Instructions for use
Lisinopril tab. 10mg No. 30

Dosage forms
tablets 10mg

Synonyms
Diropress
Diroton
Irumed
Lysigamma
Lisinopril Grindeks
Lysinotone
Lizoril
Leeten

Group
Antihypertensives - angiotensin-converting enzyme inhibitors

International non-proprietary name
Lisinopril

Composition
The active ingredient is lisinopril.

Manufacturers
Teva Pharmaceutical Enterprises Ltd (Israel)

pharmachologic effect
Antihypertensive, vasodilator, cardioprotective, natriuretic. Reduces the total peripheral vascular resistance, systemic arterial pressure, myocardial afterload, pressure in the pulmonary capillaries. Increases cardiac output and myocardial load tolerance in patients with heart failure. Increases (secondary) the activity of blood plasma renin. The effect appears after 1 hour, increases within 6-7 hours, and lasts up to 24 hours. The antihypertensive effect reaches optimal values ​​with repeated administration over several weeks. Inhibits the tissue renin-angiotensin system of the heart, prevents the development of myocardial hypertrophy and left ventricular dilatation or contributes to their reverse development (cardioprotective effect). Reduces the number of cases sudden death, reduces the likelihood of recurrent myocardial infarction, violations of coronary blood flow and the occurrence of myocardial ischemia. After oral administration, about 25% (6-60%) is absorbed. Food intake has no effect on absorption. Poorly binds to plasma proteins (6-10%). It is not biotransformed and is excreted by the kidneys unchanged, the half-life is 12 hours. It is removed by hemodialysis.

Side effect
Headache, dizziness, impaired consciousness, irritability, nervousness, transient cerebrovascular accident, fainting, ataxia, memory loss, drowsiness, insomnia, peripheral neuropathy, paresthesia, tremors, convulsions, visual disturbances, tinnitus; palpitations, chest pain, hypotension, arrhythmia, cardiac arrest, myocardial infarction, orthostatic reactions, vasculitis, depression bone marrow, leukopenia, thrombocytopenia, anemia; dry cough, malignant tumors lungs, hemoptysis, infiltration, pulmonary embolism and infarction, bronchospasm, asthma, pleural effusion, pain on breathing, bronchitis, laryngitis, sinusitis, pharyngitis, rhinitis, nose bleed, runny nose, paroxysmal postural dyspnea; dry mouth, dyspepsia, heartburn, vomiting, diarrhea / constipation, flatulence, gastrointestinal cramps, abdominal pain, hepatotoxicity (hepatitis, cholestatic jaundice, fulminant liver necrosis with a possible fatal outcome), gastritis, pancreatitis; impaired renal function, acute renal failure, pyelonephritis, dysuria, oliguria, anuria, uremia, edema, weakening of libido, impotence; arthritis, arthralgia, myalgia, neck pain, back pain; rash, urticaria, alopecia, photosensitivity, pemphigus, skin lesions and infections, toxic epidermal necrolysis, Stevens-Johnson syndrome; changes in body weight, fever, sweating, allergic reactions, incl. angioedema, development of infections, incl. herpes zoster, diabetes mellitus, dehydration, gout, increased titer of antinuclear antibodies, concentration of creatinine, urea, hyperkalemia, hyponatremia, hyperuricemia.

Indications for use
Arterial hypertension (mono- and combination therapy), incl. renovascular, acute myocardial infarction in clinically stable condition of the patient, heart failure (auxiliary treatment), incl. asymptomatic left ventricular heart failure on the background of acute myocardial infarction, postinfarction period, diabetic nephropathy.

Contraindications
Hypersensitivity, pregnancy, lactation. Restrictions on use: anaphylactoid reactions, a history of angioedema, collagenosis, bone marrow depression (leukopenia, agranulocytosis), cerebrovascular insufficiency, hypotension, impaired renal and liver function, aortic, mitral stenosis or other obstructive changes that impede the outflow of blood from the heart; hyperkalemia or a high risk of its occurrence (diabetes mellitus, severe renal failure, concomitant administration of diuretics), hyponatremia or sodium restriction in the diet, bilateral renal artery stenosis or stenosis of an artery of a single kidney, the presence of a transplanted kidney, hyperuricemia, gout, childhood and elderly age.

