Капотен®

General characteristics. Structure:

Active ingredient: 25 mg of captopril in terms of 100% substance.

Excipients: cellulose microcrystallic, starch corn, stearic acid, lactose.

Pharmacological properties:

Pharmacodynamics. The drug Kapoten® is inhibitor of an angiotensin-converting enzyme (APF). Suppresses formation of an angiotenziyon of II and eliminates its vasoconstrictive action on arterial and venous sosuyoda.

Reduces the general peripheric sosudiyosty resistance, reduces a postyonagruzka, reduces arterial pressure. Reduces preloading, reduces davleyony in the right auricle and a small circle of blood circulation. Reduces allocation of Aldosteronum in adrenal glands. The maximum hypotensive effect nayoblyudatsya within 60-90 minutes after intake. Extent of decrease in arteriyoalny pressure is identical at position of the patient "standing" and "lying". Efficiency and safety of use of captopril for children are not established. In a liyoteratura limited experience of a priyomeneniye of captopril at children is described. Children, osobenyono newborns, can be more podyoverzhena to development of hemodynamic pobyoochny effects. Cases a razyovitiya of excessive, long and nepredyoskazuyemy increase in arterial pressure, and also the related oslozhneyoniya, including an oliguria and spasms were noted.

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

Indications to use:

- Arterial hypertension, including renovascular;

- chronic heart failure (as a part of a combination therapy);

- dysfunctions of a left ventricle after the postponed myocardial infarction at clinically stable state;

- a diabetic nephropathy against the background of sakharyony diabetes of type 1 (at an albuminuria more than 30 mg/days).

Route of administration and doses:

Inside, for an hour to food. The mode of dosing is set individually. At arterial hypertension drug 2 times a day appoint in an initial dose 12,5 mg (1/2 tablets on 25 mg). At a neyoobkhodimost the dose gradually (about intervayoly 2-4 weeks) is increased to a dostizheyoniya of optimum effect. At soft and moderate degree of an arterial gipertenyoziya the usual maintenance dose sostavyolyat 25 mg 2 times a day; the maximum doyoza - 50 mg 2 times a day. At heavy arteyorialny hypertensia the initial dose makes 12,5 mg (1/2 tablets on 25 mg) 2 times a day. A dose gradually uvelichiyovat to the maximum daily dose 150 mg (but 50 mg 3 times a day).

For treatment of chronic heart failure. If before purpose of the drug Kapoten® the diuretic terayopiya was carried out, it is necessary to exclude existence of vyrayozhenny decrease in maintenance of elektroliyot and OTsK. The initial daily dose soyostavlyat 6,25 mg (1/4 tablets on 25 mg) 3 times a day. Further, at a neobkhoyodimost, the dose gradually (bucketed not less than 2 weeks) is increased. The average maintenance dose makes 25 mg 2-3 times a day, and maximum - 150 mg a day.

At dysfunctions of a left ventricle after the postponed myocardial infarction at the patients who are in clinically stable state, use of the drug Kapoten® can be begun in 3 days after a myocardial infarction. The initial dose makes 6,25 mg (1/4 tablets on 25 mg) in days, then the daily dose can be increased to 37,5-75 mg for 2-3 receptions (in a zaviyosimost from portability of drug) up to maximum - 150 mg a day.

At a diabetic nephropathy the drug Kapoten® appoint in a dose 75-100 mg, razyodelenny to 2-3 receptions. At a sugar diayobet of 1 type with a hyper albuminuria (vydeleyony 30-300 mg of albumine a day) the dose of a preyoparat makes 50 mg 2 times a day. At a proteinuria more than 500 mg a day drug is effective in a dose of 25 mg 3 times a day.

Patients with a renal failure at moderate extent of disturbance of a funkyotion of kidneys (the clearance of creatinine (CC) not meyony 30 ml/min. / 1,73 sq.m.) the drug Kapoten® can appoint 75-100 mg/days in a dose. At more expressed degree of renal failures (KK less than 30 ml/min. / 1,73 sq.m.) the initial dose has to make no more than 12,5 mg/days (1/2 tabletyok but 25 mg); further, at a neobkhodiyomost, with rather long intervayola the drug Kapoten® dose is gradually raised, on apply smaller, than usually, a daily dose of drug.

At advanced age the dose of drug is selected individually, therapy 2 times a day rekomenduyotsya to begin with a dose 6,25 mg (1/4 tablets on 25 mg) and whenever possible to support her at this level.

