Капозид®

General characteristics. Structure:

Active ingredients: 50 mg of captopril in terms of 100% of substance, 25 mg of a hydrochlorothiazide.

excipients: cellulose microcrystallic, starch prezhelatinizirovanny (corn), stearic acid, magnesium stearate, lactoses monohydrate.

Pharmacological properties:

Pharmacodynamics. Капозид® - the combined drug having hypotensive and diureticheyosky effect.

Captopril - inhibitor aigiotenzinprev-rashchayushchy enzyme (APF), reduces formation of II angiotensin of an angiotenziyon of I, reduces allocation of Aldosteronum, reduces the general peripheric vascular resistance (GPVR), the arterial davyoleniye (AD), aches - and preloading. Rasshiryayoet of an artery more than veins. Strengthens a coronary and renal krovoyotok. At prolonged use the hypertrophy of a myocardium of N of walls of arteyoriya of resistant type umenshayotsya. Captopril uluchyoshat blood supply of an ischemic myocardium; reduces aggregation of thrombocytes.

The hydrochlorothiazide - thiazide diuretic of average force, reduces a reabsorption of ions of sodium at the level of a cortical segment of a loop of Gsnle. Does not influence the acid main state (AMS). Lowers the ABP due to change of reactivity vascular стенкп, decrease in pressor influence of enyodogenny vasoconstrictive substances (an adyorenalin, a noradrenapin) and strengthenings of depressor influence on vegetative gangyoliya (to a lesser extent, for the account an umensheyoniya of the volume of the circulating blood (VCB)). Strengthens hypotensive effect of captopril.

The diuretic effect is noted 2 hours later and reaches a maximum in 4 hours after intake. Continuing action т­ся within 6-12 hours. Efficiency and safety of use of captopril for children are not established. In a liteyoratura limited experience of a primeyoneniye of captopril at children is described. Children, especially newborn, can be more podveryozhena to development of hemodynamic pobochyony effects. Cases of development of excessive, long and nepredskazuyeyomy increase in arterial pressure, and also the related complications, vklyuyochy an oliguria and spasms were noted.

Pharmacokinetics. Captopril. At intake it is quickly soaked up in digestive tract, the maximum concentration in a blood plasma is observed about 1 hour later after intake. Bioavailability of captopril sostavyolyat 60-70%. The concomitant use of food slows down absorption of captopril for 30-40%. Communication with proteins of a blood plasma sostavlyayot 25-30%. Elimination half-life 2-3 hours. Drug is removed from an organism preimuyoshchestvenno by kidneys, to 50% in a neizmenenyony look, other part - in the form of metaboyolit.

Gidrokhlorotiaznd. At intake it is rather quickly soaked up. The elimination half-life in a blood plasma makes from 5 to 15 hours at reception on an empty stomach healthy dobrovolyyoets. Removal by kidneys, 95% of a dose - in not changed look.

Indications to use:

Arterial hypertension (patients to whom the combination therapy is shown).

Route of administration and doses:

Inside, in 1 hour prior to food, on 1 tablet of 1 times a day.

Features of use:

Pregnancy and lactation. Drug Kapozid® use protivoyopokazano during pregnancy. Epidemiological data, svidetelstyovuyushchy about risk of teratogenecity after a vozyodeystviye of LPF inhibitors in the I trimester of pregnancy, were not convincing, од­нако some increase in risk cannot be excluded. If use of an ingiba a Torah of APF is considered necessary, the patsiyoentka planning pregnancy have to be translated to a pas the alternative gipoyotenzivny therapy having an ustanovlenyony profile of safety for use during pregnancy. It is known that long impact of inyogibitor of APF on a fruit in II and III trimestyora of pregnancy can lead to a naruyosheniye of its development (to depression of function of kidneys, an oligogidramnion. to delay of ossification of bones of a skull) and to development of osyolozhneniye in the newborn (such, as, renal failure, arterial гипотензпя, гииеркалиемпя). If the patsiyentyoka received the drug Kapozid® during II and III trimesters of pregnancy, рекомендует­ся to conduct ultrasonography for assessment of a condition of bones of a skull and function of kidneys of a fruit.

