Captopril helps with high blood pressure. Impact on the ability to operate machinery

With the advent of ACE inhibitor drugs, which include Captopril, the treatment of hypertension and heart failure has moved to a new level. The impressive results of studies conducted for the drugs of this group allow them to be prescribed as emergency aid and for complex treatment of the disease. How to take Captopril for high blood pressure correctly?

General characteristics of the drug

In pharmacy chains you can find several types of medicines with the word “Captopril” in the name. In fact, all these drugs differ only in name, because they are produced by different manufacturers. Therefore, if you need to purchase a medicine, you can purchase any of those available.

Captopril for blood pressure is available in one dosage form - in the form of tablets for oral use. The main active ingredient is captopril, the content of which can vary depending on the dosage from 6.25 mg to 100 mg. Excipients may vary. To become more familiar with the full composition in each specific case, you should read the instructions.

Therapeutic effect

The drug Captopril lowers blood pressure due to its inhibitory properties. They consist in the inhibition of a special enzyme responsible for the conversion of angiotensin I to angiotensin II. Therefore, this substance, which has a vasoconstrictor effect, cannot increase blood pressure – The lumen of blood vessels does not decrease and hypertension is prevented.

In addition, the product relieves tension from the vascular system, thereby reducing the load on the heart muscle. This allows it to be used in complex therapy of arterial hypertension, heart diseases (myocardial dystrophy, heart failure) and diabetic nephropathy.

Important! The drug is effective even with a slight increase in blood pressure readings (up to 125 to 80), but it can be taken in a minimal dosage.

Due to its rapid action, Captopril is prescribed as an emergency treatment for a sudden increase in blood pressure. But with its regular use, the appearance of a hypertensive crisis is prevented, and the condition of the heart and blood vessels is normalized. To achieve this effect, the medicine must be taken every day for at least five to six weeks.

How many times a day can you take medicine for effective treatment without harming your health? Pharmacists warn that the maximum daily dosage of the drug, which should not be exceeded, is 300 mg. When it increases, the effectiveness of the drug does not increase, but there is a risk of high severity of adverse reactions. Therefore, taking more than 300 mg of Captopril per day is not only ineffective, but also dangerous.

Instructions

Patients are often interested in the question: “Should I put Captopril under the tongue or drink it?” For better absorption of the main active ingredient, Captopril tablets should be taken 50 minutes before meals by swallowing. You need to drink enough water. The medicine should not be crushed or crushed. Although doctors sometimes advise dissolving it by resorption, the effectiveness of this method of administration has not been studied. It is possible that the individual characteristics of the body will allow the remedy to act faster. Therefore, you can try putting the tablet under your tongue or swallowing it every other time, and then compare the effect of the drug in both cases.

The individual dosage of the drug and how many times a day it can be taken is calculated by the doctor, based on the characteristics of the disease and the characteristics of the patient’s body. Treatment begins with the minimum dose, moving over time to the most effective dose. After using the product for the first time, over the next three hours it is necessary to measure your blood pressure every 30 minutes to check the body’s response to the active substance.

How to take with high blood pressure

How to take the drug correctly for the complex treatment of arterial hypertension? The standard procedure is as follows:

1. For the first two weeks, the patient is limited to taking 25 mg once a day (12.5 mg in two doses).
2. After this period of time, a control measurement is carried out with a tonometer. If the readings remain consistently high, the dosage is increased to 30-50 mg twice a day.
3. If no positive dynamics are observed even at this dosage, additional drug treatment is prescribed. It consists of the inclusion of drugs from the group of beta-blockers.

When diagnosing hypertension of the first or second degree, the drug is prescribed 25 mg twice a day. How often can you take the medicine if the disease has progressed to the third degree? In this case, the dose is increased to a serving of 50 to 100 mg, which is also consumed twice a day. With stable high blood pressure, this dosage is doubled every two weeks.

If hypertension has developed due to renal disease, Captopril is prescribed from 6.25 to 12.5 mg three times a day at the initial stage of treatment, which is two weeks. If after this time the pressure readings have not dropped, the drug is taken 25 mg up to four times a day.

To prevent negative consequences in the form of complications of various etiologies when taking the drug, you need to know about its interaction with other drugs of similar action:

1. Captopril is not prescribed together with drugs that increase the concentration of potassium in the circulatory system. These include potassium-sparing diuretics (Triamterene, Veroshpiron, Spironolactone), potassium compounds (Panangin), salt substitutes with a high potassium content.
2. When taken simultaneously with hypoglycemic drugs (Metformin, Gliclazide, Migliol), Captopril enhances their effect. Therefore, during treatment you need to keep your blood glucose levels under control.
3. Captopril enhances the effectiveness of anesthetics.
4. Drugs that have diuretic, vasodilator, and neuroleptic effects, which include Amlodipine, Minoxidil, Baclofen and others, when used with Captopril, enhance its hypotensive properties. Such interaction can lead to a sharp decrease in pressure by several points, which can overload the vascular system.
5. Medicines related to beta-blockers (Bisoprolol, Bisocard) also enhance the main property of Captopril, but less pronounced. Therefore, the simultaneous use of these drugs does not lead to a sharp drop in pressure.
6. When Captopril is combined with nitrate-containing drugs, their dosage should be reduced.
7. Medications in the NSAID category, which include Indomethacin, Thrombo Ass, Nise, Ketanov, Cardiomagnyl, reduce the effectiveness of Captopril. Therefore, their simultaneous administration should be adjusted for this feature.

As part of complex therapy, calcium channel blockers (Lerkamen) and cardioselective β 1-adrenergic receptor blockers (Betakor) can be prescribed together with Captopril.

special instructions

The drug is prescribed to children under 18 years of age only when absolutely necessary. The dosage is calculated strictly individually, taking into account the proportion of 2 mg per kilogram of body weight per day.

When undergoing treatment with Captopril in adults, the following recommendations should be followed:

1. If the concentration of electrolytes has been disturbed as a result of taking diuretics, diarrhea or vomiting, it must be restored to its previous volume before starting treatment with Captopril.
2. If the next dose was missed for any reason, the next day you need to drink a portion not in double volume, but in the one prescribed.
3. Renal function must be monitored throughout therapy.
4. In some cases, while taking Captopril, proteinuria (high protein content in the urine) develops. This deviation goes away on its own after some time without additional intervention. But when the protein increases to 1000 mg per day, the drug is discontinued and another is prescribed instead.

Important! During treatment with Captopril, alcohol consumption should be kept to a minimum, or better yet, not consumed at all.

