Lizinopril - instructions for use, analogs, reviews and release forms (tablets 2.5 mg, 5 mg, 10 mg, 20 mg) of the drug for the treatment of hypertension and pressure reduction in adults, children and pregnancy. Composition and interaction with alcohol

In this article, you can read the instructions for using the drug Lisinopril. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of lisinopril 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. Lizinopril analogues 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. Composition and interaction of the drug with alcohol.

Lisinopril - an ACE inhibitor, reduces the formation of angiotensin 2 from angiotensin 1. Reducing angiotensin 2 leads to a direct decrease in the release of aldosterone. Reduces the degradation of bradykinin and increases the synthesis of prostaglandins. Reduces the overall peripheral vascular resistance, arterial pressure (BP), preload, pressure in the pulmonary capillaries, causes an increase in the minute volume of blood and increased tolerance of the myocardium to loads in patients with chronic heart failure. Expands arteries more than veins. Some effects are explained by the effect on tissue renin-angiotensin systems. With prolonged use, myocardial hypertrophy and the walls of arteries of resistive type decrease. Improves the blood supply of the ischemic myocardium.

ACE inhibitors prolong life expectancy in patients with chronic heart failure, slow the progression of left ventricular dysfunction in patients who underwent myocardial infarction without clinical manifestations of heart failure. The antihypertensive effect begins approximately 6 hours later and persists for 24 hours.The duration of the effect also depends on the size of the dose. The onset of action is after 1 hour. The maximum effect is determined after 6-7 hours. With arterial hypertension, the effect is observed in the first days after the start of treatment, stable effect develops in 1-2 months.

With a sharp withdrawal of the drug, no pronounced increase in blood pressure was observed.

In addition to reducing blood pressure, lisinopril reduces albuminuria. In patients with hyperglycemia contributes to the normalization of the function of the damaged glomerular endothelium.

Lizinopril does not affect the concentration of glucose in the blood in patients with diabetes mellitus and does not increase the incidence of hypoglycemia.

Composition

Lizinopril (in the form of dihydrate) + auxiliary substances.

Pharmacokinetics

After taking the drug inside about 25% of lisinopril is absorbed from the digestive tract. Eating does not affect the absorption of the drug. Almost does not bind to blood plasma proteins. Permeability through the blood-brain and placental barrier is low. Lizinopril is not biotransformed in the body. It is excreted by the kidneys unchanged.

Indications

• arterial hypertension (in monotherapy or in combination with other antihypertensive agents);
• chronic heart failure (as part of combination therapy to treat patients taking foxglove preparations and / or diuretics);
• early treatment of acute myocardial infarction (within the first 24 hours with stable hemodynamic parameters to maintain these parameters and prevention of left ventricular dysfunction and heart failure);
• diabetic nephropathy (decreased albuminuria in insulin-dependent patients with normal blood pressure and non-insulin-dependent patients with hypertension).

Forms of release

Tablets 2.5 mg, 5 mg, 10 mg, 20 mg.

Instructions for use and dosage

Inside, regardless of food intake. With arterial hypertension, patients who do not receive other antihypertensives are prescribed 5 mg once a day. In the absence of effect, the dose is increased every 2-3 days by 5 mg to an average therapeutic dose of 20-40 mg per day (increasing the dose above 40 mg per day does not usually 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 in 2-4 weeks from the start of treatment, which should be taken into account when increasing the dose. With insufficient clinical effect, it is possible to combine the drug with other antihypertensive drugs.

If the patient received a preliminary treatment with diuretics, the use of these drugs should be stopped 2-3 days before the start of the use of lisinopril. If this is not feasible, the initial dose of lisinopril should not exceed 5 mg per day. In this case, after taking the first dose, medical supervision is recommended for several hours (the maximum effect is achieved after about 6 hours), since there may be a pronounced decrease in blood pressure.

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

With persistent arterial hypertension, prolonged maintenance therapy of 10-15 mg per day is indicated.

