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