In most cases, taking Captopril at the initial stage causes a sharp decrease in blood pressure. To reduce the impact on blood vessels, you need to lie down, raise your legs up and spend about an hour in this position. In case of severe hypotension, a sterile saline solution should be administered intravenously as soon as possible. Therefore, to prevent adverse effects, how much of the drug can be taken per day and for how long to take it is calculated by the attending physician.

Despite the high effectiveness that Captopril shows in the long-term treatment of hypertension, its prescription for this purpose is carried out less and less. This is due to the fact that the drug has a sufficient number of side effects on various organs and systems compared to new generation drugs. Therefore, it is undesirable to use Captopril for self-treatment, since an incorrectly calculated dosage or a deviation in the body’s functioning that is not detected in a timely manner can lead to serious consequences.

When a patient is diagnosed with hypertension, in any case, he must take medications to normalize blood pressure.

Large selection of medications used to lower blood pressure. One of them is Captopril.

When ingested, Captopril relaxes dilated blood vessels. The risk of stroke and heart attack is reduced.

The drug is prescribed not only to hypertensive patients. It has many other effects. Doctors prescribe it as a preventative against diabetes and cancer.

What effect does Captopril have?

First, you need to understand how the drug acts on the body in order to draw a conclusion about what it helps with. The main feature of Captopril is that it blocks the enzymes that are responsible for the exchange and processing of oligopeptide hormone.

Oligopeptide hormones constrict blood vessels, thereby increasing blood pressure.

If you use captopril for high blood pressure, you can quickly lower it. The drug is also often used to treat hypertension. It can be used for a long time.

The drug is prescribed to treat kidney failure caused by diabetes mellitus.

One of the main features of Captopril is that it has an anti-inflammatory effect.

Therefore, it is prescribed for the treatment of oncological diseases, but benign ones. Treatment of malignant neoplasms will be pointless.

What does Captopril treat?

First of all, Captopril is intended to lower blood pressure and reduce cardiac stress. Therefore, it is prescribed for heart disease, arterial hypertension, and diabetic nephropathy (damage to the blood vessels of the kidneys).

Prescribed to patients after a myocardial infarction.

Captopril inhibits the activity of enzymes that convert angiotensin 1 into angiotensin 2. Thus, the drug is in the group of angiotensin-converting enzymes.

When the drug enters the body, it forms substances that dilate blood vessels, resulting in an increase in blood pressure. If there is no formation of angiotensin 2 in the body, then the vessels continue to be dilated. Because of this, the pressure remains normal for a long time.

Due to its effective effect on blood vessels, Captopril is taken regularly, and after the pressure has normalized, it can be stopped. The pressure drops as much as possible an hour or two after taking the pill, it depends on the individual body.

To achieve a lasting reduction in blood pressure, doctors recommend taking the medicine for a month. In addition to lowering blood pressure, the drug can reduce cardiac stress. This occurs due to the expansion of the lumen of blood vessels. It is easier for the heart muscles to work and allow blood flow from the heart to the aorta and pulmonary artery.

Captopril helps people with heart failure to endure physical and emotional stress calmly and without consequences.

If you take the drug to prevent heart failure, your blood pressure will not change.

Due to its properties, Captopril is used to enhance renal blood flow and cardiac blood supply. Doctors prescribe it as a medicine for the complex treatment of heart disease and kidney vascular damage.

Antihypertensive drugs are prescribed along with Captopril. Captopril differs from such drugs in that when it is used, fluid is not retained in the body.

This means that additional use of diuretics will not be necessary. And this is important, taking antihypertensive drugs causes swelling.

Indications

Why are blood pressure tablets Captopril prescribed? First of all, the drug helps prevent a hypertensive crisis and reduces blood pressure.

Captopril is prescribed for:

• renal hypertension, this is the highest form of renal failure;
• essential hypertension (pressure increases for no specific reason);
• malignant hypertension with high blood pressure;
• diabetic nephropathy. With lesions of the renal vessels and with a diagnosis of type 1 diabetes mellitus;
• improper functioning of the ventricles, especially the left one;
• myocardial infarction.

When should you not take captopril?

The tablets are taken for cardiac diseases. There are also situations when you should not take captopril:

• narrowed aorta;
• primary hyperaldosteronism;
• narrowed mitral valves;
• pregnancy and breastfeeding;
• renal artery stenosis;
• after a kidney transplant;
• individual sensitivity to at least one component of the drug;
• myocardiopathy;

The drug is not prescribed to children under 15 years of age. It is not recommended for drivers; it may increase concentration problems.

Captopril for high blood pressure

There are many ways to take pills correctly. The dosage depends on the indications for taking the medicine.

Captopril is prescribed for high blood pressure in order to reduce it. A Captopril tablet is taken 40 minutes before meals. This is important, food significantly reduces the intended effect of the medicine.

Rules for taking Captopril:

1. For each patient, the doctor selects the dosage individually. Therefore, taking the drug on your own is highly undesirable. In the instructions for use, the dosage depends on the tablet format. They are available in 12.5 and 25 mg. Almost always, patients need to drink 50 mg per day. The medicine is taken twice a day. If you bought 12.5 mg tablets, then you need to take two tablets morning and evening, and if you bought 25 tablets, then one tablet at a time.
2. If the patient does not experience any side effects, the dosage is increased. This happens after a month of treatment, but no matter what the indications are, you should absolutely not drink more than 150 mg per day. Otherwise, irreversible reactions may begin in the body.
3. You can use the drug to quickly lower blood pressure. If, when measuring your blood pressure, you notice readings of 145/105 or more, then you need to immediately take one tablet. If after 40 minutes the pressure has not decreased, then you can drink another one. This way you can lower your blood pressure and save yourself the risk of problems with the cardiovascular system.
4. Captopril can be taken as a prophylactic for high blood pressure. In this case, a dosage of no more than 25 mg is acceptable.

Let us remind you that the dose of the drug is selected exclusively by specialists. You can only make the situation worse. Self-treatment can cause headaches, migraines, nausea, weakness, depression, attention disorders, and decreased performance.

If you notice one of the side effects while taking the medicine, then treatment with Captopril is stopped. After consulting with your doctor, he may prescribe you another medicine, such as Capoten.

Features of the drug and indications

The drug is not prescribed until the age of 15, but if there is a need, the doctor will prescribe it. Again, only a doctor can choose the dosage for a child. In this case, the dosage is not standard. It is calculated according to the child’s body weight, using the formula 1-1.5 mg per kilogram of weight. The resulting dosage is for one day.

