Hypersensitivity to lisinopril other ingredients, angioedema in history, including those associated with the use of inhibitors, idiopathic angioedema, hereditary angioedema, age 18 years (effectiveness and safety have been established).
WITH CARE aortic stenosis, trenbolone acetate hypertrophic obstructive cardiomyopathy (GOKMP), bilateral renal artery stenosis, stenosis of the artery only kidney condition after kidney transplantation, renal insufficiency (creatinine clearance (CC) of less than 30 ml / min.), Primary hyperaldosteronism, arterial hypotension, inhibition of bone marrow hematopoiesis, hyponatremia (increased risk of hypotension in patients who are at malosolevoy or salt-free diet), hypovolemic state (including diarrhea, vomiting), systemic connective tissue disease (including systemic lupus erythematosus, scleroderma), severe diabetes, gout, hyperuricemia, hyperkalemia. ischemic heart disease, cerebrovascular disease (including cerebrovascular insufficiency), severe chronic heart failure, hemodialysis vysokoprotochnyh using dialysis membranes with high permeability, advanced age.
Pregnancy and lactation
The use of lisinopril during pregnancy is contraindicated. In establishing the drug pregnancy should be stopped as soon as possible. Lisinopril crosses the plntal barrier. inhibitors in the II and III trimester of pregnancy has adverse effects on the fetus (subject to a marked reduction in blood pressure. Renal failure, hyperkalemia, hypoplasia of the skull bones, fetal death).
Data about the negative effects of the drug on the fetus when used during the I trimester there. For newborns and infants who have been exposed to inhibitors in utero, it is recommended to monitor for early detection of significant decrease in blood pressure, oliguria and hyperkalemia.
During the period of treatment with the drug should be abolished breastfeeding (no data on the penetration of lisinopril passes into breast milk).
DOSAGE AND ADMINISTRATION
Inside, 1 time a day, regardless of meals, preferably at the same time. Essential hypertension The recommended initial dose for patients not taking antihypertensive drugs, one tablet of 10 mg per day. The usual maintenance dose is one tablet of 20 mg per day; according to type parameters of BP dose can be increased to 40 mg / day. The maximum daily dose of 40 mg / day. By increasing the dose should take into account that the full manifestation of hypotensive effect requires 2-4 weeks. If the therapeutic effect is not sufficient, therapy should be supplemented by another antihypertensive agent.
Patients taking diuretics, 2-3 days before the start of therapy trenbolone acetatewith receiving diuretics should be discontinued. In cases where this is not possible, the initial dose of the drug should not exceed 5 mg / day, it is recommended to provide medical supervision of patients after taking the first dose, as may develop symptomatic hypotension (maximum effect is 6 hours after taking the drug).
Renovascular hypertension and other conditions associated with increased activity of the renin-angiotensin-aldosterone system. The recommended starting dose is 2.5-5 mg / sutkn under increased medical supervision (control of blood pressure, kidney function, potassium blood serum). Podderzhivayushuyu dose, continuing strict medical control, should be determined depending on the dynamics of blood pressure.
Since lisinopril excretion through the kidneys, the initial dose of the drug Diroton ® depends QC indicators: QA 30-70 ml / min – 10.5 mg / day, with CC 10-30 ml / min – 2.5-5 mg / day less than 10 ml / min.including patients undergoing hemodialysis – 2.5 mg / day. The maintenance dose depends on the clinical effect and selected for regular measurement of indicators of renal function, sodium and potassium concentration in the blood.
Chronic heart failure
initial daily dose of the drug Diroton ® , equal to 2.5 mg, it is possible to gradually increase after 3-5 days before the usual supporting daily dose of 5-20 mg. The dose should not exceed the maximum daily dose of 20 mg. While the use of diuretics in advance, if possible, the dose of diuretic should be reduced.
Before starting treatment drug Diroton ® and later, in the course of treatment should regularly monitor the blood pressure, kidney function, potassium and sodium in the blood to prevent the development of arterial hypotension and associated renal dysfunction.
daily dose in patients with insulin-dependent diabetes mellitus with normal blood pressure is 10 mg at one time. If necessary, the dose may be increased to 20 mg once a day 1 for reducing diastolic blood pressure to 75 mm Hg. v., as measured in a sitting position.
dose selection for patients with insulin-dependent diabetes mellitus, hypertension sufferers, carried out by the above-mentioned scheme, but the optimal diastolic blood pressure should be less than 90 mm Hg
Acute myocardial infarction
In the case of the drug Diroton ® in the first days after myocardial infarction, the initial dose is 5 mg on the second day re-appoint 5 mg on the third day – 10 mg in the future maintenance dose is 10 mg per day. In patients with acute myocardial infarction drug use for at least 6 weeks.
At a low systolic blood pressure (less than 120 mm Hg), treatment is initiated with a low dose (2.5 mg / day). In the case of arterial hypotension when the systolic blood pressure less than 100 mmHg, the maintenance dose is reduced to 5 mg / day, in case of need can be assigned temporarily at 2.5 mg / day.
In the case of long pronounced reduction in blood pressure (systolic blood pressure less than 90 mm Hg for more than 1 hour) treatment with the drug should be discontinued.
The most common side effects: dizziness, headache (in 5-6% of patients), fatigue, diarrhea, dry cough (3%), nausea, vomiting, orthostatic hypotension, skin rashes, chest pain (1-3% .)
The frequency of other side effects is less than 1%: Since the cardiovascular system: marked reduction of blood pressure, chest pain, rarely – orthostatic hypotension, tachycardia, bradycardia, the emergence of symptoms of heart failure, violation of atrioventricular conduction, myocardial infarction. On the part of the digestive tract : nausea, vomiting, abdominal pain, dry mouth, diarrhea, dyspepsia, anorexia, taste disturbance, pancreatitis, hepatitis (hepatocellular and cholestatic), jaundice (hepatocellular or cholestatic). For the skin: rash, increased sweating, photosensitivity, itchy skin, hair loss. On the part of the central nervous system: mood lability, impaired concentration, paresthesia, fatigue, somnolence, jerking of the limbs and lips, rare – asthenic syndrome, confusion. The respiratory system:dyspnea, dry cough , bronchospasm, apnea. Hematopoietic system: leukopenia, thrombocytopenia, neutropenia, agranulocytosis, anemia (decreased hemoglobin concentration, hematocrit, erythropenia).Allergic reactions: angioneurotic edema of the f, extremities, lips, tongue, epiglottis trenbolone acetate and / or larynx, intestinal angioedema edema, vasculitis, positive reaction to antinuclear antibodies, increased erythrocyte sedimentation rate, eosinophilia. in very rare cases – interstitial angioedema (interstitial lung tissue edema without departing transudate into the lumen of the alveoli). From the urogenital system:uraemia, oliguria, anuria, renal failure , acute renal failure, reduced potency. Laboratory indicators: hyperkalemia and / or hypokalemia, hyponatremia, hypomagnesemia, hyposalemia, hypercalcemia.hyperuricemia, increased concentrations of urea and creatinine in the blood plasma, hyperbilirubinemia, hypercholesterolemia, hypertriglyceridemia, impaired glucose tolerance, increased activity of “liver” transaminases, long-term treatment may be a slight decrease in hemoglobin and hematocrit, and in some cases agranulocytosis. Other: arthralgia, arthritis, myalgia, fever, exrbation of gout.