Lysinoton N: instructions for using the medicine, structure, Contraindications

Active material: Gidroxlorotiazid, Lisinopril
When ATH: C09BA03
CCF: Antihypertensive drugs
When CSF: 01.09.16.03
Manufacturer: ACTAVIS GROUP hf. (Iceland)

Lysinoton N: dosage form, composition and packaging

Pills orange-yellow, round, lenticular, labeled “LH” one side, without incision; tolerance of marbling.

Excipients: mannitol, calcium hydrogen phosphate dihydrate, pregelatinized corn starch, iron oxide yellow (E172), iron oxide red (E172), sodium croscarmellose, magnesium stearate.

14 PC. – blisters (2) – packs cardboard.

Pills white, round, lenticular, labeled “LH” on one side and a notch - on the other; tolerance of marbling.

Excipients: mannitol, calcium hydrogen phosphate dihydrate, pregelatinized corn starch, sodium croscarmellose, magnesium stearate.

14 PC. – blisters (2) – packs cardboard.

Lysinoton N: Pharmacological action

Lisinopril. ACE inhibitor, reduces the formation of angiotensin II from angiotensin I. Reducing the content of angiotensin II leads to a direct reduction in aldosterone release. It reduces the degradation of bradykinin, and increases the synthesis of PG. Reduces PR, FROM, preload, the pressure in the pulmonary capillaries, It causes an increase in cardiac output and increased exercise tolerance in patients with heart failure. It expands the artery to a greater extent, than veins. Some effects are explained by the influence on the tissue renin-angiotensin system. Prolonged use reduces myocardial hypertrophy and arterial walls resistive type. It improves blood flow to ischemic myocardium. ACE inhibitors prolong survival in patients with chronic heart failure, slow the progression of left ventricular dysfunction in patients, myocardial infarction without clinical symptoms of heart failure. Valid through 1 no, maximum effect is determined after 6-7 hours, duration - 24 no. When hypertension effect observed in the first days after the start of treatment, consistent action develops in 1-2 months.

Gidroxlorotiazid. Tiazidnый diuretic, diuretic effect which involves a violation of the reabsorption of sodium ions, Chlorine, Potassium, Magnesium, water in the distal nephron; delays excretion of calcium ions, Uric acid. It has antihypertensive properties; hypotensive action develops due to the expansion of arterioles. Almost no effect on normal blood pressure. The diuretic effect occurs within 1-2 hours, reaches through 4 hours and lasts 6-12 hours. The antihypertensive effect occurs within 3-4 days, but in order to achieve optimum therapeutic effect may require 3-4 weeks.

Lisinopril and Hydrochlorothiazide while receiving have an additive antihypertensive effect.

Lysinoton N: testimony

• Arterial hypertension (patients, which shows the combination therapy).

Lysinoton N: Dosage regimen

Inside, 1 once a day.

Essential hypertension: by 1 Table. Lizinotona N 10 mg + 12,5 mg 1 once a day. If necessary, the dose can be increased to N Lizinotona 20 mg + 12,5 mg 1 once a day.

Doses in renal failure: patients with creatinine Cl 30 less 80 ml / min, the drug can be used only after titration of the individual components of the preparation. The recommended initial dose of lisinopril in uncomplicated kidney failure - 5.10 mg.

Predshestvuyushtaya therapy diuretikami: symptomatic hypotension may occur after administration of the initial dose. Such cases are more common in patients, which it was the loss of fluids and electrolytes due to prior treatment with diuretics. Therefore, it is necessary to stop taking the diuretic 2-3 days before starting treatment Lizinotonom H (cm. "Cautions").

Lysinoton N: Side effect

In most patients, the side effects were mild and transient. The most frequent were: dizziness, headache.

Side effects, are less common:

Cardio-vascular system: marked reduction in blood pressure, chest pain; rarely – orthostatic hypotension, tachycardia, bradycardia, symptoms of heart failure, AV conduction disorders, myocardial infarction.

On the part of the digestive tract: nausea, vomiting, stomach ache, dry mouth, diarrhea, dyspepsia, anorexia, change in taste, pancreatitis, hepatitis (hepatocellular and cholestatic), jaundice.

