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Lizoretik is a combination of an angiotensin-converting enzyme inhibitor (lisinopril) and a diuretic (hydrochlorothiazide). It has antihypertensive and diuretic effect. Lisinopril. ACE inhibitor, reduces the formation of angiotensin II from angeotenzina I. Reduced maintenance angeotenzina II leads to a direct reduction in allocation aldoserona. It reduces the degradation of bradykinin and increases the synthesis of prostaglandin. Reduces the total peripheral vascular resistance, blood pressure (BP), preload, pulmonary capillary pressure, causes an increase in cardiac output and increase exercise tolerance in patients with heart failure. Artery expands to a greater extent than veins. Some masteron 100 effects are explained by the influence on the fabric Retin-angiotensin system.With prolonged use reduces myocardial hypertrophy and arterial wall of the resistive type. It improves blood flow to ischemic myocardium. ACE inhibitors prolong the life expectancy of patients with chronic heart failure, slow the progression of left ventricular dysfunction in patients with myocardial infarction without clinical manifestations of heart failure. The onset of action after 1 hour maximum effect is determined in 6-7 hours duration – 24 hours. When hypertension effect noted in the first days after the start of treatment, stable effect develops in 1-2 months. Hydrochlorothiazide. Thiazide diuretics, the diuretic effect of which is associated with impaired reabsorption of sodium, chlorine, potassium, magnesium, water in the distal nephron; delayed excretion of calcium, uric acid. It has antihypertensive properties; hypotensive action develops due to the expansion of the arterioles. Almost no effect on normal blood pressure. The diuretic effect occurs within 1-2 hours, reaches a peak after 4 hours and lasts for 6-12 hours. The antihypertensive effect occurs within 3-4 days, but may need 3-4 weeks to achieve the optimal therapeutic effect. Lisinopril and hydrochlorothiazide when used at the same time, have addetivny antihypertensive effect.

 

Indications

  • hypertension (in patients in whom combination therapy is shown).

 

Contraindications
hypersensitivity to the drug, other ACE inhibitors and derivatives of sulphonamides, anuria, severe renal impairment (creatinine clearance less than 30 mL / min.), Angioedema (including a history of use of the ACE inhibitor) Hepatology using vysokoprotochnyh membranes hypercalcemia, hyponatremia, porphyria, precoma, hepatic coma, diabetes (severe), pregnancy, lactation, age 18 years (effectiveness and safety have not been established). Precautions: aortic stenosis / hypertrophic cardiomyopathy, bilateral renal artery stenosis, stenosis artery only kidneys with progressive azotemia, condition after kidney transplantation, renal insufficiency (creatinine clearance 30 mL / min), primary hyperaldosteronism, arterial hypotension, bone marrow hypoplasia, hyponatremia (increased risk of hypotension in patients who are at malosolevoy or salt-free diet ), state, accompanied by a decrease in circulating blood volume (including diarrhea, vomiting), connective tissue disease (systemic lupus erythematosus, scleroderma), diabetes, gout, hyperuricemia, hyperkalemia, coronary heart disease, cerebrovascular disease, severe chronic heart failure, hepatic impairment, advanced age.

Dosing and Administration
Inside, once a day. Arteraialiaya hypertension 1 tablet Lizoretik 10 mg) 12.5 mg 1 time per day. If necessary, the dose may be increased to 20 mg Lizoretik 12.5 mg. Doses in renal failure patients with a creatinine clearance of more than 30 and less than 80 ml / min., The drug can be used only after titration of the individual components of the preparation. The recommended initial dose of lisinopril when not complicated by renal failure is 5-10 mg. Previous diuretic therapy Symptomatic hypotension may occur after administration of the initial dose. Such cases are more common in patients who have had a loss of fluids and electrolytes due to prior treatment with diuretics. Therefore, it is necessary to stop taking the diuretic 2-3 days before starting treatment Lizoretikom. (see. Special instructions ).

Side effects
in most patients the side effects were mild and transient. The most frequent were: dizziness, headache.
Adverse events that occurred less frequently: Cardio-vascular system: marked reduction of blood pressure, chest pain, rarely – orthostatic hypotension, tachycardia, bradycardia, the emergence of symptoms of heart failure, violation of atrioventricular conduction, myocardial infarction. on the part of the digestive tract: nausea, vomiting, abdominal pain, dry mouth, diarrhea, dyspepsia, anorexia, changes in taste, pancreatitis, hepatitis (hepatocellular and cholestatic), jaundice. nervous system: mood lability, impaired concentration attention parestenzii, fatigue, somnolence, jerking of the limbs and lips, rare – asthenic syndrome, confusion. The respiratory system – dyspnea, bronchospasm, apnea. For the skin – rash, sweating, loss of hair, photosensitivity. Allergic reaction angeonevrotichesky swelling of the face, extremities, lips, tongue, epiglottis and / or larynx (see. “Special instructions” ), skin rash, itching, fever, vasculitis, positive for antinuclear antibodies, increased erythrocyte sedimentation rate, eosinophilia.on the part of hematopoiesis : leukopenia, thrombocytopenia, neutropenia, agranulocytosis, anemia (decreased hemoglobin, hematocrit, erythropenia). With the genitourinary system – uremia, oliguria / anuria, renal dysfunction, acute renal failure, reduced potency. Laboratory indicators: hyperkalemia and / or hypokalemia, hyponatremia, hypomagnesemia, hyposalemia, hyperuricemia, hyperglycemia, increased levels of urea and creatinine, rarely – increased activity of “liver” transaminases, giperbilibinemiya, hypercholesterolemia, hypertriglyceridemia, impaired glucose tolerance. Other: dry cough, arthralgia / arthritis, myalgia, violation of fetal kidneys, aggravation of gout.

Overdose Symptoms: marked reduction of blood pressure. Treatment: Induce vomiting and / or gastric lavage, symptomatic therapy aimed at correcting dehydration and violations of water-salt balance. If hypotension administered isotonic solution. Monitoring of urea, creatinine and electrolytes in blood serum and urine output.