Method of administration and dosage
Inside, adults 1 time per day. The dose is determined individually, depending on the indications, the state of renal function and concomitant therapy. Usually the initial dose is 2.5-5 mg, the average maintenance dose is 5-20 mg, the maximum daily dose is 80 mg.

Overdose
Symptoms: acute arterial hypotension. Treatment: the introduction of saline and other symptomatic therapy.

Interaction
The antihypertensive effect is enhanced by diuretics, and indomethacin is weakened. Potassium-sparing diuretics, potassium supplements, and potassium-containing agents increase the risk of hyperkalemia. Increases the toxicity of lithium.

special instructions
Before starting treatment, adjust water and electrolyte balance... Treatment is carried out under regular medical supervision. Caution is required during surgical interventions (including dental), especially when using general anesthetics that have an antihypertensive effect. Avoid hemodialysis through high-throughput polyacrylonitrite metallyl sulfate membranes, hemofiltration, or LDL apheresis.

Storage conditions
List B. In a dry, dark place.

In this article, you can read the instructions for use medicinal product Lisinopril... The reviews of site visitors - consumers of this medicine, as well as opinions of doctors of specialists on the use of Lisinopril in their practice are presented. A big request to actively add your reviews about the drug: did the medicine help or did not help get rid of the disease, what complications were observed and side effects, possibly not declared by the manufacturer in the annotation. Analogs of Lisinopril in the presence of available structural analogs. Use for treatment arterial hypertension and reduction of pressure in adults, children, as well as during pregnancy and lactation. Composition and interaction of the drug with alcohol.

Lisinopril- ACE inhibitor, reduces the formation of angiotensin 2 from angiotensin 1. A decrease in the content of 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 total peripheral vascular resistance, blood pressure (BP), preload, pressure in the pulmonary capillaries, causes an increase in the minute blood volume and an increase in myocardial tolerance to stress in patients with chronic heart failure. Expands arteries more than veins. Some of the effects are attributed to the effect on tissue renin-angiotensin systems. At long-term use decreases hypertrophy of the myocardium and walls of resistive arteries. 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 myocardial infarction without clinical manifestations heart failure. The antihypertensive effect begins after about 6 hours and lasts 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, a stable effect develops after 1-2 months.

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

In addition to lowering blood pressure, lisinopril reduces albuminuria. In patients with hyperglycemia, it helps to normalize the function of the damaged glomerular endothelium.

Lisinopril does not affect blood glucose concentration in patients diabetes mellitus and does not lead to an increase in the incidence of hypoglycemia.

Composition

Lisinopril (in the form of a dihydrate) + excipients.

Pharmacokinetics

After taking the drug inside, about 25% of lisinopril is absorbed from the gastrointestinal tract. Food intake 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. Lisinopril is not biotransformed in the body. It is excreted by the kidneys unchanged.

Indications

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

Forms of issue

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 are not receiving other antihypertensive drugs are prescribed 5 mg once a day. In the absence of an 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 over 40 mg per day usually does not lead to a further decrease in blood pressure). The usual daily maintenance dose is 20 mg. Maximum daily dose- 40 mg.

The full effect usually develops within 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 prior treatment with diuretics, then taking such drugs should be discontinued 2-3 days before the start of Lisinopril use. If this is not feasible, then 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 a pronounced decrease in blood pressure may occur.

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

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

In chronic heart failure, they start with 2.5 mg once a day, followed by an increase in the dose by 2.5 mg after 3-5 days to the usual, maintenance daily dose of 5-20 mg. The dose should not exceed 20 mg per day.

