Diroton, pills 20mg, 28pcs

Composition

1 tablet contains lisinopril 20 mg

Pharmacological action

Diroton is an ACE inhibitor that reduces the formation of angiotensin II from angiotensin I. A decrease in angiotensin II leads to a direct decrease in the release of aldosterone. Reduces the degradation of bradykinin and increases the synthesis of prostaglandins.

Reduces OPSS, blood pressure, preload, pressure in the pulmonary capillaries, causes an increase in the minute volume of blood and increased myocardial tolerance to stress in patients with chronic heart failure. Dilates the arteries to a greater extent than the veins.

Some of the effects are attributed to effects on the tissue renin-angiotensin system. With prolonged use, hypertrophy of the myocardium and arterial walls of the resistive type decreases. Improves blood supply to the ischemic myocardium.

ACE inhibitors prolong life expectancy in patients with chronic heart failure, slow the progression of left ventricular dysfunction in patients who have suffered a myocardial infarction without clinical manifestations of heart failure.

The onset of action of the drug – in 1 hour, reaches a maximum in 6-7 hours and persists for 24 hours. The duration of the effect also depends on the amount of the dose taken. With arterial hypertension, the effect is noted in the first days after the start of treatment, a stable effect develops after 1-2 months. When the drug was abruptly discontinued, no significant increase in blood pressure was observed.

Diroton reduces albuminuria. In patients with hyperglycemia, it helps to normalize the function of damaged glomerular endothelium. It does not affect the concentration of glucose in the blood in patients with diabetes mellitus and does not lead to an increase in cases of hypoglycemia.

Indications

Arterial hypertension (in the form of monotherapy or in combination with other antihypertensive drugs);

Chronic heart failure (as part of a combination therapy for the treatment of patients taking digitalis preparations and / or diuretics);

Acute myocardial infarction (in the first 24 hours with stable hemodynamic parameters to maintain these indicators and prevent left ventricular dysfunction and heart failure);

Diabetic nephropathy (to reduce albuminuria in patients with insulin-dependent diabetes mellitus with normal blood pressure and in patients with non-insulin-dependent diabetes mellitus with arterial hypertension).

Contraindications

Angioedema in the anamnesis (including when using ACE inhibitors); hereditary angioedema; age up to 18 years (efficacy and safety have not been established); hypersensitivity to lisinopril or other ACE inhibitors; pregnancy and lactation.

With caution: with severe renal dysfunction, bilateral renal artery stenosis or stenosis of the artery of a single kidney with progressive azotemia, condition after kidney transplantation, renal failure, azotemia, hyperkalemia, aortic stenosis, hypertrophic obstructive cardiomyopathy, primary hyperaldosteronism, arterial hypotension, cerebrovascular diseases (including cerebrovascular insufficiency), coronary heart disease, coronary artery disease. immune system diseases of connective tissue (including scleroderma, systemic lupus erythematosus), suppression of bone marrow hematopoiesis, hypovolemic conditions (including as a result of diarrhea, vomiting); patients on a sodium-restricted diet, elderly patients.

Side effects

The most common side effects were dizziness, headache (5-6%), weakness, diarrhea, dry cough (3%), nausea, vomiting, orthostatic hypotension, skin rash, chest pain (1-3%).

The frequency of other adverse reactions is less than 1%.

From the cardiovascular system: marked decrease in blood pressure, chest pain; rarely-orthostatic hypotension, tachycardia, bradycardia, the appearance of symptoms of heart failure, violation of AV conduction, myocardial infarction.

From the digestive system: nausea, vomiting, abdominal pain, dry mouth, diarrhea, dyspepsia, anorexia, taste disorders, pancreatitis, hepatitis (hepatocellular and cholestatic), jaundice (hepatocellular or cholestatic), hyperbilirubinemia, increased activity of hepatic transaminases.

From the skin: urticaria, increased sweating, photosensitization, pruritus, hair loss.