Interaction with other drugs
With simultaneous use of: potassium-sparing diuretics (spironolactone, triamterene, amiloride), potassium supplements, salt substitutes containing potassium – increases the risk of hyperkalemia, especially in patients with impaired renal function, with vasodilators, barbiturates, phenothiazines, trgschiklicheskimi antidepressants, ethanol – increased hypotensive effect; with non-steroidal anti-inflammatory drugs (indomethacin, etc.), estrogen – reduced antihypertensive effect of lisinopril, with preparations of lithium – slowing lithium removal from the body (increased cardiotoxic and neurotoxic effects of lithium) with antacids and kolestraminom – reduction absorption in the gastrointestinal tract. Enhances neurotoxicity salicylates, reduces the effect of oral hypoglycemic agents, norepinephrine, epinephrine and protivopodagricakih funds, enhances the effects (including spin), cardiac glycosides, the effect of peripheral muscle relaxants, reduces excretion of quinidine. Reduces the effect of oral contraceptives.

Cautions Symptomatic hypotension is most often expressed in blood pressure occurs with a decrease in circulating blood volume caused by diuretic therapy, reducing the amount masteron 100 of salt in the diet, dialysis, diarrhea or vomiting (see. “Interaction with other medicinal products” and “Side Effects”), in patients with chronic heart failure, renal failure with simultaneous or without possible development of symptomatic hypotension. It is often diagnosed in patients with severe heart failure as a result of application of high doses of diuretics, hyponatremia or impaired renal function. In these patients, treatment should start under close medical supervision. Such rules must be followed in the appointment of patients with ischemic heart disease, cerebrovascular insufficiency, in which a sharp decrease in blood pressure can lead to heart attack or stroke. The transient hypotensive response is not a contraindication to receiving the next dose. Renal function in patients with chronic heart failure, marked reduction blood pressure after initiation of treatment with ACE inhibitors may result in further deterioration of renal function. cases of acute renal failure. in patients with bilateral renal artery stenosis or stenosis of the artery to a solitary kidney treated with ACE inhibitors, was an increase in urea and serum creatinine, usually reversible upon discontinuation of treatment. It is more common in patients with renal insufficiency. Hypersensitivity / Angioedema Angioneurotic edema of the face, extremities, lips, tongue, epiglottis and / or larynx rarely observed in patients treated with ACE inhibitors, including lisinopril, which may occur at any time during treatment. In this case, treatment with lisinopril is necessary as soon as possible and stop patient monitoring set up to complete regression of symptoms. In cases where there was only swelling of the face and lips, the condition often goes untreated, however, possible to assign antihistamines. Antinevrotichesky edema with laryngeal edema can be fatal. When covered by the language, the epiglottis, or larynx airway obstruction may occur, so it is necessary to immediately carry out the appropriate therapy (0.3-0.5 ml of epinephrine solution (epinephrine) 1: 1000 subcutaneously) and / or measures to ensure the airway Patients who was already in anamnize angioedema not associated with previous treatment with ACE inhibitors may be at increased risk of its development during treatment with an ACE inhibitor cough cough have been reported with the use of an ACE inhibitor. Cough dry, long, which disappears after discontinuation of treatment with an ACE inhibitor. In the differential diagnosis of cough should be considered, and cough caused by ACE inhibitors. Patients who are on dialysis Anaphylactic reactions observed in patients undergoing hemodialysis using dialysis membranes with high permeability, which simultaneously take ACE inhibitors. In such cases it is necessary to consider the possibility of using other types of membranes for dialysis or other angipertenzivnogo means. Surgery / general anesthesia In the application of drugs that reduce blood pressure in patients with major surgery or during general anesthesia, lisinopril may block the formation of angiotensin II. The marked reduction of blood pressure which is considered a consequence of this mechanism, it is possible to eliminate the increase in the volume of circulating blood. Before surgery (including dental) must notify the surgeon / anesthetist on the use of ACE inhibitors. Potassium in serum in some cases, there is hyperkalemia. risk factors for the development of hyperkalemia include renal insufficiency, diabetes mellitus , intake of potassium drugs, or drugs that cause an increase in the concentration of potassium in the blood (eg heparin), especially in patients with impaired renal function in patients at risk of symptomatic hypotension (located on malosolevoy or salt-free diet) with or without hyponatraemia, and patients who have received high doses of diuretics, the aforementioned state before treatment necessary to compensate (liquids and salts loss). Metabolic and endocrine effects Thiazide diuretics may affect glucose tolerance, so it is necessary to adjust the dose of antidiabetic drugs. Thiazide diuretics can reduce calcium release urine and cause hypercalcemia. Marked hypercalcaemia may be a sign of hidden hyperparathyroidism, it is recommended to discontinue treatment with thiazide diuretics before the test to evaluate the function of the parathyroid glands. During treatment Lizoretikom requires regular monitoring of potassium plasma glucose, urea, fat, and creatinine. In the period of treatment is not recommended to drink alcoholic beverages as well as alcohol increases the hypotensive effect of the drug. caution must be exercised during exercise, hot weather (risk of development of dehydration and excessive BP reduction iz-za reducing circulating blood volume). effects on ability to drive vehicles and mechanisms during treatment should refrain from driving motor vehicles and activities potentially hazardous activities that require high concentration and psychomotor speed reactions as dizziness, masteron 100 especially early in the course of treatment. q pharma

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It reduces the degradation of bradykinin and increases the synthesis of prostaglandins. Reduces the total peripheral vascular resistance (SVR), blood pressure (BP), preload, pressure in the pulmonary capillaries, causing an increase in cardiac masteron prop output (IOC) and increase tolerance to myocardial stress in patients with chronic heart failure (CHF). Artery expands to a greater extent than veins. Some effects are explained by the influence on the tissue renin-angiotensin-aldosterone system (RAAS). With prolonged use reduces myocardial hypertrophy and arterial wall of the resistive type. It improves blood flow to ischemic myocardium. ACE inhibitors prolong the life expectancy of patients with chronic heart failure, slow the progression of left ventricular dysfunction (LV) function in patients with myocardial infarction without clinical symptoms of heart failure (HF). The beginning of the antihypertensive action – after 1 hour.Maximal effect was observed after 6-7 h. Antihypertensive effect lasts for 24 hours. The duration of the effect is also dependent on the dose. When hypertension effect noted in the first days after the start of treatment, stable effect develops in 1-2 months.

Pharmacokinetics
The mean extent of absorption of lisinopril is approximately 25%, with large inter-individual variability (6-60%). Food does not affect the absorption of lisinopril.
Maximum plasma concentration is 90 ng / ml reached after 6 hours. Bioavailability – 25%. Weakly bound to plasma proteins. Permeability through the blood brain barrier and the placental barrier – is low. The metabolism of virtually exposed and excreted by the kidneys unchanged. The half-life is 12 hours in patients with chronic heart failure, cirrhosis of the liver, patients older absorption and clearance of lisinopril reduced..
Impaired renal function leads to an increase in AUC (area under the curve “concentration in plasma – time”) and half-life of lisinopril, but these changes are clinically significant only when the glomerular filtration rate is less than 30 ml / min.

