropriate therapy should be immediately carried out (0.3-0.5 ml of epinephrine (adrenaline) 1: 1000 solution) and / or measures to ensure the airway patency.

In patients who already had angioedema in history, which was not associated with the previous treatment with ACE inhibitors, the risk of its development during treatment with an ACE inhibitor may be increased.

When using an ACE inhibitor, cough was noted. The cough is dry, long-lasting, 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 reaction has also been observed in patients subjected to hemodialysis using high-permeability dialysis membranes (AN69^®), which simultaneously take ACE inhibitors. In such cases, it is necessary to consider the possibility of using a different type of membrane for dialysis or another antihypertensive agent.

When using drugs that reduce 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 increasing the BCC.

Before surgery (including dentistry), an anesthesiologist should be warned about the use of ACE inhibitors.

In some cases, hyperkalemia was observed. Risk factors for the development of hyperkalemia include renal failure, diabetes mellitus, taking potassium drugs or drugs that cause an increase in the concentration of potassium in the blood (for example, heparin), especially in patients with impaired renal function.

In patients with a 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 for (loss of fluid and salt).

Thiazide diuretics can affect glucose tolerance, so it is necessary to adjust the dose of hypoglycemic agents for oral administration. Thiazide diuretics can reduce Calcium excretion by the kidneys and cause hypercalcemia. Severe hypercalcemia can be a symptom of latent hyperparathyroidism. It is recommended to discontinue treatment with thiazide diuretics before conducting a test to assess the function of the parathyroid glands.

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

During the period of treatment is not recommended to drink alcohol, becauseethanol enhances the hypotensive effect of the drug.

Caution should be exercised when performing physical exercises, hot weather (the risk of dehydration and an excessive decrease in blood pressure due to a decrease in the BCC).

Influence on ability to drive motor transport and control mechanisms

During the period of treatment, you should refrain from driving vehicles and practicing potentially dangerous activities that require increased concentration and psychomotor speed, because dizziness is possible, especially at the beginning of the course of treatment.

Overdose

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

Treatment: symptomatic therapy, in / in the introduction of fluid, blood pressure control; therapy aimed at correcting dehydration and disorders of water-salt balance. Control of urea, creatinine and electrolytes in the serum, as well as diuresis.

Drug interaction

When applied simultaneously 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 jointly prescribed only on the basis of an individual decision of a 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), estrogen decreases the antihypertensive action of lisinopril.

With simultaneous use with lithium preparations, the removal of lithium from the body is slowed down (enhancement of the cardiotoxic and neurotoxic action of lithium).

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

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

Reduces the effect of oral contraceptives.

Ethanol enhances the hypotensive effect of the drug.

At the same time taking methyldopa increases the risk of hemolysis.

Pharmacy sales terms

The drug is available on prescription.

Terms and conditions of storage

The drug should be kept out of reach of children at a temperature not higher than 30 ° C.