Captopril - instructions for use, analogs, reviews and release forms (tablets 12.5 mg, 25 mg and 50 mg) of the drug for the treatment of hypertension and pressure reduction in adults, children and in pregnancy

In this article, you can read the instructions for using the drug Captopril. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Captopril 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 Captopril in the presence of existing structural analogues. Use to treat hypertension and reduce blood pressure in adults, children, as well as during pregnancy and lactation.

Captopril - antihypertensive agent, ACE inhibitor.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 to angiotensin 2 (which has a pronounced vasoconstrictive effect and stimulates the secretion of aldosterone in the adrenal cortex). In addition, captopril, apparently, has an effect on the kinin-kallikrein system, preventing the breakdown of bradykinin. The hypotensive effect does not depend on the plasma renin activity, the decrease in blood pressure is noted with a normal and even decreased concentration of the hormone, which is due to the effect on tissue RAAS. Increases coronary and renal blood flow.

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. With prolonged use reduces the severity of myocardial hypertrophy of the left ventricle, prevents the progression of heart failure and slows the development of dilatation of the left ventricle. Helps reduce sodium content in patients with chronic heart failure. Expands arteries more than veins.Improves the blood supply of the ischemic myocardium. Reduces the aggregation of platelets.

Reduces the tone of arterioles spreading the glomerulus of the kidneys, improving intra-cerebral hemodynamics, prevents the development of diabetic nephropathy.

Pharmacokinetics

After oral administration, at least 75% is rapidly absorbed from the digestive tract. Simultaneous food intake reduces the absorption by 30-40%. The binding with proteins, mainly albumin, is 25-30%. Excreted in breast milk. Metabolized in the liver with the formation of disulfide dimer captopril and captopril-cysteine ​​disulfide. Metabolites are pharmacologically inactive. More than 95% is excreted by the kidneys, 40-50% unchanged, the rest - in the form of metabolites.

Indications

• arterial hypertension (including renovascular);
• chronic heart failure (as part of combination therapy).

Forms of release

Tablets 12.5 mg, 25 mg and 50 mg.

Instructions for use and dosage

Captopril is prescribed an hour before meals. The dosage regimen is set individually. To ensure the following dosing regimen, it is possible to use the drug Captopril in dosage form: tablets of 12.5 mg.

With arterial hypertension, the drug is prescribed in an initial dose of 25 mg 2 times a day. If necessary, the dose gradually (with an interval of 2-4 weeks) is increased to achieve the optimal effect. With mild or moderate arterial hypertension, the usual maintenance dose is 25 mg 2 times a day; the maximum dose is 50 mg twice a day. In severe arterial hypertension, the maximum dose is 50 mg 3 times a day. The maximum daily dose is 150 mg.

For the treatment of chronic heart failure, captopril is prescribed in cases where the use of diuretics does not provide an adequate effect. The initial dose is 6.25 mg 2-3 times a day, which then gradually (with an interval of at least 2 weeks) is increased. The average maintenance dose is 25 mg 2-3 times a day. In the future, if necessary, the dose gradually (with an interval of at least 2 weeks) is increased. The maximum dose is 150 mg per day.

In the elderly, the dose of Captopril is selected individually, it is recommended to start therapy with a dose of 6.25 mg twice a day and, if possible, maintain it at this level.

If necessary, additionally prescribed loop diuretics, and not diuretics thiazide series.

Side effect

• marked decrease in blood pressure;
• tachycardia;
• orthostatic hypotension;
• peripheral edema;
• proteinuria;
• impaired renal function (increased levels of urea and creatinine in the blood);
• neutropenia, anemia, thrombocytopenia, agranulocytosis;
• dizziness;
• headache;
• paresthesia;
• drowsiness;
• impaired vision;
• feeling tired;
• asthenia;
• dry cough, which occurs after the drug has been discontinued;
• bronchospasm;
• pulmonary edema;
• angioedema, edema of the extremities, face, lips, mucous membranes, tongue, pharynx and larynx;
• serum sickness;
• lymphadenopathy;
• rash, usually maculopapular, less often vesicular or bullous;
• itching;
• increased photosensitivity;
• a violation of taste sensations;
• dry mouth;
• stomatitis;
• nausea;
• decreased appetite;
• diarrhea;
• stomach ache.