There are times when for some reason you didn’t take a pill in the morning, this does not mean that you need to take two in the evening.

When your doctor prescribes Captopril, before you start taking it, you must restore the volume of water necessary for full health.

During treatment, you should closely monitor your kidney function. Some patients experienced protein in their urine during treatment with Captopril. The protein disappears on its own, without additional therapy, after a month. But if its level exceeds 1000 mg per day, then Captopril is replaced by another drug.

If the patient experiences:

• inflammation or expansion of vascular walls;
• diffuse disorders in connective tissues;
• bilateral damage to the vessels and arteries of the kidneys;
• if the patient is taking immunosuppressants;
• when desensitizing therapy is performed.

Then Captopril is taken under the strict supervision of the attending physician.

During the first period of treatment, which is approximately three to four months, the patient donates blood every 10 days for a general analysis. After four months, you need to donate blood less often. If tests show that the number of leukocytes decreases to a level of 1 g/l or less, then the drug is replaced with another. As a rule, the level of leukocytes returns to normal after 10-14 days.

Throughout treatment, the patient periodically undergoes tests to determine creatine, urea, protein, and potassium concentrations in the blood and urine. If the protein concentration is increased, then the drug is discontinued, and if the level of creatinine and urea is increased, the doctor reduces the dosage. To prevent a sharp reducing effect of the drug, before taking the first tablet, avoid taking all diuretics. Or, their dosage is simply reduced several times. If you notice that after taking the pill, your blood pressure drops sharply, then most likely you are beginning to develop hypotension. In this case, lie on your back and raise your legs so that they are higher than your head. You need to lie in this position for at least half an hour. If the pressure does not increase, then a sterile saline solution administered intravenously will help you.

Very often, the first Captopril tablets cause a sharp drop in blood pressure, so doctors always recommend staying in hospital for the first few days to observe the body’s reaction.

Special attention should be paid to surgical intervention. When the patient is taking Captopril, any surgery is not recommended. And if surgery cannot be avoided, then you need to be careful, since general anesthesia during treatment with Captopril can sharply lower blood pressure. Therefore, immediately warn the anesthesiologist who will administer anesthesia to you.

When the patient develops jaundice, the medicine is immediately discontinued.

When a patient is undergoing therapy with Captopril, the consumption of alcoholic beverages is strictly prohibited.

Captopril may cause false-positive results when performing a urine test for acetone.

If you notice any signs of:

• infectious disease, this also applies to colds;
• increased fluid loss caused by vomiting, diarrhea, profuse sweating,

Then contact your doctor immediately.

There are cases when taking the drug can cause hyperkalemia. This is when the level of potassium in the blood increases. It is most often diagnosed in patients suffering from diabetes or kidney failure.

All of the above consequences are a reason to consult a doctor; perhaps you have an individual intolerance to the drug.

Captopril has a hypotensive effect and is widely used among various groups of patients to lower blood pressure and normalize heart rate and pulse. The drug has a strong effect, so it should be used in strict accordance with the instructions and prescriptions of the doctor. Failure to comply with recommendations for use often provokes disastrous consequences for the life and health of the patient.

Form of production

The medicine is available in the form of tablets placed in blisters. The cardboard package contains 2 plates and an insert - instructions for the use of Captopril. The dosage depends on the manufacturer, it can be 12.5, 25, 50 and 100 mg.

Description and composition

The tablets have a round, flat shape, beveled edges, and a specific odor. On one side 2 lines are visible. The color of the drug is white or grayish-white.

The main active ingredient included in the composition is captopril. Its content depends on the form of release. Excipients include talc, magnesium stearate, lactose, povidone and other components.

INN (international nonproprietary name) – Captopril.

Pharmacological effect

The drug Captopril is an antihypertensive drug, also classified as an ACE inhibitor. The enzyme angiotensin II has a vasoconstrictor effect in the body, spasm of the smooth muscles of the veins and arteries, which causes an increase in blood pressure. Captopril inhibits the conversion of the enzyme angiotensin I to angiotensin II. This property of the drug allows you to reduce peripheral pressure, relieve stress on the heart muscle, normalize a person’s condition, and prevent complications that arise from cardiovascular pathologies. In addition, the product helps improve blood flow in the kidneys.

Pharmacokinetics

After entering the stomach, the drug Captopril is actively absorbed from the digestive tract, due to which the therapeutic effect occurs quite quickly. Eating at the same time can slow it down. The maximum concentration of the active component in the blood is observed after 1 - 1.5 hours.

Metabolism occurs in the liver. The drug is excreted by the kidneys. Unchanged - from 40 to 50% of the substance. The remainder is in the form of metabolites. In case of renal failure, a cumulation effect is possible, that is, accumulation of the active component in the organ.

Important! Captopril can be excreted in mother's milk, so the use of the drug during lactation is contraindicated.

Indications for use

What does Captopril help with? A drug is prescribed to lower blood pressure. Indications for the use of Captopril are as follows:

• increased blood pressure due to kidney disease;
• rise in blood pressure, the etiology of which is unknown;
• hypertension resistant to medication;
• cardiomyopathy in patients;
• congestive processes in heart failure;
• autoimmune nephropathy;
• dysfunction of the left ventricle of the heart caused by myocardial infarction;
• hypertension in patients suffering from bronchial asthma.

Captopril is used to relieve high blood pressure

The use of Captopril should be carried out only as prescribed by a doctor, since the medicine has a number of serious contraindications.

For whom the drug is contraindicated

The drug in question is widely used in medical practice, but when prescribing it, the contraindications of Captopril should be taken into account. These include:

• narrowing of the aortic lumen;
• disturbance of sodium-potassium balance in the body due to increased synthesis of aldosterone by the adrenal cortex;
• deterioration in the functioning of the mitral valve, its narrowing;
• recent kidney transplant surgery;
• period of bearing a child;
• tendency to edema;
• myocardiopathy;
• Quincke's edema;
• lactose deficiency;
• breastfeeding period;
• personal intolerance to the drug substances;
• The patient's age is under 18 years.

Failure to comply with the contraindications described above provokes the development of serious consequences and can cause serious harm to the health and life of the patient.

Medicine dosage

Instructions for use of the medicine describe how to take Captopril for various conditions. The therapeutic effect depends on how correctly the dosage of the drug was selected.

During treatment, the dosage of the medication must be strictly observed.