In elderly people, a more pronounced long-term 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 every 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 (120 mm Hg or below), a lower dose should be prescribed - 2.5 mg. In the case of a decrease in blood pressure (systolic blood pressure is less than or equal to 100 mm Hg), the daily dose of 5 mg can, if necessary, be temporarily reduced to 2.5 mg. In the case of a prolonged 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 non-insulin dependent diabetes mellitus, 10 mg of Lisinopril is used 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 mm Hg. in a 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 a 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;
• palpitations;
• tachycardia;
• myocardial infarction;
• cerebrovascular stroke in patients with an increased risk of the disease, due to a pronounced decrease in blood pressure;
• dry mouth;
• anorexia;
• dyspepsia;
• changes in taste;
• stomach ache;
• hives;
• increased sweating;
• itchy skin;
• alopecia;
• impaired renal function;
• oliguria;
• anuria;
• acute renal failure;
• asthenic syndrome;
• lability of mood;
• confusion of consciousness;
• decreased potency;
• myalgia;
• fever;
• impaired fetal development.

Contraindications

• a history of angioedema, incl. and from the application ACE inhibitors;
• hereditary angioedema;
• age up to 18 years (efficacy and safety have not been established);
• hypersensitivity to lisinopril or other ACE inhibitors.

Application during pregnancy and lactation

The use of lisinopril during pregnancy is contraindicated. When pregnancy is established, the drug should be discontinued as early as possible. Taking ACE inhibitors in the 2nd and 3rd trimester of pregnancy has an adverse effect on the fetus (a pronounced decrease in blood pressure, renal failure, hyperkalemia, cranial hypoplasia, intrauterine death are possible). There is no data on the negative effects of the drug on the fetus when used during the 1st trimester. For newborns and infants who have been exposed to intrauterine exposure to ACE inhibitors, it is recommended to closely monitor for the timely detection of a pronounced decrease in blood pressure, oliguria, hyperkalemia.

Lisinopril crosses the placenta. There is no data on the penetration of Lisinopril into breast milk... For the period of drug treatment, it is necessary to cancel breastfeeding.

special instructions

Symptomatic hypotension

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 concurrent renal failure, a marked decrease in blood pressure is possible. It is more often detected in patients with severe chronic heart failure, as a result of the use of high doses of diuretics, hyponatremia, or impaired renal function. In such patients, treatment with Lisinopril should be started under the strict supervision of a physician (with caution, select the dose of the drug and diuretics).

Similar rules must be followed when prescribing to patients ischemic disease heart, 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.

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

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

In the case of renal artery stenosis (especially with bilateral stenosis, or in the presence of stenosis of an artery of a single kidney), as well as in case of circulatory failure due to sodium and / or fluid deficiency, the use of Lisinopril can also lead to renal dysfunction, acute renal failure, which usually turns out to be irreversible after drug withdrawal.

For acute myocardial infarction

The use of standard therapy (thrombolytics, acetylsalicylic acid, beta-blockers) is shown. Lisinopril can be used in conjunction with intravenous administration or using therapeutic transdermal nitroglycerin systems.

Surgery / general anesthesia

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

In elderly patients, the same dose leads to more high concentration the drug in the blood, therefore, special care is required when determining the dose.

Since the potential risk of agranulocytosis cannot be excluded, periodic monitoring of the blood picture is required. When using the drug under dialysis conditions with a polyacryl-nitrile membrane, anaphylactic shock may occur, therefore, either another type of membrane for dialysis, or the appointment of other antihypertensive drugs is recommended.

Impact on management ability vehicles and mechanisms

There is no data on the effect of lisinopril on the ability to drive vehicles and mechanisms, used in therapeutic doses, however, it must be borne in mind that dizziness may occur, so caution should be exercised.

Drug interactions

Lisinopril reduces the excretion of potassium from the body during treatment with diuretics.

Special care is required with the simultaneous use of the drug with:

• potassium-sparing diuretics (spironolactone, triamterene, amiloride), potassium, table salt substitutes containing potassium (the risk of hyperkalemia increases, especially with impaired renal function), so they can be co-administered only on the basis of the individual decision of the attending physician with regular monitoring of serum potassium levels blood and kidney function.

Use with caution together:

• with diuretics: with the additional administration of a diuretic to a patient taking Lisinopril, as a rule, an additive antihypertensive effect occurs - the risk of a pronounced decrease in blood pressure;
• with other antihypertensive drugs (additive effect);
• with non-steroidal anti-inflammatory drugs (NSAIDs) (indomethacin, etc.), estrogens, as well as adrenostimulants - a decrease in the antihypertensive effect of lisinopril;
• with lithium (the release of lithium may decrease, therefore, the concentration of lithium in the blood serum should be regularly monitored);
• with antacids and cholestyramine - reduce absorption in the gastrointestinal tract.