In chronic heart failure - begin with 2.5 mg 1 time per day, followed by an increase in the dose of 2.5 mg 3-5 days before the usual, maintaining a daily dose of 5-20 mg. The dose should not exceed 20 mg per day.

In elderly people, a more pronounced prolonged hypotensive effect is often observed, which is associated with a decrease in the rate of excretion of lisinopril (it is recommended to start treatment with 2.5 mg per 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. In patients with acute myocardial infarction, the drug should be applied for at least 6 weeks. At the beginning of treatment or within the first 3 days after an acute myocardial infarction in patients with low systolic BP (120 mm Hg or lower), a smaller dose of 2.5 mg should be given. In the case of a decrease in blood pressure (systolic blood pressure is below or equal to 100 mm Hg), a daily dose of 5 mg can, if necessary, temporarily reduce to 2.5 mg. In the case of a long pronounced decrease in blood pressure (systolic blood pressure below 90 mm Hg for more than 1 hour), treatment with lisinopril should be discontinued.

Diabetic Nephropathy

In patients with insulin-dependent diabetes mellitus, 10 mg of lisinopril is administered once a day. The dose may, if necessary, be increased to 20 mg once a day in order to achieve diastolic blood pressure values ​​below 75 mmHg. in the sitting position.In patients with insulin-dependent diabetes mellitus, the dosage is the same, in order to achieve diastolic blood pressure values ​​below 90 mm Hg. in the sitting position.

Side effect

• dizziness;
• headache;
• weakness;
• diarrhea;
• dry cough;
• nausea, vomiting;
• skin rash;
• chest pain;
• angioedema (face, lips, tongue, larynx or epiglottis, upper and lower extremities);
• marked decrease in blood pressure;
• orthostatic hypotension;
• impaired renal function;
• heart rhythm disturbances;
• cardiopalmus;
• increased fatigue;
• drowsiness;
• convulsive twitching of the muscles of the limbs and lips;
• leukopenia, neutropenia, agranulocytosis, thrombocytopenia;
• palpitation;
• tachycardia;
• myocardial infarction;
• cerebrovascular stroke in patients with an increased risk of the disease, due to a marked decrease in blood pressure;
• dry mouth;
• anorexia;
• dyspepsia;
• changes in taste;
• stomach ache;
• hives;
• increased sweating;
• itching;
• alopecia;
• impaired renal function;
• oliguria;
• anuria;
• acute renal insufficiency;
• asthenic syndrome;
• mood lability;
• confusion of consciousness;
• decreased potency;
• myalgia;
• fever;
• impaired development of the fetus.

Contraindications

• angioedema in the anamnesis, incl. and on the use of ACE inhibitors;
• hereditary angioedema;
• age under 18 years (effectiveness and safety not established);
• increased sensitivity to lisinopril or other ACE inhibitors.

Application in pregnancy and lactation

The use of lisinopril during pregnancy is contraindicated. When establishing a pregnancy, the drug should be stopped as soon as possible. Admission of ACE inhibitors in the 2nd and 3rd trimester of pregnancy has an adverse effect on the fetus (there may be a marked decrease in blood pressure, renal failure, hyperkalemia, skull hypoplasia, fetal death). Data on the negative effects of the drug on the fetus in case of application during the first trimester are not available. For newborns and infants who have undergone intrauterine exposure to ACE inhibitors, careful monitoring is recommended to timely detect a marked decrease in blood pressure, oliguria, and hyperkalemia.

Lizinopril penetrates the placenta. There is no data on the penetration of lisinopril into the breastmilk. For the period of treatment the drug should be abolished breastfeeding.

special instructions

Symptomatic hypotension

Most often, a marked decrease in blood pressure occurs with a decrease in the volume of fluid caused by diuretic therapy, a decrease in the amount of salt in the diet, dialysis, diarrhea, or vomiting. In patients with chronic heart failure with simultaneous renal insufficiency or without it, a marked decrease in blood pressure is possible. It is more often detected in patients with a severe stage of chronic heart failure, as a result of the use of large doses of diuretics, hyponatremia or impaired renal function. In such patients, treatment with lisinopril should be started under the strict supervision of a doctor (with care to select a dose of the drug and diuretics).