If necessary in addition naznayochat "loopback" diuretics, but not diuretics of a thiazide row.

Features of use:

Pregnancy and lactation. Drug Kapoten® use protivoyopokazano during pregnancy. The drug Kapoten® should not be used in the I trimester of pregnancy. Sootvetstvuyuyoshchy controlled researches of a primeyoneniye of APF inhibitors at pregnant women were not conducted. The available limited data on influence of drug in the I trimeyostra of pregnancy demonstrate to what use of APF inhibitors does not priyovodit to malformations of a fruit, connected with a fetotoksichnost. The epidemiological data testimonial of risk of teratogenecity after influence of APF inhibitors in the I trimester of pregnancy, were not convincing, however some uvelicheyony risk cannot be excluded. If use of APF inhibitor is considered neyoobkhodimy, the patients planning a beyoremennost have to be transferred to the alternative hypotensive therapy having the established safety profile for use during a bereyomennost.

It is known that long influence of inyogibitor of APF of a pas can lead a fruit in II and III trimestyora of pregnancy to a nayorusheniye of its development (to depression of function of kidneys, an oligogidramnion, delay of ossification of bones of a skull) and to development of osyolozhneniye in the newborn (such as, a renal failure, arterial hypotension, a hyperpotassemia). If the patsiyentyoka received the drug Kapoten® 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 APF inhibitors during pregnancy can cause development disturbances (including an arterial gipotenyoziya, a neonatal hypoplasia of bones of a cheyorep, an anury, a reversible or irreversible renal failure) and death of a ployod. At establishment of the fact of pregnancy use of the drug Kapoten® should be stopped as soon as possible.

About 1% of the accepted dose of captopril is found in breast milk. Due to the risk of development of serious pobochyony reactions in the child, it is necessary to stop breastfeeding or to cancel a terayopiya the drug Kapoten® at mother on пе­риод breastfeeding.

Before the beginning, and also regularly in a treatment proyotsessa the drug Kapoten® sleduyot to control function of kidneys. At patsiyoent with a chronic cordial nedostatochyonost apply under careful mediyotsinsky control.

At reception of APF inhibitors characteristic unproductive cough is noted, пре­кращающийся after therapy cancellation APF inhibitors In rare instances at reception of APF inhibitors note the syndrome beginning emergence of cholestatic jaundice, peyorekhodyashchy in a fulminant gepatonekroz, sometimes with a lethal outcome. 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 to establish by APF inhibitors of N observation of the patient. At some patients with diseases of kidneys, especially with a heavy stenosis of a poyochechny artery, increase in concentration of an urea nitrogen and creatinine in blood serum after decrease in arteriyoalny pressure is observed. This increase is usually reversible at the therapy termination by the drug Kapoten®. In these cases moyozht to be required a dose decline of a preparayot of Kapoten® and/or cancellation of diuretic.

Against the background of prolonged use of a preparayot of Kapoten® approximately at 20% of patients increase in kontsentrayotion of urea and creatinine of blood serum more than for 20% in comparison with norm or a reference value is observed.

Less than at 5% of patients, especially at heavy nefropatiya, it is required prekrayoshcheny treatments because of growth of concentration of creatinine.

Use of double blockade the system renin-angiotensin-aldosteronovoy (SRAA), vyzvanyony by a concomitant use of APF inhibitors and antagonists of receptors to an angioyotenzin of II or an aliskiren and aliskirensoderzhashchy drugs as it assoyotsiirovatsya with the increased frequency a razviyotiya of side effects, such as arteriyoalny hypotension, a hyperpotassemia, snizheyony functions of kidneys is not recommended (including acute poyochechny insufficiency). If odnovreyomenny use of APF and MACAW inhibitors II (double blockade of RAAS) необходи­мо, then treatment has to be carried out under control of the doctor and at implementation of poyostoyanny control of function of kidneys, a soderyozhaniye of electrolytes to blood, and also arteyorialny pressure.

Combined use of APF inhibitors and antagonists of retseptoyor to angiotensin II at patients with a diabetic nephropathy is not recommended.

