Diroton tablets 20mg, No. 56

Essential and renovascular arterial hypertension (as monotherapy or in combination with other antihypertensive drugs). Chronic heart failure (as part of combination therapy). 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 (to reduce albuminuria in patients with insulin-dependent diabetes mellitus with normal blood pressure and in patients with non-insulin-dependent diabetes mellitus with arterial hypertension).

Individual, depending on the indications, treatment regimen, kidney function. The initial dose is 2.5 mg once a day. Maintenance doses are 5-20 mg.

Active substance: lisinopril

Pregnancy, hypersensitivity to lisinopril and other ACEs. Application during pregnancy and lactation Lisinopril is contraindicated for use during pregnancy.

It is not known whether lisinopril is excreted in breast milk. Use with caution during lactation (breastfeeding).

pharmachologic effect

ACE inhibitor. The mechanism of antihypertensive action is associated with inhibition of ACE activity, which leads to a decrease in the rate of conversion of angiotensin I to angiotensin II (which has a pronounced vasoconstrictor effect and stimulates the secretion of aldosterone in the adrenal cortex). As a result of a decrease in the formation of angiotensin II, a secondary increase in plasma renin activity occurs due to the elimination of negative feedback during the release of renin and a direct decrease in aldosterone secretion. A decrease in aldosterone secretion may contribute to an increase in potassium concentration.

Reduces OPSS (afterload), pressure of wedging in the pulmonary capillaries (preload) and resistance in the pulmonary vessels, increases cardiac output and load tolerance.

Lisinopril reduces albuminuria. In patients with hyperglycemia, it helps to normalize the function of the damaged glomerular endothelium. 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 of the active substances of the drug

Essential and renovascular arterial hypertension (as monotherapy or in combination with other antihypertensive drugs). Chronic heart failure (as part of combination therapy). 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 (to reduce albuminuria in patients with insulin-dependent diabetes mellitus with normal blood pressure and in patients with non-insulin-dependent diabetes mellitus with arterial hypertension).

Dosage regimen

Individual, depending on the indications, treatment regimen, kidney function. The initial dose is 2.5 mg once a day. Maintenance doses are 5-20 mg.

Side effect

From the side of the cardiovascular system: possible arterial hypotension, chest pain.

From the side of the central nervous system: dizziness, headache, muscle weakness.

From the digestive system: diarrhea, nausea, vomiting.

Respiratory system: dry cough.

From the hematopoietic system: agranulocytosis, decreased hemoglobin and hematocrit (especially with prolonged use); in isolated cases - an increase in ESR.

From the side of water and electrolyte metabolism: hyperkalemia.

From the side of metabolism: an increase in the level of creatinine, urea nitrogen (especially in patients with kidney disease, diabetes mellitus, renovascular hypertension).

Allergic reactions: skin rash, angioedema.

Others: in isolated cases - arthralgia.

Contraindications for use

Pregnancy, hypersensitivity to lisinopril and other ACEs. Application during pregnancy and lactation Lisinopril is contraindicated for use during pregnancy.

It is not known whether lisinopril is excreted in breast milk. Use with caution during lactation (breastfeeding).

Application for impaired renal function

Use with extreme caution in patients with impaired renal function.Before starting and during therapy, renal function should be monitored.

special instructions

Lisinopril should not be used in patients with aortic stenosis, cor pulmonale. Do not use in patients with acute myocardial infarction: with the threat of developing serious hemodynamic disorders associated with the use of a vasodilator; with impaired renal function.

Renal function should be monitored before and during therapy.

Before starting treatment with lisinopril, it is necessary to compensate for the loss of fluid and salts.

Use with extreme caution in patients with impaired renal function, renal artery stenosis, severe congestive heart failure.

The likelihood of developing arterial hypotension increases with fluid loss due to diuretic therapy, a salt-restricted diet, nausea, and vomiting.

In patients with congestive heart failure with normal or slightly reduced blood pressure, lisinopril can cause severe arterial hypotension.

The simultaneous use of lisinopril with potassium-sparing diuretics, dietary supplements for food and salt substitutes containing potassium is not recommended.

With the simultaneous use of lisinopril with lithium preparations, the concentration of lithium in the blood plasma should be monitored.

Drug interactions

With simultaneous use with antihypertensive drugs, an additive antihypertensive effect is possible.

With simultaneous use with potassium-sparing diuretics (spironolactone, triamterene, amiloride), potassium preparations, salt substitutes containing potassium, the risk of hyperkalemia increases, especially in patients with impaired renal function.

With the simultaneous use of ACE inhibitors and NSAIDs, the risk of developing renal dysfunction increases, hyperkalemia is rarely observed.

With simultaneous use with 'loop' diuretics, thiazide diuretics, the antihypertensive effect is enhanced. The occurrence of severe arterial hypotension, especially after taking the first dose of a diuretic, is apparently due to hypovolemia, which leads to a transient increase in the hypotensive effect of lisinopril. The risk of impaired renal function increases.

With simultaneous use with indomethacin, the antihypertensive effect of lisinopril decreases, apparently due to the inhibition of prostaglandin synthesis under the influence of NSAIDs (which are believed to play a role in the development of the hypotensive effect of ACE inhibitors).

With simultaneous use with insulin, hypoglycemic agents, sulfonylurea derivatives, hypoglycemia may develop due to an increase in glucose tolerance.

With simultaneous use with clozapine, the concentration of clozapine in blood plasma increases.

With simultaneous use with lithium carbonate, the concentration of lithium in the blood serum increases, accompanied by symptoms of lithium intoxication.

A case of the development of severe hyperkalemia in a patient with diabetes mellitus is described while being used with lovastatin.

A case of severe arterial hypotension with simultaneous use with pergolide is described.

When used simultaneously with ethanol, the effect of ethanol is enhanced.