2010/06/14

DAPRIL

Pharmacological action

ACE inhibitor. Antihypertensives. The mechanism of action related to the blockade of ACE, which leads to suppression of the conversion of angiotensin I to angiotensin II. Reducing the concentration of angiotensin II leads to increased plasma renin and reduced secretion of aldosterone.

Reduces TPVR, BP, pre-and afterload. Reduces pressure in the pulmonary circulation and in the right atrium. Decreases aldosterone synthesis in the adrenal glands.

Onset of action is noted in 2 hours after taking the drug, the maximum effect after 4-6 h and lasts at least 24 hours


Statement

- Arterial hypertension, including renovascular (as monotherapy or in combination with other antihypertensive drugs);

- Chronic heart failure (as part of combination therapy with drugs digitalis and / or diuretics).


Dosage regimen

When hypertension dosage perform individually, depending on the level of BP.

The initial dose is 10 mg 1 time / day; supports - 20 mg 1 time / day. After a week of therapy, if necessary may increase the dose to 40 mg / day.

The maximum daily dose - 80 mg.

In chronic heart failure Dapril initial dose is 2.5 mg / day. Maintenance dose ranges from 5 to 20 mg / day.

Patients with impaired renal function dosage set depending on creatinine clearance. When spacecraft over 30 ml / min recommended daily dose - 10 mg, with spacecraft from 10 to 30 ml / min - 5 mg / day, with CC <10 ml / min - 2.5 mg / day.


Side effect

From the side of the central nervous system: dizziness, headache, fatigue, and in some cases - the lability of mood, confusion.

On the part of the digestive system: nausea, rare - abdominal pain, diarrhea, dry mouth, and in some cases - increase in liver transaminases, increase in the concentration of bilirubin in the blood serum.

On the part of the hemopoietic system: neutropenia, agranulocytosis, lower hemoglobin level and erythrocyte count.

Since the cardiovascular system: rarely - orthostatic hypotension, tachycardia.

On the part of the respiratory system: a dry cough.

Allergic reactions: seldom - skin rash, in some cases - Quincke's edema.

Other: in some cases - renal failure, hyperkalemia.


Contraindications

- Pronounced disorders of renal function;

- Azotemia;

- Hyperkalaemia;

- Bilateral renal artery stenosis or stenosis of the artery of a sole kidney with progressive azotemia;

- Status after kidney transplantation;

- Stenosis of the aorta (or similar hemodynamic);

- Primary hyperaldosteronism;

- Children age;

- II and III trimester of pregnancy;

- Lactation (breastfeeding);

- Angioedema in history;

- Hypersensitivity to lisinopril and other ACE inhibitors.


Application of pregnancy and breastfeeding

Application Dapril in II and III trimester of pregnancy is contraindicated. Lisinopril crosses the placental barrier.

No data on the penetration of lisinopril in breast milk. If necessary, the appointment Dapril during lactation should stop breastfeeding.


Application for violations of renal function

Patients with impaired renal function dosage set depending on creatinine clearance. When spacecraft over 30 ml / min recommended daily dose - 10 mg, with spacecraft from 10 to 30 ml / min - 5 mg / day, with CC <10 ml / min - 2.5 mg / day.


Cautions

Please note that the marked reduction of blood pressure occurs with a decrease in fluid volume caused by diuretic therapy, with a decrease in salt in food, during dialysis and in patients with diarrhea or vomiting. In these patients treatment should start under close medical supervision (with caution to conduct selection and dose diuretics).

Note that patients receiving ACE inhibitors and those on hemodialysis using dialysis membranes with high permeability, can develop anaphylactic reaction. In such cases, we must consider the possibility of using other types of membranes for dialysis or other antihypertensive drugs.

In the application of ACE inhibitors observed cough (dry, long-term, which disappears after cessation of treatment with ACE inhibitor). In the differential diagnosis of cough should be considered and cough caused by the use of ACE inhibitors.


Overdose

Symptoms: hypotension, electrolyte derangement, renal failure.

Treatment: in / in the introduction of saline, hemodialysis.


Drug Interactions

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

With simultaneous application Dapril with diuretics, antidepressants, a marked decrease in blood pressure.

With simultaneous application Dapril with NSAIDs decreases antihypertensive effect of Lisinopril.

With simultaneous application Dapril with drugs lithium slows excretion of lithium from the body.

Ethanol enhances the hypotensive effect of lisinopril.


Terms and Conditions of storage

The drug should be stored in a dry, protected from light and away from children at or above 25 ° C. Shelf life - 4 years.