Captopril Welfarm pills 50mg, 20pcs

Composition

Per tablet:

Active ingredient: captopril (in terms of dry matter) – 50.0 mg,

Excipients: lactose monohydrate (milk sugar), microcrystalline cellulose, magnesium stearate, talc, colloidal silicon dioxide (aerosil), crospovidone (collidone CL-M, collidone CL).

Pharmacological action

Pharmacotherapeutic group: angiotensin converting enzyme inhibitor (ACE inhibitor)

ATX code: C 09 AA 01

Pharmacological properties Pharmacodynamics

Angiotensin-converting enzyme (ACE) inhibitor of the first generation, containing a sulfhydryl group (SH-group). It has an antihypertensive effect.

By inhibiting ACE, it reduces the conversion of angiotensin I to angiotensin II and eliminates its vasoconstrictive effect on arterial and venous vessels. As a result of a decrease in the concentration of angiotensin II, a secondary increase in plasma renin activity occurs (due to the elimination of negative feedback during renin release), which leads to a direct decrease in the secretion of aldosterone by the adrenal cortex. At the same time, total peripheral vascular resistance (OPSS) and blood pressure (BP), resistance in the pulmonary vessels decrease, and post – and preload on the heart decreases. Increases the minute volume of the heart and exercise tolerance.

Dilates the arteries to a greater extent than the veins. Causes a decrease in bradykinin degradation (one of the effects of ACE) and an increase in prostaglandin synthesis.

The antihypertensive effect does not depend on the activity of blood plasma renin, a decrease in blood pressure is noted with normal and even reduced hormone activity, which is due to the effect on the tissue renin-angiotensin-aldosterone system (RAAS).

Increases coronary and renal blood flow. With prolonged use, it reduces the severity of myocardial hypertrophy and resistive arterial walls, prevents the progression of heart failure and slows down the development of left ventricular dilation.

Improves blood supply to the ischemic myocardium. Reduces platelet aggregation. Helps to reduce the content of sodium ions in patients with heart failure.

Reduces the tone of the glomerular arterioles of the kidneys, thereby improving intra-glomerular hemodynamics, and prevents the development of diabetic nephropathy. In doses of 50 mg / day, it exhibits angioprotective properties against the vessels of the microcirculatory bed and can slow down the progression of chronic renal failure in diabetic nephroangiopathy.

A decrease in blood pressure, unlike direct vasodilators (hydralazine, minoxidil, etc. ), is not accompanied by reflex tachycardia and leads to a decrease in myocardial oxygen demand. In case of heart failure, an adequate dose does not affect the value of blood pressure. The maximum decrease in blood pressure is observed 60-90 minutes after ingestion. The duration of the antihypertensive effect depends on the dose of the drug taken and reaches optimal values within a few weeks of therapy.

Withdrawal of captopril should not occur abruptly, as this can cause a significant increase in blood pressure.

Absorption – fast, is about 75% of the dose taken (when taken simultaneously with food, the absorption of the drug decreases by 30-40%), bioavailability-35-40% (the effect of “primary passage” through the liver). Binding to plasma proteins (mainly albumins) is 25-30%. The time to reach the maximum concentration in blood plasma (Cmax = 114 ng/ml) when taken orally is 30-90 minutes. Less than 0.002% of the captopril dose is secreted in breast milk. It penetrates only slightly (less than 1%) through the blood-brain barrier and placental barrier.

It is metabolized in the liver to form a disulfide dimer of captopril and captopril-cysteine sulfide. The metabolites are pharmacologically inactive.

The elimination half-life of captopril is about 2-3 hours. About 95% is excreted by the kidneys during the first day, of which 40-50% is unchanged, the rest is in the form of metabolites. In the daily urine,38% of unchanged captopril and 62% – in the form of metabolites are determined.

Accumulates in chronic renal failure. The half-life in renal insufficiency is 3.5-32 hours, so patients with impaired renal function should reduce the dose of the drug and / or increase the interval between doses.

