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Hinapril - instructions for use, reviews, analogs and formulations (5 mg, 10 mg, 20 mg and 40 mg tablets) drugs for the treatment of hypertension and heart failure in adults, children and pregnancy. Composition and alcohol

Hinapril - instructions for use, reviews, analogs and formulations (5 mg, 10 mg, 20 mg and 40 mg tablets) drugs for the treatment of hypertension and heart failure in adults, children and pregnancy. Composition and alcohol

In this article, you can read the instructions for using the drug Hinapril. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Hinapril 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 Hinapril in the presence of existing structural analogues. Use for the treatment of hypertension and chronic heart failure in adults, children, as well as in pregnancy and lactation.Composition and interaction of the drug with alcohol.

 

Hinapril - inhibitor of angiotensin-converting enzyme (ACE). ACE is an enzyme that catalyzes the conversion of angiotensin 1 into angiotensin 2, which has a vasoconstrictive effect and increases the tone of the vessels, including by stimulating the secretion of aldosterone with the adrenal cortex. Hinapril competitively inhibits ACE and causes a decrease in vasopressor activity and aldosterone secretion. Elimination of the negative effect of angiotensin 2 on renin secretion by the feedback mechanism leads to an increase in renin activity of the blood plasma. At the same time, lowering blood pressure (BP) is accompanied by a decrease in the total peripheral vascular resistance (OPSS) and resistance of renal vessels, while changes in the heart rate (HR), cardiac output, renal blood flow, glomerular filtration rate and filtration fraction are minor or absent .

 

Composition

 

Hinapril hydrochloride + excipients.

 

Pharmacokinetics

 

The concentration of quinapril in the blood plasma after ingestion reaches a maximum within 1 hour.Eating does not affect the degree of absorption, but can increase the time to reach maximum concentration (fatty foods can reduce the speed and degree of absorption of quinapril). Taking into account the excretion of quinapril and its metabolites (intermediate products of metabolism in living cells) by the kidneys, the degree of absorption is approximately 60%. Approximately 97% of quinapril is circulated in the blood plasma in a protein-related form. Hinapril and its metabolites do not penetrate the BBB (blood-brain barrier). Under the influence of hepatic enzymes, quinapril is rapidly metabolized to quinaprilate by cleavage of the ester group (the main metabolite is dibasic acid of quinapril), which is an ACE inhibitor. About 38% of the ingested dose of quinapril circulates in the blood plasma in the form of quinaprilate. It is excreted by the kidneys - 61% and through the intestines - 37%.

 

Indications

  • arterial hypertension (high blood pressure) as monotherapy or in combination with thiazide diuretics and beta-blockers;
  • chronic heart failure in combination therapy.

 

Forms of release

 

Tablets coated with 5 mg, 10 mg, 20 mg, 40 mg.

 

Instructions for use and dosing regimen

 

Take inside, without chewing, regardless of the time of eating, squeezed with water.

 

Arterial hypertension

 

With monotherapy, the recommended initial dose of Hinapril in patients not receiving diuretics is 10 mg once a day. Depending on the clinical effect, the dose can be increased (doubling) to a maintenance dose of 20 or 40 mg per day, which is usually prescribed in 1 or 2 doses. As a rule, the dose should be changed at intervals of 4 weeks. In most patients, the use of the drug Hinapril once a day can achieve a persistent therapeutic response. The maximum daily dose is 80 mg per day.

 

With simultaneous use with diuretics, the recommended initial dose of the drug Hinapril in patients who continue to take diuretics is 5 mg 1 time per day. Subsequently, it is increased (as indicated above) until the optimal therapeutic effect is achieved.

 

Chronic heart failure

 

The recommended initial dose of Hinapril is 5 mg 1-2 times a day. After taking the drug, the patient must be under medical supervision to detect symptomatic arterial hypotension.In case of good tolerability of the initial dose of Hinapril, it can be increased to 10-40 mg per day, divided into 2 doses.

