Lisinopril Plus caps. 10mg/5mg per circuit. cell pack No. 14x2 (lisinopril+amlodipine)

Compound

Directions for use and doses

Inside, regardless of food intake. For arterial hypertension, patients not receiving other antihypertensive drugs are prescribed 5 mg 1 time per day. If there is no effect, the dose is increased every 2–3 days by 5 mg to an average therapeutic dose of 20–40 mg/day (increasing the dose above 40 mg/day usually does not lead to a further decrease in blood pressure). The usual daily maintenance dose is 20 mg. The maximum daily dose is 40 mg.

The full effect usually develops within 2–4 weeks from the start of treatment, which should be taken into account when increasing the dose. If the clinical effect is insufficient, it is possible to combine the drug with other antihypertensive drugs.

If the patient has received prior treatment with diuretics, then taking such drugs should be stopped 2-3 days before starting lisinopril. If this is not feasible, then the initial dose of lisinopril should not exceed 5 mg/day. In this case, after taking the first dose, medical supervision is recommended for several hours (the maximum effect is achieved after approximately 6 hours), because A pronounced decrease in blood pressure may occur.

In case of renovascular hypertension or other conditions with increased activity of the RAAS, it is also advisable to prescribe a low initial dose of 2.5–5 mg per day, under enhanced medical supervision (monitoring blood pressure, renal function, potassium concentration in the blood serum). The maintenance dose, while continuing strict medical supervision, should be determined depending on the dynamics of blood pressure.

In case of renal failure, due to the fact that lisinopril is excreted through the kidneys, the initial dose should be determined depending on creatinine clearance, then, in accordance with the response, a maintenance dose should be set under conditions of frequent monitoring of renal function, potassium and sodium levels in the blood serum.

* Including patients undergoing hemodialysis treatment.

For persistent arterial hypertension, long-term maintenance therapy of 10–15 mg/day is indicated.

For CHF, the initial dose is 2.5 mg 1 time per day, followed by an increase by 2.5 mg after 3–5 days to the usual maintenance daily dose of 5–20 mg. The dose should not exceed 20 mg/day.

In elderly people, a more pronounced and prolonged hypotensive effect is often observed, which is associated with a decrease in the rate of elimination of lisinopril (it is recommended to start treatment with 2.5 mg/day).

Acute myocardial infarction (as part of combination therapy). On the first day - 5 mg orally, then 5 mg every other day, 10 mg after two days and then 10 mg once a day. The course of treatment is at least 6 weeks.

At the beginning of treatment or during the first 3 days after acute myocardial infarction in patients with low sBP (120 mmHg or lower), a lower dose of 2.5 mg should be prescribed. If blood pressure decreases (sBP is less than or equal to 100 mm Hg), the daily dose of 5 mg is temporarily reduced to 2.5 mg if necessary. In case of prolonged pronounced decrease in blood pressure (sBP below 90 mm Hg for more than 1 hour), treatment with lisinopril should be discontinued.

Diabetic nephropathy. In patients with non-insulin-dependent diabetes mellitus, 10 mg of lisinopril is used once a day. If necessary, it is possible to increase the dose to 20 mg 1 time per day in order to achieve DBP values ​​below 75 mmHg. Art. in a sitting position. In patients with insulin-dependent diabetes mellitus, the dosage is the same in order to achieve DBP values ​​below 90 mmHg. Art. in a sitting position.

Lisinopril, 10 mg, tablets, 30 pcs.

Treatment with lisinopril for chronic heart failure should be started in a hospital setting with combination therapy with diuretics or diuretics in high doses (for example, more than 80 mg of furosemide), fluid or salt deficiency (hypovolemia or hyponatremia: serum sodium less than 130 mmol/l), low blood pressure , unstable heart failure, reduced renal function, therapy with high doses of vasodilators, patient age over 70 years.

The concentration of electrolytes and creatinine in the blood serum and blood cell counts should be monitored, especially at the beginning of therapy and in risk groups (patients with renal failure, connective tissue diseases), as well as with the simultaneous use of immunosuppressants, cytostatics, allopurinol and procainamide.

Arterial hypotension.