Use of a gpdrokhlorotiazid at a bereyomennost is not recommended as moyozht to worsen perfusion of a placenta and вы­зван" jaundice of the fruit/newborn, thrombocytopenia, disturbance of water electrolytic balance and it is possible, other undesirable reactions observed at adults.

Use of APF inhibitors during pregnancy can cause development disturbances (including arterial hypotension, a neonatal hypoplasia of bones of a cheyorep, an anury, a reversible or irreversible renal failure) and fruit death. 11ri establishment of the fact of pregnancy use of the drug Kapozid® should be stopped as soon as possible. Captopril and a hydrochlorothiazide after a priyeyom in the feeding woman obnaruzhiyovatsya in breast milk. Due to the risk of development of the serious side reactions at a reyobenka caused by both active ingredients it is necessary to stop breastfeeding or to cancel therapy preyoparaty Kapozid® at mother for grudyony feeding.

In an initiation of treatment the chrezyomerny lowering of arterial pressure, especially at patients with chronic seryodechny insufficiency, a severe form of arterial hypertension (including renal genesis) and/or a renal failure can be observed. 11ered an initiation of treatment it is necessary to skomyopensirovat deficit of ions of sodium and a priyovesta in norm the volume of the circulating blood (to reduce a dose of the diureyotik appointed earlier or, in some cases completely to cancel them), and also to define pokazateyol of function of kidneys.

11eobkhodim regular control a soderzhayoniya in a blood plasma of potassium ions and calcium (especially at the patients receiving lecheyony cardiac glycosides, glucocorticosteroids, often using slabiyotelny and also at elderly patients), glucose, uric acid, lipids (a holeyosterin and triglycerides), urea and creatinine, activity of "hepatic" feryoment.

Especially regular control of the level of arterial pressure and laboratory indicators is necessary in the following слу­чаях: at patients from a renal nedostatochnoyostyyu; patients with arterial hypertension of a heavy current (including renal genesis); at elderly patients (65 years are more senior); at patients with disturbances of water electrolytic balance and a dekompensirovanny chronic renal nedostatochyonost; and also receiving at the same time Allopyrinolum, lithium drugs, прокаина­мид and the medicines reducing immunity.

At reception of LPF inhibitors characteristic unproductive cough, пре­кращающийся after therapy cancellation is noted by LPF ingitor.

At some patients with diseases of kidneys, especially with a heavy stenosis of a pochechyony artery, increase in konyotsentration of an urea nitrogen and creatinine in blood serum after decrease in arteriyoalny pressure is observed. This phenomenon usually об­ратимо, is also observed decrease in a kontsenyotration of an urea nitrogen and creatinine in a syyovorotka of blood in case of drug withdrawal. The dose decline of a preyoparat of Kapozid® and/or cancellation of diuretic can be required. In certain cases against the background of use of LPF inhibitors increase in content of potassium in blood serum is observed. The risk of development of a hyperpotassemia at use of LPF inhibitors is increased at the patients with a renal failure and a diabetes mellitus and also accepting the kaliysberegayushchy diuretics, drugs of potassium or other drugs causing increase in content of potassium in blood (for example, гепа­рин). It is necessary to avoid simultaneous use калийсберегающнх diuretics and drugs of potassium.