Alcohol enhances the effect of the drug.

Analogs of the drug Lisinopril

Structural analogs for active substance:

• Dapril;
• Diropress;
• Diroton;
• Irumed;
• Lizacard;
• Lysigamma;
• Lisinopril Grindeks;
• Lisinopril Organic;
• Lisinopril Pfizer;
• Lisinopril Stada;
• Lisinopril OBL;
• Lisinopril Teva;
• Lisinopril dihydrate;
• Lysinotone;
• Lisonorm;
• Lizoril;
• Listril;
• Leeten;
• Accepted;
• Rileys Sanovel;
• Sinopril.

In combination with hydrochlorothiazide:

• Zonixem ND;
• Zonixem NL;
• Iruzid;
• Ko-Diroton;
• Lisinopril H;
• Lizinoton H;
• Lysoretic;
• Listril Plus;
• Leeten N;
• Rileys Sanovel plus;
• Skopril plus.

In combination with Amlodipine:

• Equacard;
• Equator.

In the absence of analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps, and see the available analogues for the therapeutic effect.

Release form: Solid dosage forms... Pills.

General characteristics. Composition:

Pharmacological properties:

Indications for use:

Important! Check out the treatment

Method of administration and dosage:

Application features:

Side effects:

Interaction with other medicinal products:

Contraindications:

Overdose:

Storage conditions:

List B. In a dry, dark place at a temperature not exceeding 25 ° C. Keep out of the reach of children. Expiration date: 2 years. You should not take the drug after the expiration date.

Vacation conditions:

On prescription

Package:

Tablets of 5, 10 or 20 mg. 10 tablets in a blister made of polyvinyl chloride film and aluminum foil; 20 or 30 tablets in a jar of light-protective glass or in a polymer jar or in a polymer bottle; Each jar or bottle or 1, 2 or 3 blister packs, together with instructions for use, are placed in a cardboard box.

The main component of the drug is lisinopril dihydrate ... But depending on the manufacturer of the drug, the composition of the additional substances may be different.

The Ukrainian company Avant produces Lisinopril with such auxiliary components as corn starch ,calcium hydrogen phosphate ,iron oxide , mannitol ,magnesium stearate .

And the Russian manufacturer ALSI Pharma produces a product with the following additional components: ,colloidal silicon dioxide ,talc ,lactose monohydrate , microcrystalline cellulose ,magnesium stearate .

In addition, such forms of drug release are known as Lisinopril-Ratiopharm, Lisinopril-Astrafarm, Lisinopril Teva, Lisinopril Stada. They have the following additional components:

• Lisinopril-Astrafarm - corn starch ,colloidal silicon dioxide ,mannitol ,calcium hydrogen phosphate , magnesium stearate ;
• Lisinopril-Ratiopharm - mannitol ,calcium hydrogen phosphate , magnesium stearate , pregelatinized starch , croscarmellose sodium (20 mg tablets also contain the PB-24824 dye, and the medicine in 10 mg tablets also contains the PB-24823 dye).

Lisinopril Stada has as an active ingredient lisinopril hydrate ... And in addition, the following additional substances: pregelatinized starch ,colloidal anhydrous silicon oxide , mannitol ,magnesium stearate ,corn starch , calcium phosphate disubstituted dihydrate .

Release form

Pills.

pharmachologic effect

The medicine has hypotensive ,cardioprotective ,vasodilating and natriuretic effect on the human body.

Pharmacodynamics and pharmacokinetics

Lisinopril tablets block APF , increase the content endogenous vasodilating PG and prevent the transition angiotensin I v angiotensin II ... They also reduce conversion arginine vasopressin and endothelin-1 , reduce myocardial afterload, total peripheral vascular resistance, pulmonary capillary pressure and systemic pressure. In patients with heart failure increase myocardial load tolerance and cardiac output ... Promotes increased activity plasma.