Contraindications

• angioedema, incl. hereditary, in the anamnesis (including in the anamnesis after application of other ACE inhibitors);
• severe renal dysfunction, azotemia, hyperkalemia, bilateral stenosis of the renal arteries or stenosis of a single kidney with progressive azotemia, condition after kidney transplantation, primary hyperaldosteronism;
• stenosis of the aortic aorta, mitral stenosis, presence of other obstructions to outflow of blood from the left ventricle of the heart;
• severe liver dysfunction;
• arterial hypotension;
• cardiogenic shock;
• pregnancy and lactation;
• age to 18 years (efficacy and safety in children not established).
• increased sensitivity to captopril and other ACE inhibitors.

special instructions

Before the start, and also regularly during the treatment with the drug captopril, kidney function should be monitored.

In chronic heart failure, the drug is used under conditions of careful medical supervision.

With exceptional caution appoint captopril to patients with diffuse connective tissue diseases or systemic vasculitis; patients receiving immunosuppressants, especially in the presence of violations of kidney function (the risk of serious infections that are not amenable to antibiotic therapy). In such cases, monitor the pattern of peripheral blood before using captopril, every 2 weeks for the first 3 months of therapy, and periodically - in the subsequent treatment period.

The drug is used with caution on the background of treatment with Allopurinol or procainamide, as well as against the background of treatment with immunosuppressants (including, azathioprine, cyclophosphamide), especially in patients with impaired renal function.

Caution is used in patients with a history of kidney disease, as the risk of developing proteinuria increases. In such cases, during the first 9 months of treatment with captopril, the amount of protein in the urine should be monitored on a monthly basis. If the level of protein in the urine exceeds 1 g per day, you need to decide whether to continue using the drug. With caution appoint captopril to patients with stenosis of the renal arteries, tk. there is a risk of kidney dysfunction; In the case of increased levels of urea or creatinine in the blood, a reduction in the dose of captopril or withdrawal of the drug may be required.

When hemodialysis in patients receiving captopril, the use of dialysis membranes with high permeability (including AN69) should be avoided. this increases the risk of anaphylactoid reactions.

The likelihood of developing arterial hypotension in the course of treatment can be reduced if stopping the use of diuretics or significantly reducing their dose 4 to 7 days before the start of treatment with captopril.

In the case of symptomatic arterial hypotension after taking captopril, the patient should take a horizontal position with raised legs.

In the case of severe arterial hypotension, a positive effect is observed with intravenous administration of an isotonic sodium chloride solution.

In the case of angioedema, the drug is withdrawn and carefully monitored. If the edema is localized on the face, special treatment is usually not required (to reduce the severity of symptoms can be used antihistamines); if the swelling spreads to the tongue, throat or larynx and there is a threat of development of airway obstruction, epinephrine (adrenaline) should be injected subcutaneously (0.5 ml at 1: 1000 dilution).

Impact on the ability to drive vehicles and manage mechanisms

During the treatment with captopril it is necessary to refrain from driving motor vehicles and practicing potentially dangerous activities that require an increased concentration of attention and speed of psychomotor reactions.possibly dizziness, especially after taking the initial dose.

Drug Interactions

Diuretics and vasodilators (eg, minoxidil) potentiate the hypotensive effect of captopril.

With the combined use of captopril with Indomethacin (and, possibly, with other non-steroidal anti-inflammatory drugs (NSAIDs)), a decrease in hypotensive effect may be noted.

The hypotensive effect of captopril may decrease estrogen (Na + delay).

The hypotensive effect of captopril can be slowed down when administered to patients receiving clonidine.

Simultaneous use with potassium-sparing diuretics or with potassium preparations can lead to hyperkalemia.

With the simultaneous use of lithium salts, it is possible to increase the concentration of lithium in the blood serum.

The use of captopril in patients taking allopurinol or procainamide increases the risk of developing neutropenia and / or Stevens-Johnson syndrome.

The use of captopril in patients taking immunosuppressants (eg, cyclophosphacin or azathioprine) increases the risk of hematological disorders.

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

Simultaneous use of insulin and oral hypoglycemic drugs increases the risk of developing hypoglycemia.

Analogues of the drug Captopril

Structural analogs for the active substance:

• Alkadyl;
• Angiopril-25;
• Blokordil;
• Vero Captopril;
• Kapoten;
• Captopril Hexal;
• Captopril Sandoz;
• Captopril AKOS;
• Captopril Acry;
• Captopril Sar;
• Captopril STI;
• Captopril UBF;
• Captopril Ferein;
• Captopril FPO;
• Captopril Aegis;
• Katopil;
• Epsetron.

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