Monopril - instructions for use, analogs, reviews and release forms (10 mg and 20 mg tablets) drugs for the treatment of heart failure, hypertension and pressure reduction in adults, children and pregnancy. Composition

In this article, you can read the instructions for using the drug Monopril. There are reviews of visitors to the site - consumers of this medication, as well as opinions of specialists on the use of Monopril in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Monopril in the presence of existing structural analogs. Use for the treatment of heart failure, hypertension and depression of pressure in adults, children, as well as during pregnancy and lactation.Composition of the preparation.

Monopril - ACE inhibitor. Is a prodrug, from which the active metabolite fosinoprilat is formed in the body. It is believed that the mechanism of antihypertensive action is associated with competitive inhibition of ACE activity, which leads to a decrease in the rate of conversion of angiotensin 1 into angiotensin 2, which is a potent vasoconstrictor. As a result of a decrease in the concentration of angiotensin 2, a secondary increase in plasma renin activity occurs due to elimination of negative feedback during the release of renin and a direct decrease in aldosterone secretion. In addition, fosinoprilat, apparently, has an effect on the kinin-kallikrein system, preventing the breakdown of bradykinin.

Due to vasodilator effect, reduces OPSS (afterload), wedging pressure in the pulmonary capillaries (preload) and resistance in the pulmonary vessels; increases the minute volume of the heart and tolerance to the load.

Composition

Fosinopril sodium + excipients.

Pharmacokinetics

When ingested slowly absorbed from the gastrointestinal tract. Admission with food can slow down, but not the degree of absorption.It is metabolized in the liver and in the mucosa of the digestive tract by hydrolysis to form fozinoprilata, which is implemented due to a hypotensive effect of pharmacological activity. The binding of fosinoprilata to plasma proteins is 97-98%. It is excreted by the kidneys - 44-50% and through the intestine - 46-50%.

Indications

• arterial hypertension (in the form of monotherapy or as part of combination therapy);
• chronic heart failure (as part of combination therapy).

Forms of release

Tablets 10 mg and 20 mg.

Instructions for use and dosage

Inside. The dosage of the drug should be selected individually.

Arterial hypertension. The recommended initial dose of the drug is 10 mg once a day. The dose should be selected depending on the dynamics of blood pressure lowering.

The usual dose is 10 to 40 mg once a day. In the absence of sufficient hypotensive effect, additional prescription of diuretics is possible.

If treatment is to begin Monoprilom background therapy with diuretics, the initial dose it should not exceed 10 mg careful clinical monitoring of the patient's condition.

Heart failure.The recommended initial dose is 5 mg 1 or 2 times a day. Depending on the therapeutic effectiveness, the dose can be increased with a weekly interval up to a maximum of 40 mg once a day.

Arterial hypertension and heart failure with impaired renal or hepatic function

Since the removal of the drug from the body occurs in two ways, reducing the dose to patients with impaired renal or liver function is usually not required.

Elderly patients. Differences in efficacy and safety of treatment with the drug of patients aged 65 years and older and young patients are not observed. However, it is impossible to exclude a greater susceptibility in some elderly patients to the drug due to possible overdose phenomena due to delayed excretion of it.

Side effect

• marked decrease in blood pressure;
• orthostatic hypotension;
• tachycardia;
• a feeling of palpitations;
• arrhythmias;
• angina pectoris;
• myocardial infarction;
• pain in the chest;
• "tides" of blood to the skin of the face;
• heart failure;
• fainting;
• nausea, vomiting;
• constipation;
• intestinal obstruction;
• pancreatitis;
• hepatitis;
• stomatitis, glossitis;
• phenomena of dyspepsia;
• abdominal pain;
• anorexia;
• intestinal edema;
• cholestatic jaundice;
• dysphagia;
• flatulence;
• a violation of appetite;
• change in body weight;
• dryness of the oral mucosa;
• dry cough;
• dyspnea;
• pharyngitis;
• laryngitis;
• sinusitis;
• pulmonary infiltrates;
• bronchospasm;
• dyspnea;
• nasal bleeding;
• rhinorrhea;
• development or aggravation of symptoms of chronic renal failure;
• proteinuria, oliguria, hypercreatininaemia, increased urea concentration;
• stroke;
• cerebral ischemia;
• dizziness;
• headache;
• weakness;
• insomnia;
• anxiety;
• depression;
• confusion of consciousness;
• paresthesia;
• drowsiness;
• hearing and vision impairment;
• noise in ears;
• skin rash;
• itching;
• angioedema;
• neutropenia, leukopenia, eosinophilia, lymphadenitis, decreased hemoglobin and hematocrit;
• arthritis;
• exacerbation of gout;
• hyperkalemia, hyponatremia;
• increased ESR.