The drug can cause a sharp decrease in blood pressure, especially after the first dose. Symptomatic hypotension in patients with high blood pressure without complications is rare. Symptomatic hypotension occurs more often in patients with electrolyte or fluid deficiency, receiving diuretics, following a low-salt diet, after vomiting or diarrhea, or after hemodialysis. Symptomatic hypotension has been observed primarily in patients with chronic heart failure with or without resulting renal failure, as well as in patients receiving high doses of loop diuretics, hyponatremia or impaired renal function. In such patients, therapy should be initiated under strict medical supervision, preferably in a hospital setting, with low doses and dosage adjustments should be made with caution. At the same time, monitoring of renal function and serum potassium levels is necessary. If possible, treatment with diuretics should be discontinued.

Caution is also necessary in patients with angina or cerebral vascular disease, in whom an excessive decrease in blood pressure can lead to myocardial infarction or stroke.

The risk of symptomatic hypotension during lisinopril therapy can be reduced by discontinuing the diuretic before starting lisinopril treatment.

If arterial hypotension occurs, the patient should be placed down, given fluids, or given intravenous fluid (fluid replacement). Atropine may be required to treat associated bradycardia. After successful elimination of arterial hypotension caused by taking the first dose of the drug, there is no need to abandon the subsequent careful increase in dose. If arterial hypotension in a patient with heart failure becomes systematic, a dose reduction and/or discontinuation of the diuretic and/or lisinopril may be required. If possible, diuretic treatment should be discontinued 2–3 days before starting lisinopril therapy.

Arterial hypotension in acute myocardial infarction.

In acute myocardial infarction, therapy with lisinopril should not be initiated if, due to previous treatment with vasodilators, there is a risk of further serious deterioration of hemodynamic parameters. This applies to patients with SBP 100 mmHg. Art. and below or with cardiogenic shock. With SBP 100 mm Hg. Art. and below the maintenance dose should be reduced to 5 mg or 2.5 mg. In acute myocardial infarction, taking lisinopril can lead to severe arterial hypotension. In case of persistent arterial hypotension (SBP less than 90 mm Hg for more than 1 hour), lisinopril therapy should be discontinued.

In patients with chronic heart failure after acute myocardial infarction, lisinopril should be prescribed only if hemodynamic parameters are stable.

Renovascular hypertension/renal artery stenosis (see “Contraindications”).

In renovascular hypertension and bilateral (or unilateral in the case of a solitary kidney) renal artery stenosis, the use of lisinopril is associated with an increased risk of excessive reduction in blood pressure and renal failure. This risk may be exacerbated by the use of diuretics. Even in patients with unilateral renal artery stenosis, renal failure may be accompanied by only minor changes in serum creatinine levels. Therefore, treatment of such patients should be carried out in a hospital under close medical supervision, starting with a low dose, and increasing the dose should be gradual and careful. During the first week of therapy, diuretic treatment should be interrupted and renal function monitored.

Renal dysfunction.

Use with caution in patients with reduced renal function. Such patients require a lower dose or a longer interval between doses (see "Dosage and Administration").

Reports of an association between lisinopril therapy and renal failure relate to patients with chronic heart failure or existing renal dysfunction (including renal artery stenosis). With timely diagnosis and proper treatment, renal failure associated with lisinopril therapy is usually reversible.

In some patients with arterial hypertension without obvious renal dysfunction, an increase in blood urea and creatinine was observed during simultaneous therapy with lisinopril and diuretics. In this situation, it may be necessary to reduce the dose of the ACE inhibitor or discontinue the diuretic, and the possible presence of undiagnosed renal artery stenosis should also be considered.

Lisinopril therapy for acute myocardial infarction should not be prescribed to patients with signs of renal dysfunction: serum creatinine concentration more than 177 µmol/l (2 mg/dl) and/or proteinuria more than 500 mg per day. Lisinopril should be discontinued if renal dysfunction develops during therapy (serum creatinine Cl <30 ml/min or a doubling of the serum creatinine level compared to its level before treatment).

Elevated serum potassium levels (hyperkalemia).

Lisinopril therapy may lead to increased levels of potassium ions in the blood serum (hyperkalemia), especially in the presence of existing renal or heart failure. Prescribing additional therapy with potassium-sparing diuretics or potassium supplements is undesirable, because this can cause a significant increase in serum potassium ion levels. However, if therapy is considered appropriate, regular monitoring of serum potassium levels is necessary during treatment.