 

Given the clinical and pharmacokinetic data in patients with impaired renal function, the initial dose should be selected as follows:

  • KK more than 60 ml per minute - the initial dose of 10 mg;
  • KK 30-60 ml per minute - the initial dose of 5 mg;
  • KK 10-30 ml per minute - the initial dose of 2.5 mg (half a tablet of a 5 mg tablet).

 

If the tolerability of the initial dose is good, then the drug Hinapril can be used 2 times a day. The dose of Hinapril can be increased gradually, not more than once a week, to increase taking into account clinical, hemodynamic effects, as well as kidney function.

 

The recommended initial dose of Hinapril in elderly patients is 10 mg once a day. In the future, it is increased until an optimal therapeutic effect is achieved.

 

Side effect

  • headache;
  • dizziness;
  • insomnia;
  • drowsiness;
  • cough;
  • increased fatigue;
  • rhinitis (inflammation of the mucous membrane of the nasal band);
  • nausea and / or vomiting;
  • Myalgia (pain in the muscles);
  • paresthesia (numbness, tingling, "goose bumps" on the skin);
  • increased excitability;
  • depression;
  • Vertigo (loss of balance, which is accompanied by a feeling of rotation of the body around objects, or on the contrary - by rotating objects around the body);
  • impaired vision;
  • diarrhea;
  • dyspepsia (bloating, rumbling in the abdomen);
  • stomach ache;
  • dryness of the mucous membrane of the mouth or throat;
  • pancreatitis (inflammation of the pancreas);
  • gastrointestinal bleeding;
  • angioedema of the intestine (edema of the intestinal mucosa);
  • hepatitis (inflammation of the liver);
  • hemolytic anemia (destruction of erythrocytes);
  • thrombocytopenia (decrease in the number of platelets);
  • marked decrease in blood pressure;
  • angina, palpitations, tachycardia;
  • heart failure;
  • myocardial infarction;
  • stroke;
  • increased blood pressure;
  • cardiogenic shock (complication of myocardial infarction, in 90% of cases resulting in death);
  • fainting;
  • vasodilation (decreased skeletal muscle tone);
  • pharyngitis (inflammation of the mucous membrane of the pharynx);
  • dyspnea (violation of frequency and depth of breathing, accompanied by a feeling of lack of air);
  • chest pain;
  • alopecia (baldness);
  • increased sweating;
  • Pemphigus (special blisters on healthy skin);
  • skin itching, rash;
  • reaction photosensitivity (allergic reactions to sunlight);
  • backache;
  • arthralgia (joint pain);
  • urinary tract infections;
  • acute renal insufficiency;
  • decreased potency;
  • anaphylactic reactions (a rapidly evolving life-threatening manifestation of allergy);
  • angioedema (swelling of the subcutaneous tissue, skin and mucous membranes);
  • general malaise;
  • viral infections.

 

Contraindications

  • angioedema in a history as a result of previous therapy with ACE inhibitors;
  • hereditary and / or idiopathic angioedema;
  • pregnancy;
  • the period of breastfeeding;
  • age to 18 years;
  • deficiency of lactase, lactose intolerance and glucose-galactose malabsorption syndrome;
  • simultaneous use with aliskiren and aliskirenoderzhaschimi means or with antagonists of the receptors of angiotensin 2 (APA 2) or with other preparations inhibiting RAAS (double blockade of RAAS);
  • in patients with diabetes mellitus or in patients with diabetes mellitus with lesion of target organs (diabetic nephropathy);
  • in patients with impaired renal function;
  • in patients with hyperkalemia (more than 5 mmol per liter);
  • in patients with chronic heart failure and arterial hypotension;
  • hypersensitivity to any component of the drug.