Indications

-Arterial hypertension (including renovascular).

– Chronic heart failure (as part of complex therapy).

– Left ventricular dysfunction after a previous myocardial infarction in a clinically stable condition.

– Diabetic nephropathy on the background of type 1 diabetes mellitus (with albuminuria of more than 30 mg / day).

Use during pregnancy and lactation

The use of Captopril Velpharm during pregnancy is contraindicated.

Captopril Velpharm should not be used in the first trimester of pregnancy. No relevant controlled studies have been conducted on the use of ACE inhibitors in pregnant women. Limited data on the effects of the drug in the first trimester of pregnancy indicate that the use of ACE inhibitors does not lead to fetal malformations associated with fetotoxicity. Epidemiological data indicating a risk of teratogenicity after first-trimester exposure to ACE inhibitors have not been conclusive, but some increased risk cannot be ruled out.

The use of ACE inhibitors during pregnancy can lead to morbidity and death of the fetus and / or newborn. Long-term use of captopril in the second and third trimesters is toxic to the fetus (decreased renal function, lack of water, delayed ossification of the skull bones) and newborns (neonatal renal failure, hypotension, hyperkalemia).

In addition, the use of ACE inhibitors in the first trimester of pregnancy is associated with a potentially increased risk of developing fetal birth defects.

Women planning pregnancy should not use ACE inhibitors (including Captopril Velpharm). Women of childbearing age should be aware of the potential dangers of using ACE inhibitors (including Captopril Velpharm). If pregnancy occurs during the use of Captopril Velpharm, the drug should be discontinued as soon as possible and fetal development should be regularly monitored.

If the patient received the drug during the second and third trimesters of pregnancy, it is recommended to conduct an ultrasound examination to assess the condition of the skull bones and fetal kidney function.

If the use of an ACE inhibitor is considered necessary, patients planning pregnancy should be transferred to alternative antihypertensive therapy that has an established safety profile for use during pregnancy. Approximately 1% of the administered dose of Captopril Velpharm is found in breast milk. Due to the risk of serious adverse reactions in the child, breast-feeding should be discontinued or therapy with the drug should be discontinued in the mother during breastfeeding.

Contraindications

– hypersensitivity to captopril, other components of the drug or to other ACE inhibitors (including in the anamnesis);

– hereditary and/or idiopathic angioedema, angioneurotic edema in medical history (compared to previous therapy with other ACE inhibitors);

– severe renal dysfunction, refractory hyperkalemia, bilateral renal artery stenosis, stenosis of a solitary kidney with progressive azotemia, condition after kidney transplantation, primary aldosteronism;

severe disturbances of liver function;

– pregnancy;

– the period of breastfeeding;

– age up to 18 years (efficacy and safety not established);

– lactose intolerance, lactase deficiency or glucose-galactose malabsorption;

– simultaneous use of ACE inhibitors (including captopril) with aliskiren and iliskilendirmesi drugs in patients with diabetes mellitus type 2 or impaired renal function (glomerular filtration rate (GFR) less than 60 ml/min/1.73 m 2 of the body surface area) (see section “Interaction with other medicines”);

– simultaneous use of antagonists of receptors of angiotensin II (APA II) in patients with diabetic nephropathy.

With caution

Hypertrophic obstructive cardiomyopathy, connective tissue diseases (especially systemic lupus erythematosus or scleroderma), inhibition of bone marrow hematopoiesis (risk of neutropenia and agranulocytosis), cerebrovascular diseases, coronary heart disease, diabetes mellitus (increased risk of hyperkalemia), a diet with a restriction of table salt, conditions accompanied by a decrease in the volume of circulating blood (including diarrhea, vomiting, in patients who are on treatment hemodialysis), mitral stenosis, aortic stenosis and similar changes impeding the outflow of blood from the left ventricle of the heart, impaired liver function, chronic renal failure, surgery/general anesthesia, hemodialysis using high-flow membranes (for example, AN69®), desensitizing therapy, low-density lipoprotein (LDL) apheresis, taking potassium-sparing diuretics, potassium preparations, potassium-containing salt substitutes and lithium, hyperkalemia, renovascular hypertension, when used in patients of the black race, in elderly patients (dose adjustment is required).