Besides, at use of AG1F inhibitors along with thiazide diuretiyoka the risk of development of a hypopotassemia therefore in such cases it is necessary to carry out regular monitoring of a soderyozhaniye of potassium to blood during therapy is not excluded. It is necessary to be careful at reception of AIF inhibitors by patients with a mitral/aortal stenosis / a hypertrophic subaortic stenosis; in case of cardiogenic shock and hemodynamically significant obstruction - reception is not recommended. Use of double blockade the system renin-angiotensin-aldosteronovoy (SRAA), vyzvanyony by a concomitant use of AIF inhibitors and antagonists of receptors to angiotensin II of a pla of an aliskiren and aliskirensoderzhashchy drugs as it assoyotsiirovatsya with the increased frequency a razviyotiya of side effects, such as arteriyoalny hypotension is not recommended. a gpperkaliyemiya, snizheyony functions of kidneys (including acute pochechyony insufficiency). If simultaneous use of APF and BLACKAMOOR inhibitors (double blockade of RAAS) is necessary, then treatment has to carry out ться under control of the doctor and at implementation of constant control of function of kidneys, level of elektroliyot to blood, and also arterial a davleyoniya.

Combined use of APF inhibitors п antagonists of retseptoyor to angiotensin II at patients with a diabeyotichesky nephropathy is not recommended. When carrying out a hemodialysis at the patients receiving APF inhibitors it is necessary to izyobegat uses of dialysis membranes with high-permeability (for example, AN69) as in such cases the risk of development of anaphylactoid reakyotion povyshayotsya. Anaphylactoid reactions were noted also at patients to whom the procedure of removal of lipoproteins of low density (аферез) by absorption with по­мощью a sulfate dextran was carried out. It is necessary to rasyosmotret a question of use either gipoyotenzivny drugs of other class, or other type of dialysis membranes. In case of development of a Quincke's disease drug is cancelled and carry out careful medical observation before total disappearance of symptoms. Ангионевротнчеекпй hypostasis of a throat can privesyot by a lethal outcome. If hypostasis lokaliyozutsya on a face, special treatment usually is not required (for reduction of a vyyorazhennost of symptoms there can be primeyonena antihistaminic drugs); if hypostasis extends to language, a throat or a throat and there is a threat of development of obstruction of respiratory tracts, следу­ ет immediately to enter Epinephrinum (адрена­лин) subcutaneously (0,3-0,5 ml in cultivation 1:1000). In rare instances at patients to a poyosla of reception of LPF inhibitors the Quincke's disease of intestines was noted, kotoyory was followed by pains in a belly poyolost (with nausea п vomiting or without them), sometimes - at normal values of an aktivyonost S-1-esterazy п without the previous face edema. Hypostasis of intestines should be vklyuyochit in a range of a differential diagnoyostika of patients with complaints to pains in an abdominal cavity at reception of APF inhibitors.

At representatives of negroid race cases of development of a Quincke's disease otmeyochatsya with a bigger frequency in comparison with representatives of Caucasian race. At two patients undergoing the procedure of desensitization by poison pereponchatokryyoly against the background of reception of captopril zhizneugrozhayushchy anaphylactoid reakyotion are noted. At temporary cancellation of LPF inhibitor at the same patients it was succeeded to avoid anaphylactoid reactions. It is necessary to soblyuyodat care when carrying out a desenyosibilization at the patients accepting APF inhibitors.

At patients with a diabetes mellitus, poluyochayushchy hypoglycemic drugs (hypoglycemic means for intake or insulin), it is necessary to control carefully glycemia level, osobenyono within the first month of therapy by APF ingiyobitor.

APF inhibitors are less effective at representatives negroid, than at patsiyenyot of Caucasian race that can be connected with bigger prevalence of low activity of a renin at representatives of negroid race.

When carrying out extensive surgical interventions or at use of means for the general anesthesia which have giyopotenzivny effect at patients, priyonimayushchy APF inhibitors, the excess lowering of arterial pressure can be noted. In these cases it is possible to increase the volume of the circulating blood.

