Quinapril

When ATH:
C09AA06

Characteristic.

White or off-white amorphous powder, soluble in water.

Pharmacological action.
Gipotenzivnoe, vazodilatirtee, kardioprotektivnoe, natriuretic.

Application.

Arterial hypertension (mono- or combination therapy), heart failure (combination therapy).

Contraindications.

Hypersensitivity, availability of information on the medical history of angioedema during ACE inhibitors, pregnancy, lactation.

Restrictions apply.

Assessment of the risk-benefit ratio is necessary in autoimmune diseases, bone marrow depression (leukopenia, thrombocytopenia), gipotenzii, disorders of cerebral or coronary circulation, severe heart failure, obliterating atherosclerosis of the lower extremities; aortic, mitral stenosis or other obstructive changes, impede the outflow of blood from the heart; diabetes, renal insufficiency, hyperkalemia (more 5,5 mmol / l), hyponatremia or limitation of sodium in the diet, carrying out dialysis treatments, anesthesia and surgery, dehydration, bilateral renal artery stenosis or stenosis of the artery to a solitary kidney, the presence of the transplanted kidney, hyperuricemia, podagre, chronic obstructive pulmonary disease, in children (Safety and efficacy have not determined) and old 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.

Cardio-vascular system and blood (hematopoiesis, hemostasis): heartbeat, myocardial infarction, gipertenzivnye crisis, angina, orthostatic hypotension, heart failure, arrhythmia, cardiogenic shock, gemoliticheskaya anemia, thrombocytopenia, leukopenia, agranulocytosis.

From the digestive tract: dry mouth and throat, nausea, vomiting, constipation or diarrhea, gastrointestinal bleeding, pancreatitis, changes in liver function tests, cholestatic jaundice, fulminant hepatic necrosis (can be fatal).

From the nervous system and sensory organs: headache, cerebrovascular disorders, weakness, dizziness, fainting, depression; blurred vision, amblyopia.

For the skin: rash, itch, prurigo, exfoliative dermatitis, photosensitivity.

From the respiratory system: dry cough, pharyngitis, bronchitis, bronchospasm, dyspnoea.

With the genitourinary system: progression or the development of acute renal failure, oligurija, proteinuria.

Other: pain syndrome (backache, Breast, stomach, myalgia, arthralgia), dermatopolymyositis, angioedema, the development of infections, fever; increase in serum creatinine, urea, hyperkalemia, giponatriemiya.

Cooperation.

Effects strengthen antihypertensives(additive effect), incl. beta-blockers with significant systemic absorption of ophthalmic dosage forms, diuretics, alcohol, antidepressants imipraminovogo series, neuroleptics; weaken - estrogens, NSAIDs, sympathomimetic. Potentiates the vasodilating effect of nitrates (prevents the development of tolerance to nitrates), hypoglycemic effect of oral hypoglycemic agents (a correction mode last dose), the hypotensive effect of certain anesthetic agents; reduces secondary hyperaldosteronism and hypokalemia, caused by diuretics. Increases lithium toxicity (Increases concentration of plasma) In a joint application, delays elimination of clonidine in its previous reception. NSAIDs increase the risk of renal dysfunction, potassium-sparing diuretics, kalisodergaszczye other means, kalievыe supplements, заменители соли — риск развития гиперкалиемии. Mielodepressanty, interferon, allopurinol, prokaynamyd, cytostatics and glucocorticoids increases the risk of neutropenia and / or fatal agranulocytosis. Antacids and tetracyclines decrease (of 28-37%) the speed and completeness of absorption from the gastrointestinal tract.

Overdose.

Symptoms: severe hypotension.

Treatment: to reduce the dose or the complete removal of the drug; recommended gastric lavage, giving patients a horizontal position, introduce measures to increase BCC (a physiological solution, transfusion of other blood liquids); simptomaticheskaya therapy: appointment of epinephrine (n / a or I /), antihistamines, hydrocortisone (I /). Carrying hemo- and peritoneal dyalyza maloэffektyvno.

Dosing and Administration.

Inside, at the same time (preferably in the morning). Hypertension -initial dose 10 mg / day under the control of blood pressure (monitoring for 2-6 hours), поддерживающая — 20–40 мг/сут в 1–2 приема, the maximum dose - 80 mg / day. The dose is adjusted slowly to 2-4-week intervals depending on the dynamics of blood pressure. Against the background of hyponatremia and dehydration as a result of prior diuretic therapy, renal dysfunction (Cl креатинина 30–60 мл/мин) starting dose is 5 mg / day, при Cl креатинина 10–30 мл/мин — 2,5 mg (under the control of blood pressure). In congestive heart failure — начальная доза 2,5–5 мг 1–2 раза в сутки, поддерживающая — 20–40 мг/сут в 2 admission.

Precautions.

Treatment is carried out under regular medical supervision. Before treatment should be discontinued antihypertensive therapy (for 1 Sun), previous treatment (or significantly reduce the dose) Diuretics (4-7 days) and adjust the water and electrolyte balance. During therapy necessary to control blood pressure, the peripheral blood (before treatment, first 3-6 months of therapy and thereafter at periodic intervals to 1 year, especially in patients with an increased risk of neutropenia), protein level, Plasma potassium, BUN, creatinine, renal function, body weight, diet. Care should be taken during surgical interventions (including dental), especially when used general anesthetics, hypotensive effect. Avoid hemodialysis through high capacity membranes poliakrilonitritmetallilsulfata (например АN69), gemofilytratsii or LDL apheresis (may develop anaphylaxis or anaphylactoid reactions). Giposensibilizatsionnaya therapy may increase the risk of anaphylactic reactions. At the time of treatment is recommended the use of alcohol. Be wary of during the drivers of vehicles and people, skills relate to the high concentration of attention.