Capoten pills 25 mg 40 pcs
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Active ingredients
Captopril
Release form
Pills
Composition
Active ingredient: Captopril (Captopril) Active ingredient concentration (mg): 25
Pharmacological effect
ACE inhibitor. Suppresses the formation of angiotensin II and eliminates its vasoconstrictor effect on arterial and venous vessels. Reduces the round neck, afterload, lowers blood pressure. Reduces preload, reduces pressure in the right atrium and the pulmonary circulation. Reduces the release of aldosterone in the adrenal glands. The maximum hypotensive effect is observed within 60-90 minutes after ingestion. The degree of reduction in blood pressure is the same in the position of the patient standing and lying. The efficacy and safety of captopril in children have not been established. The literature describes limited experience with captopril in children. Children, especially newborns, may be more likely to develop hemodynamic side effects. There have been cases of excessive, prolonged and unpredictable increases in blood pressure, as well as associated complications, including oliguria and seizures.
Pharmacokinetics
Absorption When ingested, it is rapidly absorbed from the gastrointestinal tract. Cmax in plasma is reached approximately 1 hour after administration. Bioavailability of captopril is 60-70%. Simultaneous food intake slows down the absorption of the drug by 30-40%. Distribution Binding to blood proteins is 25-30%. Excretion of T1 / 2 is 2-3 hours. The drug is excreted from the body mainly in the urine, up to 50% in unchanged form, the rest - as metabolites.
Indications
- arterial hypertension (as monotherapy and in combination with other antihypertensive drugs, for example, with thiazide diuretics); - chronic heart failure (as part of combination therapy); - ischemic heart disease (left ventricular dysfunction after myocardial infarction in patients in stable clinical condition) - diabetic nephropathy (microalbuminuria> 30 mg / day) in insulin-dependent diabetes mellitus.
Contraindications
- Quincke edema (hereditary or associated with the use of ACE inhibitors in history); severe renal dysfunction; severe liver dysfunction; hyperkalemia; bilateral renal artery stenosis or arterial stenosis of the only kidney with progressive azotemia; kidney transplantation; - Aortic stenosis and similar obstructive changes,impeding the outflow of blood from the left ventricle; - pregnancy; - lactation period (breastfeeding); - hypersensitivity to the drug and other ACE inhibitors.
Precautionary measures
Do not exceed the recommended dose. With caution, you should prescribe the drug for severe autoimmune diseases of the connective tissue (including SLE, scleroderma); oppression of bone marrow hematopoiesis (risk of developing neutropenia and agranulocytosis); cerebral ischemia; diabetes mellitus (increased risk of hyperkalemia); primary hyperaldosteronism; CHD; conditions accompanied by a decrease in BCC (including vomiting, diarrhea); hypotension; impaired renal and / or liver function; chronic heart failure; performing surgery / general anesthesia; patients on hemodialysis; patients on a sodium restricted diet; when conducting hemodialysis using high-strength membranes (for example, AN69), desensitizing therapy, LDL apheresis; simultaneous use of potassium-sparing diuretics, potassium preparations, potassium-containing substitutes, lithium preparations, immunosuppressants, allopurinol, procainamide (risk of developing neutropenia, agranulocytosis); elderly patients (dose adjustment required); Negroid patients.
Use during pregnancy and lactation
Use of the drug Capoten is contraindicated in pregnancy. The drug Capoten should not be used in the first trimester of pregnancy. Appropriate controlled studies of the use of ACE inhibitors in pregnant women have not been conducted. The limited data available on the effects of the drug in the first trimester of pregnancy indicate that the use of ACE inhibitors does not lead to fetal developmental defects associated with fetotoxicity. Epidemiological data indicating the risk of teratogenicity after exposure to ACE inhibitors in the first trimester of pregnancy were not convincing, but a slight increase in risk cannot be ruled out. If the use of an ACE inhibitor is deemed necessary, patients planning a pregnancy should be transferred to alternative anti-hypertensive therapy, which has an established safety profile for use in pregnancy.that long-term effects of ACE inhibitors on the fetus in the second and third trimesters of pregnancy can lead to impaired development (reduced kidney function, oligohydramnios, slowing down ossification of the skull bones) and the development of complications in the newborn (such as renal failure, arterial hypotension, hyperkalemia). If the patient received Capoten in the II and III trimesters of pregnancy, it is recommended to conduct an ultrasound to assess the state of the bones of the skull and kidney function of the fetus. The use of ACE inhibitors during pregnancy can cause developmental disorders (including arterial hypotension, neonatal hypoplasia of the skull bones, anuria, reversible or irreversible renal failure) and fetal death. When establishing the fact of pregnancy, the use of the drug Capoten should be stopped as soon as possible. Approximately 1% of the dose of captopril found in breast milk. In connection with the risk of serious adverse reactions in the child, breastfeeding should be stopped or therapy with the drug Capoten in the mother should be discontinued for the period of breastfeeding.
Dosage and administration
Doses of Capoten should be selected by a doctor. Inside, one hour before meals, 25-50 mg 2-3 times a day (but not more than 450 mg per day), for children the initial dose is 0.15-0.3 mg / kg (but not more than 6 mg / kg per day).
Side effects
On the part of the cardiovascular system: orthostatic hypotension, tachycardia, peripheral edema, lowering blood pressure. On the part of the respiratory system: dry cough, usually passing after drug withdrawal, bronchospasm, pulmonary edema. Allergic reactions: angioedema of the extremities, face, lips, mucous membranes of the membranes, tongue, pharynx and larynx. From the side of the central nervous system: headache, dizziness, ataxia, paresthesia, drowsiness, visual disturbances. From the side of water and electrolyte metabolism: hyperkalemia, gi onatremia, proteinuria, elevated urea nitrogen and creatinine in the blood, acidosis. From the hematopoietic organs: neutropenia, agranulocytosis, thrombocytopenia, anemia, a positive test for antibodies to the nuclear antigen (rarely). From the digestive system: a violation of taste, dry mouth , stomatitis, gingival hyperplasia, increased activity of liver enzymes, abdominal pain, diarrhea, hepatitis, hyperbilirubinemia.
Overdose
Symptoms: a sharp decrease in blood pressure, shock, stupor, bradycardia, impaired water and electrolyte balance, renal failure. Treatment: gastric lavage, the introduction of adsorbents and sodium sulfate for 30 minutes after taking the drug, the introduction of 0.9% sodium chloride solution or other plasma-substituting drugs ( pre-patient should be transferred to a horizontal position with a low head, then carry out activities to fill the BCC), hemodialysis. For bradycardia or severe vagal reactions, atropine is administered. The use of an artificial pacemaker may be considered. Peritoneal dialysis is ineffective for removing captopril from the body.
Interaction with other drugs
In patients taking diuretics, Capoten may potentiate the hypotensive effect. A similar restriction on the use of table salt (salt-free diets) and hemodialysis also have a similar effect. Usually, an excessive decrease in blood pressure occurs within the first hour after taking the first prescribed dose of Capoten. Vasodilators (for example, nitroglycerin) in combination with Capoten should be used in the lowest effective doses because of the risk of an excessive decrease in blood pressure. Care should be taken when using the drug Capoten ( with or without diuretic) and drugs that affect the sympathetic nervous system (for example, ganglioblokatory, alpha-blockers). When used together Capoten and indomethacin (and, possibly, other NSAIDs, for example, acetylsalicylic acid), there may be a decrease in the hypotensive effect, especially in hypertension, accompanied by low renin activity. In patients with risk factors (advanced age, hypovolemia, simultaneous use of diuretics, impaired kidney function), simultaneous use of NSAIDs (including COX-2 inhibitors) and ACE inhibitors (including captopril) can lead to deterioration of renal function, up to acute renal failure. Kidney damage is usually reversible in such cases. Kidney function should be periodically checked in patients taking Capoten and NPVS. When therapy is administered with Capoten, potassium-saving diuretics (for example, triamterene, spironolactone, amiloride), potassium preparations, potassium supplements, salt substitutes (contain significant amounts of potassium ions) should be prescribed only when proven hypokalemia, becausetheir use increases the risk of hyperkalemia. With the simultaneous use of ACE inhibitors (especially in combination with diuretics) and lithium preparations, an increase in the lithium content in the blood serum, and, consequently, the toxicity of lithium preparations is possible. Serum lithium levels should be determined periodically. If insulin and hypoglycemic agents for oral administration are used at the same time, such as sulfonylurea derivatives, with ACE inhibitors, including Capoten, an excessive decrease in blood glucose concentration is possible. It is necessary to control the concentration of glucose in the blood at the start of therapy with Capoten and, if necessary, adjust the dose of the hypoglycemic drug. arterial hypotension, hyperkalemia, reduced kidney function (including acute renal failure). Use of the drug K potentials in patients receiving allopurinol or procainamide, increases the risk of neutropenia and / or syndrome Stevens-Dzhonsona.Primenenie Capoten drug in patients receiving immunosuppressive agents (eg azathioprine or tsiklofosfatsin), increases the risk of hematological disorders.
special instructions
Before starting, as well as regularly in the process of treatment with the drug Capoten should monitor renal function. In patients with chronic heart failure, Capoten should be used under close medical supervision. When using ACE inhibitors, a characteristic nonproductive cough is observed, which stops after discontinuation of therapy with ACE inhibitors. In rare cases, when ACE inhibitors are used, sometimes fatal. The mechanism of development of this syndrome is unknown. If a patient receiving therapy with ACE inhibitors develops jaundice or there is a marked increase in liver enzyme activity, discontinue treatment with ACE inhibitors and establish patient monitoring. In some patients with kidney disease,especially with severe stenosis of the renal artery, an increase in the concentrations of urea nitrogen and serum creatinine after a decrease in blood pressure is observed. This increase is usually reversible after discontinuation of therapy with Kapoten. In these cases, it may be necessary to reduce the dose of the drug Capoten and / or cancel the diuretic. Against the background of long-term use of the drug Capoten, an increase in the concentration of urea and serum creatinine by more than 20% is observed in approximately 20% of patients compared to normal or baseline. Less than 5% of patients, especially with severe nephropathies, require discontinuation of treatment due to an increase in creatinine concentration. It is not recommended to use a double blockade of RAAS caused by the simultaneous use of ACE inhibitors and angiotensin II or aliskiren receptor antagonists and aliskiren-containing drugs, since it was associated with elevated the incidence of side effects such as hypotension, hyperkalemia, reduced kidney function (including acute renal failure). If simultaneous use of ACE inhibitors and angiotensin II receptor antagonists (double blockade of RAAS) is necessary, treatment should be carried out under the supervision of a physician and with the ongoing monitoring of kidney function, electrolytes in the blood, and AD. Combined use of inhibitors and receptor antagonists is not recommended. angiotensin II in patients with diabetic nephropathy. In patients with arterial hypertension, when using the drug Capoten, severe arterial hypotension is observed only in p. dkih cases; the likelihood of developing this condition increases with increased loss of fluid and salt (for example, after intensive diuretic treatment), in patients with heart failure or being on dialysis. The possibility of a sharp decrease in blood pressure can be minimized with prior cancellation (4-7 days) of a diuretic or an increase in sodium chloride intake (about a week before the start of treatment), or by administering the drug Capoten at the beginning of treatment at low doses (6.25-12.5 mg / day). With caution, the drug is prescribed to patients on a low sodium or salt-free diet (an increased risk of developing hypotension and hyperkalemia). An excessive decrease in blood pressure may occur in patients during major surgical procedures. eractions, as well as the use of anesthetics with hypotensive effect.In such cases, measures to increase BCC are used to correct reduced blood pressure. Excessive blood pressure reduction due to the use of antihypertensive drugs may increase the risk of myocardial infarction or stroke in patients with IHD or vascular diseases of the brain. With the development of arterial hypotension patient should be transferred to a horizontal position with a low head. May require i.v. administration of a 0.9% sodium chloride solution. Care should be taken when using ACE inhibitors in patients with mitral / aortic stenosis / hypertrophic obstructive cardiomyopathy; in the case of cardiogenic shock and hemodynamically significant obstruction, the use of the drug is not recommended. Patients taking ACE inhibitors had neutropenia / agranulocytosis, thrombocytopenia and anemia. In patients with normal renal function and in the absence of other disorders, neutropenia is rare. In renal failure, simultaneous use of the drug Capoten and allopurinol resulted in neutropenia. The drug Capoten should be used very carefully in patients with autoimmune diseases of the connective tissue, in receiving immunosuppressants, allopurinol and procainamide, especially in the presence of previously existing kidney function disorders. Due to the fact that the majority of lethal cases of neutropenia against the background of the use of ACE inhibitors developed in these patients, they should be monitored for the number of blood leukocytes before starting treatment, for the first 3 months every 2 weeks, then every 2 months. All patients should monthly monitor the number of leukocytes in the blood in the first 3 months after the start of therapy with the drug Capoten, then every 2 months. If the number of leukocytes is below 4000 / µl, repeated blood count is shown, below 1000 / µl - the drug is discontinued, continuing to monitor the patient. Usually, the number of neutrophils is restored within 2 weeks after discontinuation of the drug Capoten. In 13% of cases of neutropenia, death was noted. In almost all cases, the death of neutropenia was noted in patients with connective tissue diseases, renal or heart failure, while receiving immunosuppressants or a combination of both of these factors. When using ACE inhibitors, proteinuria can occur, mainly in patients with impaired renal function, and when using the drug in high doses.In most cases, proteinuria with the use of the drug Capoten disappeared or its severity decreased within 6 months, regardless of whether the drug was stopped or not. Indicators of kidney function (blood urea nitrogen and creatinine concentrations) in patients with proteinuria were almost always within the normal range. In patients with kidney disease, the urine protein content should be determined before starting treatment and periodically throughout the course of therapy. In some cases, against the background of the use of ACE inhibitors, incl. drug Capoten, there is an increase in the content of potassium in the serum. The risk of developing hyperkalemia with the use of ACE inhibitors is increased in patients with renal insufficiency and diabetes mellitus, as well as receiving potassium-saving diuretics, potassium preparations or other drugs that cause an increase in the content of potassium in the blood (for example, heparin). The simultaneous use of potassium-sparing diuretics and potassium preparations should be avoided. In addition, when using ACE inhibitors simultaneously with thiazide diuretics, the risk of hypokalemia development is not excluded, therefore in such cases regular potassium in the blood should be monitored during therapy. When performing hemodialysis in patients receiving ACE inhibitors, use of a high permeability (for example, AN69), since in such cases the risk of anaphylactoid reactions increases. Anaphylactoid reactions were also observed in patients undergoing an apheresis procedure for LDL using dextran sulfate. Consideration should be given to the use of either antihypertensive drugs of another class or another type of dialysis membrane. In rare cases, during therapy with ACE inhibitors, life-threatening anaphylactoid reactions were noted in patients undergoing desensitization with hymenoptera (bees, wasps). In these patients, these reactions were prevented by temporarily discontinuing therapy with an ACE inhibitor. Special care should be taken in case of desensitization of such patients. In case of development of angioedema, the drug is canceled and careful medical monitoring is carried out until the symptoms disappear.Angioedema of the larynx can be fatal. If the edema is localized on the face, special treatment is usually not required (antihistamines can be used to reduce the severity of symptoms); If the edema spreads to the tongue, pharynx or larynx and there is a threat of airway obstruction, epinephrine (adrenaline) should be immediately administered (0.3-0.5 ml at a dilution of 1: 1000). In rare cases, patients after taking ACE inhibitors had angioedema of the intestines, which was accompanied by abdominal pain (with nausea and vomiting or without them), sometimes with normal values of C-1-esterase activity and without prior edema of the face. Intestinal edema should be included in the range of differential diagnosis of patients with complaints of abdominal pain when using ACE inhibitors. In representatives of the Negroid race, cases of angioedema edema were observed with a higher frequency compared with Caucasians. in Caucasian patients, which may be due to the higher prevalence of low renin activity in members of the Negroid race. Patients with sugar diabetics receiving hypoglycemic drugs (hypoglycemic agents for oral administration or insulin) should be carefully monitored for glycemia, especially during the first month of treatment with ACE inhibitors. When performing extensive surgical procedures or when applying general anesthesia drugs with hypotensive effect, in patients taking ACE inhibitors, there may be an excessive decrease in blood pressure. In these cases, the BCC can be increased. When using the drug Capoten, a false positive reaction may be observed when analyzing urine on acetone. Effect on the ability to drive motor vehicles and control mechanisms During the period of treatment, it is necessary to refrain from driving motor vehicles and engage in potentially hazardous activities that require increased concentration and speed psychomotor reactions, because dizziness may occur, especially after taking the initial dose.