At patients with arterial hypertension at drug Kapoten® use vyrayozhenny arterial hypotension nablyudayotsya only in rare instances; the probability of development of this state increases at the increased loss of liquid and salts (a nayoprimer, after intensive treatment of a diuyoretikama), at patients with a cordial nedosyotatochnost or being on dialysis. The possibility of sharp decrease in arterialyyony pressure can be reduced to a miniyomum at preliminary cancellation (in 4-7 days) diuretic or increase in a postupyoleniye of sodium of chloride (approximately in a week prior to reception), or by a drug Kapoten® nayoznacheniye at the beginning of a leyocheniye in small doses (6,25-12,5 mg/days).

With care appoint to the patients who are on a light-salted or bessoleyovy diet (the increased risk of development of aryoterialny hypotension) and a hyperpotassemia. Excess decrease in an arterial davyoleniye can be noted at patients during large surgeries, and also at use of the means for the general anesthesia possessing a hypotensive efyofekt. In similar cases for correction of reduced arterial pressure priyomenyat measures for increase in volume of tsiryokuliruyushchy blood.

Excess decrease in an arterial davyoleniye owing to reception of hypotensive drugs can increase risk of development of a myocardial infarction or stroke in patsiyenyot with coronary heart disease or diseases of vessels of a brain. At development of arterial hypotension the patient has to accept horizontal position with the raised legs. Intravenous administration of 0,9% of solution a chloride nayotriya can be required.

It is necessary to be careful at reception of APF inhibitors by patients with a mitral/aortal stenosis / a hypertrophic obstructive kardioyomiopatiya; in case of cardiogenic shock and hemodynamically significant obstruction reception is not recommended.

At the patients accepting APF inhibitors the neutropenia/agranulocytosis, thrombocytopenia and anemia were noted. е normal funktsiyoy kidneys and in lack of others disturbance the neutropenia occurs at patients seldom. At pochechyony insufficiency the concomitant use of the drug Kapoten® and Allopyrinolum privoyodit to a neutropenia.

The drug Kapoten® should be used very carefully at patients with autoimmunyony diseases of a connecting tkayona, at accepting immunosuppressors, Allopyrinolum and procaineamide, especially in the presence of the renal failure which is available earlier. Because the bolyyoshinstvo of lethal cases of 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 by the drug Kapoten®, then - each 2 months. If the number of leukocytes are lower 4000/mkl poyokazano repeated carrying out the general anayoliz of blood, below 1000/mkl - stop reception of a preparayot, continuing observation of the patient. Usually recovery of number of neutrophils happens within 2 weeks after drug withdrawal of Kapoten®. In 13% cases of a neutropenia noted a lethal outcome. Practically in all случа­ях the lethal outcome was noted 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 APF 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 Kapoten® 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 of N periodically throughout a terayopiya course. In certain cases against the background of a primeyoneniye of APF inhibitors, including the drug Kapoten®, increase in a soderyozhaniye of potassium in blood serum is observed. The risk a hyperpotassemia razyovitiya at use of inyogibitor of APF is increased at the patients with poyochechny insufficiency and a sugar diayobet and also accepting the kaliysberegayushchy diuretics, drugs of potassium or other drugs causing increase in content of potassium in blood (for example, heparin). It is necessary to avoid simultaneous use of kaliysberegayushchy diuretics and drugs of potassium. Besides, at a priyomeneniya of APF inhibitors along with thiazide diuretics the risk of development of a hypopotassemia therefore in such cases it is necessary to carry out a regular moyonitoring of content of potassium to blood in вре­мя therapies is not excluded.

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) with the help a sulfate dextran was carried out. It is necessary to consider a question of use of either hypotensive preparayot of other class, or other type of diayolizny membranes.

In rare instances against the background of therapy ingibiyotor of APF noted zhizneugrozhayushchy anaphylactoid reactions at the patsiyenyot taking a desensitization course by means of poison of Hymenoptera (a pcheyola, a wasp). At such patients these reakyotion managed to be prevented by the vremenyony termination of therapy by APF inhibitor. It is necessary to observe a special ostorozhyonost in case of performing desensitization to such patients.

In case of development of a Quincke's disease drug is cancelled and carry out careful medical observation before total disappearance of symptoms. Angioyonevrotichesky 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 a razviyotiya of obstruction of respiratory tracts, sleduyot immediately to enter Epinephrinum (adrenaline) subcutaneously (0,3-0,5 ml in cultivation 1:1000). In rare instances at patients to a poyosla of reception of APF inhibitors the Quincke's disease of intestines was noted, kotoyory was followed by pains in a belly poyolost (with nausea and vomiting or without them), sometimes - at normal values of an aktivyonost S-1-esterazy and 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 patients with a diabetes mellitus, poluyochayushchy hypoglycemic drugs (giyopoglikemichesky 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 surgeries or at use of the means for the general anesthesia having hypotensive effect for the patients accepting APF inhibitors the izbyyotochny lowering of arterial pressure can be noted. And these cases it is possible to increase the volume of the circulating blood.

