2010/06/14

Lisinopril

The international name:
Lisinopril (Lisinopril)

Group Affiliation:
ACE blocker

Description of the active substance (INN):
Lisinopril

Dosage form:
Tablets

Mode of action:
ACE inhibitor, reduces the formation of angiotensin II from angiotensin I. Reduction of angiotensin II leads to a direct decrease release of aldosterone. Reduce the degradation of bradykinin and increases the synthesis of Pg. Reduces TPVR, blood pressure, preload, pressure in the pulmonary capillaries, causing an increase in the IOC and increase tolerance to myocardial stress in patients with CHF. Extends the artery to a greater extent than the vein. Some effects are due to effects on tissue renin-angiotensin system. Prolonged use reduces myocardial hypertrophy and arterial wall of the resistive type. Improves blood flow to ischemic myocardium. ACE inhibitors prolong life in patients with CHF, slow the progression of left ventricular dysfunction in patients with myocardial infarction without clinical signs of heart failure. Onset of action - after 1 h. The maximum effect is determined in 6-7 h, duration - 24 hours When hypertension effect noted in the first days after the start of treatment, stable operation develops within 1-2 months.

Indications:
Hypertension (including symptomatic), CHF, early treatment of acute myocardial infarction in hemodynamically stable patients (as part of combination therapy). In a combination therapy of acute myocardial infarction (within 24 h, with stable hemodynamics). Diabetic nephropathy .

Contraindications:
Hypersensitivity to lisinopril or any other ACE inhibitors, pregnancy, laktatsii.C caution. Angioedema in history against a background of ACE inhibitor therapy, hereditary or idiopathic angioedema, aortic stenosis, cerebrovascular disease (including failure of cerebral blood flow), ischemic heart disease, coronary insufficiency, severe systemic autoimmune connective tissue disease (including SLE , scleroderma), inhibition of bone marrow hemopoiesis, diabetes mellitus, hyperkalaemia, bilateral renal artery stenosis, stenosis of the artery the only kidney condition after kidney transplantation, renal failure, a diet with restriction of Na +, the state, accompanied by a decrease in the bcc (including diarrhea, vomiting ), advanced age, the age of 18 years (safety and efficacy have not been studied).

Adverse effects:
From the CCC: lowering blood pressure, arrhythmias, chest pain, rarely - orthostatic hypotension, tachycardia. The nervous system: dizziness, headache, fatigue, drowsiness, muscle twitching limbs and lips, rarely - asthenia, mood lability, confusion . On the part of the digestive system: nausea, dyspepsia, decreased appetite, change in taste, abdominal pain, diarrhea, dry mouth. From the side of hematopoiesis: leukopenia, thrombocytopenia, neutropenia, agranulocytosis, anemia (a decrease in Hb, erythropenia). allergic reactions: angioedema, skin rash, itching. Laboratory indicators: hyperkalemia, hyperuricemia, rarely - increased activity of "liver" transaminases, hyperbilirubinemia. Other: dry cough, lower potency, seldom - acute renal failure, arthralgia, myalgia, fever, edema ( tongue, lips, limbs), a developmental disorder of the kidneys of the fetus.

Dosage and administration:
Inside, in arterial hypertension - 5 mg 1 time per day. In the absence of the effect of dose increase every 2-3 days at 5 mg up to the average therapeutic dose of 20-40 mg / day (increasing the dose above 20 mg / day usually does not lead to a further decrease in BP). The maximum daily dose - 80 mg. At CH - start with the 2.5 mg dose, with a subsequent increase in dose to 2.5 mg every 3-5 days. In elderly are often more pronounced long-term hypotensive effect, which is associated with a decrease in clearance rate of lisinopril (recommended to start treatment with 2.5 mg / day). When CRF accumulation occurs with a decrease in filtering of less than 50 ml / min (the dose should be reduced by a factor of 2, with the spacecraft at least 10 ml / min is required to reduce the dose by 75%). In resistant hypertension shown long-term maintenance therapy of 10-15 mg / day, with CH - by 7.5-10 mg / day.

Cautions:
Require special care in prescribing for patients with bilateral renal artery stenosis or stenosis of the artery of a sole kidney (possibly increasing the concentration of urea and creatinine in the blood), in patients with coronary heart disease or cerebrovascular disease, decompensated CHF (subject to hypotension, myocardial infarction, stroke). In patients with CHF occurred hypotension may lead to deterioration of renal function. With the use of drugs that reduce blood pressure in patients with extensive surgery or during anesthesia with lisinopril may block the formation of angiotensin II, secondary to compensatory renin allocation. The safety and efficacy of lisinopril in children has not been established. Before treatment is necessary to compensate for lost fluids and salts. Use during pregnancy is contraindicated, except in cases where other drugs can not be used or are ineffective (the patient must be informed of the potential risk to the fetus).

Interaction:
Slows the excretion of drugs Li +. NSAIDs, estrogens, adrenostimulyatorov reduced hypotensive effect. With simultaneous use of potassium-sparing diuretics and medications K + possible hyperkalemia. Combined use of beta-blockers, BCCI, diuretics and other antihypertensive drugs increases the severity of the hypotensive action. Antacids and kolestiramin reduce absorption in the gastrointestinal tract. myelotoxic drugs - the risk of marked inhibition of bone marrow hematopoiesis.