Lisinopril

When ATH:
C09AA03

Characteristic.

Crystalline powder white or nearly white, without smell, soluble in water, it is soluble in methanol and practically insoluble in ethanol.

Pharmacological action.
Gipotenzivnoe, vazodilatirtee, kardioprotektivnoe, natriuretic.

Application.

Arterial hypertension (mono- and combination therapy), incl. renovascular; congestive heart failure (in a combination therapy for the treatment of patients, taking drugs digitalis and / or diuretics); acute myocardial infarction (first 24 h with stable hemodynamics to maintain these indicators, and for prevention of cardiac dysfunction left chamber and heart failure); diabeticheskaya nephropathy (insulin-dependent reduction of albuminuria in patients with normal blood pressure, and insulin-dependent patients with hypertension).

Contraindications.

Hypersensitivity to lisinopril other ACE inhibitors; angioedema in history, incl. and from the use of ACE inhibitors, hereditary angioedema or idiopathic edema; pregnancy, lactation, Age to 18 years (Safety and efficacy have not been determined).

Restrictions apply.

Assessment of the risk-benefit ratio in the following cases: cerebrovascular diseases (incl. cerebrovascular insufficiency), CHD, coronary insufficiency, collagenoses (incl. systemic lupus erythematosus, scleroderma), inhibition of bone marrow hematopoiesis, hypotension, aortic, mitral stenosis or other obstructive changes, impede the outflow of blood from the heart; hyperkalemia, or high risk of its occurrence (diabetes, severe renal insufficiency, co-administration of diuretics), azotemia, hyponatremia or restriction of sodium in the diet, bilateral renal artery stenosis or stenosis of the artery to a solitary kidney, the transplanted kidney, primary aldosteronism, hyperuricemia, advanced age.

Pregnancy and breast-feeding.

Contraindicated in pregnancy.

Category actions result in FDA - C (I trimester). (The study of reproduction in animals has revealed adverse effects on the fetus, and adequate and well-controlled studies in pregnant women have not held, However, the potential benefits, associated with drugs in pregnant, may justify its use, in spite of the possible risk.)

Category actions result in FDA - D (II and III trimesters).

At the time of treatment should stop breastfeeding.

Side effects.

From the nervous system and sensory organs: headache, dizziness, fatigue, disturbances of consciousness, irritability, nervousness, transient ischemic attack, fainting, ataxia, memory decline, drowsiness, insomnia, peripheral neuropathy, paraesthesia, tremor, convulsions, visual disturbances (diplopia, photophobia, decrease in visual acuity), noise in ears.

Cardio-vascular system and blood (hematopoiesis, hemostasis): heartbeat, chest pain, marked reduction in blood pressure, arrhythmia (Atrial and ventricular tachycardia, Atrial fibrillation, bradycardia and others.), cardiac arrest, myocardial infarction, orthostatic reactions, vasculitis, bone marrow depression, leukopenia, thrombocytopenia, anemia.

From the respiratory system: dry cough, malignant lung tumors, hemoptysis, the infiltration, embolism and pulmonary infarction, bronchospasm, asthma, pleural effusion, pain when breathing, bronchitis, laringit, sinusitis, pharyngitis, rhinitis, nose bleed, cold, paroxysmal postural dyspnoea.

From the digestive tract: dry mouth, dyspepsia, heartburn, nausea, vomiting, diarrhea / constipation, flatulence, spasms of the gastrointestinal tract, abdominal pain, gepatotoksichnostь (hepatitis, cholestatic jaundice, fulminant hepatic necrosis with possible fatal), gastritis, pancreatitis.

With the genitourinary system: impairment of renal function, acute renal failure, pyelonephritis, dizurija,oligurija, anurija, uremia, swelling, the weakening of the libido, impotence.

On the part of the musculoskeletal system: arthritis, arthralgia, myalgia, pain in the neck, back.

For the skin: rash, hives, alopecia, photosensitivity, pemphigus, damage and skin infections, toxic epidermal necrolysis, Syndrome Stevens - Johnson.

Other: reduction (increase) body weight, fever, Sweating, allergic reactions, incl. angioedema, the development of infections, incl. gerpes zoster, diabetes, degidratatsiya, gout, increasing titer of antinuclear antibodies, creatinine concentration, urea, hyperkalemia, giponatriemiya, hyperuricemia.

Cooperation.

Increase the hypotensive effect of diuretics, weakens-indometacin. When combined with a nitrate, propranolol, and digoxin were observed clinically significant adverse pharmacokinetic interactions. Increases lithium toxicity. Potassium-sparing diuretics, potassium supplements and kalisodergaszczye funds increase the risk of hyperkalemia.

Overdose.

Symptoms: severe hypotension.

Treatment: the introduction of saline and other symptomatic therapy. Removed by hemodialysis.

Dosing and Administration.

Inside, 1 once a day. The dose is determined individually, depending on the evidence, the state of renal function and concomitant therapy. The initial dose is 2.5-5 mg, average supporting dose is 5-20 mg, maximum daily - 80 mg.

Precautions.

Treatment is carried out under regular medical supervision. Before treatment should be adjusted water-electrolyte balance. During treatment requires monitoring of blood pressure, protein level and plasma potassium, BUN, creatinine, renal function, blood picture, body weight and dieting. Care should be taken during surgery (including dental), especially when used general anesthetics, hypotensive effect. Avoid hemodialysis through high capacity membranes poliakrilonitritmetallilsulfata (For example, AN69), gemofilytratsii or LDL apheresis (may develop anaphylaxis or anaphylactoid reactions).

Cooperation

Active substance	Description of interaction
Verapamil	FMR: synergism. Strengthens (mutually) hypotensive effect.
Gidroxlorotiazid	FMR: synergism. Strengthens (mutually) hypotensive effect. Against the background of lisinopril reduced the loss of potassium.
Diclofenac	FMR: antagonizm. Reduces hypotensive effect. Increases (mutually) risk of renal failure.
Diclofenac potassium	FMR. Reduces hypotensive effect. Increases (mutually) risk of renal failure.
Ibuprofen	FMR. It weakens the hypotensive effect (consequently inhibiting prostaglandins decreases renal blood flow and renal retention of sodium and fluids). Combined use may increase the risk of renal impairment, especially in patients with hypovolemia.
Indapamid	FMR: synergism. Strengthens (mutually) antihypertensive effect (, severe hypotension).
Indomethacin	FMR. It weakens the hypotensive effect (consequently inhibiting prostaglandins decreases renal blood flow and renal retention of sodium and fluids). Combined use may increase the risk of renal impairment, especially in patients with hypovolemia.
Ketoprofen	FMR. Reduces hypotensive effect, increases (mutually) risk of renal failure.
Ketorolac	FMR. Reduces hypotensive effect, increases (mutually) risk of renal failure.
Meloxicam	FMR. Reduces hypotensive effect, increases (mutually) risk of renal failure.
Naproxen	FMR. Reduces hypotensive effect, increases (mutually) risk of renal failure.
Piroxicam	FMR. Reduces hypotensive effect, increases (mutually) risk of renal failure.
Risperidone	FMR: synergism. Enhances the hypotensive effect.
Spironolactone	FMR: synergism. Enhances the hypotensive effect, increases (mutually) the risk of hyperkalemia.
Flurbyprofen	FMR: antagonizm. Reduces hypotensive effect, increases (mutually) risk of renal failure.
Celecoxib	FMR. Reduces hypotensive effect, increases (mutually) risk of renal failure (especially in patients with impaired renal function).
Ethacrynic acid	FMR: synergism. Increase the hypotensive effect. Against the background of lisinopril reduced the loss of potassium.