Contraindications

• hypersensitivity to fosinopril or any other substance in the formulation;
• angioedema in the anamnesis, incl. and after taking other ACE inhibitors;
• pregnancy;
• lactation period;
• age to 18 years (efficacy and safety not established).

Carefully:

• kidney failure;
• hyponatremia (risk of dehydration, arterial hypotension, chronic renal failure);
• bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney;
• aortic stenosis;
• condition after kidney transplantation;
• desensitization;
• systemic connective tissue diseases (including systemic lupus erythematosus, scleroderma) - increased risk of developing neutropenia or agranulocytosis;
• hemodialysis;
• cerebrovascular diseases (including cerebral circulatory insufficiency);
• IHD; chronic heart failure 3-4 tbsp. (according to the NYHA classification);
• diabetes;
• oppression of bone marrow hematopoiesis;
• hyperkalemia;
• gout;
• with a diet with salt restriction;
• conditions, accompanied by a decrease in BCC (including diarrhea, vomiting, previous treatment with diuretics).

Application in pregnancy and lactation

The use of Monopril during pregnancy is contraindicated.

In the period of treatment for women of childbearing age, reliable means of contraception should be used.

Monopril is excreted in breast milk.If fosinopril is needed during lactation, the question of stopping breastfeeding should be resolved.

Use in children

Contraindicated in children and adolescents under the age of 18 years (safety of use in children is not established).

Application in elderly patients

There is no special correction of the dosage regimen of Monopril in elderly patients.

special instructions

They are used with caution for renal vascular hypertension, cardiac insufficiency, hyperkalemia, quincke edema, hypovolemia and / or decreased osmolarity of plasma of various etiologies, as well as in hemodialysis patients.

2-3 days before the start of treatment with fosinopril, prior therapy with diuretics is recommended to be canceled, except for patients with malignant or difficult to treat hypertension. In such cases, fosinopril therapy should be started immediately, in a reduced dose, with careful medical supervision and careful dose increase.

Symptomatic arterial hypotension with ACE inhibitors most often develops in patients after intensive treatment with diuretics, a diet limiting intake of table salt, or in the conduct of renal dialysis.Transient arterial hypotension is not a contraindication for continuing treatment after taking measures to restore BCC.

In patients with chronic heart failure, treatment with ACE inhibitors can cause an excessive antihypertensive effect, which can lead to oliguria or azotemia with a fatal outcome. Therefore, in the treatment of fosinopril in patients with chronic heart failure, careful clinical monitoring is necessary, especially during the first 2 weeks of treatment, as well as with any increase in the dose of fosinopril or diuretic.

Inhibitors of ACE in rare cases cause edema of the intestinal mucosa. In this case, patients have abdominal pain (sometimes without nausea and vomiting), face swelling may also be absent, the level of C1-esterases is normal. After discontinuation of ACE inhibitors, symptoms disappear. Swelling of the intestinal mucosa should be taken into account in differential diagnosis in patients with abdominal pain while taking ACE inhibitors.

Against the background of treatment with ACE inhibitors during hemodialysis using high-permeability membranes, as well as during the apheresis of LDL with the adsorption of dextran sulfate, anaphylactic reactions may develop.In these cases, the use of dialysis membranes of a different type or other antihypertensive therapy should be considered.