For arterial hypertension

The prescription for Captopril for hypertension is selected exclusively by a specialist, based on medical history and blood pressure readings. Depending on the mercury level, the daily dosage at the beginning of treatment is usually from 100 to 150 mg of the drug. The tablets are divided into several doses at equal intervals of time. If there is no desired effect, the dose is increased. In addition to Captopril, your doctor may prescribe other medications, such as diuretics.

For heart failure and hypovolemia

Patients with these diseases are prescribed a single use of the drug. First, patients drink 6.25 – 12.5 mg. After a week, the dose is doubled and divided into two doses. During therapy, blood pressure should be measured regularly. If the desired result is not achieved, the dosage is increased to 60–100 mg.

After myocardial infarction (short-term treatment)

During the first 24 hours, it is recommended to take 6 to 12 mg of the drug. After a day, the dosage is increased to 25 mg. On the third day and subsequent days - 100 mg Captopril. The total duration of treatment is up to 4 weeks, which can be extended by a specialist.

Long-term treatment of myocardial infarction

Captopril is used 3 to 16 days after the attack. Therapy is carried out under the close supervision of medical personnel in a hospital setting. First, the patient is given 6.25 mg. Every other day - 12 mg, divided into 2 doses. After a few days - 25 mg for 3 doses. In this way, the dosage increases to 100 – 150 mg. The duration of treatment is determined depending on the work of the heart and the dynamics of pressure, heart rate and other indicators.

Relief of hypertensive crisis

To lower blood pressure, you need to put Captopril under the tongue. After a quarter of an hour, the dose is repeated, but no more than 3 tablets per day. If the patient takes Nitroglycerin in combination with the drug, the dose of Captopril is reduced to 2 tablets.

Treatment of diabetic nephropathy

Patients with diabetic nephropathy are prescribed 75 to 100 mg of the drug per day. The dose is divided into 3 equal parts. The tablets must be swallowed with sufficient liquid. Captopril is more often used as a complex therapy with the simultaneous use of other drugs that reduce blood pressure.

The dose of the drug varies for different diseases

Important! The above information is provided for informational purposes only. Using any of the schemes on your own is extremely dangerous to your health.

Speed ​​of onset of therapeutic effect

How long does it take for Captopril to work and how to take the tablet correctly? The product is intended for oral use, but sometimes it can be taken under the tongue.

The effect of the drug begins in approximately 15 minutes, which depends on the characteristics of each organism and the patient’s diagnosis. If the patient has eaten shortly before, the effect of the tablet may slow down somewhat. In this case, the effect occurs within 15–20 minutes.

Use among pregnant women

Women carrying a baby often experience increased blood pressure. This is due to changes that occur in the body, exacerbation of cardiovascular pathologies. This leads to the question of whether pregnant women can take the drug in question? Captopril during pregnancy is contraindicated in any trimester. If necessary, the drug can be prescribed in the second and third trimester under the close supervision of a leading physician.

During lactation, the drug should also be avoided. If the doctor has prescribed a remedy, stop breastfeeding.

Use in pediatrics

Captopril is not prescribed for children. The drug is contraindicated for people under 18 years of age. In some cases, the doctor may decide on the advisability of using the medication from the age of 14. Therapy is carried out only if the expected benefit outweighs the risk.

Treatment of elderly patients

Among elderly patients, the drug is used with extreme caution, only in situations where the expected benefit is higher than the risk to the patient's health.

For older people, Captopril is prescribed in extreme cases.

Alcohol compatibility

The compatibility of Captopril and alcohol is extremely undesirable. This combination leads to a decrease in the body’s absorption of potassium, because alcoholic drinks wash this trace element out of the body. A lack of potassium provokes, in turn, a persistent increase in blood pressure.

After drinking alcohol, the use of Captopril is also often ineffective. This is especially true for hypertension caused by potassium deficiency. If an increase in pressure is observed against the background of impaired functioning of the cardiovascular system, the use of the medicine is allowed.

In addition, Captopril and alcohol are allowed to be combined to relieve a hypertensive crisis due to a hangover, with the exception of those patients who have renal failure.

Drug interactions

When prescribing tablets, the specialist must take into account their interaction with other drugs:

• simultaneous use of the drug with immunosuppressants and cytostatics increases the risk of developing leukopenia;
• the threat of hyperkalemia increases with treatment with Captopril and potassium-sparing diuretics, vitamin complexes containing potassium, dietary supplements;
• if the patient simultaneously takes Captopril and non-steroidal anti-inflammatory drugs, renal dysfunction may develop;
• careless combination of Captopril and diuretics increases the risk of developing persistent hypotension;
• severe hypotension is diagnosed when Captopril is combined with anesthesia;
• Aspirin reduces the effect of the drug in question;
• reduces the effectiveness of Captopril Indomethacin, Ibuprofen;
• simultaneous administration of Captopril with medications containing insulin increases the risk of developing hypoglycemia. This happens by increasing the body's tolerance to glucose;
• ACE inhibitors in combination with the drug in question can cause a persistent decrease in blood pressure.

Important! If the patient is taking Captopril and there is a need to use any other drugs, this should be discussed with the attending physician.

Side effects

Sometimes, while taking the medication, side effects of Captopril develop. Violations are observed in various organs and systems. These include:

• allergic reaction - redness, itching, swelling of the dermis, urticaria, nasal congestion, conjunctivitis;
• blood composition disorder;
• deterioration in the functioning of the urinary system, protein in the urine;
• from the respiratory system – barking dry cough;
• decreased blood pressure;
• weakness, irritability, nervousness, apathy;
• from the gastrointestinal tract - nausea, loss of appetite, flatulence, stool disorders.

If you do not pay attention to side effects, there is a risk of overdose with Captopril. In this case, the patient experiences a sharp drop in pressure, severe swelling of the extremities, headache and dizziness, numbness of the fingers, nausea, bloating, and vomiting.

First aid for overdose is gastric lavage, taking sorbents. If the person does not get better, it is necessary to call an ambulance.

special instructions

Special instructions indicated in the instructions for use include:

• the use of the drug among patients with autoimmune disorders can lead to a deterioration in blood composition;
• during treatment, a person must regularly take a blood test to determine the number of leukocytes;
• Before using the drug, it is recommended to normalize the water-salt balance. This will help avoid such phenomena as hypotension;
• Captopril is prescribed with extreme caution to people with impaired renal function;
• during therapy, a urine test may show the presence of acetone;
• During the course of therapy, the patient should limit foods high in salt;
• After taking the drug, dizziness and weakness are often noted. Therefore, it is recommended to avoid activities that require increased concentration.

