Lisinopril

General characteristics. Structure:

Active agent: lisinopril dihydrate of 10.888 mg (экв. 10 mg of lisinopril)

Pharmacological properties:

Pharmacodynamics. APF inhibitor, reduces formation of II angiotensin of angiotensin I. Decrease in content of angiotensin II leads to direct reduction of allocation of Aldosteronum. Reduces degradation of bradikinin and increases synthesis of Pg. Reduces OPSS, the ABP, preloading, pressure in pulmonary capillaries, causes increase in the IOC and increase in tolerance of a myocardium to loadings in patients with HSN. Expands arteries more than veins. Some effects are explained by influence on fabric a system renin-angiotenzinovye. At prolonged use the hypertrophy of a myocardium and walls of arteries of resistive type decreases. Improves blood supply of an ischemic myocardium. APF inhibitors extend life expectancy at sick HSN, slow down progressing of dysfunction of LZh at the patients who had a myocardial infarction without clinical manifestations of SN. The beginning of action - in 1 h. The maximum effect is defined by 6-7 h, duration - 24 h. At arterial hypertension the effect is noted in the first days after an initiation of treatment, stable action develops in 1-2 months.

Pharmacokinetics. Absorption - 30% (6-60%); bioavailability - 25%. Poorly contacts proteins of plasma. Permeability through GEB and a placental barrier - low. Cmax - about 90 ng/ml, TCmax - 7 h. To metabolism it is practically not exposed and removed by kidneys in not changed look. T1/2 is 12 h.

Indications to use:

Arterial hypertension (including symptomatic), HSN, early treatment of an acute myocardial infarction at hemodynamically stable patients (as a part of a combination therapy). As a part of a combination therapy of an acute myocardial infarction (in the first 24 h, with stable indicators of a hemodynamics). Diabetic nephropathy.

Route of administration and doses:

Inside, at arterial hypertension - on 5 mg of 1 times a day. In the absence of effect the dose is raised by each 2-3 days on 5 mg to an average therapeutic dose of 20-40 mg/days (increase in a dose usually does not lead over 20 mg/days to further decrease in the ABP). The maximum daily dose - 80 mg. At SN - begin with 2.5 mg once, with the subsequent increase in a dose by 2.5 mg in 3-5 days. At elderly more expressed long hypotensive action is often observed that it is connected with reduction of speed of removal of lisinopril (it is recommended to begin treatment with 2.5 mg/days). At HPN cumulation comes at decrease in filtering less than 50 ml/min. (the dose has to be reduced twice, at KK less than 10 ml/min. are required to reduce a dose by 75%). At persistent arterial hypertension the long maintenance therapy on 10-15 mg/days is shown, at SN - on 7.5-10 mg/days.

Features of use:

Extra care at appointment as the patient with a bilateral stenosis of renal arteries or a stenosis of an artery of the only kidney is required (increase in concentration of urea and creatinine in blood), the patient with an ischemic heart disease or a cerebrovascular disease is possible, from dekompensirovanny HSN (arterial hypotension, a myocardial infarction, a stroke are possible). At patients with HSN the arising arterial hypotension can lead to deterioration in function of kidneys. At use of HP, the reducing ABP, for patients at extensive surgical intervention or during anesthesia lisinopril can block formation of angiotensin II, secondary in relation to compensatory allocation of a renin. Safety and efficiency of use of lisinopril for children is not established. Before an initiation of treatment it is necessary to offset loss of liquid and salts. Use during pregnancy is contraindicated, except for cases when to apply other. The hp is impossible or they are inefficient (the patient has to be informed on potential risk for a fruit). With care. A Quincke's disease in the anamnesis against the background of therapy by APF inhibitors, a hereditary or idiopathic Quincke's disease, an aortal stenosis, cerebrovascular diseases (including insufficiency of cerebral circulation), an ischemic heart disease, coronary insufficiency, serious autoimmune general diseases of connecting fabric (including hard currency, a scleroderma), oppression of a marrowy hemopoiesis, a diabetes mellitus, a hyperpotassemia, a bilateral stenosis of renal arteries, a stenosis of an artery of the only kidney, a state after transplantation of kidneys, a renal failure, a diet with restriction of Na+, the states which are followed by decrease in OTsK (including diarrhea, vomiting), advanced age, age up to 18 years (safety and efficiency of use are not studied).

Side effects:

From CCC: decrease in the ABP, arrhythmia, a stethalgia, is rare - orthostatic hypotension, tachycardia.

From a nervous system: dizziness, a headache, increased fatigue, drowsiness, twitching of muscles of extremities and lips, is rare - an adynamy, lability of mood, confusion of consciousness.

From the alimentary system: nausea, dyspepsia, a loss of appetite, taste change, an abdominal pain, diarrhea, dryness in a mouth.

From bodies of a hemopoiesis: leukopenia, thrombocytopenia, neutropenia, agranulocytosis, anemia (decrease in Hb, erythrocytopenia).

Allergic reactions: Quincke's disease, skin rashes, itch.

Laboratory indicators: hyperpotassemia, hyperuricemia; seldom - increase in activity of "hepatic" transaminases, a hyperbilirubinemia.

Others: Sukhoi cough, decrease in a potentiality; seldom - an acute renal failure, an arthralgia, a mialgiya, fever, hypostasis (language, lips, extremities), disturbance of development of kidneys of a fruit.

Interaction with other medicines:

Slows down removal of the drugs Li+. NPVP, estrogen, adrenostimulyator reduce hypotensive effect. At simultaneous use with kaliysberegayushchy diuretics and the drugs K+ the hyperpotassemia is possible. The combined use with beta adrenoblockers, BMKK, diuretics, etc. in hypotensive HP increases expressiveness of hypotensive action. Antacids and Colestyraminum reduce absorption in a GIT. Myelotoxic HP - risk of the expressed oppression of a marrowy hemopoiesis.

Contraindications:

Hypersensitivity to lisinopril or the APF other inhibitors, pregnancy, the lactation period.

Overdose:

Symptoms (arise at reception of a single dose of 50 mg): the expressed decrease in the ABP; dryness in a mouth, drowsiness, an urination delay, a lock, concern, an acrimony. Treatment: symptomatic therapy, intravenous administration of liquid, controlling ABP, water and electrolytic balance and normalization of the last. Lisinopril can be removed from an organism by means of a hemodialysis.

Storage conditions:

List B. In the dry, protected from light place, at a temperature not above 25 °C. To store in the place, unavailable to children.

Issue conditions:

According to the recipe

Packaging:

tablets of 10 mg (banks polymeric, planimetric strip packagings)