 

Carefully:

  • symptomatic arterial hypotension in patients who had previously taken diuretics and followed a diet with restricted intake of table salt;
  • severe heart failure in patients with a high risk of hypotension;
  • severe chronic heart failure;
  • conditions, accompanied by a decrease in BCC (including vomiting and diarrhea);
  • Hyperkalemia (high content of potassium in the blood);
  • oppression of bone marrow hematopoiesis;
  • aortic stenosis, hypertrophic obstructive cardiomyopathy, mitral stenosis;
  • cerebrovascular insufficiency, coronary artery disease, coronary insufficiency - a sharp decrease in blood pressure on the background of therapy with ACE inhibitors, can worsen the course of these diseases;
  • bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney, condition after kidney transplantation;
  • impaired renal function;
  • in patients on hemodialysis (QC less than 10 ml per minute) - data on the use of quinapril in these patients is not enough;
  • autoimmune systemic diseases of connective tissue (including systemic lupus erythematosus, scleroderma);
  • violations of the liver (especially with simultaneous use with diuretics);
  • with simultaneous use with potassium-sparing diuretics;
  • diabetes;
  • extensive surgical interventions and general anesthesia;
  • simultaneous administration of other antihypertensive drugs.

 

Application in pregnancy and lactation

 

The use of the drug Hinapril is contraindicated in pregnancy, in women planning pregnancy, as well as in women of reproductive age who do not use reliable methods of contraception.

 

Women of reproductive age who take Hinapril should use reliable methods of contraception.

 

When diagnosing pregnancy, Hinapril should be discontinued as early as possible.

 

The use of ACE inhibitors in pregnancy is accompanied by an increased risk of anomalies from the cardiovascular and nervous systems of the fetus. In addition, against the background of the administration of ACE inhibitors in pregnancy, described cases of malnutrition, premature birth, the birth of children with arterial hypotension,kidney pathology (including acute kidney failure), hypoplasia of the skull bones, limb contractures, craniofacial malformations, lung hypoplasia, intrauterine growth retardation, open arterial duct, as well as cases of intrauterine fetal death and newborn death. Often, anhydration is diagnosed after the fetus has been irreversibly damaged.

 

Newborns who have been exposed to ACE inhibitors in utero should be observed to detect arterial hypotension, oliguria (decrease in the amount of urine released by the kidneys) and hyperkalemia. When oliguria occurs, blood pressure and renal perfusion should be maintained.

 

Hinapril should not be given during breastfeeding because ACE inhibitors, including quinapril, penetrate to a limited extent in breast milk. Given the potential for serious adverse events in a newborn, Hinapril should be withdrawn during lactation or to stop breastfeeding.

 

Use in children

 

Contraindicated in children and adolescents under 18 years.

 

Application in elderly patients

 

The recommended initial dose of Hinapril in elderly patients is 10 mg once a day. In the future, it is increased until an optimal therapeutic effect is achieved.

 

special instructions

 

In the treatment of ACE inhibitors, cases of angioedema in the head and neck, including 0.1% of patients receiving quinapril, have been described. When a laryngeal whistle or angioedema, face, tongue, or vocal cords, quinapril should be immediately withdrawn. The patient should be given adequate treatment and observed before the regression of the symptoms of edema. To reduce the symptoms can be used antihistamines. Angioedema with involvement of the larynx can lead to death. If edema of the tongue, vocal cords or larynx threatens with the development of airway obstruction, adequate emergency therapy, including subcutaneous injection of an epinephrine (adrenaline) solution 1: 1000 (0.3-0.5 ml), is necessary.

 

In the treatment of ACE inhibitors, cases of angioedema of the intestine are also described. Patients noted abdominal pain (with / without nausea or vomiting).In some cases, without a previous angioedema and a normal activity of C1-esterase. The diagnosis was established with the help of CT of the abdominal region, ultrasound or at the time of surgery. Symptoms disappeared after discontinuation of ACE inhibitors. Therefore, in patients with abdominal pain taking ACE inhibitors, the differential diagnosis should take into account the possibility of angioedema edema development.