Side effects

According to the World Health Organization (WHO), adverse reactions are classified according to their frequency as follows: very common (≥ 1/10); common (≥ 1/100, < 1/10); uncommon (≥ 1/1000, < 1/100); rare (≥ 1/10000, < 1/1000); very rare (

From the central nervous system: often-taste disorders, sleep disorders, dizziness, drowsiness; rarely-headache, paresthesia, asthenia; very rarely-depression, cerebrovascular disorders, including stroke, fainting, impaired consciousness.

From the skin: often – pruritus with and without rashes, skin rash (maculopapular, less often-vesicular or bullous), baldness; very rarely-urticaria, Stevens-Johnson syndrome, erythema multiforme, photosensitivity, erythroderma, exfoliative dermatitis, pemphigoid reactions.

From the genitourinary system: rarely-impaired renal function, acute renal failure, polyuria, oliguria, increased frequency of urination; very rarely-nephrotic syndrome, sexual dysfunction, gynecomastia.

From the side of metabolism: rarely-anorexia; very rarely-hyperkalemia, hypoglycemia.

Musculoskeletal disorders: very rare – myalgia, arthralgia.

On the part of the digestive system: often – dryness of the oral mucosa, nausea, vomiting, abdominal pain, diarrhea, constipation; rarely – stomatitis, aphthous ulcers of the inner surface of the mucous membrane of the cheeks and tongue, gum hyperplasia; very rarely – glossitis, peptic ulcer, pancreatitis, liver dysfunction, cholestasis, jaundice, hepatitis (including rare cases of hepatonecrosis), increased activity of “liver” transaminases, increased blood pressure. serum bilirubin concentrations, angioedema of the intestinal mucosa.

Hematopoietic disorders: very rarely – neutropenia, agranulocytosis, pancytopenia, especially in patients with impaired renal function, anemia (including aplastic, hemolytic), thrombocytopenia, lymphadenopathy, eosinophilia, autoimmune diseases and / or increased titer for antinuclear antibodies.

From the respiratory system: often-dry, irritating (unproductive) cough, shortness of breath; very rarely – bronchospasm, rhinitis, allergic alveolitis, eosinophilic pneumonia, pulmonary edema.

From the side of the senses: very rarely – visual acuity disorder.

From the cardiovascular system: infrequently-tachycardia or tachyarrhythmia, palpitation, angina pectoris, orthostatic hypotension, Raynaud’s syndrome, “flushes” of blood to the face, pallor, peripheral edema; very rarely-cardiogenic shock, cardiac arrest.

Laboratory parameters: very rarely – proteinuria, eosinophilia, hyperkalemia, hyponatremia, hypoglycemia, increased concentration of urea nitrogen and creatinine in blood plasma, acidosis, decreased hemoglobin and hematocrit, decreased number of white blood cells, platelets, increased erythrocyte sedimentation rate (ESR).

Others: infrequently-chest pain, fatigue, weakness; very rarely-fever; frequency unknown-a symptom complex that includes facial skin hyperemia, nausea, vomiting, and a decrease in blood pressure.

Interaction

Concomitant use of ACE inhibitors with other drugs that affect the RAAS, including angiotensin II receptor antagonists (ARA II) and aliskiren, leads to an increase in the frequency of cases of severe lowering of blood pressure, hyperkalemia, and impaired renal function (including acute renal failure). It is necessary to monitor blood pressure, renal function, and plasma electrolyte levels when using captopril with other drugs that affect the RAAS.

Concomitant use of ACE inhibitors with drugs containing aliskiren is contraindicated in patients with diabetes mellitus and/or moderate to severe renal insufficiency (GFR less than 60 ml/min / 1.73 m2 of body surface area) and is not recommended in other patients.