Pharmacokinetics in particular groups of patients
in patients with chronic heart failure absorption and clearance lisinopril reduced bioavailability is 16%.
In patients with renal impairment (creatinine clearance less than 30 mL / min), the concentration of lisinopril is several times higher than the concentration in the blood plasma of healthy volunteers and marked increase in the time to reach maximum concentration in the plasma and an increase in half-life.
elderly patients concentration of lisinopril in the plasma increased on average by 60% and the area under the curve “concentration-time” 2 times greater than in younger patients.
patients with cirrhosis of lisinopril reduced bioavailability by 30% and the clearance is reduced by 50% compared with patients with normal liver function.

Therapeutic indications
– Essential and renovascular hypertension (AH) (as monotherapy or in combination with other antihypertensive agents);
– Chronic heart failure (CHF) (in combination therapy);
– early treatment of acute myocardial infarction in combination therapy (in the first 24 hours with stable hemodynamics to maintain these indicators and prevention of left ventricular dysfunction and heart failure);
– diabetic nephropathy (reduction of albuminuria in patients with type 1 diabetes with normal blood pressure and patients with type 2 diabetes with hypertension).

Contraindications
– Hypersensitivity to lizinoprilu, other ACE inhibitors, and drug components;
– Angioedema in history, including during treatment with ACE inhibitors;
– hereditary angioedema or idiopathic angioedema edema
– Pregnancy
– lactation;
– age of 18 years (effectiveness and safety have not been established);
– lactose intolerance, lactase deficiency, glucose-galactose malabsorption.

Precautions
aortic stenosis, hypertrophic obstructive cardiomyopathy, bilateral renal artery stenosis, stenosis of the artery only kidney condition after kidney transplantation, severe renal impairment (creatinine clearance (CC) of less than 30 ml / min.), Primary hyperaldosteronism, hypotension, inhibition of bone marrow hematopoiesis, hyponatremia (increased risk of hypotension in patients who are at malosolevoy or salt-free diet), hypovolemic state (including diarrhea, vomiting), systemic connective tissue disease (including systemic lupus erythematosus, scleroderma), diabetes, hyperkalaemia , ischemic heart disease, cerebrovascular disease (including cerebrovascular insufficiency), severe chronic heart failure, hemodialysis using dialysis membranes vysokoprotochnyh (AN69®), advanced age.

Pregnancy and lactation
Use of the drug Lisinopril during pregnancy is contraindicated. In establishing the drug pregnancy should be stopped as soon as possible. ACE inhibitors in the II and III trimester of pregnancy has adverse effects on the fetus (subject to marked reduction of blood pressure, renal failure, hyperkalemia, hypoplasia of the skull bones, fetal death). Data about the negative effects of the drug on the fetus when used during the I trimester there. For newborns and infants who have been exposed to ACE inhibitors in utero, it is recommended to monitor for early detection of significant decrease in blood pressure, oliguria and hyperkalemia.
During the period of treatment with the drug should be abolished breastfeeding (no data on the penetration of lisinopril passes into breast milk).

Dosing and Administration
Inside, 1 time per day in the morning, regardless of the meal, preferably at the same time.
Essential hypertension: an initial dose – 10 mg / day maintenance dose – 20 mg / day, maximum daily dose – 40 mg . Stable antihypertensive effect develops in 1-2 months, which should be considered when increasing the dose. If use of the drug at the maximum dose does not cause a sufficient therapeutic effect, it is possible additional purpose other antihypertensive agents.
Patients receiving pre diuretics, you must cancel them for 2-3 days prior to the start of the drug. If unable to cancel diuretics initial dose of lisinopril should not exceed 5 mg / day.
Renovascular hypertension or other conditions with increased activity of the RAAS: the initial dose – 2.5-5 mg / day under the control of blood pressure, kidney function, potassium blood serum. The maintenance dose is set depending on the magnitude of blood pressure.
In chronic renal failure (CRF) is determined by the dose depending on creatinine clearance (CC): with CC 30-70 ml / min – 5.10 mg / day, with CC – 10-30 ml / min – 2.5-5 mg / day, less than 10 ml / min, including patients on dialysis – 2.5 mg / day. The maintenance dose is determined depending on the pressure (controlled by the kidneys, potassium and sodium content in the blood).
CCF (simultaneously with diuretics and / or cardiac glycosides): initial dose – 2.5 mg / day, with a gradual increase of 2.5 mg every 3-5 days maintenance daily dose of 5-10 mg / day. The maximum daily dose – 20 mg. If possible, the dose of diuretic should be reduced before you start taking lisinopril.
Elderly patients are often observed a more pronounced long-term antihypertensive effect, which is associated with a decrease in the rate of excretion of lisinopril (it is recommended to start treatment with 2.5 mg / day – ½ tablets of 5 mg).
Acute myocardial infarction (in combination therapy in the first 24 hours with stable hemodynamics) in the first 24 hours – 5 mg, and then 5 mg a day,
10 mg every two days and then 10 mg 1 time per day. The course of treatment -. 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 mmHg or lower) prescribe a lower dose – 2.5 mg. In case of reduction of blood pressure (systolic blood pressure less than or equal to 100 mm Hg) a daily dose of 5 mg, if necessary, temporarily reduced to 2.5 mg. In the case of long pronounced reduction in blood pressure (systolic blood pressure below 90 mm Hg for more than 1 hour) treatment with the drug is stopped.
Diabetic nephropathy: an initial dose – 10 mg / day, which, if necessary, increased to 20 mg / day to achieve diastolic blood pressure values below 75 mm Hg measured in the “sitting” for patients with type 1 diabetes and below 90 mmHg in the “sitting” in patients with type 2 diabetes.