Similar rules should be adhered to when assigning patients with coronary heart disease, cerebrovascular insufficiency, in which a sharp decrease in blood pressure can lead to myocardial infarction or stroke.

Transient hypotensive reaction is not a contraindication for taking the next dose of the drug.

With the use of lisinopril in some patients with chronic heart failure, but with normal or low blood pressure, there may be a decrease in blood pressure,which is usually not the reason for discontinuing treatment.

Before starting treatment with lisinopril, if possible, normalize the sodium concentration and / or replace lost fluid, carefully monitor the effect of the initial dose of lisinopril on the patient.

In the case of stenosis of the renal artery (especially with bilateral stenosis, or in the presence of stenosis of the artery of a single kidney), as well as inadequate circulation due to lack of sodium and / or liquid, the use of lisinopril can lead to impaired renal function, acute renal failure, which usually is irreversible after drug discontinuation.

With acute myocardial infarction

The use of standard therapy (thrombolytics, acetylsalicylic acid, beta-adrenoblockers) is shown. Lizinopril can be used together with intravenous administration or with the use of therapeutic transdermal systems of nitroglycerin.

Surgery / general anesthesia

With extensive surgical interventions, as well as with the use of other drugs that cause a decrease in blood pressure, lisinopril, blocking the formation of angiotensin 2, can cause a pronounced unpredictable decrease in blood pressure.

In elderly patients, the same dose leads to a higher concentration of the drug in the blood, therefore special caution is required when determining the dose.

Because the potential risk of agranulocytosis can not be ruled out, periodic monitoring of the blood picture is required. When the drug is used in dialysis with a polyacryl-nitrile membrane, anaphylactic shock can occur, so either a different type of dialysis membrane or other antihypertensive agents is recommended.

Impact on the ability to manage vehicles and mechanisms

There is no data on the effect of lisinopril on the ability to drive vehicles and mechanisms, applied in therapeutic doses, but it must be borne in mind that dizziness may occur, therefore, care must be taken.

Drug Interactions

Lizinopril reduces the excretion of potassium from the body when treated with diuretics.

Special care is required when using the drug simultaneously with:

• potassium-sparing diuretics (spironolactone, triamterene, amiloride), potassium, substitutes for table salt,(the risk of developing hyperkalemia increases, especially with impaired renal function), so they can be jointly administered only on the basis of an individual decision of the treating physician with regular monitoring of the potassium level in the blood serum and kidney function.

Use with caution:

• with diuretics: with the additional administration of a diuretic, the patient receiving lisinopril usually has an additive antihypertensive effect - the risk of a marked decrease in blood pressure;
• with other antihypertensive agents (additive effect);
• with non-steroidal anti-inflammatory drugs (NSAIDs) (indomethacin, etc.), estrogens, as well as adrenostimulators - a decrease in the antihypertensive effect of lisinopril;
• with lithium (liberation of lithium may decrease, therefore, the concentration of lithium in serum should be monitored regularly);
• with antacids and colestyramine - reduce absorption in the digestive tract.

Alcohol enhances the effect of the drug.

Analogues of Lizinopril

Structural analogs for the active substance:

• Dapril;
• Diropress;
• Diroton;
• Irumed;
• Lysacard;
• Lizigamma;
• Lysinopril Grindeks;
• Lysinopril Organic;
• Lysinopril Pfizer;
• Lizinopril Stade;
• Lysinopril OBL;
• Lysinopril Teva;
• Lysinopril dihydrate;
• Lysinoton;
• Lisonorm;
• Lysoril;
• Listril;
• Liten;
• Assigned;
• Rileys Sanovel;
• Sinopril.

In combination with hydrochlorothiazide:

• Zoniksem ND;
• Zonix NL;
• Isuzid;
• Co-Diroton;
• Lysinopril H;
• Lysinoton H;
• The Lizorethic;
• Listril Plus;
• Liten N;
• Rileys Sanovel Plus;
• Skopril is a plus.

In combination with amlodipine:

• Ecquard;
• Equator.

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