Concomitant use of ACE inhibitors with angiotensin II receptor antagonists is contraindicated in patients with diabetic nephropathy and is not recommended in other patients.

Combined use with potassium-sparing diuretics (triamterene, amiloride, spironolactone and its derivative-eplerenone), potassium preparations, potassium supplements, salt substitutes (contain significant amounts of potassium ions) increases the risk of hyperkalemia. If necessary, their simultaneous use with captopril should monitor the plasma potassium content.

When using high doses of diuretics (thiazide diuretics, “loop” diuretics) simultaneously with captopril due to a reduced volume of circulating blood, the risk of hypotension increases, especially at the beginning of captopril therapy.

The antihypertensive effect of captopril is potentiated when used concomitantly with aldesleukin, alprostadil, beta-blockers, alpha-1-blockers, central alpha-2-adrenomimetics, diuretics, cardiotonics, slow calcium channel blockers, minoxidil, muscle relaxants, nitrates and vasodilators. Antidepressants, antipsychotics, anxiolytics, and sleeping pills may also enhance the antihypertensive effect of captopril.

With prolonged use, the antihypertensive effect of captopril is weakened by Indometacin and other nonsteroidal anti-inflammatory drugs( NSAIDs), including selective cyclooxygenase-2 inhibitors (sodium ion retention, reduced prostaglandin synthesis, especially against the background of low renin activity) and estrogens.

NSAIDs and ACE inhibitors have been described to have an additive effect on increasing serum potassium levels, while reducing renal function. These effects are reversible. Rarely, acute renal failure may occur, especially in patients with previous renal impairment, in elderly patients, or with reduced circulating blood volume (with dehydration).

The use of ACE inhibitors in patients undergoing surgery with general anesthesia may lead to a pronounced decrease in blood pressure, especially when using general anesthesia agents that have an antihypertensive effect.

Slows down the elimination of lithium preparations, increasing the concentration of lithium in the blood. If the concomitant use of captopril and lithium preparations is necessary, the serum lithium concentration should be carefully monitored.

When using captopril while taking allopurinol or procainamide, the risk of developing Stevens-Johnson syndrome and/or neutropenia increases.

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

Sympathomimetics may reduce the antihypertensive effect of captopril.

Insulin and oral hypoglycemic agents increase the risk of hypoglycemia.

Concomitant use of captopril with food or antacids slows the absorption of captopril in the gastrointestinal tract.

During captopril therapy, the use of ethanol is not recommended, since ethanol increases the antihypertensive effect of captopril.

The antihypertensive effect of captopril is weakened by epoetins, estrogens and combined oral contraceptives, carbenoxolone, glucocorticosteroids and naloxone.

Probenecid reduces the renal clearance of captopril and increases its serum concentrations in the blood.

The use of captopril in patients taking immunosuppressants (for example, azathioprine or cyclophosphamide) increases the risk of developing hematological disorders. Captopril increases the concentration of digoxin in blood plasma by 15-20%.

Increases the bioavailability of propranolol.

Cimetidine, slowing down the metabolism in the liver, increases the concentration of captopril in the blood plasma.

Clonidine reduces the severity of the antihypertensive effect.

Interaction of ACE inhibitors with drugs containing co-trimoxazole [trimethoprim+sulfamethoxazole] causes an increased risk of hyperkalemia.

Interaction with dipeptidyl peptidase type IV (DPP-IV) inhibitors (gliptins), for example, sitagliptin, saxagliptin, vildagliptin, linagliptin increases the risk of angioedema.

Interaction with racecadotril increases the risk of angioedema. Interaction with estramustine increases the risk of angioedema.

How to take it, course of use and dosage

Inside 1 hour before meals. The dosage regimen is set individually.