The medicine blocks tissue renin-angiotensin the heart system, prevents the appearance of myocardial hypertrophy and dilations left ventricle or helps in their disappearance.

The effect of the drug manifests itself after about 60 minutes, increases over 6-7 hours and continues throughout the day. Maximum hypotensive the effect appears with a course of several weeks.

The active substance is absorbed by about 25%. The timing of the meal does not affect absorption. Plasma protein binding is low. The active substance is not biotransformed and is excreted by the kidneys unchanged. The half-life is 12 hours.

Indications for the use of Lisinopril

This medication should not be taken without the appointment of a specialist. Indications for the use of Lysinopropil may be different. How to take and from what the pills will help in each case, only the doctor knows.

As a rule, Lisinopril tablets have the following indications for use:

• arterial hypertension ;
• chronic heart failure ;
• diabetic nephropathy when insulin dependent and Type II ;
• spicy without arterial hypotension .

Contraindications

The drug should not be taken when hypersensitivity to its components, and.

It is undesirable to prescribe this remedy when:

• hyperkalemia ;
• anaphylactoid reactions ;
• collagenoses ;
• cerebrovascular insufficiency ;
• disorders in the work of the kidneys and liver;
• bilateral renal artery stenosis ;
• transplanted kidney;
• old age;
• v anamnesis ;
• bone marrow depression ;
• hypotension ;
• obstructive changes that prevent outflow from the heart;
• hyponatremia , as well as with a diet with limited sodium intake;
• stenosis of an artery of a solitary kidney ;
• hyperuricemia ;
• childhood.

Side effects

Side effects can be different, they arise from different systems and organs:

• nervous system - irritability, ataxia , increased fatigue, transient cerebrovascular accident, visual impairment, nervousness, fainting, peripheral neuropathy , decreased memory, tinnitus;
• gastrointestinal tract - dry mouth, vomiting, painful sensations in a stomach, gastritis , nausea, cramps, hepatotoxicity , ;
• musculoskeletal system - arthralgia , myalgia , neck and back pain;
• the respiratory system - of the lungs, and lung infarction , painful sensations when breathing, hemoptysis, nasal, paroxysmal postural dyspnea , infiltration , pleural effusion , bronchospasm , runny nose;
• genitourinary system -, problems with kidney function, oliguria , uremia , dysuria decreased libido;
• skin -, pemphigus , Lyell's syndrome , photosensitivity, rash, skin lesions and infections, Stevens Johnson syndrome .

In addition, it is possible the following manifestations: development of infections, weight loss, increase antinuclear antibody titer and content urea , level increase creatinine , hyperkalemia , hyperuricemia , dehydration , hyponatremia .

If any side effects, you need to urgently consult with a specialist.

Instructions for use of Lisinopril (Way and dosage)

The medicine is taken daily 1 time per morning time, regardless of the meal. This should be done at the same time, while drinking some liquid.

The exact dosage and treatment regimen is selected by a specialist on an individual basis. It depends on what Lysinopropyl is used, what drugs are taken with it and what the condition of the kidneys is.

At arterial hypertension in case of treatment without others antihypertensive medication dosage is 2.5 mg once a day. For the greatest efficiency, 2-4 weeks of therapy is carried out. Only then can the daily dosage be increased to a maximum of 20 mg. The daily dose should not exceed 40 mg.

If needed hypotensive the effect is not achieved, you need to additionally take another antihypertensive other means pharmacotherapeutic group .

The drug also enhances the effect of ethanol. The symptoms of alcohol intoxication intensify. At the same time, it is possible to increase hypotensive effect of Lisinopril, so it is necessary to avoid alcoholic beverages during therapy with this drug or not to take it within 24 hours after drinking alcohol.

The use of this medication in conjunction with drugs for, narcotic, antidepressants , muscle relaxants with hypotensive action, as well as hypnotics leads to an increase hypotensive effect.

Thrombolytics increase the likelihood arterial hypotension ... This combination must be prescribed with caution and carefully monitor the patient's condition.

Sympathomimetics greatly weaken hypotensive the effect of the drug. And the combination with drugs that provide myelosuppressive action, increase the risk and / or neutropenia .