From the nervous system: mood lability, impaired concentration, paresthesia, fatigue, drowsiness, jerking of the limbs and lips; rarely – asthenic syndrome, confusion.

The respiratory system: dyspnoea, bronchospasm, apnea.

For the skin: hives, Sweating, hair loss, photosensitivity.

Allergic reactions: angioneurotic edema of the face, limbs, lips, language, epiglottis and / or larynx (cm. "Cautions"), skin rashes, itch, fever, vasculitis, positive for antinuclear antibodies, increased erythrocyte sedimentation rate, eozinofilija.

From the side of hematopoiesis: leukopenia, thrombocytopenia, neutropenia, agranulocytosis, anemia (decrease in hemoglobin, gematokrita, erythropenia).

With the genitourinary system: uremia, oligurija / anurija, impairment of renal function, acute renal failure, reduced potency.

Laboratory findings: hyperkalemia and / or hypokalemia, giponatriemiya, gipomagniemiya, chloropenia, hyperuricemia, giperglikemiâ, increase in urea and creatinine; rarely – increased activity of "liver" transaminases, giperʙiliruʙinemija, hypercholesterolemia, hypertriglyceridemia, reduced glucose tolerance.

Other: dry cough, arthralgia / arthritis, myalgia, Developmental disorders of the kidneys of the fetus, worsening of gout.

Lysinoton N: Contraindications

Increased sensitivity to the drug, other ACE inhibitors and derivatives of sulfonamides;

• anurija,
• severe renal insufficiency (Cl creatinine less than 30 ml / min),
• angioedema (incl. and a history of the use of ACE inhibitors),
• hemodialysis using membranes vysokoprotochnyh,
• hypercalcemia,
• giponatriemiya,
• porphyria,
• Prek,
• pechenochnaya coma,
• diabetes (severe),
• pregnancy,
• breastfeeding,
• Age to 18 years (efficacy and safety have not been established).

Carefully – aortalnыy stenosis / hypertrophic kardyomyopatyya, bilateral renal artery stenosis, stenosis of the artery to a solitary kidney with progressive azotemia, condition after kidney transplantation, renal failure (Cl creatinine less than 30 ml / min), primary hyperaldosteronism, hypotension, bone marrow hypoplasia, giponatriemiya (an increased risk of hypotension in patients, are on a salt-free diet or malosolevoy), states, accompanied by a decrease in the bcc (incl. diarrhea, vomiting), connective tissue diseases (systemic lupus erythematosus, scleroderma), diabetes, gout, hyperuricemia, hyperkalemia, CHD, cerebrovascular insufficiency, severe chronic heart failure, hepatic failure, advanced age.

Lysinoton N: Cautions

Symptomatic hypotension

Most often marked decrease in blood pressure occurs with a decrease in the bcc, caused by diuretic therapy, reducing the amount of salt in the food, dializom, diarrhea or vomiting (cm. "Cooperation" and "Side Effects"). In patients with chronic heart failure with simultaneous renal insufficiency with or without symptomatic hypotension may develop. It is often diagnosed in patients with severe heart failure, as a consequence of the use of high doses of diuretics, hyponatremia or impaired renal function. In these patients, treatment should start under close medical supervision. Such rules must be followed in the appointment of patients with coronary artery disease, cerebrovascular insufficiency, in which the sharp decline in blood pressure can lead to heart attack or stroke.

Transient hypotensive response is not a contraindication to receiving the next dose.

Impaired renal function

In patients with chronic heart failure, marked reduction in blood pressure after initiation of therapy with ACE inhibitors may result in further deterioration of renal function.

Cases of acute renal failure.

In patients with bilateral renal artery stenosis or stenosis of the artery to a solitary kidney, ACE inhibitor, It showed an increase of urea and creatinine in the serum, usually reversible upon discontinuation of treatment. More common in patients with renal insufficiency.

Hypersensitivity / Angioedema

Angioedema persons, limbs, lips, language, epiglottis and / or larynx (It may occur at any time during treatment) rarely observed in patients, treated with an ACE inhibitor, including lisinopril. In this case, treatment with lisinopril must be discontinued as soon as possible and establish a monitoring patients to complete regression of symptoms. In cases, when swelling appeared only on the face and lips, the condition often goes away without treatment, However, you can assign antihistamines.