Side effects:
The most common side effects: dizziness, headache, fatigue, diarrhea, dry cough, nausea. Cardio – vascular system : marked reduction of blood pressure, chest pain, orthostatic hypotension, tachycardia, bradycardia, new or worsening symptoms of heart failure, violation of atrioventricular conduction, myocardial infarction, palpitations. On the part of the central nervous system : emotional lability, impaired concentration, paraesthesia, somnolence, jerking of the limbs and lips, fatigue, asthenic syndrome, confusion. From the side of hematopoiesis : leukopenia, neutropenia, agranulocytosis, thrombocytopenia, anemia (decreased concentration, hemoglobin, hematocrit, erythropenia). The respiratory system : dyspnea, dry cough, bronchospasm. From the digestive system : dryness of the oral mucosa, anorexia, dyspepsia, taste changes, abdominal pain, pancreatitis, jaundice (hepatocellular or cholestatic), hepatitis. For the skin : increased sweating, alopecia, photosensitivity, pruritus. With the genitourinary system : renal failure, oliguria, anuria, acute renal failure, uremia, proteinuria , reduced potency. Allergic reactions : angioneurotic edema of the face, extremities, lips, tongue, epiglottis and / or throat, skin rash, hives, fever, positive test results antinuclear antibodies, increased erythrocyte sedimentation rate, eosinophilia, leukocytosis, intestinal angioedema. Other : . myalgia, arthralgia / arthritis, vasculitis With simultaneous use of ACE inhibitors and gold preparations (sodium aurothiomalate) intravenously, describes a symptom, including facial flushing, nausea, vomiting, and hypotension. Laboratory indicators : hyperkalemia, masteron prophyponatremia, increased activity of “liver” transaminases, hyperbilirubinemia, hypercreatininemia, increasing concentrations of urea.

Overdose
Symptoms: marked reduction of blood pressure, dryness of the oral mucosa, drowsiness, urinary retention, constipation, fluid and electrolyte balance, renal failure, shortness of breath, tachycardia, palpitations, bradycardia, dizziness, anxiety, irritability.
Treatment: gastric lavage reception activated carbon, giving the horizontal position of the patient with elevated legs, replenishment of circulating blood volume – intravenous 0.9% sodium chloride solution or other plasma solutions, if necessary – vasopressor drugs, monitoring of the cardiovascular and respiratory systems, blood pressure, bcc , urea, creatinine, fluid and electrolyte balance. In the case of bradycardia resistant -. The use of artificial pacemaker
Hemodialysis is effective.

Interaction with other drugs
With simultaneous use of potassium-sparing diuretics (spironolactone, triamterene, amiloride), potassium supplements, salt substitutes containing potassium – increases the risk of hyperkalemia, especially in patients with impaired renal function. Therefore, they can jointly appoint only on the basis of individual decisions the doctor for regular monitoring of potassium serum levels and renal function.
In an application with beta-blockers, blockers “slow” calcium channel blockers, diuretics and other antihypertensive agents enhancement of the antihypertensive effect of the drug.
Lisinopril can be used in conjunction with beta-blockers, acetylsalicylic acid (in doses less than 300 mg / day), thrombolytics, nitrates.
while the use of vasodilators, barbiturates, phenothiazines, tricyclic antidepressants, ethanol – increased antihypertensive action of the drug.
in an application with non-steroidal anti-inflammatory drugs (NSAIDs) (including selective cyclooxygenase-2 inhibitors), estrogens and adrenostimulyatorov – reduced antihypertensive effect of lisinopril.
in an application with drugs lithium – slower excretion of lithium (increased cardiotoxic and neurotoxic effects of lithium).
at the same time use with antacids and colestyramine -. reduced absorption in the gastrointestinal tract
drug increases neurotoxicity salicylates, reduces the effect of hypoglycemic agents for oral administration, norepinephrine (noradrenaline), epinephrine (adrenaline) and protivopodagricakih preparations enhances the effects (including spin), cardiac glycosides effect peripheral muscle relaxants, reduces excretion of quinidine.
reduces the effect of oral contraceptives. At the same time taking methyldopa increased risk of hemolysis.
The combined use with selective serotonin reuptake inhibitors can lead to severe hyponatremia.
The combined use with allopurinol, procainamide, cytostatics may cause leukopenia.
With the simultaneous use of ACE inhibitors and gold preparations (sodium aurothiomalate) intravenously, describes a symptom, including facial flushing, nausea, vomiting, and hypotension.