With arterial hypertension, treatment begins with the lowest effective dose of 12.5 mg 2 times a day. Attention should be paid to the tolerability of the first dose within the first hour. If arterial hypotension develops, the patient should be transferred to the “lying” position with raised legs (such a reaction to the first dose should not serve as an obstacle to further therapy). If necessary, the dose is gradually increased (at intervals of 2-4 weeks) until the optimal effect is achieved.

For mild to moderate hypertension, the usual maintenance dose is 25 mg (1/2 tablet of 50 mg) 2 times a day; the maximum dose is 50 mg 2 times a day. In severe hypertension, the maximum daily dose of Captopril Velpharm is 150 mg (50 mg 3 times a day).

In case of chronic heart failure, it is prescribed together with diuretics and/or in combination with cardiac glycosides (in order to avoid an initial excessive decrease in blood pressure, before prescribing the drug, the diuretic is discontinued or the dose is reduced). The initial daily dose is 6.25 mg (for this dosage regimen, it is necessary to use captopril in tablets of 12.5 mg with a risk or in tablets of 25 mg with a cross-shaped risk of other manufacturers) 3 times a day, in the future, if necessary, the dose is increased gradually (at intervals of at least 2 weeks). The average maintenance dose is 25 mg (1/2 tablet of 50 mg) 2-3 times a day, and the maximum dose is 150 mg per day. In the case of symptomatic hypotension in heart failure, the dose of diuretics and / or other concomitant vasodilators may be reduced to achieve a sustained effect of Captopril Velpharm.

If the left ventricular function is impaired after a myocardial infarction in patients who are in a clinically stable condition, the use of Captopril Velpharm can be started as early as 3 days after a myocardial infarction. The initial dose is 6.25 mg per day (for this dosage regimen, it is necessary to use captopril in tablets of 12.5 mg with a risk or in tablets of 25 mg with a cross-shaped risk of other manufacturers). If necessary, the dose is gradually increased over several weeks to 75 mg per day in 2-3 doses (depending on the tolerability of the drug) up to the maximum daily dose of 150 mg (50 mg 3 times a day).

If hypotension develops, a dose reduction may be required. Subsequent attempts to apply the maximum daily dose of 150 mg should be based on patient tolerance.

In diabetic nephropathy, the drug Captopril Velpharm is prescribed at a dose of 75-100 mg per day in 2-3 doses. In insulin-dependent diabetes (type 1) with microalbuminuria (albumin excretion 30-300 mg per day), the dose of the drug is 50 mg 2 times a day. With a total protein clearance of more than 500 mg per day, the drug is effective at a dose of 25 mg (1/2 tablet of 50 mg) 3 times a day.

In patients with moderate renal impairment (GFR – not less than 30 ml/min/1.73 m2), Captopril Velpharm can be prescribed at a dose of 75-100 mg per day. With a more pronounced degree of renal dysfunction (GFR-less than 30 ml / min/1.73 m2), the initial dose should be no more than 12.5 mg per day (for this dosage regimen, captopril should be used in tablets of 25 mg with a risk of other manufacturers); in the future, if necessary, the dose is gradually increased at fairly long intervals, but a lower daily dose of the drug is used than in the case of treatment of arterial hypertension.

If necessary, “loop” diuretics are additionally prescribed, and not thiazide-type diuretics.

Recommended dose adjustment regimen for Captopril Velpharm in patients with impaired renal function

In elderly patients, the initial dose is 6.25 mg 2 times a day (for this dosage regimen, captopril should be used in 12.5 mg tablets with a risk or in 25 mg tablets with a cross-shaped risk of other manufacturers) and, if possible, maintained at this level to prevent impaired renal function. It is recommended to adjust the dose of the drug constantly depending on the therapeutic response of the patient and maintain it at the lowest possible level.

Overdose

Symptoms: marked decrease in blood pressure, up to collapse, shock, stupor, bradycardia, water-electrolyte balance disorders, acute renal failure, myocardial infarction, acute cerebrovascular accident, thromboembolic complications.