Angioedema with laryngeal edema can be fatal. When I covered language, epiglottis or larynx may occur airway obstruction, therefore it is necessary to immediately carry out the appropriate therapy (0,30.5 ml of epinephrine solution (adrenaline) 1:1000 n / a) and / or to implement measures to ensure the airway.

Patients, with a history of angioedema have been, not related to previous treatment with an ACE inhibitor, It may be at increased risk of its development during treatment with an ACE inhibitor (cm. "Contra").

Cough

When using an ACE inhibitor cough celebrated. Dry Cough, long, which disappears after discontinuation of treatment with an ACE inhibitor. In the differential diagnosis of cough and cough should be considered, resulting from the use of an ACE inhibitor.

Sick, on dialysis

An anaphylactic reaction is observed in patients, subjected to dialysis using a dialysis membrane with high permeability, who take ACE inhibitors at the same time. In such cases it is necessary to consider the use of another type of membrane dialysis or other antihypertensive agents.

Surgery / general anesthesia

In the application of funds, lowering blood pressure, in patients with extensive surgery or during general anesthesia, lisinopril may block the formation of angiotensin II. Marked decrease in blood pressure, which is considered a consequence of this mechanism, You can eliminate the increase in BCC.

Before surgery (including dentistry) must notify the surgeon / anesthesiologist on the use of ACE inhibitors.

Potassium in Serum

In some cases, there is hyperkalemia.

Risk factors for the development of hyperkalemia include renal insufficiency, diabetes, potassium supplementation or drugs, causing an increase in the potassium concentration in the blood (naprimyer heparin), especially in patients with impaired renal function.

Patients, at risk of symptomatic hypotension (are on a salt-free diet or malosolevoy) with or without hyponatraemia, and in patients, who received high doses of diuretics, the above condition before treatment must be compensated (loss of fluids and salts).

Metabolic and endocrine effects

Thiazide diuretics may affect glucose tolerance, therefore it is necessary to adjust the dose of antidiabetic drugs.

Thiazide diuretics may reduce urinary calcium excretion and cause hypercalcemia. Marked hypercalcaemia may be a sign of hidden hyperparathyroidism (it is recommended to discontinue treatment thiazide diuretics before the test to assess the function of the parathyroid glands).

During treatment Lizinotonom H requires regular monitoring of plasma potassium, Glucose, urea, lipids and creatinine.

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

Caution must be exercised during exercise, hot weather (the risk of dehydration and excessive reduction of blood pressure due to lower BCC).

Effects on ability to drive and use machines

During treatment should refrain from driving vehicles and Occupation potentially hazardous activities, require high concentration and speed of psychomotor reactions, tk. dizziness, especially at the beginning of treatment.

Lysinoton N: Overdose

Symptoms: marked reduction in blood pressure.

Treatment: cause vomiting and / or gastric lavage, simptomaticheskaya therapy, aimed at correcting dehydration and violations of water-salt balance.

If hypotension – isotonic solution.

Control of urea, Electrolytes and creatinine in blood serum, and diuresis.

Lysinoton N: Drug Interactions

In an application:

• with potassium-sparing diuretics (spironolactone, triamterene, amilorid), potassium supplements, salt substitutes, containing potassium – increased risk of hyperkalemia, especially in patients with impaired renal function;
• with vasodilators, ʙarʙituratami, fenotiazinami, tricyclic antidepressants, ethanol – increased hypotensive action;
• NSAIDs (indomethacin etc.), Estrogen – decrease antihypertensive effect of lisinopril;
• with lithium – slowing excretion of lithium from the body (strengthening of cardiotoxic and neurotoxic effects of lithium);
• with antacids and kolestiraminom – reduced absorption in the gastrointestinal tract.

Enhances neurotoxicity salicylates, reduces the effect of oral hypoglycemic agents, norepinephrine, epinephrine and protivopodagricakih funds, enhances the effects of (including side) cardiac glycosides, effects of peripheral muscle relaxants, reduces the excretion of quinidine.

It reduces the effect of oral contraceptives