Compliance with special instructions is an important aspect of treatment with Captopril

Gross formula

C 9 H 15 NO 3 S

Pharmacological group of the substance Captopril

Nosological classification (ICD-10)

CAS code

62571-86-2

Characteristics of the substance Captopril

White or off-white crystalline powder with a faint sulfur odor, containing a sulfhydryl residue. Soluble in water (160 mg/ml), methanol and ethanol (96%). Poorly soluble in chloroform and ethyl acetate, insoluble in ether.

Pharmacology

pharmachologic effect- hypotensive, vasodilating, natriuretic, cardioprotective.

Inhibits ACE, prevents the transition of angiotensin I to angiotensin II (has a vasoconstrictor effect, promotes the release of aldosterone) and prevents the inactivation of endogenous vasodilators - bradykinin and PGE 2. Increases the activity of the kallikrein-kinin system, increases the release of biologically active substances (PGE 2 and PGI 2, endothelial relaxing and atrial natriuretic factor), which have a natriuretic and vasodilator effect, improving renal blood flow. Reduces the release of norepinephrine from nerve endings, the formation of arginine vasopressin and endothelin?1, which have vasoconstrictor properties. ACE activity decreases by 40% 1–3 hours after administration at a dose of 12.5 mg (50% inhibition of enzyme activity requires a plasma concentration of 22 nmol/l). The hypotensive effect appears 15–60 minutes after oral administration, reaches a maximum after 60–90 minutes and lasts 6–12 hours. The duration of the hypotensive effect depends on the dose and reaches optimal values ​​within several weeks with repeated use. Reduces peripheral vascular resistance, pre- and afterload on the heart, pressure in the pulmonary circle and pulmonary vascular resistance, increases cardiac output (heart rate does not change). In patients with heart failure, it increases exercise tolerance, reduces pulmonary capillary wedge pressure, reduces the size of dilated myocardium (with long-term therapy), improves well-being, increases life expectancy, i.e. has a cardioprotective effect. In large doses (500 mg/day) it exhibits angioprotective properties against microcirculatory vessels, increases the diameter of large peripheral arteries (from 13% to 21%) and slows down the progression of renal failure in diabetic nephropathy (reduces the need for dialysis procedures, kidney transplantation, delays death). Reduces the incidence of cardiovascular complications in hypertension in combination with diabetes mellitus. In patients with moderate arterial hypertension, when used in doses of 25–50 mg 2 times a day, it increases the quality and duration of life, general well-being, improves sleep and emotional status.

Quickly and completely absorbed from the gastrointestinal tract, the minimum absorption is 60–75%. In the presence of food, bioavailability decreases by 30–55% without significant changes in pharmacokinetic and pharmacodynamic parameters. When taken on an empty stomach, it is detected in the blood after 15 minutes, Cmax is reached after 30–90 minutes. By the end of the day, the remaining concentration relative to Cmax is 7–8%. Sublingual use improves bioavailability and accelerates the onset of action. In plasma, it is 25–30% bound to proteins (mainly albumin). Passes through histohematic barriers, excluding the blood-brain barrier, through the placenta and penetrates into breast milk (the concentration reaches approximately 1% of the level in the mother's blood). T1/2 is 2–3 hours and increases in patients with congestive heart failure and against the background of renal failure to 3.5–32 hours. The volume of distribution is 0.7 l/kg, clearance is 56 l/h. It undergoes biotransformation in the liver with the formation of the disulfide dimer of captopril and captopril-cysteine ​​disulfide. Excreted mainly by the kidneys (2/3 of the dose is excreted within 4 hours; more than 95% within 24 hours) in the form of metabolites and unchanged (40–50%).

Use of the substance Captopril

Arterial hypertension (mono- and combination therapy), congestive heart failure, cardiomyopathy, impaired left ventricular function in a stable condition in patients after myocardial infarction, diabetic nephropathy against the background of type 1 diabetes mellitus (with albuminuria more than 30 mg/day).

Contraindications

Hypersensitivity, the presence of anamnestic information about the development of Quincke's edema with previous prescription of ACE inhibitors, hereditary or idiopathic Quincke's edema, primary hyperaldosteronism, pregnancy, breastfeeding.

Restrictions on use

An assessment of the risk-benefit ratio is necessary in the following cases: leukopenia, thrombocytopenia, aortic stenosis or other obstructive changes that impede the outflow of blood from the heart; hypertrophic cardiomyopathy with low cardiac output; severe renal dysfunction; bilateral renal artery stenosis or stenosis of the artery of a single kidney; presence of a transplanted kidney; hyperkalemia; childhood.

Use during pregnancy and breastfeeding

Contraindicated during pregnancy.

Breastfeeding should be stopped during treatment.

Side effects of the substance Captopril

From the nervous system and sensory organs: fatigue, dizziness, headache, central nervous system depression, drowsiness, confusion, depression, ataxia, convulsions, numbness or tingling sensation in the extremities, visual and/or smell disturbances.

From the cardiovascular system and blood (hematopoiesis, hemostasis): hypotension, incl.

orthostatic, angina pectoris, myocardial infarction, cardiac arrhythmia (atrial tachy- or bradycardia, atrial fibrillation), palpitations, acute cerebrovascular accident, peripheral edema, lymphadenopathy, anemia, chest pain, pulmonary embolism, neutropenia, agranulocytosis (0. 2% - in patients with impaired renal function, 3.7% - against the background of collagenosis), thrombocytopenia, eosinophilia. From the respiratory system:

bronchospasm, shortness of breath, interstitial pneumonitis, bronchitis, non-productive dry cough. From the gastrointestinal tract:

anorexia, taste disturbance, stomatitis, ulcerative lesions of the oral and gastric mucosa, xerostomia, glossitis, difficulty swallowing, nausea, vomiting, dyspepsia, flatulence, abdominal pain, constipation or diarrhea, pancreatitis, liver damage (cholestasis, cholestatic hepatitis, hepatocellular necrosis). From the genitourinary system

: renal dysfunction, oliguria, proteinuria, impotence. From the skin:

facial redness, rash, itching, exfoliative dermatitis, toxic epidermal necrolysis, pemphigus, herpes zoster, alopecia, photodermatitis. Allergic reactions:

Stevens-Johnson syndrome, urticaria, Quincke's edema, anaphylactic shock, etc. Other:

increased body temperature, chills, sepsis, arthralgia, hyperkalemia, gynecomastia, serum sickness, increased blood levels of liver enzymes, urea nitrogen, acidosis, positive reaction when testing for antibodies to nuclear antigen.