 

Patients who have a history of angioedema, not associated with the use of an ACE inhibitor, may increase the risk of developing it with treatment with drugs of this group.

 

Patients receiving ACE inhibitors during desensitizing therapy with Hepaticoptera venom can develop life-threatening anaphylactoid reactions. By temporarily stopping the use of ACE inhibitors, these reactions could be avoided, but they arose again with the occasional administration of these drugs.

 

Anaphylactoid reactions can also develop with the use of ACE inhibitors in patients who have undergone aphelesis of LDL by absorption with dextran sulfate or in patients,which are on hemodialysis using high-flow membranes, such as polyacrylonitrile (for example, AN69). Therefore, similar combinations should be avoided, using either other antihypertensive drugs, or alternative membranes for hemodialysis.

 

Symptomatic arterial hypotension is rarely seen with Hinapril in patients with uncomplicated arterial hypertension, but it can develop as a result of therapy with ACE inhibitors in patients with reduced BCC, for example, with a diet with limited intake of salt, hemodialysis. In case of symptomatic arterial hypotension, symptomatic therapy should be performed (the patient should take a horizontal position and, if necessary, administer an intravenous infusion with a 0.9% solution of sodium chloride). Transient arterial hypotension is not a contraindication to the further use of the drug, however in such cases it is necessary to reduce its dose or assess the advisability of simultaneous therapy with diuretics.

 

Other causes of BCC reduction, such as vomiting or diarrhea, can also lead to a marked decrease in blood pressure. In such cases, patients should consult a doctor.

 

In patients receiving diuretics, the use of Hinapril may also lead to the development of symptomatic arterial hypotension. Such patients are advisable to temporarily stop taking a diuretic 2-3 days before the start of treatment with Hinapril, except for patients with malignant or hard-to-treat hypertension. If monotherapy with Hinapril does not provide the necessary therapeutic effect, treatment with diuretics should be resumed. If diuretic can not be canceled, then Hinapril is used in a low initial dose.

 

In patients with chronic heart failure, who are at increased risk of severe arterial hypotension, treatment with Hinapril should be started with the recommended dose under the close supervision of a doctor. Patients should be observed during the first two weeks of treatment, as well as in all cases when the dose of Hinapril is increased.

 

When therapy with ACE inhibitors in patients with uncomplicated hypertension patients in rare cases develop agranulocytosis, which is more common in patients with impaired renal function and connective tissue diseases. In the treatment of hinapril agranulocytosis rarely developed.When using Hinapril (as well as other ACE inhibitors) in patients with connective tissue diseases and / or kidney disease, the number of leukocytes in the blood should be monitored.

 

In susceptible patients, suppression of RAAS activity can lead to impaired renal function. In patients with severe chronic heart failure, whose kidney function may depend on RAAS activity, treatment with ACE inhibitors, including Hinapril, may be accompanied by oliguria and / or progressive azotemia, and in rare cases, with acute renal failure and / or death. The use of APA 2, ACE inhibitors or aliskiren can lead to a double blockade of the activity of RAAS. This effect can be manifested by lowering blood pressure, hyperkalemia and changes in kidney function (including acute renal failure) compared with monotherapy. Blood pressure, renal function and electrolyte content in blood plasma should be carefully monitored in patients taking Hinapril and other drugs that affect RAAS. It is necessary to avoid simultaneous use of RAAS-active agents and Hinapril.If this combination is necessary, it is necessary to evaluate the ratio of the expected benefit to the possible risk of the combination and regularly monitor the function of the kidneys and potassium content in each individual case.

 

In patients with chronic heart failure or hypertension with unilateral or bilateral stenosis of the renal artery in treatment with ACE inhibitors, in some cases, an increase in the concentration of urea Nitrogen in the blood and serum creatinine was observed. These changes were almost always reversible and disappeared after the withdrawal of the ACE inhibitor and / or diuretic. In such cases, during the first few weeks of treatment, kidney function should be monitored.

