Lisinopril pills 20mg №50

Latin name

LISINOPRIL

Release form

Pills

Packaging

50 pcs.

pharmachologic effect

An ACE inhibitor, reduces the formation of angiotensin II from angiotensin I. A decrease in the content of angiotensin II leads to a direct decrease in the release of aldosterone. Reduces the degradation of bradykinin and increases prostaglandin synthesis. Reduces the total peripheral vascular resistance, blood pressure (BP), preload, pressure in the pulmonary capillaries, causes an increase in the minute volume of blood and an increase in myocardial tolerance to stress in patients with chronic heart failure. Expands arteries to a greater extent than veins. Some effects are due to effects on the tissue renin-angiotensin-aldosterone system. With prolonged use, hypertrophy of the myocardium and the walls of resistive arteries is reduced. Improves blood supply to ischemic myocardium.
ACE inhibitors prolong life expectancy in patients with chronic heart failure, slow down the progression of left ventricular dysfunction in patients who have had a myocardial infarction without clinical manifestations of heart failure.
Onset of action - after 1 h. The maximum antihypertensive effect is determined after 6-7 hours and lasts for 24 hours.In case of arterial hypertension, the effect is noted in the first days after the start of treatment, a stable action develops after 1-2 months. With a sharp withdrawal of the drug is not marked a marked increase in blood pressure.
In addition to lowering blood pressure, lisinopril reduces albuminuria. Lisinopril does not affect the concentration of glucose in the blood in patients with diabetes mellitus and does not lead to an increase in hypoglycemia.

Indications

Arterial hypertension (in monotherapy or in combination with other antihypertensives).
Chronic heart failure (as part of combination therapy for the treatment of patients taking cardiac glycosides and / or diuretics).
Early treatment of acute myocardial infarction as part of combination therapy (in the first 24 hours with stable hemodynamic parameters to maintain these indicators and prevent left ventricular dysfunction and heart failure).
Diabetic nephropathy (reducing albuminuria in patients with type 1 diabetes with normal blood pressure, and patients with type 2 diabetes with arterial hypertension).

Contraindications

Hypersensitivity to lisinopril or other ACE inhibitors.
Angioedema in history, including during the use of ACE inhibitors.
Hereditary angioedema or idiopathic angioedema.
Pregnancy and lactation.
Age up to 18 years (efficacy and safety have not been established).
Lactase deficiency, lactose intolerance, glucose-galactose malabsorption syndrome.

Carefully
Severe renal dysfunction, bilateral renal artery stenosis or arterial stenosis of a single kidney with progressive azotemia, a condition after kidney transplantation, azotemia, hyperkalemia, aortic stenosis, hypertrophic obstructive cardiomyopathy, primary hyper aldosteronism, arterial hypotension, cerebral disease, ischedural disease, ischemia, ischeromesis, ischemia, ischemia, ischemia, ischemia, ischemia, ischemia, ischemia, aortic, cerebral artery ), coronary heart disease, coronary insufficiency, autoimmune systemic diseases of the connective tissue (including le scleroderma, systemic lupus erythematosus); oppression of bone marrow hematopoiesis; dietary salt diet; hypovolemic states (including as a result of diarrhea, vomiting); old age, hemodialysis using high-permeability high-permeability dialysis membranes (AN69®).

Use during pregnancy and lactation

The use of Lisinopril during pregnancy is contraindicated. At establishment of pregnancy reception of a drug Lisinopril needs to be stopped as soon as possible. Acceptance of ACE inhibitors in the II and III trimester 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 during the first trimester is not.For newborns and infants who have been exposed to intrauterine effects of ACE inhibitors, it is recommended to conduct careful monitoring to timely detect a pronounced decrease in blood pressure, oliguria, hyperkalemia.
Lisinopril penetrates through the placenta. No data on the penetration of lysinopril into breast milk. If the drug Lisinopril is needed during lactation, breastfeeding should be canceled.