In rare instances at reception of APF inhibitors the syndrome beginning emergence of cholestatic jaundice, peyorekhodyashchy in a fulminant gepatonekroz, sometimes with a lethal outcome is noted. The mechanism of development of this syndrome is unknown. Esyoli at the patient receiving therapy by APF ingiyobitor develops jaundice or the expressed increase in an aktivyonost of "hepatic" enzymes is noted, it is necessary to stop treatment by APF inhibitors and to establish observation of the patient. At the patients accepting APF inhibitors the neutropenia/agranulocytosis, thrombocytopenia and anemia were noted. With normal funktsiyoy kidneys and in lack of other disturbances the neutropenia occurs at patients seldom. The drug Kapozid® should be used very carefully at patients with autoimmunyony diseases of a connecting tkayona, at accepting immunosuppressors, ал­лопуринол and procaineamide, especially in the presence of the renal failure which is available earlier.

Because the bolyyoshinstvo of lethal cases a neutropenia against the background of APF inhibitors developed at such patients, it is necessary to control at them number of leukocytes of blood before an initiation of treatment, in the first 3 months - each 2 weeks, then - each 2 months. At all patients it is necessary to konyotrolirovat monthly number of leukocytes in blood in the first 3 months after the beginning of therapy, zayoty - each 2 months. If the number of leykotsiyot are lower 4000/mkl, repeated performing the general blood test is shown, below 1000/mkl-administration of drug is stopped, continuing observation of the patient. Usually recovery of number of neutrophils happens within 2 weeks after a captopril otyomena. In 13% cases of a neytroyopeniya noted a lethal outcome. Praktiyocheski in all cases a lethal outcome of an otyomechala at patients with diseases of connecting fabric, renal or heart failure, against the background of reception of immunosuppressors or at a combination of both specified factors.

At use of LPF inhibitors the proteinuria, generally at payotsiyent with a renal failure can be noted, and also at use of high doses of prepayorat. In most cases the proteinuria at administration of drug of captopril disappeared or degree of its expressiveness decreased within 6 months irrespective of, administration of drug stopped or not. Poyokazateli functions of kidneys (concentration of an urea nitrogen in blood and creatinine) at payotsiyent with a proteinuria almost always were within norm. At patients with zabolevayoniya of kidneys it is necessary to define soderzhayony a squirrel in urine before an initiation of treatment and periodically a pas a therapy course extent. At reception of thiazide diuretics exceptional cases of development of an agranulocytosis п oppressions of function of marrow were celebrated.

Sulfonamide derivatives (including a hydrochlorothiazide) can cause a prekhodyayoshchy myopia and acute closed-angle glaucoma, risk factors are an alleryogiya on drugs of sulphonylurea or penicillin in the anamnesis. Symptoms (sharp decrease in visual acuity, pain in an eyeglobe) are usually observed through не­сколько hours - several weeks later nayochat treatments. At emergence of symptoms it is necessary to stop reception of a preyoparat immediately; if necessary it is necessary to naznayochit drugs for correction of vnutriglazyony pressure.

At all patients accepting thiazide diuretics it is necessary to reveal clinical signs of disturbance of water and electrolytic balance (a hyponatremia, a gipokhloremichesky alkalosis, a hypopotassemia). It is especially important to determine the content of electrolytes in blood serum and urine at a strong rvoyota or at introduction of infusional rastvoyor. The suyokhost of a mucous membrane of an oral cavity, a zhayozhd, weakness, a lethargy, confusion a soznayoniya, concern, pains or spasms in muscles, muscular weakness, an excess lowering of arterial pressure, an oliguria, tachycardia, nausea, vomiting can be signs of disturbances of water electrolytic balance.

The hypopotassemia can provoke or strengthen cardiotoxic effect of heart glucosides. The lack of hloridion is usually poorly expressed and does not demand a korrekyotion. At patients with hypostases at a hot poyogoda the hyponatremia caused by increase in volume of tsirkuliyoruyushchy blood can be observed. It is necessary to limit potrebyoleny liquids. In cases of a zhizneugrozhayushchy hyponatremia appoint reception of piyoshchevy salt. During therapy the hyperuricemia or an aggravation of a course of gout can be noted by thiazide diuretics; moyozht also to be shown latentno a protekayuyoshchy diabetes mellitus.