 

The half-life of quinaprilate increases with decreasing CC. In patients with SC less than 60 mL per minute, Hinapril should be used at a lower initial dose. In such patients, the dose of the drug should be increased taking into account the therapeutic effect, with regular monitoring of kidney function, although in clinical studies there was no further deterioration in renal function in drug treatment.

 

Hinapril in combination with diuretics should be used with caution in patients with impaired function or progressive liver disease, since small changes in the water-electrolyte balance can cause the development of hepatic coma.

 

ACE inhibitors, including Hinapril, can increase serum potassium levels.

 

Hinapril can reduce hypokalemia caused by thiazide diuretics with simultaneous application. The use of Hinapril in combination therapy with potassium-sparing diuretics has not been studied. Given the risk of further increase in serum potassium, combined therapy with potassium-sparing diuretics should be carried out with caution, under the control of potassium in the blood serum.

 

Patients with diabetes may need more careful observation and correction of the dose of hypoglycemic agents for ingestion and insulin and glycemic control, especially during the first month of therapy with an ACE inhibitor, including Hinapril.

 

In the treatment of ACE inhibitors, including Hinapril, development of cough was noted. In a typical case, it is unproductive, persistent and passes after discontinuation of therapy.In the differential diagnosis of cough, its possible association with ACE inhibitors should be considered.

 

Before surgery (including dentistry), it is necessary to alert the surgeon / anesthesiologist about the use of ACE inhibitors.

 

If any symptoms of infection (eg acute tonsillitis, fever) occur, the patient should immediately consult a doctor, as they may be a manifestation of neutropenia (a decrease in the level of neutrophils in the blood).

 

Impact on the ability to drive vehicles and manage mechanisms

 

When using Hinapril, caution should be exercised when driving vehicles or doing other work that requires increased attention, especially at the beginning of treatment, due to the danger of developing arterial hypotension and dizziness.

 

Drug Interactions

 

Tetracycline and other drugs that interact with magnesium

 

Simultaneous use of Tetracycline with Hinapril reduces the absorption of tetracycline by about 28-37% due to the presence of magnesium carbonate as an auxiliary component of the drug. At simultaneous application it is necessary to consider the possibility of such interaction.

 

Lithium

 

In patients who simultaneously received lithium drugs and ACE inhibitors, an increase in lithium serum levels and signs of lithium intoxication were observed by increasing sodium excretion. Use these drugs simultaneously with caution. The treatment shows a regular determination of the lithium content in blood serum. The simultaneous use of diuretics can increase the risk of lithium intoxication.

 

Diuretics

 

With the simultaneous use of Hinapril with diuretics, there is an increase in antihypertensive action.

 

Drugs that increase the serum potassium content

 

If the patient receiving Hinapril is shown potassium-sparing diuretics (eg spironolactone, triamterene or amiloride), potassium preparations and salt substitutes containing potassium, then they should be used carefully under the control of potassium concentration in the serum.

 

Hypoglycemic agents for oral administration and insulin

 

Therapy with ACE inhibitors is sometimes accompanied by the development of hypoglycemia in patients with diabetes mellitus receiving insulin or hypoglycemic agents for oral ingestion. Hinapril enhances the effect of hypoglycemic agents for ingestion and insulin.

 

Other drugs

 

There were no signs of clinically significant pharmacokinetic interaction of Hinapril with propranolol, hydrochlorothiazide, Digoxin or cimetidine. The use of Hinapril 2 times a day did not significantly affect the anticoagulant effect of Warfarin when it was applied once (evaluated on the basis of prothrombin time).

 

Simultaneous multiple use of Atorvastatin at a dose of 10 mg with Hinapril at a dose of 80 mg did not lead to significant changes in the equilibrium pharmacokinetic parameters of atorvastatin.

 

Hinapril increases the risk of developing leukopenia with concomitant use with allopurinol, cytostatic agents, immunosuppressants, procainamide.