At administration of drug of Kapoten® false positive reaction can nayoblyudatsya in the analysis of urine on acetone.

Influence on ability to manage vehicles and mechanisms. During treatment it is necessary to vozderzhiyovatsya from driving of motor transport and zanyayotiya by potentially dangerous types of a deyayotelnost demanding the raised konyotsentration of attention and speed of psikhomoyotorny reactions since perhaps golovokruyozheny, especially after reception of an initial dose.

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 a cardiovascular sisteyoma: infrequently - tachycardia or a tachyarrhythmia, stenocardia, a heart consciousness, oryotostatichesky arterial hypotension, peyoriferichesky hypostases, the expressed lowering of arterial pressure, Reynaud's syndrome, "inflows" of blood to face skin, pallor; very seldom - a cardiac standstill, 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, an enanthesis, an alopecia; infrequently - angionevroticheyosky hypostasis of extremities, persons, lips, sliziyosty covers, language, a throat and throat; seldom - a Quincke's disease of a kishechniyok; very seldom - a small tortoiseshell, Stiyovensa-Johnson's syndrome, a multiformny erythema, photosensitivity,

From the central nervous sisteyoma: often - drowsiness, dizziness; seldom - a headache, dizziness, an ataxy, paresthesia; very seldom - a consciousness sputanyonost, a depression, disturbances of mozyogovy blood circulation, including a stroke and a syncope, 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 mucous membrane 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, an anoyoreksiya; 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 exceptional cases of a gepatonekroz), a hyperbilirubinemia.

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

From an urinary system: seldom - renal failures (including a renal failure), a polyuria, an oliguria, the speeded-up urination; very seldom - a nephrotic syndrome.

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

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

Laboratory indicators: very seldom - a proteinuria, an eosinophilia, a hyperpotassemia, a hyponatremia, the increased maintenance of an urea nitrogen, bilirubin and creatinine in blood, decrease in a hematocrit, decrease in hemoglobin, leukocytes, thrombocytes, a giyopoglikemiya.

Interaction with other medicines:

At the patients accepting diureticheyosky means, the drug Kapoten® can exponentiate hypotensive action. Also restriction of reception of table salt (electrolyte-deficient diets), a hemodialysis have similar effect. Usually excess lowering of arterial pressure occurs within 1 hour after reception of the first appointed drug Kapoten® dose.

Vazodilatatora (for example, нитроглице­рин) in combination with the drug Kapoten® it is necessary to apply in the lowest effekyotivny doses in view of risk excessive lowerings of arterial pressure.

It is necessary to be careful at joint purpose of the drug Kapoten® (without or with diuretic) and the medicines exerting impact on a sympathetic nervous system (for example, ganglioblokator, alpha adrenoblockers).

At combined use of the drug Kapoten® and indometacin (and, perhaps, other non-steroidal anti-inflammatory drugs, for example, of acetylsalicylic acid) decrease in hypotensive action can be noted, especially at arterial hypertension, со­провождающейся by low activity of a renin. At patients with risk factors (advanced age, a hypovolemia, simultaneous use of diuretics, a renal failure), simultaneous use of non-steroidal anti-inflammatory drugs (including cyclooxygenase-2 inhibitors) and APF inhibitors (including captopril), can lead to deterioration in function of kidneys, up to an acute renal failure. Usually renal failures in such cases happen reversible. It is necessary to control periodically function of kidneys at the patients accepting the drug Kapoten® and non-steroidal anti-inflammatory drugs.

At therapy the drug Kapoten® kaliysberegayushchy diuretics (for example, Triamterenum, Spironolactonum, amiloride, эплеренон), potassium drugs, potassium additives, salt substitutes (contain significant amounts of potassium ions) it is necessary to appoint only at the proved hypopotassemia as their use increases risk of development of a hyperpotassemia.

At simultaneous use of ingibitoyor of APF (especially in combination with diuretics) and drugs of lithium increase in content of lithium in blood serum, and, therefore, toxicity of drugs of lithium is possible. It is necessary to determine periodically the content of lithium and blood serum.