Cautions
Marked reduction in blood pressure often occurs with a decrease in circulating blood volume caused by diuretic therapy, reducing the amount of salt in the diet, hemodialysis, diarrhea or vomiting. In patients with chronic heart failure with simultaneous renal failure or without her, perhaps marked reduction in blood pressure. It is most often diagnosed in patients with severe stage of chronic heart failure as a result of application of high doses of diuretics, hyponatremia or impaired renal function. In these patients, treatment should start under close medical supervision (with caution in selection of dosage and diuretics).Such rules must be followed in the appointment of patients with ischemic heart disease, cerebrovascular insufficiency, in which a sharp decrease in blood pressure can lead to heart attack or stroke. Prior to treatment, if possible, should be to normalize the concentration of sodium and / or fill the volume of circulating blood, carefully controlled initial dose effect on the patient. Treatment of symptomatic hypotension includes bed rest, and, if necessary, on / in the liquid (saline infusion). Transient hypotension is not a contraindication to treatment with lisinopril, however, may require the temporary cancellation of his or dose reduction.
Treatment with Lisinopril is contraindicated in case of cardiogenic shock and acute myocardial infarction, if vasodilator appointment can significantly worsen the hemodynamic parameters, such as when the systolic BP less than 100 mm Hg. v.
In patients with acute myocardial infarction decreased renal function (creatinine concentration in plasma is more than 177 umol / l and / or proteinuria greater than 500 mg / 24 h) is a contraindication for use of the drug Lisinopril. In the case of renal insufficiency during lisinopril therapy (serum creatinine concentration in the blood plasma to more than 265 mmol / l, or twice the baseline), the doctor has to decide the need for treatment discontinuation.
In bilateral renal artery stenosis and renal artery stenosis sole kidney, as well as with hyponatremia and / or reducing the volume of circulating blood or circulatory failure, hypotension caused by the intake of the drug Lisinopril may lead to a decrease in renal function and the subsequent development of reversible (after discontinuation of the drug), acute renal failure. A slight temporary increase in the concentration of urea and creatinine in the blood can be observed in cases of impaired renal function, especially against the background of simultaneous treatment with diuretics. In cases of a significant reduction in renal function (creatinine clearance less than 30 ml / min) require careful monitoring of renal function.
Angioneurotic edema of the face, extremities, lips, tongue, epiglottis and / or the larynx is rare in patients treated with ACE inhibitors, including the drug Lisinopril, It may occur at any time during treatment. In this case, treatment with lisinopril as soon as possible and stop patient monitoring set up to complete regression of symptoms. In cases where only the face and lips originated edema, a condition often goes untreated, however, possible to assign antihistamines. Angioedema with laryngeal edema can be fatal. When covered by the language, the epiglottis, or larynx airway obstruction may occur, so it is necessary to immediately carry out the appropriate therapy (0.3-0.5 ml of epinephrine solution (epinephrine) 1: 1000 subcutaneous administration of corticosteroids, antihistamines) and / or measures to ensure airway patency.
in patients with a history already had angioedema not associated with previous treatment with ACE inhibitors, the risk of its development during treatment with an ACE inhibitor can be increased.
An anaphylactic reaction is observed and in patients on hemodialysis using vysokoprotochnyh dialysis membranes (AN69®), which simultaneously receive lisinopril. In such cases it is necessary to consider the possibility of using other types of dialysis membranes or other antihypertensive agents. You may experience anaphylactic reactions during low-density lipoprotein apheresis dextran sulfate.
In some cases, desensitization to Hymenoptera venom (wasp, bee, etc..), Treatment with ACE inhibitors was accompanied by hypersensitivity reactions. Such can be avoided by previously temporarily interrupt receiving ACE inhibitors.
In patients with extensive surgery or during general anesthesia, ACE inhibitors (such as lisinopril) can block the formation of angiotensin II. Reduction in blood pressure associated with this mechanism of action, adjusted increase in circulating blood volume. Before surgery (including dental) must notify the surgeon / anesthetist on the use of Lisinopril drug.
Use of the recommended doses of the drug in elderly patients may be associated with an increased concentration of lisinopril in the blood, so the titration requires special attention and is carried out, depending on renal function and blood pressure of the patient.
However, so in the elderly and younger patients Lisinopril antihypertensive effect of the drug is masteron prop expressed in the same degree.
By the use of ACE inhibitors coughing was observed. Cough dry, long, which disappears after discontinuation of treatment with ACE inhibitors. In the differential diagnosis of cough should be considered, and cough caused by the use of ACE inhibitors.
In some cases, there is hyperkalemia. The risk for the development of hyperkalemia factors include renal failure, diabetes, intake of potassium drugs or drugs that increase potassium in the blood (eg heparin), especially in patients with impaired renal function. During the period of drug treatment requires regular monitoring of blood potassium ion plasma glucose, urea, lipids.
During the period of treatment is not recommended to drink alcohol, as alcohol increases the antihypertensive effect of the drug.
Caution must be exercised during exercise, hot weather (risk of dehydration and excessive reduction of blood pressure due to a decrease in blood volume).
Since it is impossible to eliminate the potential risk of agranulocytosis, requires periodic monitoring of blood picture.
based on the results of epidemiological studies suggest that concomitant use of ACE inhibitors and insulin and hypoglycemic agents for oral administration may lead to hypoglycemia. The greatest risk of observed within the first weeks of combination therapy, and in patients with impaired renal function. In patients with diabetes requires careful glycemic control, especially during the first month of treatment with an ACE inhibitor. ACE inhibitors may lead to the development of cholestatic jaundice with progression to fulminant hepatic necrosis, so you need to stop taking the drug with an increase in activity of “liver” transaminases and the occurrence of symptoms of cholestasis.

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ACE inhibitor, reduces the formation of angiotensin II from angiotensin I. Reduction of angiotensin II leads to a direct reduction of aldosterone release. It reduces the degradation of bradykinin and increases the synthesis of prostaglandins. It reduces the total peripheral vascular resistance, blood pressure (BP), preload, pressure in the pulmonary capillaries, causing an increase in cardiac output and increase tolerance to myocardial stress in patients with chronic heart failure. Artery expands to a greater extent than veins. Some effects are explained by the influence on the tissue renin-angiotensin system. With testosterone suspension results prolonged use reduces myocardial hypertrophy and arterial wall of the resistive type. It improves blood flow to ischemic myocardium. ACE inhibitors prolong the life expectancy of patients with chronic heart failure, slow the progression of left ventricular dysfunction in patients with myocardial infarction without clinical manifestations of heart failure. The antihypertensive effect begins in about 6 hours and is maintained for 24 hours. Duration of the effect is also dependent on the dose. Onset of action -. 1 hour maximum effect is determined after 6-7 hours.When hypertension effect noted in the first days after the start of treatment, stable effect develops in 1-2 months. With a sharp lifting of the drug was observed pronounced increase in blood pressure. In addition to lowering blood pressure lisinopril reduces albuminuria. Patients with hyperglycemia promotes the normalization of the function of the damaged glomerular endothelium. Lisinopril not affect the blood glucose concentration in diabetic patients and leads to increased incidence of hypoglycemia. Pharmacokinetics suction. After oral administration around 25% of lisinopril absorbed from the gastrointestinal tract. Food does not affect the absorption of the drug. Absorbance is average of 30%, bioavailability -. 29% . The distribution almost does not bind to plasma proteins. The maximum plasma concentration (90 ng / mL) was reached after 7 hours. The permeability of the blood-brain and placental barrier is low. Metabolism. Lisinopril is not biotransformed in the body. Excretion. Excreted by the kidneys unchanged.The half-life is 12 hours. Pharmacokinetics in specific patient groups In patients with chronic heart failure Absorption clearance lininoprila reduced. In patients with renal insufficiency, the concentration of lisinopril several times higher than plasma concentrations in the volunteers, and increased time observed maximum plasma concentration and increase half-life. elderly patients drug concentration in plasma and area under the curve in a 2-fold greater than in younger patients.

Indications
Arterial hypertension (as monotherapy or in combination with other antihypertensive agents), chronic heart failure (in a combination therapy for the treatment of patients taking drugs digitalis and / or diuretics), early treatment of acute myocardial infarction (during the first 24 hours with stable hemodynamics to maintain these indicators and prevention of left ventricular dysfunction and heart failure), diabetic nephropathy (insulin-dependent reduction of albuminuria in patients with normal blood pressure and insulin dependent patients with hypertension).

Contraindications
: Hypersensitivity to lizinoprilu or other ACE inhibitors, angioedema in history, including the use of ACE inhibitors, hereditary angioedema, age 18 years (effectiveness and safety have been established).

Precautions : severe renal impairment, a bilateral renal artery stenosis or stenosis of the artery only kidneys with progressive azotemia, condition after kidney transplantation, renal failure, azotemia, hyperkalemia, aortic stenosis, hypertrophic obstructive kardiomipatiya, primary aldosteronism, hypotension, cerebrovascular disease ( including cerebrovascular insufficiency), ischemic heart disease, coronary insufficiency, autoimmune systemic diseases of connective tissue (including scleroderma, systemic lupus erythematosus); inhibition of medullary hematopoiesis; sodium restricted diet; hypovolemic states (including through diarrhea, vomiting); elderly age.