Strengthens the possible hypotensive effect of anesthetics. Reduces secondary hyperaldosteronism and hypokalemia caused by diuretics. Increases plasma concentrations of lithium and digoxin. The effects are enhanced by other antihypertensive drugs, including beta-blockers, incl.

with systemic absorption from ophthalmic dosage forms, diuretics, clonidine, narcotic analgesics, antipsychotics, alcohol, weaken - estrogens, NSAIDs, sympathomimetics, antacids (reduce bioavailability by 45%). Potassium-sparing diuretics, cyclosporine, potassium-containing drugs and supplements, salt substitutes, and low-salt milk increase the risk of hyperkalemia. Drugs that suppress bone marrow function (immunosuppressants, cytostatics and/or allopurinol) increase the risk of developing neutropenia and/or fatal agranulocytosis. Strengthens the inhibitory effect of alcohol on the central nervous system. Probenecid slows down the excretion of captopril in the urine.

Overdose Symptoms:

acute arterial hypotension, cerebrovascular accident, myocardial infarction, thromboembolism, angioedema. Treatment:

dose reduction or complete withdrawal of the drug; gastric lavage, transferring the patient to a horizontal position, taking measures to increase blood volume (administration of isotonic sodium chloride solution, transfusion of other blood-substituting fluids), symptomatic therapy: epinephrine (s.c. or i.v.), antihistamines, hydrocortisone (i.v. ) . Carrying out hemodialysis, if necessary, using an artificial pacemaker.

Routes of administration

Inside.

Treatment is carried out under regular medical supervision. Before starting treatment (1 week), previous antihypertensive therapy should be discontinued. In patients with malignant hypertension, the dose is gradually increased every 24 hours until the maximum effect is achieved under the control of blood pressure. During therapy, monitoring of blood pressure, peripheral blood patterns (before starting treatment, in the first 3–6 months of treatment and at periodic intervals thereafter for up to 1 year, especially in patients with an increased risk of neutropenia), protein levels, plasma potassium, and urea nitrogen , creatinine, kidney function, body weight, diet. With the development of hyponatremia and dehydration, correction of the dosage regimen (dose reduction) is necessary. A maculopapular or urticarial (less commonly) rash occurs during the first 4 weeks of treatment and disappears when the dose is reduced, the drug is discontinued, and antihistamines are administered. Dose-dependent neutropenia develops within 3 months after the start of therapy (the maximum decrease in the number of leukocytes is observed within 10–30 days and persists for about 2 weeks after discontinuation of the drug). Cough (more often observed in women) often appears during the first week (from 24 hours to several months) of therapy, persists during treatment and stops a few days after the end of therapy. Taste disturbance and loss of body weight are reversible and are restored after 2–3 months of therapy. Caution is required when performing surgical interventions (including dental), especially when using general anesthetics that have a hypotensive effect. If cholestatic jaundice develops and fulminant liver necrosis progresses, treatment should be discontinued. Hemodialysis through high-performance polyacrylonitrile metaallyl sulfate membranes (for example, AN69), hemofiltration or LDL apheresis should be avoided (possible development of anaphylaxis or anaphylactoid reactions). Hyposensitizing therapy may increase the risk of anaphylactic reactions. It is recommended to avoid drinking alcoholic beverages during treatment. Use with caution while working for vehicle drivers and people whose profession involves increased concentration.

special instructions

If a dose is missed, the subsequent dose is not doubled. When testing for acetonuria, a positive result is possible.

Captopril - indications and instructions for use (how to take tablets), analogues, reviews and price of the drug. At what dosage of Captopril does blood pressure normalize? Action when applied under the tongue

Thank you

Captopril is a drug from the group of angiotensin-converting enzyme (ACE) inhibitors that lowers blood pressure. Captopril is used to treat arterial hypertension, chronic heart failure, myocardial dystrophy and diabetic nephropathy.

Varieties, names, composition and release form

Currently, Captopril is available in several of the following varieties:

• Captopril;
• Captopril-Vero;
• Captopril Hexal;
• Captopril Sandoz;
• Captopril-AKOS;
• Captopril-Acri;
• Captopril-Ros;
• Captopril-Sar;
• Captopril-STI;
• Captopril-UBF;
• Captopril-Ferein;
• Captopril-FPO;
• Captopril Stada;
• Captopril-Egis.

These varieties of the drug actually differ from each other only by the presence of an additional word in the name, which reflects the abbreviation or well-known name of the manufacturer of a particular type of drug. Otherwise, the varieties of Captopril are practically no different from each other, since they are produced in the same dosage form, contain the same active substance, etc. Moreover, often even the active substance in the varieties of Captopril is identical, since it is purchased from large manufacturers China or India.

The differences in the names of the varieties of Captopril are due to the need for each pharmaceutical company to register the drug they produce under an original name that is different from others. And since in the past, during the Soviet period, these pharmaceutical plants produced the same Captopril using exactly the same technology, they simply add another word to the well-known name, which is an abbreviation of the name of the enterprise and, thus, a unique name is obtained, from a legal point of view different from all others.

Thus, there are no significant differences between the varieties of the drug, and therefore, as a rule, they are combined under one common name “Captopril”. Further in the text of the article we will also use one name - Captopril - to refer to all its varieties.

All varieties of Captopril are available in a single dosage form - this tablets for oral administration. As an active substance tablets contain substance captopril, the name of which, in fact, gave the name to the drug.

Varieties of Captopril are available in different dosages such as 6.25 mg, 12.5 mg, 25 mg, 50 mg and 100 mg per tablet. Such a wide range of dosages allows you to choose the optimal option for use.

As auxiliary components Varieties of Captopril may contain different substances, since each company can modify their composition, trying to achieve optimal production efficiency. Therefore, to clarify the composition of the auxiliary components of each specific type of drug, it is necessary to carefully study the attached leaflet with instructions.

Recipe

The prescription for Captopril in Latin is written as follows:
Rp: Tab. Captoprili 25 mg No. 50
D.S. Take 1/2 - 2 tablets 3 times a day.

The first line of the prescription after the abbreviation “Rp” indicates the dosage form (in this case Tab. – tablets), the name of the drug (in this case – Captoprili) and its dosage (25 mg). After the “No” icon, the number of tablets that the pharmacist must dispense to the owner of the prescription is indicated. In the second line of the recipe after the abbreviation "D.S." provides information for the patient containing instructions on how to take the drug.

What does Captopril help with (therapeutic effect)

Captopril lowers blood pressure and reduces the load on the heart. Accordingly, the drug is used in the treatment of arterial hypertension, heart diseases (heart failure, condition after myocardial infarction, myocardial dystrophy), as well as diabetic nephropathy.