APF inhibitors, including captopril, can exponentiate hypoglycemic effect of insulin and hypoglycemic means for intake, such as sulphonylurea derivatives.

It is necessary to control concentration of glucose in blood at the beginning of therapy by the drug Kapoten®, and in case of need to adjust a dose of hypoglycemic medicine.

Double blockade the system renin-angiotensin-aldosteronovoy (SRAA), vyzvanyony a concomitant use of APF inhibitors and antagonists of receptors to an angioyotenzin of II or an aliskiren and aliskirensoderzhashchy drugs, was associated with the increased frequency of development of side effects, such as arterial hypotension, hyperpotassemia, depression of function по­чек (including an acute renal nedostayotochnost).

Use of the drug Kapoten® for the patsiyenyot accepting Allopyrinolum or procaineamide increases risk of development of a neutropenia and/or Stephens-Johnson's syndrome.

Use of the drug Kapoten® for the patsiyenyot accepting immunodepressants (for example, циклофосфацин or Azathioprinum), increases risk of development of gematologiyochesky disturbances.

Contraindications:

- Hypersensitivity to captopril, any other component of a prepayorat or other APF inhibitors;
- a Quincke's disease (Quincke's edema) in the anamnesis connected with reception of ingibitoyor APF and a hereditary/idiopathic Quincke's disease);
- heavy abnormal liver functions and/or kidneys;
- refractory hyperpotassemia;
- a bilateral stenosis of renal arteries, a stenosis of an artery of the only kidney with a proyogressiruyushchy azotemia;
- a state after transplantation of a kidney;
- a stenosis of the mouth of an aorta and similar an izmeneyoniya, the blood complicating outflow from a left ventricle;
- simultaneous use with aliskireny and aliskirensoderzhashchy drugs at patients with a diabetes mellitus or a naruyosheniye of function of kidneys (SKF less than 60 ml/min.);
- pregnancy;
- breastfeeding period;
- age up to 18 years (efficiency and a bezoyopasnost are not established);
- lactose intolerance, deficit of a laktayoza and syndrome of glyukozo-galaktozny malabsorption.

With care:
- serious autoimmune illness of soyoedinitelny fabric (including system krasyony lupus, scleroderma);
- oppression of a marrowy hemopoiesis (risk of development of a neutropenia and agranulotsiyotoz);
- brain ischemia;
- a diabetes mellitus (the risk of development of a hyperpotassemia is increased);
- the patients who are on a hemodialysis;
- a diet with restriction of table salt;
- primary hyper aldosteronism;
- coronary heart disease;
- the states which are followed by decrease in volume of the circulating blood (including vomiting, diarrhea);
- advanced age (correction of doses is required);
- surgical intervention / the general anesthesia, arterial hypotension, use for patients of negroid race, a renal failure and/or a liver, hronicheyosky heart failure, гемодиа­лиз with use high-flowing мем­бран (for example, AN69®), desensibiliziyoruyushchy therapy, аферез lipoproteins of the low density (LPNP), simultaneous use of kaliysberegayushchy diuretiyok, drugs of potassium, kaliysoderzhashchy substitutes and lithium, simultaneous priyoy immunodepressants, Allopyrinolum, procaineamide (risk of development of a neutropenia, agranulocytosis).

Overdose:

Symptoms: sharp lowering of arterial pressure, shock, stupor, bradycardia, naruyosheniya of water and electrolytic balance, poyochechny insufficiency.

Treatment: a gastric lavage, administration of adsorbents and sodium of sulfate within 30 minutes after reception, introduction of 0,9% of a rasyotvor of sodium of chloride or other plazmozayomeshchayushchy solutions (previously a payotsiyenta to lay, raise legs and then to hold events for completion of OTsK), a hemodialysis. At bradycardia or the expressed vagal reactions - administration of atropine. The primeyoneniye of an artificial pacemaker can be considered. Peyoritonealny dialysis is inefficient for removal of captopril from an organism.

Storage conditions:

In the dry place, at a temperature not above 25 °C. To store in the place, unavailable to children. A period of validity - 5 years. Not to use drug after a period of validity.

Issue conditions:

According to the recipe

Packaging:

On 10 or 14 tablets in planimetric yacheykoyovy packaging. 4 blister strip packagings on 10 tablets or 2 or 4 planimetric yacheykoyovy packagings on 14 tablets together with an instyoruktion on use place in a pack from a cardboard.