Thiazide diuretics can cause sniyozheny concentration of the connected iodine in a syyovorotka of blood without signs of dysfunction of a thyroid gland. Against the background of reception of thiazide drugs calcium excretion degree decreases; cases of pathological changes of the epithelial bodies which are followed by a hypercalcemia and a hypophosphatemia were noted. Before control of function of epithelial bodies it is necessary to stop reception of a thiazide diuyoretik. Against the background of reception of thiazide prepayorat increase in degree of an eksyokretion of magnesium was noted that can lead to a hypomagnesiemia.

The drug Kapozid® can cause false positive reaction in the analysis of urine to acetone and distort test results with bentiromide.

At emergence of fever, a hyperadenosis and/or signs of a layoringit and/or pharyngitis it is necessary to define number of leukocytes immediately. Reception of thiazide diuretics can be the cause of a positive take when carrying out a drug test.

Influence on ability to manage vehicles and mechanisms. During treatment it is necessary to be careful during the driving of motor transport and occupation other potentially dangerous types of activity demanding the increased concentration of attention and speed of psychoemotional reactions.

Side effects:

Under the frequency of side reactions понимает­ся: often-> 1/100, <1/10, infrequently-> 1/1000, <1/100, it is rare-> 1/10000, <1/1000, is very rare - <1/10000.

From cardiovascular system: infrequently - tachycardia or a tachyarrhythmia, stethalgias, stenocardia, feeling a serdtsebiyeyoniya, a myocardial infarction, orthostatic hypotension, синкопэ, peripheral hypostases, the expressed decrease in an arterial davyoleniye, Reynaud's syndrome, "inflows" of blood to face skin, pallor; very seldom - a heart ostayonovka, cardiogenic shock.

From respiratory system: often - dry unproductive cough, an asthma; very seldom - a bronchospasm, an eosinophilic pneumonitis, rhinitis, a fluid lungs.

Allergic reactions: often - a skin itch, with rashes or without them, sometimes сопро­вождающийся fever and an arthralgia, an enanthesis, an alopecia; infrequently - a soyosudisty cutaneous dropsy and a hypodermic kletchatyoka; seldom - a Quincke's disease of a kiyoshechnik; very seldom - a small tortoiseshell, sinyodry Stephens-Johnson, the multiformny erythema, photosensitivity, an erythrosis, reversible pemfigoidny tests, a violent pempigus, exfoliative deryomatit, an allergic alveolitis, eosinophilic pneumonia, a Quincke's disease of extremities, persons, lips, mucous обо­лочек, language, a throat and a throat (including with a lethal outcome).

From the central nervous system: often - drowsiness, dizziness; seldom - a headache, dizziness, an ataxy, paresthesia; very seldom - confusion of a sozyonaniye, a depression, disturbances of a brain krovobrashcheniye, including a stroke and a sinkoyopa, a sight illegibility.

From bodies of a hemopoiesis: very seldom - a neutropenia, an agranulocytosis, a pancytopenia, a lymphadenopathy, an eosinophilia, thrombocytopenia, anemia (including aplayostichesky and hemolitic forms), a caption poyovysheniye on antinuclear an antiteyola, autoimmune diseases.

From the alimentary system: often - nausea, vomiting, irritation of a sliziyosty cover of a stomach, an abdominal cavity pain, diarrhea, a lock, taste disturbance, dryness of a mucous membrane of an oral cavity; seldom - stomatitis, aphthous stomatitis, anorexia; very seldom - a glossitis, stomach ulcer, pancreatitis, a hyperplasia of gums, an abnormal liver function and a cholestasia (including a zhelyotukha), increase in activity of enzymes of a liver, hepatitis (including a necrosis), a giperbiyolirubinemiya.

From a musculoskeletal apparayot: very seldom - a mialgiya, an arthralgia, a miayosteniya.