From the central nervous system: lability of mood, impaired concentration, paresthesia, increased fatigue, drowsiness, convulsive twitching of the muscles of the limbs and lips; rarely-asthenic syndrome, confusion.

From the respiratory system: dyspnoea, dry cough, bronchospasm, apnea.

From the hematopoietic system: leukopenia, thrombocytopenia, neutropenia, agranulocytosis, anemia (decreased hemoglobin concentration, hematocrit, erythrocytopenia), with long – term treatment, a slight decrease in hemoglobin and hematocrit is possible, in some cases-agranulocytosis.

Allergic reactions: angioedema of the face, extremities, lips, tongue, epiglottis and / or larynx, intestinal angioedema, vasculitis, positive reactions to antinuclear antibodies, increased ESR, eosinophilia; in very rare cases – interstitial angioedema (edema of the interstitial lung tissue without transudate entering the alveolar lumen).

From the genitourinary system: uremia, oliguria, anuria, impaired renal function, acute renal failure, decreased potency.

Laboratory parameters: hyperkalemia and / or hypokalemia, hyponatremia, hypomagnesemia, hypochloremia, hypercalcemia, hyperuricemia, increased urea and creatinine concentrations in blood plasma, hypercholesterolemia, hypertriglyceridemia, decreased glucose tolerance.

Others: arthralgia, arthritis, myalgia, fever, gout exacerbation.

Interaction

Concomitant use of Diroton with potassium-sparing diuretics (spironolactone, triamterene, amiloride), potassium preparations, and salt substitutes containing potassium increases the risk of hyperkalemia, especially in patients with impaired renal function. Therefore, co-use is possible only on the basis of an individual doctor’s decision, with regular monitoring of serum potassium and kidney function.

When used concomitantly with beta-blockers, slow calcium channel blockers, diuretics and other antihypertensive agents, an increase in the hypotensive effect of the drug is observed.

With the simultaneous use of ACE inhibitors and gold preparations (sodium aurothiomalate) intravenously, a symptom complex is described, including facial hyperemia, nausea, vomiting and arterial hypotension.

When used concomitantly with vasodilators, barbiturates, phenothiazines, tricyclic antidepressants, and ethanol, the antihypertensive effect of the drug increases.

Concomitant use of Diroton with NSAIDs (including selective COX-2 inhibitors), estrogens, and adrenomimetics reduces the antihypertensive effect of lisinopril.

When used concomitantly with lithium preparations, the elimination of lithium from the body slows down (increased cardiotoxic and neurotoxic effects of lithium).

When used concomitantly with antacids and colestyramine, absorption in the gastrointestinal tract decreases.

The drug Diroton increases the neurotoxicity of salicylates, weakens the effect of hypoglycemic agents for oral use, norepinephrine, epinephrine and anti-gouty drugs, increases the effects (including side effects) of cardiac glycosides, the effect of peripheral muscle relaxants, reduces the excretion of quinidine.

Reduces the effect of oral contraceptives.

When taking methyldopa at the same time, the risk of developing hemolysis increases.

How to take, course of use and dosage

The drug is taken orally 1 time a day, in the morning, with all indications, before or after meals, always at about the same time of day.

With essential hypertension, patients who do not receive other antihypertensive drugs are prescribed 10 mg 1 time a day. 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. If the clinical effect is insufficient, the drug can be combined with other antihypertensive agents.

If the patient has received prior treatment with diuretics, then their use should be stopped 2-3 days before the start of Diroton use. If it is impossible to cancel diuretics, then the initial dose of Diroton should not exceed 5 mg/ In this case, after taking the first dose, medical monitoring is recommended for several hours (the maximum effect is reached in about 6 hours), since a pronounced decrease in blood pressure may develop.

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

In renal insufficiency, due to the fact that lisinopril is excreted by the kidneys, the initial dose should be determined depending on creatinine clearance, then, in accordance with the reaction, a maintenance dose should be established in conditions of frequent monitoring of renal function, serum potassium and sodium concentrations.