 

Hypotensive drugs, narcotic analgesics, medicines for general anesthesia increase the antihypertensive effect of Hinapril.

 

Estrogens, NSAIDs (including selective inhibitors of COX-2) weaken the antihypertensive effect of Hinapril due to fluid retention. In addition, in elderly patients, in patients with reduced BCC (including patients receiving diuretic therapy) or in patients with impaired renal function,simultaneous use of NSAIDs (including selective inhibitors of COX-2), with ACE inhibitors, including Hinapril, may lead to impaired renal function, including possible acute renal failure. It is necessary to regularly monitor the state of kidney function in patients receiving both NSAIDs and Hinapril.

 

The use of APA 2, ACE inhibitors or aliskiren can lead to a double blockade of the activity of RAAS. This effect can be manifested by lowering blood pressure, hyperkalemia and changes in kidney function (including acute renal failure) compared with monotherapy.

 

Ethanol (alcohol) increases the antihypertensive effect of Hinapril.

 

Drugs that cause depression of bone marrow function increase the risk of developing neutropenia and / or agranulocytosis.

 

With the simultaneous use of ACE inhibitors and gold preparations (sodium aurotyomalate intravenously), a symptom complex is described, including facial flushing, nausea, vomiting and a decrease in blood pressure.

 

Patients simultaneously receiving therapy with inhibitors of mTOR enzymes (eg, tamsirolimus) or with DPP-4 inhibitors (sitagliptin, vildagliptin, alogliptin, saxagliptin, linagliptin) or estramustine may be at greater risk of developing angioedema.Care should be taken when using these drugs with Hinapril simultaneously.

 

Analogues of the drug Hinapril

 

Structural analogs for the active substance:

  • Akkupro;
  • Hinapril hydrochloride;
  • Hinapril NW.

 

Analogues for the pharmacological group (ACE inhibitors):

  • Alkadyl;
  • Amprilan;
  • Angiopril;
  • Arentopress;
  • Bagopril;
  • Berlipril;
  • Vazolapril;
  • Vazolong;
  • Hypernica;
  • Gopten;
  • Dapril;
  • Dilaprel;
  • Diropress;
  • Diroton;
  • The Zocardis;
  • Involor;
  • Inhibeys;
  • Irumed;
  • Kapoten;
  • Captopril;
  • Quadropril;
  • Cooverex;
  • The Korandil;
  • Korpril;
  • Lysacard;
  • Lizigamma;
  • Lysinopril;
  • Lysinoton;
  • Liziprex;
  • Lysoril;
  • Listril;
  • Liten;
  • Myopril;
  • Monopril;
  • Moex;
  • Parnavell;
  • Perindopril;
  • Perineva;
  • Perinpress;
  • Pyrimil;
  • Piristar;
  • Prestarium;
  • Prilazid;
  • Assigned;
  • Ramigamma;
  • Ramicardium;
  • Ramipril;
  • Renipril;
  • Renitek;
  • Rileys Sanovel;
  • Sinopril;
  • Tritace;
  • Fosicard;
  • Fozinap;
  • Fosinopril;
  • Fosinotek;
  • Hartil;
  • Cilazapril;
  • Ednit;
  • Enazil 10;
  • Enalacor;
  • Enalapril;
  • Enam;
  • Enap;
  • Enarenal;
  • Enafarm;
  • Envas;
  • Enipril;
  • Epsetron.

 

Response of a therapist

 

Patients who address me with complaints of increased blood pressure,after a complete examination and identify possible causes of this dangerous condition, I recommend using the drug Hinapril. This drug is quite effective both in monotherapy and in complex treatment with the use of thiazide diuretics and beta adrenoblockers. When you receive a noticeably lower blood pressure, increases the body's resistance to physical exertion, and with prolonged therapy improves blood flow to the heart muscle, increases coronary and renal blood flow. Of the minuses I can identify a fairly serious list of contraindications, side effects. Therefore, this medicine without a doctor's appointment is strictly prohibited.

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