From an urinary system: infrequently - renal failures (vklyuyochy a renal failure), a polyuria, an oliguria, the speeded-up urination, a nephrotic syndrome.

From bodies of a reproduction: very seldom - impotence, a gynecomastia.

Others: infrequently - stethalgias, increased fatigue, feeling sick.

Laboratory indicators: often - an eozinoyofiliya, it is very rare - a proteinuria, a hyperpotassemia, a hyponatremia (including simyoptomatichesky), the increased maintenance of an urea nitrogen, bilirubin and creatinine in blood, decrease in a hematocrit, decrease in hemoglobin, leukocytes, thrombocytes.

Interaction with other medicines:

Captopril. At the patients accepting diuretic means, especially at the beginning of therapy, and a takyozha in a combination to restriction of reception of edible salt (electrolyte-deficient diets) or geyomodializy. izyobytochny decrease arterial a davleyoniya which usually occurs within 1 hour after reception of the first naznachenyony dose of the drug Kapozid® can sometimes be observed. It is necessary to provide control of a condition of a patsiyenyot within the I hour after reception of the first doyoza of drug. If the excess lowering of arterial pressure is noted, it is necessary to lay the patient, to raise legs and if necessary to appoint an intravenous injection of 0,9% of solution of sodium chloride. Passing excessive decrease in arteriyoalny pressure is not a protivopokayozaniye to further therapy which can be continued after normalization of aryoterialny pressure with the help a uvelicheyoniya of volume of the circulating blood.

Vazodilatatora (for example, нитроглице­рин) in combination with the drug Kapozid® it is necessary to apply in the lowest effective doses in view of risk of an excess lowering of arterial pressure. It is necessary to be careful at the joint purpose of the drug Kapozid® and medicines exerting impact on a sympathetic nervous sisteyoma (for example, ganglioblokator, alpha adrenoblockers).

At therapy by the drugs containing kaptoirit, the kaliysberegayuena diuretics (for example, Triamterenum, спнронолактон, amiloride, эплеренон), it is only necessary to appoint potassium drugs, kayoliyevy additives, substitutes of edible salt (contain significant amounts of potassium ions) at dokayozanny a gipokapiyemna as their primeneyony increases risk of development of a hyperpotassemia.

The drug Kapozid® raises a digoxin kontsentrayotion in a blood plasma for 15-20%, increases bioavailability of propranolol. The risk of development immunodepressive a deystyoviya increases at the combined use with procaineamide, and also the drugs blocking canalicular secretion (decrease in quantity of leyyokotsit and granulocytes). Raises a neurotoxicity of salicylates, action of not depolarized mporelaksant of competitive type of action, ethanol.

Reduces quinidine removal, effect of hypoglycemic medicines for intake, Norepinephrinum, Epinephrinum and antigouty drugs.

Strengthens side effects of cardiac glycosides. especially at co-administration with drugs which uveliyochivat removal of potassium ions and magnesium and/or calcium ions detain (a napriyomer, diuretics, hormones of bark of nadpochechniyok, laxatives, Amphotericinum In, карбеноксолон, penicillin G, salicylates). LPF inhibitors, including captopril, moyonut to potentiate hypoglycemic эф­фект insulin and gipoglpkemichesky means for intake, such as proyoizvodny sulfonilmochevnna. It is necessary to control concentration of glucose in blood at the beginning of therapy by the drug Kapoyozid®, and in case of need to korrektiyorovat a dose of hypoglycemic medicine.

Double blockade renin-aigiotenzin-aldosteronovy system (RLLS), vyzvanyony a concomitant use of LPF inhibitors and antagonists of receptors to angiotensin II of a pla of an aliskiren and aliskirensoderzhashchy drugs, was associated with the increased frequency of development of side effects, such as arterial gipotenyoziya, hyperpotassemia, depression of function по­чек (including an acute renal nedostatochyonost).