special instructions

Symptomatic hypotension
Most often, a pronounced decrease in blood pressure occurs with a decrease in circulating blood volume (BCC) caused by diuretic therapy, a decrease in table 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.
Under the strict supervision of a physician, Lisinopril should be used for patients with coronary heart disease, cerebrovascular insufficiency, in which a sharp decrease in blood pressure can lead to a myocardial infarction or stroke. Transient arterial hypotension is not a contraindication for taking the next dose of the drug.
When using the drug Lisinopril, in some patients with chronic heart failure, but with normal or decreased blood pressure, there may be a decrease in blood pressure, which is usually not a reason to stop treatment.
Before the start of drug treatment, if possible, normalize the sodium content and / or replenish the BCC, carefully monitor the effect of the initial dose of Lisinopril on the patient.
In the case of stenosis of the renal arteries (especially in bilateral stenosis or in the presence of stenosis of the artery of a single kidney), as well as circulatory failure due to lack of sodium ions and / or fluids, use of Lisinopril can lead to impaired renal function, acute renal failure, which usually proves irreversible even after discontinuation of the drug.
In acute myocardial infarction
The use of standard therapy (thrombolytics, Acetylsalicylic acid, beta-blockers) is shown. Lisinopril may be used in conjunction with intravenous administration or with the use of therapeutic transdermal systems Nitroglycerin.

Surgical intervention / general anesthesia
With extensive surgical interventions, as well as 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.
In elderly patients, the same dose leads to a higher concentration of the drug in the blood, so special care is required in determining the dose.
Since the potential risk of agranulocytosis cannot be excluded, periodic monitoring of the blood picture is required. When using the drug in dialysis conditions with polyacryl-nitrile membranes, anaphylactic shock may occur, therefore either a different type of dialysis membrane or the appointment of other antihypertensive agents is recommended.

Impact on the ability to drive vehicles and mechanisms
There are no data on the effect of Lisinopril on the ability to drive vehicles and mechanisms used in therapeutic doses, however, it must be borne in mind that early treatment may develop arterial hypotension, which may affect the ability to drive vehicles and work with potentially dangerous mechanisms, and dizziness and drowsiness may also occur, so care should be taken.

Composition

1 pill contains:

Active ingredient: lisinopril dihydrate (corresponds to lisinopril) 20 mg;

Excipients: milk sugar (lactose); MCC; 1500 starch (pregelatinized); aerosil (colloidal silicon dioxide); talc; Magnesium stearate.

Dosage and administration

Inside, 1 time per day in the morning, regardless of the meal, preferably at the same time.
In hypertension, patients who do not receive other antihypertensive drugs are prescribed 5 mg 1 time per day. In the absence of effect, the dose is increased every 2-3 days by 5 mg to an average therapeutic dose of 20-40 mg / day (an increase in dose over 40 mg / day usually does not lead to a further decrease in blood pressure). The usual daily maintenance dose is 20 mg.
The maximum daily dose is 40 mg.
The full effect usually develops after 2-4 weeks from the start of treatment, which should be considered when increasing the dose. With insufficient clinical effect, it is possible to combine the drug with other antihypertensive drugs.
If the patient has received prior treatment with diuretics, then the use of such drugs should be stopped 2-3 days before starting to use Lisinopril. If this is not possible, then the initial dose of Lisinopril should not exceed 5 mg per day. In this case, after taking the first dose, medical control is recommended for several hours (the maximum effect is reached after about 6 hours), since a pronounced decrease in blood pressure may occur.
In case of renovascular hypertension or other conditions with increased activity of the renin-angiotensin-aldosterone system, it is also advisable to prescribe a low initial dose of 5 mg per day, under enhanced medical control (control of blood pressure, kidney function, serum potassium ions). Maintenance dose, continuing strict medical supervision, should be determined depending on the dynamics of blood pressure.
In renal failure, due to the fact that lisinopril is eliminated by the kidneys, the initial dose should be determined depending on creatinine clearance. Further, the selection of doses should be made depending on individual reactions with regular monitoring of renal function, the content of potassium, sodium in serum.
Creatinine clearance
ml / min Initial dose,
mg / day
30-70 5-10 
10-30 5 
(including patients on hemodialysis)
With persistent arterial hypertension, long-term maintenance therapy is indicated at 10-15 mg / day.
In chronic heart failure: the initial dose is 2.5 mg per day, with a gradual increase in 3-5 days to 5-10 mg per day. The maximum daily dose is 20 mg.
Acute myocardial infarction (as part of combination therapy): in the first 24 hours - 5 mg, then 5 mg every other day, 10 mg after two days, and then 10 mg once a day. The course of treatment is at least 6 weeks.
In the case of a prolonged pronounced decrease in blood pressure (systolic blood pressure less than 90 mm Hg. Art. More than 1 hour), treatment with the drug should be stopped.
Diabetic nephropathy: in patients with type 2 diabetes mellitus, 10 mg of Lisinopril is used 1 time per day. The dose may, if necessary, be increased to 20 mg once a day in order to achieve diastolic blood pressure values ​​below 75 mm Hg. in the sitting position. In patients with type 1 diabetes, the dose is the same in order to achieve diastolic blood pressure values ​​below 90 mm Hg. in the sitting position.