The effect of Captopril is to suppress the activity of the enzyme that ensures the conversion of angiotensin I to angiotensin II, therefore the drug is classified as an ACE inhibitor (angiotensin-converting enzyme). Due to the action of the drug, the body does not produce angiotensin II, a substance that has a powerful vasoconstrictor effect and, accordingly, increases blood pressure. When angiotensin II is not produced, the blood vessels remain dilated and, accordingly, blood pressure is normal, not elevated. Thanks to the effect of Captopril, when taken regularly, blood pressure decreases and remains within acceptable and acceptable limits. The maximum decrease in pressure occurs 1 - 1.5 hours after taking Captopril. But to achieve a lasting reduction in blood pressure, the drug must be taken for at least several weeks (4 – 6).

Also the drug reduces the load on the heart, expanding the lumen of blood vessels, as a result of which the heart muscle needs less effort to push blood into the aorta and pulmonary artery. Thus, Captopril increases the tolerance of physical and emotional stress in people suffering from heart failure or who have suffered a myocardial infarction. An important property of Captopril is the lack of effect on blood pressure when used in the treatment of heart failure.

In addition, Captopril increases renal blood flow and blood supply to the heart, as a result of which the drug is used in the complex therapy of chronic heart failure and diabetic nephropathy.

Captopril is well suited for inclusion in various combinations with other antihypertensive drugs. In addition, Captopril does not retain fluid in the body, which distinguishes it from other antihypertensive drugs that have a similar property. That is why, while taking Captopril, there is no need to additionally use diuretics to eliminate swelling caused by the antihypertensive drug.

Indications for use

Captopril is indicated for use in the treatment of the following diseases:

• Arterial hypertension (as monotherapy or as part of combination therapy. The drug is most effective in combination with thiazide diuretics, such as Hydrochlorothiazide, etc.);
• Congestive heart failure;
• Impaired left ventricular function in people who have had a myocardial infarction (applies only if the patient’s condition is stable);
• Diabetic nephropathy developed in type I diabetes mellitus (used for albuminuria more than 30 mg/day);
• Autoimmune nephropathies (rapidly progressive forms of scleroderma and systemic lupus erythematosus).

For people suffering from both hypertension and bronchial asthma, Captopril is the drug of choice.

Captopril - instructions for use

General provisions and dosages

Captopril should be taken one hour before meals, swallowing the tablet whole, without biting, chewing or crushing in any other way, but with a sufficient amount of water (at least half a glass).

The dosage of Captopril is selected individually, starting with the minimum and gradually increasing to an effective one. After taking the first dose of 6.25 mg or 12.5 mg, blood pressure should be measured every half hour for three hours to determine the response and severity of the drug in a particular person. In the future, when increasing the dose, the pressure should also be measured regularly an hour after taking the tablet.

It must be remembered that the maximum permissible daily dosage of Captopril is 300 mg. Taking the drug in an amount of more than 300 mg per day does not lead to a stronger decrease in blood pressure, but provokes a sharp increase in the severity of side effects. Therefore, taking Captopril in a dosage of more than 300 mg per day is impractical and ineffective.

Captopril for blood pressure(for arterial hypertension) start taking 25 mg once a day or 12.5 mg 2 times a day. If after 2 weeks the blood pressure does not drop to acceptable values, then the dosage is increased and taken 25–50 mg 2 times a day. If, when taking Captopril at this increased dosage, the pressure does not decrease to acceptable values, then hydrochlorothiazide 25 mg per day or beta-blockers should be additionally added.

For moderate or mild hypertension, a sufficient dosage of Captopril is usually 25 mg 2 times a day. In severe forms of hypertension, the dosage of Captopril is adjusted to 50–100 mg 2 times a day, doubling it every two weeks. That is, in the first two weeks a person takes 12.5 mg 2 times a day, then over the next two weeks - 25 mg 2 times a day, etc.

For high blood pressure caused by kidney disease, Captopril should be taken 6.25 - 12.5 mg 3 times a day. If after 1 - 2 weeks the pressure does not decrease to acceptable values, then the dosage is increased and taken 25 mg 3 - 4 times a day.

For chronic heart failure Captopril should be started at 6.25 – 12.5 mg 3 times a day. After two weeks, the dosage is doubled, bringing it to a maximum of 25 mg 3 times a day, and the drug is taken for a long time. For heart failure, Captopril is used in combination with diuretics or cardiac glycosides.

For myocardial infarction You can take Captopril on the third day after the end of the acute period. In the first 3–4 days you need to take 6.25 mg 2 times a day, then the dose is increased to 12.5 mg 2 times a day and drink for a week. After this, if the drug is well tolerated, it is recommended to switch to 12.5 mg three times a day for 2 to 3 weeks. After this period of time, subject to normal tolerability of the drug, they switch to taking 25 mg 3 times a day with monitoring of the general condition. Captopril is taken for a long time at this dosage. If the dosage of 25 mg 3 times a day is not sufficient, then it is allowed to increase it to the maximum - 50 mg 3 times a day.

For diabetic nephropathy Captopril is recommended to be taken 25 mg 3 times a day or 50 mg 2 times a day. For microalbuminuria (albumin in urine) more than 30 mg per day, the drug should be taken 50 mg 2 times a day, and for proteinuria (protein in urine) more than 500 mg per day Captopril should be taken 25 mg 3 times a day. The indicated dosages are increased gradually, starting with the minimum and doubling every two weeks. The minimum dosage of Captopril for nephropathy may vary, as it is determined by the degree of renal dysfunction. The minimum dosages with which you need to start taking Captopril for diabetic nephropathy, depending on kidney function, are shown in the table.

The indicated daily dosages should be divided into 2 to 3 doses per day. Elderly people (over 65 years of age), regardless of kidney function, should start taking the drug at 6.25 mg 2 times a day, and after two weeks, if necessary, increase the dosage to 12.5 mg 2-3 times a day.

If a person suffers from any kidney disease (not diabetic nephropathy), then the dosage of Captopril for him is also determined by creatinine clearance and is the same as for diabetic nephropathy.

Captopril under the tongue

Captopril is taken under the tongue in exceptional cases when it is necessary to quickly reduce blood pressure. When absorbed under the tongue, the effect of the drug develops after 15 minutes, and when taken orally, only after an hour. That is why Captopril is taken under the tongue to relieve a hypertensive crisis.