Hydrochlorothiazide. Cimetidinum, slowing down metabolism of a kaptoyopril in a liver, raises its kontsentrayotion in a blood plasma. Indometacin and druyogy non-steroidal anti-inflammatory drugs, including inhibitors of the CEC looksigenazy-2, and also table salt can reduce anti-hypertensive deystyovy drug, especially at the arterial hypertension which is followed by low activity of a renin and also to reduce a hydrochlorothiazide vsayosyvayemost. At patsiyenyot with risk factors (advanced age, a gppovolemiya, simultaneous use of diuretics, dysfunction of nights), simultaneous use of non-steroidal anti-inflammatory drugs (vklyuyochy cyclooxygenase-2 inhibitors) and APF inyogibitor (including captopril), can lead to deterioration in function по­чек, up to an acute renal nedostatochyonost. Usually dysfunctions of nights in such cases happen reversible. It is necessary to control periodically function по­чек at the patients accepting the drug Kapozid® and non-steroidal anti-inflammatory drugs.

Can promote disturbance of elektroyolitny balance, in particular development of a hypopotassemia at a concomitant use with amfoterntsiny In, глюкокортикостероидамн, adrenokortikotronny hormone (AKTG). It is necessary to control a potassium soyoderzhaniye in a blood plasma. The hydrochlorothiazide can strengthen deystyovy nedenolyarizuyushchy muscle relaxants, means for the general anesthesia, primenyaeyomy in surgery (for example, Tubocurarini chloridum and a gallamin of a trietiodid therefore correction of doses of these drugs can be required. Are recommended monitoring and at an opportunity correction of water electrolytic balance before hirurgicheyosky intervention. The hydrochlorothiazide reduces effect приме­няющихся in the therapeutic purposes of pressor amines (for example, Norepinephrinum) concerning arteries, however, полно­стью does not prevent it.

Follows приме­нять lower doses of preanestetik and anesthetics. If it is possible, the hydrochlorothiazide should be cancelled for не­делю to surgical intervention. The combination with nitrates, thiazide diuretics, verapamil, a beta adrenoblockers and other gipotenyozivny drugs, inhibitors of a monoaminooxidase (MAO), ganglioblokator, and also tricyclic antidepressants, hypnotic drugs and etanoyoly increases expressiveness гипотензивно­го effect.

At co-administration of ingibitoyor of APF with drugs of lithium delay of removal of ions of lithium, increase in content of lithium in a syyovorotka of blood and, as a result, strengthening of the damaging action on heart and the central nervous system (CNS) can take place. Besides, the hydrochlorothiazide also increases risk of toxicity of lithium. At use of a similar combination therapy sleduyot to carry out regular monitoring of a soyoderzhaniye of lithium in blood serum. Medicines, intensively связы­вающиеся with proteins, strengthen diureticheyosky effect.

Dose adjustment of anyotikoagulyant for intake, a probenetsid and Sulfinpyrazonum as the hydrochlorothiazide can suppress their deyyostviye can be required.

The hydrochlorothiazide shows giperurikemichesky action therefore correction of doses of anti-uricosuric drugs at a simultaneous priyomeneniye can potreyobovatsya.

Diazokspd strengthens hyper glycemic, giperurikurichesky and anti-hypertensive effect of thiazide diuretics therefore it is necessary to control concentration of moyochevy acid and glucose in kroyova serum.

At a concomitant use of hypoglycemic means for intake and an inyosulin increase in their doses as the hydrochlorothiazide increases concentration of glucose in blood can be required. At odnoyovremenny reception Methyldopums development of hemolysis of erythrocytes is possible. Kolestiyoramin and колестипол can detain or reduce absorbability of the hydrochlorothiayazidi. Diuretics (Triamterenum, amiloride and Spironolactonum) and heparin promote potassium salt, the kaliysberegayuena a hyperpotassemia razviyotiya.