Simultaneous use with, immunosuppressants , Procainamide , cytostatics, corticosteroids can cause leukopenia .

At dialysis therapies are possible anaphylactoid reactions in case of application high-flow polyacrylonitrile metal sulfonate membranes .

Terms of sale

On prescription.

Storage conditions

You need to keep the medicine in a dry place out of the reach of small children, at temperatures up to 250C.

Shelf life

The shelf life of Lisinopril, Lisinopril Stada and Lisinopril-Astrafarm is 3 years. Lisinopril-Ratiopharm can be stored for a maximum of 4 years. And the shelf life of Lisinopril Teva is 2 years.

Lisinopril's analogs

The main analogues of Lisinopril in pharmacies can be found as follows:

• Lizinokol ;
• Aurolayza ;
• Lizoril ;
• Vitopril ;
• Lipril ;
• Dapril ;
• Rileys-Sanovel ;
• Skopril ;
• Zonixem ;
• Lizinovel ;
• Lizzie Sandoz .

The cost of these drugs is not much different. All analogues of Lisinopril have their own peculiarities of application, so they should not be used without a doctor's prescription.

Active substance

Lisinopril

Dosage form

pills

Manufacturer

Vertex, Russia

Composition

1 tablet contains:

Active substance: lisinopril dihydrate (corresponds to lisinopril) 10 mg,

Excipients: milk sugar (lactose); MCC; starch 1500 (pregelatinized); aerosil (colloidal silicon dioxide); talc; magnesium stearate.

pharmachologic effect

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 the synthesis of prostaglandins. Reduces the total peripheral vascular resistance, blood pressure (BP), preload, pressure in the pulmonary capillaries, causes an increase in the minute blood volume and an increase in myocardial tolerance to stress in patients with chronic heart failure. Expands arteries more than veins. Some of the effects are attributed to the effect on the tissue renin-angiotensin-aldosterone system. With prolonged use, the hypertrophy of the myocardium and the walls of the resistive arteries decreases. 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 myocardial infarction without clinical manifestations of heart failure.
The onset of action is after 1 hour. The maximum antihypertensive effect is determined after 6-7 hours and lasts for 24 hours. With arterial hypertension, the effect is observed in the first days after the start of treatment, a stable effect develops after 1-2 months. With a sharp withdrawal of the drug, a pronounced increase in blood pressure was not noted.
In addition to lowering blood pressure, lisinopril reduces albuminuria. Lisinopril does not affect the concentration of glucose in the blood in patients with diabetes mellitus and does not lead to an increase in the incidence of hypoglycemia.

Indications

Arterial hypertension (in monotherapy or in combination with other antihypertensive drugs).
Chronic heart failure (as part of combination therapy for the treatment of patients taking cardiac glycosides and / or diuretics).
Early treatment of acute myocardial infarction as part of combination therapy (in the first 24 hours with stable hemodynamic parameters to maintain these parameters and prevent left ventricular dysfunction and heart failure).
Diabetic nephropathy (decrease in albuminuria in patients with type 1 diabetes mellitus with normal blood pressure, and patients with type 2 diabetes mellitus with arterial hypertension).

Contraindications

Hypersensitivity to lisinopril or other ACE inhibitors.
History of angioedema, including with the use of ACE inhibitors.
Hereditary angioedema or idiopathic angioedema.
Pregnancy and lactation.
Age up to 18 years (efficacy and safety have not been established).
Lactase deficiency, lactose intolerance, glucose-galactose malabsorption syndrome.

Carefully
Severe renal dysfunction, bilateral renal artery stenosis or stenosis of a solitary kidney artery with progressive azotemia, condition after kidney transplantation, azotemia, hyperkalemia, aortic stenosis, hypertrophic obstructive cardiomyopathy, primary hyperaldosteronism, arterial hypotension, cerebrovascular diseases (including cerebrovascular insufficiency), ischemic heart disease, coronary insufficiency, autoimmune systemic diseases of the connective tissue (including scleroderma, systemic lupus erythematosus); oppression of bone marrow hematopoiesis; diet with restriction of table salt; hypovolemic conditions (including as a result of diarrhea, vomiting); advanced age, hemodialysis using high-flow, high-permeability dialysis membranes (AN69®).