Pregnancy and lactation
The use of lisinopril during pregnancy is contraindicated. In establishing the drug pregnancy should be stopped as soon as possible. ACE inhibitors in the II and III trimester of pregnancy has adverse effects on the fetus (subject to marked reduction of blood pressure, renal failure, hyperkalemia, hypoplasia of the skull, fetal death). Data about the negative effects of the drug on the fetus when used during the I trimester there. For newborns and infants who have been exposed to ACE inhibitors in utero, should be closely monitored for timely detection of significant decrease in blood pressure, oliguria and hyperkalemia.
Lisinopril crosses the placenta. No data on the penetration of Lisinopril passes into breast milk. For the period of drug treatment should be abolished breastfeeding.

Dosing and Administration
Inside, regardless of meals. When hypertension patients are not receiving other antihypertensive drugs, prescribed 5 mg 1 time per day. If no effect dose is increased every 2-3 days on average to 5 mg of a therapeutic dose of 20-40 mg / day (an increase of more than 40 mg / day usually will not lead to further reduction in blood pressure). The usual daily maintenance dose – 20 mg. The maximum daily dose – 40 mg.
The full effect usually develops within 2-4 weeks of starting treatment, which should be considered when increasing the dose. When there is insufficient clinical effect of the drug can be combined with other antihypertensive agents.
If the patient has received prior treatment with diuretics, the use of these drugs should be discontinued for 2-3 days prior to the application Lizigammy. If this is not feasible, then Lizigammy initial dose should not exceed 5 mg per day. In this case, after the first dose is recommended medical supervision for several hours (maximum action is reached after about 6 hours), since it may be a marked reduction in blood pressure. If renovascular hypertension or other conditions with increased activity of the renin-angiotensin-aldosterone system appropriate to appoint as lower initial dose – 2.5-5 mg a day, under increased medical supervision (control of blood pressure, the kidneys, the concentration of potassium in blood serum). Maintenance dose, continuing strict medical control should be determined depending on the dynamics of AD. In renal failure because the lisinopril excreted through the kidneys, the initial dose should be determined according to the creatinine clearance, then according to the reaction, should establish a maintenance dose of a conditions of frequent monitoring of renal function, potassium, sodium in serum. 

At the reception of hypertension shows a long-term maintenance of 10-15 mg / day treatment. In chronic heart failure – begin with 2.5 mg 1 time per day, with a consequent increase in the dose of 2.5 mg every 3-5 days to normal, maintenance a daily dose of 5-20 mg. The dose should not exceed 20 mg per day. In the elderly often observed more pronounced prolonged hypotensive effect, which is associated with a decrease in the rate of excretion of lisinopril (it is recommended to start treatment with 2.5 mg / day). Acute myocardial infarction (in combination therapy) On the first day – 5 mg orally, followed by 5 mg every other day, 10 mg every two days and then 10 mg 1 time per day. In patients with acute myocardial infarction drug use 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 mmHg or lower..) It is necessary to prescribe a lower dose – 2 5 mg. In case of reduction of blood pressure (systolic blood pressure less than or equal to 100 mm Hg. Art.), A daily dose of 5 mg may be, if necessary temporarily reduced to 2.5 mg. In the case of long pronounced reduction in blood pressure (systolic blood pressure below 90 mm Hg. Art. 1 hour), treatment should be stopped Lizigammoy. Diabetic nephropathy in patients with insulin-dependent diabetes mellitus used Lizigammy 10 mg 1 time per day. The dose may, if necessary, be increased to 20 mg 1 time per day in order to achieve values below the diastolic blood pressure of 75 mm Hg. Art. in a sitting position. Patients with insulin-dependent diabetes mellitus is the same dosage, in order to achieve values below the diastolic blood pressure of 90 mm Hg. Art. in a sitting position.

Side effects:
The most common side effects: testosterone suspension results dizziness, headache (in 5-6% of patients), fatigue, diarrhea, dry cough (3%), nausea, vomiting, orthostatic hypotension, skin rashes, chest pain (1-3% ). Other side effects (frequency <1%): the part of the immune system: (0.1%), angioedema (face, lips, tongue, larynx or epiglottis, the upper and lower limbs). Since the cardiovascular system: marked reduction of blood pressure , orthostatic hypotension, renal dysfunction, disorders, heart palpitations heart rhythm. On the part of the central nervous system: fatigue, drowsiness, convulsive twitching of the muscles of the limbs and lips. From the hematopoietic system: leucopenia, neutropenia, agranulocytosis, thrombocytopenia, long-term treatment – a slight decrease in hemoglobin concentration and hematocrit, erythropenia.Laboratory indicators: hyperkalemia, azotemia, hyperuricemia, hyperbilirubinemia, increased activity of “liver” enzymes, especially when there is a history of kidney disease, diabetes, and renovascular hypertension. rare side effects (less than 1% ): Since the cardiovascular system: heart rate; tachycardia; myocardial infarction; cerebrovascular stroke in patients with an increased risk of disease, as a result of pronounced reduction in blood pressure. On the part of the digestive tract: dry mouth, anorexia, dyspepsia, changes in taste, abdominal pain, pancreatitis, hepatocellular or cholestatic jaundice, hepatitis.For the skin: hives, increased sweating, itching, alopecia. From the urinary system: renal failure, oliguria, anuria, acute renal failure, uremia, proteinuria. On the part of the immune system: the syndrome, including the acceleration of erythrocyte sedimentation rate (ESR), arthralgia and appearance antinuclear antibodies. On the part of the central nervous system: asthenic syndrome, mood lability, confusion, reduced potency. Other: myalgia, fever, disturbance of fetal development.

Overdose
Symptoms (occur when receiving a single dose of 50 mg): marked reduction of blood pressure; dry mouth, drowsiness, urinary retention, constipation, anxiety, irritability.
. Treatment: symptomatic therapy, intravenous fluids, controlling blood pressure, fluid and electrolyte balance and normalize the last
Lisinopril can be removed from the body by hemodialysis.