Effect of methenamin can decrease at combined use with a hydrochlorothiazide because of increase in alkali reaction of urine. Carbamazepine increases risk of development of a symptomatic hyponatremia at simultaneous use with a hydrochlorothiazide. At the combined calcium of a primeneyoniya of salts and thiazide diuretiyok, vitamin D and thiazide diuretics the content of calcium in blood serum moyozht to raise in connection with delay of its removal. Control a calcium soderzhayoniya in blood serum is necessary and at a neobyokhodimost correction of its dose.

Contraindications:

- hypersensitivity to captopril, any other component of drug or other APF inhibitors, thiazide diuretics and other derivatives of streptocide (cross allergic reactions are possible);
- a Quincke's disease hereditary or idiopathic, including in the anamnesis against the background of reception of APF inhibitors;
- aortal stenosis,
- mitral stenosis;
- hypertrophic obstructive cardiomyopathy;
- bilateral stenosis of renal arteries, renal artery stenosis of the only kidney;
- transplantation of a kidney (in the anamnesis);
- chronic heart failure;
- cardiogenic shock,
- arterial hypotension,
- heavy liver failure (prekoma or coma);
- heavy renal failure (blood serum creatinine more than 1,8 mg / 100 ml or clearance of creatinine less than 20-30 ml/min., anury);
- primary hyper aldosteronism;
- simultaneous use with aliskireny and aliskirensoderzhashchy drugs at patients with a diabetes mellitus or a renal failure (SKF less than 60 ml/min.),
- pregnancy,
- breastfeeding period,
- age up to 18 years (efficiency and safety is not established),
- lactose intolerance, deficit of lactase and syndrome of glyukozo-galaktozny malabsorption. With care:
- Abnormal liver functions, the progressing liver diseases,
- moderate renal failure (clearance of creatinine of 30-60 ml/min.),
- proteinuria (more than 1 g/days),
- hypopotassemia (not корригирующаяся medicines);
- hyponatremia,
- hypovolemia,
- hypercalcemia,
- gout, hyperuricemia,
- general diseases of connecting fabric and other autoimmune diseases (including system lupus erythematosus, scleroderma, nodular periarteritis);
- advanced age (65 years are more senior),
- co-administration of the medicines suppressing defense reactions of an organism (glucocorticosteroids, cytostatics, immunodepressants), Allopyrinolum, procaineamide;
- surgical intervention / the general anesthesia, use for patients of negroid race, a hemodialysis with use of high-strength membranes (for example, AN69®), the desensibilizing therapy, simultaneous use of kaliysberegayushchy diuretics, drugs of potassium, kaliysoderzhashchy substitutes and lithium, an acute myopia and secondary closed-angle glaucoma.

Overdose:

Symptoms: a sharp lowering of arterial pressure, shock, a stupor, the bradycardia, disturbances of water and electrolytic balance, the renal failure, a lethargy (which can progress in a coma within several hours) which is not followed by disturbance of water and electrolytic balance and causing only insignificant suppression of functions of breath and heart. Can be noted irritation mucous and increase in sokratitelny activity of digestive tract.

Treatment: use of measures for a conclusion from a coma or a condition of a stupor, a gastric lavage, administration of adsorbents and sodium of sulfate within 30 minutes after reception, introduction of 0,9% of solution of sodium of chloride or other plasma substituting solutions, a hemodialysis. At bradycardia or the expressed vagal reactions - administration of atropine. Use of an artificial pacemaker can be considered. Peritoneal dialysis is inefficient for removal of captopril from an organism.

Storage conditions:

At a temperature not above 25 °C. To store in the place, unavailable to children. A period of validity - 3 years. Not to use drug after a period of validity.

Issue conditions:

According to the recipe

Packaging:

Tablets of 50 mg + 25 mg. Packaging: on 14 tablets in a blister strip packaging from a film of polyvinyl chloride and aluminum foil. 2 blister strip packagings together with the application instruction place in a pack from a cardboard.