Treatment: gastric lavage, use of adsorbents and sodium sulfate no later than 30 minutes after taking the drug; transfer the patient to the “lying” position with raised legs, take measures aimed at restoring blood pressure, replenishing the volume of circulating blood (for example, intravenous use of 0.9% sodium chloride solution), symptomatic therapy – epinephrine (epinephrine) – subcutaneously or intravenously, antihistamines, hydrocortisone – intravenously. Atropine should be used for bradycardia or severe vagal reactions. Hemodialysis may be used; peritoneal hemodialysis is ineffective.

Description

Round flat-cylindrical tablets of white or almost white color with a characteristic smell with a risk and chamfer. The presence of “marbling” is allowed.

Special instructions

Blood pressure and kidney function should be monitored regularly before starting and during treatment with Captopril Velpharm. In patients with chronic heart failure, the drug is used under close medical supervision.

Arterial hypotension

In patients with arterial hypertension, when using the drug Captopril Velpharm, severe hypotension is observed only in rare cases, the probability of developing this condition increases with a decrease in the volume of circulating blood and a violation of the water-electrolyte balance (for example, after intensive treatment with diuretics), in patients with chronic heart failure or who are on hemodialysis. The possibility of a sharp decrease in blood pressure can be minimized by first canceling the diuretic (4-7 days in advance) or replenishing the volume of circulating blood (about a week before the start of use), or by using the drug Captopril Velpharm in small doses at the beginning of treatment (6.25-12.5 mg/day).

A marked decrease in blood pressure when using antihypertensive drugs in patients with impaired cerebral circulation, with cardiovascular diseases may increase the risk of myocardial infarction or stroke. If hypotension develops, the patient should take a horizontal position with raised legs. Sometimes it may be necessary to replenish the volume of circulating blood.

Renovascular hypertension

There is an increased risk of hypertension and renal failure in patients with bilateral renal artery stenosis of a single kidney when using ACE inhibitors. Impaired renal function may occur with a moderate change in serum creatinine concentration. In such patients, therapy should be initiated under close medical supervision with low doses, careful titration and monitoring of renal function.

Concomitant use of ACE inhibitors (including Captopril Velpharm) with drugs containing aliskiren is contraindicated in patients with diabetes mellitus and/or moderate to severe renal insufficiency (GFR less than 60 ml/min / 1.73 m2 of body surface area) and is not recommended in other patients.

Concomitant use of ACE inhibitors with angiotensin II receptor antagonists is contraindicated in patients with diabetic nephropathy and is not recommended in other patients.

Impaired renal function

Proteinuria may occur in patients with renal insufficiency or when taking high doses of ACE inhibitors (including Captopril Velpharm). In most cases, proteinuria decreased or disappeared within 6 weeks, regardless of whether treatment with Captopril Velpharm was continued or not. Parameters of renal function, such as residual blood nitrogen and creatinine, rarely changed in patients with proteinuria. In patients with kidney disease, the protein content in the urine should be determined before starting therapy and periodically during the course of therapy.

Hyperkalemia

In some cases, when using the drug Captopril Velpharm, an increase in the content of potassium in the blood serum is observed. The risk of developing hyperkalemia with ACE inhibitors is increased in patients with renal insufficiency and diabetes mellitus, as well as taking potassium-sparing diuretics, potassium preparations, and other drugs that cause an increase in blood potassium (for example, heparin). Concomitant use of potassium-sparing diuretics and potassium supplements should be avoided. Use with caution in patients on a low-salt or salt-free diet (increased risk of hypotension and hyperkalemia).