Interaction with other medicinal products
require special care while applying the drug with: potassium-sparing diuretics (spironolactone, triamterene, amiloride), potassium, Vice salts containing potassium (increased risk of hyperkalemia, especially with impaired renal function, so they can jointly appoint only . based on the individual judgment of the prescribing physician with regular monitoring of potassium serum levels and renal function
Caution can be applied together: a diuretic: the additional administration of a diuretic to a patient receiving Lisinopril, as a rule, comes an additive antihypertensive effect – the risk of significant decrease in blood pressure;

 

  • with other antihypertensive agents (additive effect);
  • with non-steroidal anti-inflammatory drugs (. indomethacin, etc.), estrogens and adrenostimulyatorov – reduced antihypertensive effect of lisinopril;
  • with lithium (lithium excretion may be reduced, so you should regularly monitor the concentration of lithium in blood serum);
  • with antacids and colestyramine – reduce absorption in the gastrointestinal tract. Alcohol enhances the effect of the drug.
    Lisinopril reduces potassium excretion from the body in the treatment of diuretic.Cautions Symptomatic hypotension is most often pronounced decrease in blood pressure occurs with a decrease in fluid volume caused by diuretic therapy, reduction of salt in food, dialysis, diarrhea or vomiting. In patients with chronic heart failure with simultaneous renal failure or without her, perhaps marked reduction in blood pressure. It is often diagnosed in patients with severe stage of chronic heart failure as a result of application of high doses of diuretics, hyponatremia or impaired renal function. In these patients, treatment Lizigammoy should start under close medical supervision (with caution in selection of dosage and diuretics). Such rules must be followed in the appointment of patients with ischemic heart disease, cerebrovascular insufficiency, in which a sharp decrease in blood pressure can testosterone suspension results lead to heart attack or stroke. Transient hypotensive response is not a contraindication to receiving the next dose of the drug. in applying Lizigammy, 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 cause for discontinuation of treatment. Before treatment Lizigammoy at Wherever possible, normalize the concentration of sodium and / or compensate for the lost volume of liquid carefully control action starting dose Lizigammy to the patient. in the case of renal artery stenosis (especially in bilateral stenosis or in the presence of artery stenosis single kidney) and circulatory failure due to lack of sodium and / or liquid Lizigammy use may lead to renal dysfunction, acute renal failure, which is usually irreversible after discontinuation of the drug. in acute myocardial infarction The application of standard therapy (thrombolytics, acetylsalicylic acid, beta-blockers). Lizigammu may be used in conjunction with intravenous or using therapeutic transdermal nitroglycerin systems. Surgery / general anesthesia In extensive surgical interventions, as well as the use of other drugs that cause a decrease in blood pressure, lisinopril, blocking the formation of angiotensin II of, can cause pronounced unpredictable blood pressure reduction . in elderly patients the same dose results in a higher concentration of drug in the blood, so extra care is required when determining the dose. Because you can not rule out the potential risk of agranulocytosis, requires periodic monitoring of blood picture. In applying the drug in a dialysis polyacryl-nitrile membrane can occur anaphylactic shock, it is recommended that a different type of dialysis membrane or appointment of other antihypertensive agents.

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The drug is based on the blockade of acetaldehyde dehydrogenase, which is involved in the metabolism of ethanol. This leads to increasing the concentration of ethyl alcohol metabolite – acetaldehyde causing negative sensations (flushing, nausea, vomiting, tachycardia, decrease in blood pressure (BP) and the like), which make it extremely unpleasant alcohol Lidevina after administration. This buy testosterone suspension leads to a conditioned reflex aversion to the taste and smell of alcoholic beverages. The maximum therapeutic effect is reached within 12 hours after receiving peroralyyugo and may continue for 10-14 days after cessation of treatment. Combination dnsul-Piram with vitamins. The combination of the disulfiram with vitamin B3 and B4 provides a pronounced clinical effect on the reception of even small doses of alcohol, has minimal side effects, reduces the toxicity of disulfiram, provides for prevention of alcoholic polyneuropathy and hypovitaminosis. PharmacokineticsAfter oral absorption of disulfiram from the gastrointestinal tract (GIT) is from 70 to 90%. It is rapidly metabolized, recovering to dithio-carbamate, which he presented as a glucuronyl conjugate or transformed into diethyl-lamin and carbon sulfide, part of which (4-53%) is output from the light.

Indications
Treatment and prevention of relapse of chronic alcoholism.

Contraindications Absolute: diseases of the cardiovascular system in the stage of decompensation, hearing (auditory nerve neuritis) and the eye (glaucoma, optic neuritis); asthma, emphysema; pulmonary tuberculosis, severe hepatic impairment, disease-forming organs, diabetes, hyperthyroidism, epilepsy and convulsions of any origin, mental illness, exacerbation of peptic ulcer disease, kidney disease, malignant tumor, polyneuritis any etiology, pregnancy, increased individual sensitivity to the drug. Relative: cardiovascular diseases in the stage of compensation, advanced age (over 60), peptic ulcer and 12 duodenal ulcer in remission, residual effects after cerebrovascular accident, previously transferred teturamnye (precipitates a) psychoses.

Precautions
Lidevin should be taken with caution in patients with renal insufficiency and hypothyroidism, especially when the risk of a possible combination with alcohol.

Dosage and administration
Treatment is prescribed after careful obsledovashr patient and warning of the consequences and complications. The drug is taken orally by 125-500 mg 2 times a day on an individual scheme (dose calculation being based on disulfiram). After 7-10 days carried disulfiramalkogolnuyu sample (20-30 ml of 40% after administration regia 500 mg) is increased to 10-20 ml (maximum dose of 100 120 ml of vodka) with a weak dose of alcohol of reaction. The sample is repeated every 1-2 days in the hospital and after 3-5 days, outpatient correction doses of alcohol and / or the need for the drug. Further it is possible to use a maintenance dose of 125-200 mg per day for 1-3 years.

Side effects due to the properties of disulfiram:

  • Metallic taste in the mouth.
  • Unpleasant smell in patients with colostomy (associated with carbon sulfide).
  • Rare cases of hepatitis, sometimes found in patients with eczema of nickel, not suffering from alcoholism.
  • Polyneuropathy of the lower limbs, optic neuritis.
  • Memory loss, confusion, fatigue.
  • Headache.
  • Skin allergic buy testosterone suspension reactions.

Related to the combination of disulfiram-ethanol:

  • Cases of respiratory failure; cardiovascular collapse, cardiac arrhythmias, angina pectoris, myocardial infarction sometimes, and neurological disorders; swelling of the brain.