Elderly patients.

In elderly patients, the effect of ACE inhibitors may be more pronounced than in younger patients. Therefore, treatment of elderly patients should be carried out with caution. For patients over 65 years of age, an initial dose of lisinopril of 2.5 mg/day is recommended, as well as monitoring of blood pressure and renal function.

Children.

The effectiveness and safety of lisinopril in children has not been sufficiently studied, so its use is not recommended.

Primary hyperaldosteronism.

In primary aldosteronism, antihypertensive drugs whose action is based on inhibition of the renin-angiotensin system are usually ineffective, so the use of lisinopril is not recommended.

Proteinuria.

Rare cases of proteinuria have been reported, especially in patients with reduced renal function or after taking sufficiently high doses of lisinopril. For clinically significant proteinuria (more than 1 g/day), the drug should be used only after careful comparison of the expected benefits and potential risks and with regular monitoring of clinical and laboratory parameters.

LDL pheresis/desensitization.

During LDL pheresis using dextran sulfate, concomitant therapy with ACE inhibitors can lead to life-threatening anaphylactic reactions. These reactions (for example, a drop in blood pressure, difficulty breathing, vomiting, allergic skin reactions) are also possible when lisinopril is prescribed against the background of desensitizing therapy for insect bites (for example, bees or wasps).

If LDL pheresis or desensitization therapy for insect bites is necessary, lisinopril should be temporarily replaced with another drug (but not an ACE inhibitor) for the treatment of hypertension or heart failure.

Tissue swelling/angioedema (see “Contraindications”).

There are rare reports of angioedema of the face, extremities, lips, tongue and nasopharynx in patients receiving ACE inhibitors, including lisinopril. Edema can develop at any stage of therapy, which in such cases should be stopped immediately and the patient's condition monitored.

If the swelling is limited to the face and lips, it usually goes away without treatment, although antihistamines may be used to relieve symptoms.

The risk of developing angioedema during therapy with ACE inhibitors is higher in patients who have a history of angioedema not associated with the use of ACE inhibitors.

Angioedema of the tongue and nasopharynx is life-threatening. In this case, emergency measures are indicated, including immediate subcutaneous administration of 0.3–0.5 mg of epinephrine or slow intravenous administration of 0.1 mg of epinephrine while monitoring ECG and blood pressure. The patient must be hospitalized. Before discharge, the patient should be observed for at least 12–24 hours until all symptoms disappear completely.

Aortic stenosis/hypertrophic cardiomyopathy.

ACE inhibitors should be prescribed with caution to patients with obstruction of blood outflow from the left ventricle. In case of hemodynamically significant obstruction, lisinopril is contraindicated.

Neutropenia/agranulocytosis.

Rare cases of neutropenia or agranulocytosis have been reported in patients with arterial hypertension receiving ACE inhibitors. They were rarely observed in uncomplicated arterial hypertension, but were more common in patients with renal failure, especially with concomitant lesions of vascular or connective tissues (for example, systemic lupus erythematosus or dermatosclerosis) or with simultaneous therapy with immunosuppressants. Regular monitoring of blood leukocytes is indicated for such patients. After discontinuation of ACE inhibitors, neutropenia and agranulocytosis disappear.

If there is an increase in body temperature, enlarged lymph nodes and/or sore throat during treatment, you should immediately consult a doctor and determine the concentration of leukocytes in the blood.

Surgical interventions/general anesthesia.

In patients undergoing major surgery and receiving general anesthesia with drugs that lower blood pressure, lisinopril blocks the formation of angiotensin II due to compensatory secretion of renin. If arterial hypotension develops as a result, it can be corrected by replenishing fluid volume (see “Interactions”).

In case of malignant hypertension or chronic heart failure, the initiation of therapy, as well as dose changes, should be done in a hospital setting.

If you take the drug at a dose lower than prescribed or skip a dose of the drug, it is unacceptable to double the dose at the next dose. Only a doctor can increase the dose.

In case of temporary interruption or cessation of therapy in patients with heart failure, symptoms may reappear. Do not interrupt treatment without consulting your doctor.

There are no studies of the effect of this drug on the ability to drive vehicles. However, one should take into account the possibility of impaired ability to drive vehicles and machinery, as well as to work without reliable support due to dizziness and increased fatigue that sometimes occur.