Side effects

The incidence of side effects is characterized as often (1%), rarely (1%).
The most common side effects are: dizziness, headache, fatigue, diarrhea, dry cough, nausea.
From the side of the cardiovascular system: often - a marked decrease in blood pressure, orthostatic hypotension; rarely - chest pain, tachycardia, bradycardia, worsening symptoms of chronic heart failure, impaired atrioventricular conduction, myocardial infarction.
From the side of the central nervous system: often - paresthesias, mood lability, confusion, drowsiness, convulsive twitching of the muscles of the limbs and lips, rarely - asthenic syndrome.
From the side of hematopoietic organs: rarely - leukopenia, neutropenia, agranulocytosis, thrombocytopenia, with long-term treatment - anemia (decreased hemoglobin, hematocrit, erythropenia).
From the respiratory system: rarely - shortness of breath, bronchospasm.
From the side digestive system: rarely - dryness of the oral mucosa, anorexia, dyspepsia, taste changes, abdominal pain, pancreatitis, jaundice (hepatocellular or cholestatic), hepatitis.
From the side of the skin: rarely - urticaria, skin itching, increased sweating, alopecia, photosensitivity.
From the genitourinary system: rarely - impaired renal function, oliguria, anuria, acute renal failure, uremia, proteinuria, decreased potency.
Laboratory indicators: often - hyperkalemia, hyponatremia; rarely - hyperbilirubinemia, increased activity of "liver" enzymes, hypercreatininemia, increased concentration of urea and creatinine.
Allergic reactions: rarely - angioedema of the face, extremities, lips, tongue, epiglottis and / or larynx, skin rashes, pruritus, fever, false positive test results for antinuclear antibodies, increased erythrocyte sedimentation rate (ESR), eosinophilia, leukocytosis. In rare cases, intestinal angioedema.
Others: arthralgia / arthritis, vasculitis, myalgia.

Interaction

With the simultaneous use of the drug with potassium-sparing diuretics (spironolactone, triamterene, amiloride), potassium preparations, salt substitutes containing potassium, cyclosporine, the risk of hyperkalemia increases, especially with impaired renal function, therefore they can be used together only with regular monitoring of the content of potassium ions in serum and renal function.
The combined use of lisinopril with beta-blockers, blockers of "slow" calcium channels (BMCC), diuretics, tricyclic antidepressants / neuroleptics and other antihypertensive drugs enhances the severity of the hypotensive effect.
Lisinopril slows down the excretion of lithium preparations. Therefore, at joint application it is necessary to regularly monitor the concentration of lithium in the blood serum.
Antacids and cholestyramine reduce the absorption of lisinopril in the gastrointestinal tract.
When used together with insulin and hypoglycemic agents for oral administration, there is a risk of hypoglycemia.
Non-steroidal anti-inflammatory drugs (NSAIDs) (including selective inhibitors of cyclooxygenase-2 (COX-2)), estrogens, adrenomimetics reduce the hypotensive effect of lisinopril.
With the simultaneous use of ACE inhibitors and intravenous gold preparations (sodium aurothiomalate), a symptom complex has been described, including facial flushing, nausea, vomiting and a decrease in blood pressure.
When used together with selective inhibitors reuptake of serotonin can lead to severe hyponatremia.
Combined use with allopurinol, procainamide, cytostatics can lead to leukopenia.