In chronic heart failure, the initial dose is 2.5 mg once a day, which can be increased to the usual maintenance daily dose of 5-20 mg. The daily dose should not exceed 20 mg.

In acute myocardial infarction (as part of combination therapy) on the first day,5 mg is prescribed, then 5 mg every other day,10 mg in two days and then 10 mg once a day. In patients with acute myocardial infarction, the drug should be used for at least 6 weeks. At the beginning of treatment or during the first 3 days after acute myocardial infarction in patients with low systolic blood pressure (

In diabetic nephropathy in patients with insulin-dependent diabetes mellitus, Diroton is used at a dose of 10 mg 1 time a day. If necessary, the dose can be increased to 20 mg once a day in order to achieve diastolic blood pressure values below 75 mm Hg in a sitting position. In patients with non-insulin-dependent diabetes mellitus, the drug is prescribed in the same dose, in order to achieve diastolic blood pressure values below 90 mm Hg in a sitting position.

Overdose

Symptoms: marked decrease in blood pressure.

Treatment: if necessary, symptomatic therapy is performed (intravenous fluid use, control and normalization of blood pressure, water and electrolyte balance). Lisinopril can be eliminated from the body by dialysis.

Special instructions

Most often, a marked decrease in blood pressure occurs with a decrease in fluid volume caused by diuretic therapy, a decrease in the salt content in food, dialysis, diarrhea or vomiting. In chronic heart failure with or without concomitant renal failure, a marked decrease in blood pressure is possible. More often, a pronounced decrease in blood pressure is detected in patients with severe chronic heart failure, as a result of the use of high-dose diuretics, hyponatremia or impaired renal function. In such patients, treatment with Diroton should be started under the strict supervision of a doctor (with caution, select the dose of the drug and diuretics).

Similar rules should be followed when prescribing Diroton to patients with CHD, cerebrovascular insufficiency, in which a sharp decrease in blood pressure can lead to myocardial infarction or stroke.

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

When using Diroton 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 a reason to stop treatment.

Before starting treatment with Diroton, if possible, the sodium concentration should be normalized and / or the lost volume of fluid should be replenished, and the effect of the initial dose of Diroton on the patient’s blood pressure should be carefully monitored.

In the case of renal artery stenosis (especially with bilateral stenosis or in the presence of stenosis of the artery of a single kidney), as well as with circulatory failure due to a lack of sodium and/or fluid, the use of Diroton can lead to impaired renal function, acute renal failure, which usually turns out to be irreversible after discontinuation of the drug.

In acute myocardial infarction, the use of standard therapy (thrombolytics, acetylsalicylic acid, beta-blockers) is indicated. It is possible to use Diroton together with intravenous use or with the use of therapeutic transdermal nitroglycerin systems.

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 II, can cause a pronounced unpredictable decrease in blood pressure.

In elderly patients, the use of standard doses leads to a higher concentration of the drug in the blood, so special care is required when determining the dose, despite the fact that there are no differences in the antihypertensive effect of Diroton in elderly and young patients.

Since the potential risk of agranulocytosis cannot be excluded, periodic monitoring of the blood picture is required.

When using the drug in a polyacrylonitrile membrane dialysis setting, anaphylactic shock may occur, so either a different type of dialysis membrane is recommended, or other antihypertensive agents are prescribed.

There are no data on the effect of lisinopril on the ability to drive vehicles and mechanisms, but it should be borne in mind that dizziness may occur, so caution should be exercised.

Form of production

Pills.

Storage conditions

At a temperature of 15-30 °C

Shelf life

3 years

Active ingredient

Lisinopril

Conditions of release from pharmacies

By prescription

Dosage form

Tablets

Purpose

For adults as directed by your doctor

Indications

Myocardial Infarction, Heart Failure, Diabetic Nephropathy, Hypertension