Side effects

The incidence of side effects is characterized as often (1%), rarely (1%).
The most common side effects are dizziness, headache, fatigue, diarrhea, dry cough, nausea.
Since the cardiovascular system: often - a pronounced decrease in blood pressure, orthostatic hypotension; rarely - chest pain, tachycardia, bradycardia, exacerbation of symptoms of chronic heart failure, impaired atrioventricular conduction, myocardial infarction.
From the side of the central nervous system: often - paresthesias, mood lability, confusion, drowsiness, jerky muscles of the extremities and lips, rarely - asthenic syndrome.
From the side of blood-forming organs: rarely - leukopenia, neutropenia, agranulocytosis, thrombocytopenia, with long-term treatment - anemia (decrease in hemoglobin, hematocrit,erythropenia).
On the part of the respiratory system: rarely - shortness of breath, bronchospasm.
On the part of the digestive system: rarely - dryness of the oral mucosa, anorexia, dyspepsia, changes in taste, abdominal pain, pancreatitis, jaundice (hepatocellular or cholestatic), hepatitis.
On the part of the skin: rarely - urticaria, pruritus, sweating, alopecia, photosensitivity.
On the part of the urogenital system: rarely - impaired renal function, oliguria, anuria, acute renal failure, uremia, proteinuria, reduced potency.
Laboratory indicators: often - hyperkalemia, hyponatremia; rarely - hyperbilirubinemia, increased activity of liver enzymes, hypercreatininemia, increased concentrations of urea and creatinine.
Allergic reactions: rarely - angioedema of the face, extremities, lips, tongue, epiglottis and / or larynx, skin rashes, pruritus, fever, false positive test for antinuclear antibodies, increased erythrocyte sedimentation rate (ESR), eosinophilia, leukocytosis. In rare cases, intestinal angioedema.
Other: arthralgia / arthritis, vasculitis, myalgia.

Drug interaction

With simultaneous use of the drug with potassium-sparing diuretics (spironolactone, triamterene, amiloride), potassium preparations, salt substitutes containing potassium, cyclosporine, increases the risk of hyperkalemia, especially when the kidney function is impaired, therefore they can be used together only with regular monitoring of the content of potassium ions in serum and kidney function.
The combined use of lisinopril with beta-blockers, blockers of “slow” Calcium channels (BMCC), diuretics, tricyclic antidepressants / neuroleptics and other antihypertensives increases the severity of the hypotensive action.
Lisinopril slows down the excretion of lithium preparations. Therefore, when combined, it is necessary to regularly monitor the concentration of lithium in the serum.
Antacids and colestyramine reduce the absorption of lisinopril in the gastrointestinal tract.
When used together with insulin and hypoglycemic agents for oral administration, the risk of hypoglycemia is possible.
Nonsteroidal anti-inflammatory drugs (NSAIDs) (including selective cyclooxygenase-2 inhibitors (COX-2)), estrogens, adrenomimetiki reduce the hypotensive effect of lisinopril.
With the simultaneous use of ACE inhibitors and intravenous gold preparations (sodium aurothiomalate), a symptom complex has been described, including facial flushing, nausea, vomiting, and a decrease in blood pressure.
When combined with selective serotonin reuptake inhibitors, it can lead to severe hyponatremia.
Combined use with Allopurinol, procainamide, cytostatics can lead to leukopenia.

Symptoms (occur when taking a single dose of 50 mg): a pronounced decrease in blood pressure, dryness of the oral mucosa, drowsiness, urinary retention, constipation, anxiety, irritability.
Treatment: no specific antidote. Symptomatic therapy.Gastric lavage, the use of enterosorbents and laxatives. Intravenous administration of 0.9% sodium chloride solution is shown. In the case of treatment-resistant bradycardia, it is necessary to use an artificial pacemaker. It is necessary to control blood pressure, indicators of water and electrolyte balance. Hemodialysis is effective.

In a dry, dark place at a temperature not higher than 25 ºС.