Use during pregnancy and breastfeeding

Captopril is contraindicated for use throughout pregnancy, since experimental studies on animals have proven its toxic effect on the fetus. Taking the drug from the 13th to the 40th week of pregnancy can lead to fetal death or developmental defects.

If a woman is taking Captopril, it should be discontinued immediately as soon as pregnancy becomes known.

During the entire period of use of Captopril, it is necessary to monitor kidney function. In 20% of people, while taking the drug, proteinuria (protein in the urine) may appear, which goes away on its own within 4 to 6 weeks without any treatment. However, if the protein concentration in the urine is above 1000 mg per day (1 g/day), then the drug must be discontinued.

Captopril should be used with caution and under close medical supervision if a person has the following conditions or diseases:

• Systemic vasculitis;
• Diffuse connective tissue diseases;
• Bilateral renal artery stenosis;
• Taking immunosuppressants (Azathioprine, Cyclophosphamide, etc.), Allopurinol, Procainamide;
• Carrying out desensitizing therapy (for example, bee venom, SIT, etc.).

In the first three months of therapy, take a general blood test every two weeks. Subsequently, blood tests are performed periodically until the end of Captopril administration. If the total number of leukocytes decreases to less than 1 G/l, then the drug should be discontinued. Typically, the normal number of leukocytes in the blood is restored 2 weeks after discontinuation of the drug. In addition, it is necessary to determine the concentration of protein in the urine, as well as creatinine, urea, total protein and potassium in the blood during the entire period of taking Captopril every month. If the protein concentration in the urine is above 1000 mg per day (1 g/day), then the drug must be discontinued. If the concentration of urea or creatinine in the blood progressively increases, then the dosage of the drug should be reduced or discontinued.

To reduce the risk of a sharp decrease in blood pressure when starting to use Captopril, it is necessary to discontinue diuretics 4–7 days before the first dose of tablets or reduce their dosage by 2–3 times. If, after taking Captopril, blood pressure decreases sharply, that is, hypotension develops, then you should lie on your back on a horizontal surface and raise your legs up so that they are above your head. You need to lie in this position for 30–60 minutes. If hypotension is severe, then to quickly eliminate it, you can inject a regular sterile saline solution intravenously.

Since the first doses of Captopril quite often provoke hypotension, it is recommended to select the dosage of the drug and begin its use in a hospital setting under the constant supervision of medical personnel.

While using Captopril, any surgical interventions, including dental ones (for example, tooth extraction), should be performed with caution. The use of general anesthesia while taking Captopril can provoke a sharp decrease in blood pressure, so the anesthesiologist should be warned that the person is taking this drug.

While using Captopril, a person may develop a rash on the body, which usually occurs in the first 4 weeks of treatment and goes away with a reduction in dosage or additional intake of antihistamines (for example, Parlazin, Suprastin, Fenistil, Claritin, Erius, Telfast, etc.). Also, while taking Captopril, a persistent non-productive cough (without sputum discharge), loss of taste and weight loss may occur, but all these side effects disappear 2 to 3 months after stopping the use of the drug.

Impact on the ability to operate machinery

Since Captopril can cause dizziness, during its use it is recommended to avoid potentially dangerous activities that require high reaction speed and concentration.

Overdose

An overdose of Captopril is possible and is manifested by the following symptoms:

• A sharp decrease in blood pressure (hypotension);
• Stupor;
• Bradycardia (decrease in heart rate less than 50 beats per minute);
• Cerebrovascular accident;
• Myocardial infarction;
• Angioedema;
• Water and electrolyte imbalances.

To eliminate an overdose, it is necessary to completely stop taking the drug, perform gastric lavage, place the person on a flat horizontal surface and begin replenishing the volume of circulating blood and electrolytes. To do this, saline solution, plasma substitutes, etc. are administered intravenously. In addition, symptomatic therapy is provided, aimed at maintaining the normal functioning of vital organs and systems. For symptomatic therapy, adrenaline (increases blood pressure), antihistamines, hydrocortisone, artificial pacemaker (pacemaker) are used, and if necessary, hemodialysis is performed.

Interaction with other drugs

Captopril should not be taken with drugs that increase the concentration of potassium in the blood, such as potassium-sparing diuretics (Spironolactone, Triamterene, Veroshpiron, etc.), potassium compounds (Asparkam, Panangin, etc.), heparin, potassium-containing salt substitutes.

Captopril enhances the effect of hypoglycemic drugs (Metformin, Glibenclamide, Gliclazide, Miglitol, Sulfonylurea, etc.), therefore, when used in combination, blood glucose levels should be constantly monitored. In addition, Captopril enhances the effect of drugs for anesthesia, painkillers and alcohol.

The simultaneous use of Captopril with immunosuppressants (Azathioprine, Cyclophosphamide, etc.), Allopurinol or Procainamide increases the risk of developing neutropenia (a decrease in the level of leukocytes in the blood below normal) and Stevens-Johnson syndrome.

The use of Captopril against the background of ongoing desensitizing therapy, as well as in combination with Estramustine and gliptins (Linagliptin, Sitagliptin, etc.) increases the risk of anaphylactic reactions.

The use of Captopril with gold preparations (Aurothiomolate, etc.) causes redness of the facial skin, nausea, vomiting and a decrease in blood pressure.

Side effects of Captopril

Captopril tablets can cause the following side effects from various organs and systems:

1. Nervous system and sensory organs:

• Increased fatigue;
• Dizziness;
• Central nervous system depression;
• Confusion;
• Ataxia (impaired coordination of movements);
• Paresthesia (feeling of numbness, tingling, “pins and needles” in the limbs);
• Impaired vision or smell;
• Taste disturbance;

2. Cardiovascular system and blood:

• Hypotension (low blood pressure);
• Orthostatic hypotension (a sharp drop in blood pressure when moving from a sitting or lying position to a standing position);
• Angina;
• Myocardial infarction;
• Arrhythmia;
• Acute cerebrovascular accident;
• Peripheral edema;
• Tides;
• Pale skin;
• Cardiogenic shock;
• Neutropenia (decrease in the number of neutrophils in the blood);
• Agranulocytosis (complete disappearance of basophils, eosinophils and neutrophils from the blood);
• Thrombocytopenia (low platelet count below normal);
• Eosinophilia (increased number of eosinophils above normal).

3. Respiratory system:

• Bronchospasm;
• Interstitial pneumonitis;
• Non-productive cough (without sputum production).

4. Gastrointestinal tract:

• Taste disturbance;
• Ulcers on the mucous membrane of the mouth and stomach;
• Xerostomia (dry mouth due to insufficient salivation);