Complications of chronic administration: rarely psychosis, resembling alcoholic; hepatitis, gastritis; in patients suffering from cardiovascular diseases is possible thrombosis of the brain vessels, so the complaints of paresthesia should stop the drug immediately limbs and face; exacerbation of polyneuritis.
When receiving doses of alcohol of more than 50-80 ml of vodka while taking Lead Evin develop severe disorders of the cardiovascular and respiratory systems, edema, convulsions. In this case urgently carried out detoxication therapy, administered analeptics, symptomatic treatment.

 

Overdose
combination with ethanol can cause depression of consciousness up to coma, cardiovascular collapse, neurological complications. Treatment is symptomatic.

Interaction with other medicinal products is contraindicated in combination:

  • Alcohol. hypersensitive reaction (flushing, erythema, vomiting, tachycardia).

Avoid taking alcoholic drinks and medicines containing alcohol. Undesirable combinations:

  • Isoniazid. Violations of conduct and co-ordination.
  • Nitro-5-imidazole (metronndazol, ordinazol, seknidazol, tinidazole). Delirious disorder, confusion.
  • Phenytoin. A significant and rapid rise in the level of phenytoin plasma with toxic symptoms (suppression of its metabolism).

If the combination can not be avoided, it is necessary to conduct the clinical observation and monitoring of drug concentrations in plasma during and after treatment Lidevinom. Combinations requiring caution:

    • Warfarin (and other oral anticoagulants). The increased effect of oral anticoagulants and risk of bleeding (decrease warfarin collapse of the liver). It is recommended more frequent buy testosterone suspension monitoring of warfarin concentration and dose adjustment of anticoagulants within 8 days after the cancellation Lidevina.

Theophylline. Lidevin inhibits the metabolism of theophylline. As a result, the theophylline dose should be adjusted (reduced dose), depending on the clinical symptoms and the drug concentration in plasma.

  • Benzodiazepines. Disulfiram may potentiate the sedative effects of benzodiazepines by inhibiting their oxidative metabolism (especially chlordiazepoxide and diazepam). Benzodiazepine dosage should be adjusted according to the clinical manifestations.
  • Tricyclic antidepressants. Perhaps strengthening the reaction of alcohol intolerance (especially if patients on a background of reception Lidevina take alcoholic drinks).

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testosterone suspension cycle

Breaks down the main component of connective tissue interstitial substance – hyaluronic acid (mucopolysaccharide, which consists of acetylglucosamine and glucuronic acid, is the cementing substance of connective tissue) and reduces testosterone suspension cycle its viscosity, increases the tissue and vascular permeability, facilitates the movement of fluids in the interstices spaces; reduces tissue swelling, softens and flattens scars, increases the amount of motion in the joints, reduces contracture and prevents their formation. Hyaluronidase causes the breakdown of hyaluronic acid to glucosamine and glucuronic acid and thereby reduces its viscosity. The duration of action when administered intradermally – up to 48 hours.

Indications
Burn, traumatic, post-surgical scars; nonhealing ulcers (including radiation); Dupuytren’s contracture; joint stiffness, joint contractures (after inflammation, injuries), osteoporosis, ankylosing spondylitis, severe disease of lumbar disc; chronic tenosynovitis, scleroderma (skin manifestations), the soft tissue hematoma surface localization; preparations for dermatological and plastic surgery on the scar nodules. Tuberculosis of the lungs (bronchi complicated by nonspecific lesions), inflammation of the upper respiratory tract and bronchi with obstruction phenomena. Traumatic lesions of nerve plexus and peripheral nerves (plex neuritis).Hyphema, hemo-ftalm, retinopathy of various etiologies.

Contraindications:
Hypersensitivity, acute infectious and inflammatory diseases, recent hemorrhage, acute intercurrent disease, children under 18 years. For inhalation – pulmonary tuberculosis with severe respiratory failure; lung, bleeding, coughing up blood; malignancies, fresh vitreous hemorrhage. Concomitant estrogen. Data on the use of the drug have no children.

Precautions
Pregnancy, lactation.

Dosage and administration:
When scarring lesions of subcutaneous (under the scar-altered tissue) or intramuscularly (near the site of injury) administered 64 CU (1 ml) daily or every other day (a total of 10-20 injections).
In traumatic lesions of nerve plexus and peripheral nerves is administered subcutaneously to the affected nerve (64 UE in procaine solution) every other day; a course – 12-15 injections. The course of treatment is repeated as needed.
When used in ophthalmic practice, the drug is administered subkonyunktivalno – 0.3 ml, parabulbarno – 0.5 mL, and electrophoresis.
Patients with pulmonary tuberculosis with the productive nature of inflammation is administered in combination therapy for increasing the concentration of antibacterial drugs testosterone suspension cycle in lesions by injection and / or inhalation; Inhalation is administered daily one time with 5 ml (320 CU). The course of treatment consists of 20-25 inhalation. If necessary to repeat courses at intervals of 1.5-2 months.
Outwardly, in the form of dressings impregnated with the drug solution. To prepare the solution every 64 UE dissolved in 10 ml of sterile 0.9% sodium chloride solution or boiled water at room temperature.This solution is wetted with a sterile bandage, folded in 4-5 layers, applied it to the affected area, cover with waxed paper and fix soft bandage. The dose depends on the area affected (20-60 iu / sq cm.), On average – 300 ME on the bandage. The bandage is applied daily for 15-18 hours for 15-60 days. With prolonged use every 2 weeks make a break for 3-4 days.
When using electrophoresis method ME 300 was dissolved in 60 ml of distilled water, add 2-3 cap of 0.1% hydrochloric acid solution and injected from the anode to the affected area for 20 -30 min. The treatment course – 15-20 sessions. The applicator dosing regimen can be alternated with electrophoresis. The prepared solution should be used within 24 hours.

Side effects:
Allergic reactions; long-term use – local irritating effect.

Overdose Symptoms: fever, nausea, vomiting, dizziness, tachycardia, decreased blood pressure, local swelling, urticaria, erythema. Treatment: administration of epinephrine, corticosteroids; antihistamines.

Interaction with other drugs
improves the absorption of drugs administered subcutaneously or intramuscularly, enhances the effect of local anesthetics.

Specific guidance
solution should not be injected through the catheter in which solutions containing cations previously injected. Injectable testosterone suspension cycle solutions are prepared by 0.9% sodium chloride or 0.5% solution of procaine solution for inhalation – 0.9% sodium chloride solution for electrophoresis -. In distilled water
to test intradermal injection with 20 Before treatment advisable l of hyaluronidase.
It should not be administered in the area of infectious inflammation and swelling. In acute hemorrhages hyaluronidase does not apply. how much to inject for weight loss

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