Perhaps the development of agranulocytosis and suppression of bone marrow function during treatment with ACE inhibitors. These cases are noted more often in patients with impaired renal function, especially in the presence of systemic connective tissue diseases (systemic lupus erythematosus or scleroderma). Before the beginning of therapy with ACE inhibitors and during treatment, the total number of leukocytes and the leukocyte formula are determined (once a month for the first 3-6 months of treatment and in the first year of treatment in patients with an increased risk of neutropenia).

When there is a noticeable icterus and a marked increase in the activity of liver enzymes, treatment with Monopril should be discontinued and appropriate treatment should be prescribed.

In arterial hypertension in patients with bilateral renal artery stenosis or stenosis of the artery of a single kidney, and also with the simultaneous use of diuretics without signs of impaired renal function during treatment with ACE inhibitors, the concentration of blood urea Nitrogen and serum creatinine may increase.These effects are usually reversible and pass after discontinuation of treatment. You may need to reduce the dose of a diuretic and / or fosinopril.

In patients with severe chronic heart failure, with altered RAAS activity, treatment with ACE inhibitors can lead to oliguria, progressive azotemia, and, in rare cases, to acute renal failure and a possible fatal outcome.

During therapy with fosinopril, the patient must exercise caution when performing physical exercises or in hot weather due to the risk of dehydration and arterial hypotension due to a decrease in BCC.

Before and during treatment the drug requires control of blood pressure, kidney function, potassium content, hemoglobin, creatinine, urea concentration, electrolyte concentration and hepatic transaminase activity in the blood.

Impact on the ability to drive vehicles and manage mechanisms

Care must be taken when driving vehicles or doing other work that requires increased attention, because possibly dizziness, especially after the initial dose of fosinopril.

Drug Interactions

With simultaneous use with antacids, it is possible to increase the absorption of fosinopril.

With simultaneous use with antihypertensive drugs may increase the antihypertensive effect.

With the simultaneous use of Monopril with diuretics, it is possible to develop severe arterial hypotension.

With simultaneous use with potassium-sparing diuretics, potassium preparations, an increase in the potassium concentration in the blood plasma is possible.

With the simultaneous use of lithium carbonate, it is possible to increase the concentration of lithium in blood plasma and increase the risk of intoxication.

With the simultaneous use of Monopril with drugs used in anesthesia, analgesics may increase the antihypertensive effect.

With simultaneous use with acenocoumarol, the case of bleeding is described.

When used simultaneously with indomethacin, other non-steroidal anti-inflammatory drugs (NSAIDs) (acetylsalicylic acid), a decrease in the effectiveness of ACE inhibitors is possible.

Analogues of the drug Monopril

Structural analogs for the active substance:

• Fosicard;
• Fozinap;
• Fosinopril;
• Fosinotek.

Analogues for the pharmacological group (ACE inhibitors):

• Accoustic massage;
• Akkupro;
• Alkadyl;
• Amprilan;
• Arentopress;
• Bagopril;
• Berlipril;
• Blokordil;
• Vazolapril;
• Vazolong;
• Hypernica;
• Gopten;
• Dalnev;
• Dapril;
• Dilaprel;
• Diroton;
• The Zocardis;
• Zonix;
• Involor;
• Irumed;
• Kapoten;
• Captopril;
• Co-Diroton;
• Ko-Perineva;
• Co-benefit;
• Korenitec;
• Lysinopril;
• Lysinoton;
• Lysoril;
• Listril;
• Liten;
• Noliprel;
• Noliprel A Bee Fort;
• Noliprel forte;
• Perindopril;
• Perineva;
• Prestan;
• Prestarium;
• Ramepress;
• Ramipril;
• Renipril;
• Renitek;
• Tark;
• Tritace;
• Hartil;
• Ecquard;
• Equator;
• Enalapril;
• Enam;
• Enap;
• Enarenal;
• Enipril;
• Enziks;
• Epsetron.

Similar medicines:

Other medicines: