Co-Dyroton pills 10 mg + 12.5 mg 30 pcs
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Active ingredients
Lisinopril + Hydrochlorothiazide
Release form
Pills
Composition
Lisinopril dihydrate 10.89 mg, which corresponds to the content of lisinopril 10 mg hydrochlorothiazide 12.5 mg adjuvants: mannitol - 50 mg, aluminum lacquer based on indigotin dye (e132) - 0.2 mg, pregelatinized starch - 2.25 mg, corn starch - 31 mg, hydrophilophenophylamine; mg, starch partially pregelatinized - 2.25 mg, magnesium stearate - 5 mg.
Pharmacological effect
Antihypertensive drug. It has an antihypertensive and diuretic effect. Lysinopril is an ACE inhibitor, reduces the formation of angiotensin II from angiotensin I. A decrease in the content of angiotensin II leads to a direct decrease in the release of aldosterone. Reduces the degradation of bradykinin and increases prostaglandin synthesis. Reduces the OPSS, blood pressure, preload, pressure in the pulmonary capillaries, causes an increase in the minute volume of blood and increased tolerance to stress in patients with chronic heart failure. Expands arteries to a greater extent than veins. Some effects are attributed to effects on tissue renin-angiotensin systems. With prolonged use decreases the severity of myocardial hypertrophy and the walls of resistive-type arteries. It improves blood supply to the ischemic myocardium. ACE inhibitors prolong life expectancy in patients with chronic heart failure, slow down the progression of left ventricular dysfunction in patients who have had a myocardial infarction without clinical manifestations of heart failure. The antihypertensive effect begins after about 6 hours and lasts for 24 hours. The duration of the effect also depends on the dose. Onset of action - after 1 h. 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, a stable action develops after 1-2 months. With a sharp withdrawal of the drug, there is no pronounced increase in blood pressure. lisinopril reduces albuminuria. In patients with hyperglycemia, it helps normalize the function of the damaged glomerular endothelium. Lysinopril does not affect the concentration of glucose in the blood of patients with diabetes mellitus and does not lead to an increase in hypoglycemia. , water in the distal nephron; delays the excretion of calcium ions,uric acid. It has antihypertensive properties; hypotensive effect develops due to the expansion of arterioles. Practically does not affect the normal level of blood pressure. The diuretic effect develops after 1-2 hours, reaches a maximum after 4 hours and lasts for 6-12 hours. The antihypertensive effect occurs after 3-4 days, but it may take 3 to achieve the optimal therapeutic effect. - 4 weeks. Lizinopril and hydrochlorothiazide, if used simultaneously, have an additive antihypertensive effect.
Pharmacokinetics
Lisinopril. After taking lisinopril orally, Cmax in serum is reached after 7 hours. It is poorly bound to plasma proteins. The average degree of absorption of lisinopril is about 25%, with significant interindividual variability (6-60%). Food does not affect lysinopril absorption. Lisinopril is not metabolized and is excreted unchanged exclusively by the kidneys. After repeated administration, the effective T1 / 2 of lisinopril is 12 h. Impaired renal function slows down the excretion of lisinopril, but this slowdown becomes clinically significant only when the glomerular filtration rate decreases below 30 ml / min. Elderly patients have an average of 2 times higher level of the maximum concentration of the drug in the blood and AUC, compared with patients of younger age. Lisinopril is eliminated from the body by hemodialysis. It penetrates to a small extent through BBB. Hydrochlorothiazide is not metabolized, but undergoes rapid excretion through the kidneys. T1 / 2 of the drug ranges from 5.6 to 14.8 hours. At least 61% of the drug taken inside is excreted unchanged for 24 hours. Hydrochlorothiazide penetrates the placental barrier, but does not penetrate the BBB.
Indications
- arterial hypertension (in patients for whom combination therapy is indicated).
Contraindications
- angioedema (including angioedema in history, associated with the use of ACE inhibitors); - anuria; - severe renal failure (CC less than 30 ml / min); - hemodialysis using high-flow membranes; - hypercalcemia; - porphyria; - precoma; - hepatic coma; - severe forms of diabetes; - age up to 18 years (efficacy and safety not established); - hypersensitivity to lisinopril, other ACE inhibitors or hydrochlorothiazide and auxiliary substances. hip rtroficheskaya cardiomyopathy,bilateral renal artery stenosis, arterial stenosis of a single kidney with progressive azotemia, condition after kidney transplantation, renal failure (CC more than 30 ml / min), primary hyperaldosteronism, arterial hypotension, bone marrow hypoplasia, hyponatremia (increased risk of arterial hypotension in patients on a low-salt or salt-free diet), hypovolemic states (including diarrhea, vomiting), connective tissue diseases (including systemic lupus erythematosus, scleroderma), diabetes mellitus beta, gout, oppression of bone marrow hematopoiesis, hyperuricemia, hyperkalemia, ischemic heart disease, cerebrovascular diseases (including cerebrovascular insufficiency), severe chronic heart failure, liver failure, old age.
Precautionary measures
During treatment, psoriasis may worsen. During pheochromocytoma, propranolol can only be used after taking an alpha blocker. After a long course of treatment, propranolol should be discontinued gradually, under the supervision of a physician. during anesthesia, you must stop taking propranolol or find a remedy for anesthesia with minimal negative inotropic effects. The impact on the ability to drive vehicles and control mechanisms of patients whose activities require increased attention, the question of the use of propranolol on an outpatient basis should be addressed only after evaluating the individual response of the patient.
Use during pregnancy and lactation
The use of lisinopril during pregnancy is contraindicated. When establishing pregnancy, the drug should be stopped as soon as possible. Acceptance of ACE inhibitors in the II and III trimesters of pregnancy has an adverse effect on the fetus (pronounced reduction in blood pressure, renal failure, hyperkalemia, hypoplasia of the skull bones, fetal death) are possible. Data on the negative effects of the drug on the fetus in the case of use in the first trimester is not. For newborns and infants who have undergone intrauterine effects of ACE inhibitors, it is recommended to monitor for the timely detection of pronounced reduction in blood pressure, oliguria, hyperkalemia. During the period of drug treatment, breastfeeding should be canceled.
Dosage and administration
Assign inside of 1 tab. 1 time / dayIf within 2-4 weeks the proper therapeutic effect is not achieved, the dose of the drug can be increased to 2 tab. 1 time / day. In patients with CC 30-80 ml / min, the drug can be used only after selecting the dose of individual components of the drug. The recommended initial dose of lisinopril for uncomplicated renal failure is 5-10 mg. Symptomatic arterial hypotension may occur after taking the initial dose of the drug. Such cases are more common in patients who have had a loss of fluid and electrolytes due to previous treatment with diuretics. Therefore, you should stop taking diuretics 2-3 days before the start of treatment with the drug.
Side effects
The most common side effects are: dizziness, headache. For the cardiovascular system: marked reduction in blood pressure, chest pain; rarely - orthostatic hypotension, tachycardia, bradycardia, the appearance of symptoms of heart failure, impaired AV conduction, myocardial infarction. On the digestive system: nausea, vomiting, abdominal pain, dry mouth, diarrhea, dyspepsia, anorexia, taste change, pancreatitis hepatitis (hepatocellular and cholestatic), jaundice. For skin: urticaria, increased sweating, photosensitization, pruritus, hair loss. For CNS: mood lability, impaired concentration, paresthesia and fatigue, somnolence, jerking of the limbs and lips; rarely - asthenic syndrome, confusion. From the respiratory system: dyspnea, dry cough, bronchospasm, apnea. swelling of the face, extremities, lips, tongue, epiglottis and / or larynx, skin rashes, itching, fever, vasculitis, positive reactions to antinuclear antibodies, increased ESR, eosinophilia. From the urogenital side Stema: uremia, oliguria / anuria, impaired renal function, acute renal failure, reduced potency. Laboratory parameters: hyperkalemia and / or hypokalemia, hyponatremia, hypomagnemia, hypochloremia, hypercalcemia,hyperuricemia, hyperglycemia, elevated plasma urea and creatinine levels, hyperbilirubinemia, hypercholesterolemia, hypertriglyceridemia, decreased glucose tolerance, increased hepatic transaminase activity, especially when there is a history of kidney problems, i have i'm not applied to ipodices, i have i'm not using i have, i am using i'm not using i have, i'm not using i have, i'm not using i'm, i am using heart, i have i'm not using i have, i am using heart, i'm not disabled i have, i am disabled, i have i'm not using i have, i am using heart, i have i'm not using i have, i am using heart patterns, kidney, i rd line, i'm not using i have, i am using i have, i am disabled, i am disabled, i have not i have i’m using i have, i am using heart, i have i'm not using i have, i am wearing heart, i'm not i , fever, impaired fetal development, aggravation of gout.
Overdose
Symptoms: marked reduction in blood pressure, dry mouth, drowsiness, urinary retention, constipation, anxiety, irritability. Treatment: symptomatic therapy, IV fluids, blood pressure control; therapy aimed at correcting dehydration and disorders of water-salt balance. Control of urea, creatinine and electrolytes in the serum, as well as diuresis.
Interaction with other drugs
When applied simultaneously with potassium-sparing diuretics (spironolactone, triamterene, amiloride), potassium preparations, salt substitutes containing potassium, the risk of hyperkalemia increases, especially in patients with impaired renal function. Therefore, they can be jointly prescribed only on the basis of an individual physician's decision with regular monitoring of serum potassium and kidney function. When used simultaneously with vasodilators, barbiturates, phenothiazines, tricyclic antidepressants, ethanol, an increase in antihypertensive effect is noted. Others), estrogen has a decrease in the antihypertensive effect of lisinopril. With simultaneous use with lithium preparations, lithium is slowed down. from the body (enhancing the cardiotoxic and neurotoxic effects of lithium). When used simultaneously with antacids and Kolestiramin, absorption in the gastrointestinal tract is reduced. glycosides, the effect of peripheral muscle relaxants, reduces the excretion of quinidine. Reduces the effect of oral contraceptives. Ethanol increases g potenzivny effect Preparata.pri same time taking methyldopa increased risk of hemolysis.
special instructions
Most often, a pronounced decrease in blood pressure occurs with a decrease in fluid volume caused by diuretic therapy, a decrease in the amount of salt in food, dialysis, diarrhea or vomiting. In patients with chronic heart failure with or without simultaneous renal insufficiency, blood pressure may be pronounced. It is more often detected in patients with a severe class of chronic heart failure, as a result of the use of large doses of diuretics, hyponatremia or impaired renal function. In such patients, treatment should begin under the strict supervision of a physician. Similar rules should be followed when prescribing IHD patients, cerebrovascular insufficiency, in which a sharp decrease in blood pressure can lead to myocardial infarction or stroke. fluid volume, carefully control the effect of the initial dose of the drug on the patient. In patients with chronic heart failure, a marked decrease Blood pressure after the start of treatment with ACE inhibitors can further worsen renal function. Cases of acute renal failure were noted. In patients with bilateral renal artery stenosis or arterial stenosis of a single kidney who received ACE inhibitors, there was an increase in serum urea and creatinine, usually reversible after stopping treatment. It was more common in patients with renal failure. Angioedema of the face, extremities, lips, tongue, epiglottis and / or larynx was rarely observed in patients treated with ACE inhibitors, including lisinopril, which can occur during any period of treatment. In this case, treatment with lisinopril should be stopped as soon as possible and patients should be monitored until symptoms are fully regressed. In cases where there is swelling of the face and lips, the condition most often passes without treatment, however, it is possible to prescribe antihistamines. Angioedema with laryngeal edema can be fatal. When a tongue, epiglottis or larynx is covered, an airway obstruction may occur,therefore, it is necessary to immediately carry out the appropriate therapy (0.3-0.5 ml of epinephrine (adrenaline) solution 1: 1000 n / a) and / or measures to ensure the airway patency. In patients who already had angioedema in the anamnesis that was not associated with the previous treatment ACE inhibitors, the risk of its development during treatment with an ACE inhibitor may be increased. When using an ACE inhibitor, cough was noted. The cough is dry, long-lasting, which disappears after stopping treatment with an ACE inhibitor. In the differential diagnosis of cough, cough caused by the use of an ACE inhibitor should also be taken into account. Anaphylactic reaction was also observed in patients subjected to hemodialysis using dialysis membranes with high permeability (AN69), which also take ACE inhibitors. In such cases, it is necessary to consider the possibility of using another type of membrane for dialysis or another antihypertensive agent. When using drugs that reduce blood pressure in patients with extensive surgical intervention or during general anesthesia, lisinopril can block the formation of angiotensin II. mechanism, can be eliminated by an increase in the BCC. Before surgery (including dentistry) it is necessary to warn the anesthesiologist about the use of an inhibitor APF.V some cases, there is hyperkalemia. Risk factors for the development of hyperkalemia include renal failure, diabetes mellitus, taking potassium drugs or drugs that increase the concentration of potassium in the blood (for example, heparin), especially in patients with impaired renal function. In patients who have a risk of symptomatic hypotension (located on low salt or salt-free diet) with or without hyponatremia, as well as in patients who received high doses of diuretics, the above conditions must be compensated before starting treatment (loss of fluid and and salts thereof) .Tiazidnye diuretics may affect glucose tolerance, therefore, necessary to adjust the dose of hypoglycemic agents for oral administration. Thiazide diuretics can reduce calcium excretion by the kidneys and cause hypercalcemia. Severe hypercalcemia can be a symptom of latent hyperparathyroidism.It is recommended to discontinue treatment with thiazide diuretics before conducting a test to assess the function of the parathyroid glands. During the period of drug treatment, regular monitoring of plasma potassium, glucose, urea, lipids is necessary. ethanol enhances the hypotensive effect of the drug. Caution should be exercised when performing physical exercises, hot weather (risk of dehydration and excessive blood pressure reduction due to lower BCC). Impact on the ability to drive vehicles and control mechanisms hazardous activities that require increased concentration and psychomotor speed, because dizziness is possible, especially at the beginning of the course of treatment.