How to take, course and dosage

Inside, 1 time per day in the morning, regardless of the meal, preferably at the same time.
With arterial hypertension, patients who are not receiving other antihypertensive drugs are prescribed 5 mg once a day. In the absence of an effect, the dose is increased every 2-3 days by 5 mg to an average therapeutic dose of 20-40 mg / day (increasing the dose over 40 mg / day usually does not 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 within 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 has received prior treatment with diuretics, then the intake of such drugs should be discontinued 2-3 days before the start of the use of the drug Lisinopril. If this is not possible, then the initial dose of the drug 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 a pronounced decrease in blood pressure may occur.
In case of renovascular hypertension or other conditions with increased activity of the renin-angiotensin-aldosterone system, it is advisable to prescribe a low initial dose of 5 mg per day, under enhanced medical supervision (control of blood pressure, renal function, potassium ion content in serum). The maintenance dose, while continuing strict medical supervision, should be determined depending on the dynamics of blood pressure.
In renal failure, due to the fact that lisinopril is excreted by the kidneys, the initial dose should be determined depending on the creatinine clearance. Further, the selection of doses should be made depending on individual reactions with regular monitoring of renal function, potassium, sodium in serum.
Clearance of creatinine,
ml / min Initial dose,
mg / day
30-70 5-10
10-30 5
(including patients on hemodialysis)
With persistent arterial hypertension, long-term maintenance therapy of 10-15 mg / day is indicated.
In chronic heart failure: the initial dose is 2.5 mg per day, with a gradual increase in 3-5 days to 5-10 mg per day. The maximum daily dose is 20 mg.
Acute myocardial infarction (as part of combination therapy): in the first 24 hours - 5 mg, then 5 mg every other day, 10 mg every two days and then 10 mg once a day. The course of treatment is at least 6 weeks.
In the case of a prolonged marked decrease in blood pressure (systolic blood pressure less than 90 mm Hg. Art. More than 1 hour), treatment with the drug should be discontinued.
Diabetic nephropathy: in patients with type 2 diabetes mellitus, 10 mg of the drug Lisinopril is used 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 mm Hg. in a sitting position. In patients with type 1 diabetes mellitus, the dose is the same in order to achieve diastolic blood pressure values ​​below 90 mm Hg. in a sitting position.

Overdose

Symptoms (occur when taking a single dose of 50 mg): a marked decrease in blood pressure, dryness of the oral mucosa, drowsiness, urinary retention, constipation, anxiety, irritability.
Treatment: there is no specific antidote. Symptomatic therapy. Gastric lavage, the use of enterosorbents and laxatives. Intravenous administration of 0.9% sodium chloride solution is shown. In the case of treatment-resistant bradycardia, an artificial pacemaker is necessary. It is necessary to control blood pressure, indicators of water and electrolyte balance. Hemodialysis is effective.

Special instructions

Symptomatic hypotension
Most often, a pronounced decrease in blood pressure occurs with a decrease in circulating blood volume (BCC) caused by diuretic therapy, a decrease in table salt in food, dialysis, diarrhea or vomiting. In patients with chronic heart failure with or without concurrent renal failure, a marked decrease in blood pressure is possible.
Under the strict supervision of a physician, Lisinopril should be used in patients with ischemic heart disease, cerebrovascular insufficiency, in which a sharp decrease in blood pressure can lead to myocardial infarction or stroke. Transient arterial hypotension is not a contraindication for taking the next dose of the drug.
When using the drug 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 a reason for stopping treatment.
Before starting treatment with the drug, if possible, the sodium content should be normalized and / or the BCC should be replenished, the effect of the initial dose of Lisinopril on the patient should be carefully monitored.
In the case of stenosis of the renal arteries (especially with bilateral stenosis or in the presence of stenosis of an artery of a single kidney), as well as in case of circulatory failure due to a lack of sodium ions and / or fluid, the use of Lisinopril can lead to impaired renal function, acute renal failure, which usually irreversible even after drug withdrawal.
For acute myocardial infarction
The use of standard therapy (thrombolytics, acetylsalicylic acid, beta-blockers) is shown. Lisinopril can be used in conjunction 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, by blocking the formation of angiotensin II, 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, so special care is required in determining the dose.
Since the potential risk of agranulocytosis cannot be excluded, periodic monitoring of the blood picture is required. When using the drug under dialysis conditions with polyacryl-nitrile membranes, anaphylactic shock may occur, therefore, either another type of membrane for dialysis, or the appointment of other antihypertensive agents is recommended.

Influence on the ability to drive vehicles and mechanisms
There is no data on the effect of the drug Lisinopril on the ability to drive vehicles and mechanisms, used in therapeutic doses, however, it must be borne in mind that at the beginning of treatment, arterial hypotension may develop, which can affect the ability to drive vehicles and work with potentially dangerous mechanisms, and dizziness and drowsiness may also occur, so use caution.

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