Neutropenia/agranulocytosis

In the first 3 months of therapy, the number of white blood cells in the blood is monitored monthly, then – once every 3 months. Neutropenia / agranulocytosis, anemia, and thrombocytopenia have been reported in patients taking ACE inhibitors, including Captopril Velpharm. Neutropenia is rare in patients with normal renal function and no other complicating factors.Captopril should be used with great caution in patients with connective tissue diseases who are simultaneously receiving immunosuppressive therapy (allopurinol or procainamide), especially in patients with existing renal dysfunction. In such patients, a clinical blood test is monitored every 2 weeks for the first 3 months, and then every 2 months. If the number of white blood cells is below 4.0 × 109 /l, a general blood test is indicated, below 1.0 × 109 /L-the drug is discontinued. These patients may develop severe infections that do not respond to intensive antibiotic therapy. During treatment, all patients should be instructed that if signs of infection occur (e. g., sore throat, fever), they should inform the doctor and perform a clinical blood test with a white blood cell formula calculation. In most patients, the white blood cell count quickly returns to normal when treatment with Captopril is discontinued.

Anaphylactoid reactions

Patients taking Captopril Velpharm on the background of desensitizing therapy with hymenopteran venom, etc., have an increased risk of developing anaphylactoid reactions. This can be avoided if you first temporarily stop taking the drug.

When performing hemodialysis in patients receiving Captopril Velpharm, the use of dialysis membranes with high permeability (for example, AN69®) should be avoided, since in such cases the risk of anaphylactoid reactions increases. In rare cases, patients receiving ACE inhibitors may develop life-threatening anaphylactoid reactions during low-density lipoprotein (LDL) apheresis using dextran sulfate. To prevent anaphylactoid reactions, ACE inhibitor therapy should be discontinued before each LDL apheresis procedure using high-flow membranes.

Angioedema

In patients taking Captopril Velpharm, when abdominal pain occurs, it is necessary to differentiate with intestinal angioedema.

If angioedema develops, the drug is discontinued and careful medical supervision and symptomatic therapy are provided. 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 and a threat to the patient’s life, epinephrine (epinephrine) should be immediately administered subcutaneously (0.5 ml in a dilution of 1:1000), and also make sure that the airway is free.

It is recommended to stop taking ACE inhibitors, including Captopril Velpharm,12 hours before surgery, warning the anesthesiologist about the use of ACE inhibitors.

Cough

The development of an unproductive, prolonged cough when taking ACE inhibitors is reversible and resolves after discontinuation of treatment.

Diabetes mellitus

In patients with diabetes mellitus who are taking oral hypoglycemic agents or insulin, the blood glucose concentration should be regularly monitored during the first month of treatment with Captopril Velpharm.

Impaired liver function

Several cases of impaired liver function with cholestatic jaundice, fulminant liver necrosis, and sometimes fatal outcomes have been reported during ACE inhibitor therapy.

If jaundice develops during therapy with Captopril Velpharm or the activity of “hepatic” transaminases increases, the drug should be discontinued immediately; the patient should be closely monitored and, if necessary, receive appropriate therapy.

Hypokalemia

Simultaneous use of an ACE inhibitor and a thiazide diuretic does not exclude the possibility of hypokalemia. It is recommended to regularly monitor the level of potassium in the blood.

Surgery/Anesthesia

Hypotension may occur in patients who have undergone extensive surgery or while using anesthetics that are known to lower blood pressure. If arterial hypotension occurs, it is recommended to replenish the volume of circulating blood.

Ethnic differences

ACE inhibitors, including Captopril Velpharm, have a less pronounced antihypertensive effect in patients of the black race, which, apparently, is associated with the frequent occurrence of low renin activity in this group of patients.

Laboratory data

Captopril may be the cause of a false-positive urine test for acetone.

Influence on the ability to drive vehicles and mechanisms

During treatment, it is necessary to refrain from driving vehicles and engaging in potentially dangerous activities that require increased concentration of attention and speed of psychomotor reactions, as dizziness is possible, especially after taking the initial dose.

Storage conditions

In a place protected from light at a temperature not exceeding 25 ° C. Keep out of reach of children.

Shelf

life is 3 years.

Do not use after the expiration date.

Active ingredient

Captopril

Conditions of release from pharmacies

By prescription

Dosage form

Tablets