Sandoz instructions for use from pressure. Captopril Sandoz - an ACE inhibitor for lowering blood pressure

1 tablet contains:

active substance: captopril 6.25 mg; 12.5 mg; 25 mg; 50 mg or 100 mg;

Excipients: microcrystalline cellulose 30.0 mg/35.0 mg/70.0 mg/140.0 mg/280.0 mg; corn starch 2.5 mg/5.0 mg/10.0 mg/20.0 mg/40.0 mg; lactose monohydrate 45.0 mg/25.0 mg/50.0 mg/100.0 mg/200.0 mg; stearic acid 1.25 mg/2.5 mg/5.0 mg/10.0 mg/20.0 mg.

Dosage 6.25 mg: white, round, biconvex tablets with a uniform surface. Dosage 12.5 mg: white, round tablets with a uniform surface, convex on one side and with a dividing line on the other side (press-separable tablet).

Dosage 25 mg:

Dosage 50 mg: white, round tablets in the form of a quatrefoil with a uniform surface, with a chamfer and a cruciform risk on both sides.

Dosage 100 mg: white, round tablets, convex on one side and cross-scored on the other side (splitting tablet).

Absorption- fast, is about 75% of the dose taken. Food intake reduces bioavailability by 30-40%. Associated with plasma proteins - 25-30%, mainly with albumin. Less than 0.002% of the accepted dose of captopril is secreted with mother's milk, does not penetrate the blood-brain barrier.

Metabolized in the liver with the formation of a disulfide dimer of captopril and captopril-cysteine ​​sulfide. Metabolites are pharmacologically inactive. The half-life of captopril is about 2-3 hours.

About 95% output by the kidneys during the first day, of which 40-50% is unchanged, the rest is in the form of metabolites. 4 hours after a single dose, the urine contains about 38% of unchanged captopril and 28% in the form of metabolites, after 6 hours - only in the form of metabolites; in daily urine - 38% of unchanged captopril and 62% - in the form of metabolites.

As a result of the accumulation of captopril and its metabolites in the kidneys, a violation of their function may occur. The half-life in renal failure is 3.5 - 32 hours. Cumulates in chronic renal failure. That's whypatients with impaired renal function the dose of the drug should be reduced and / or the interval between doses should be increased.

Arterial hypertension, incl. renovascular;

chronic heart failure (as part of complex therapy);

N violation of the function of the left ventricle after myocardial infarction in a clinically stable condition;

Diabetic nephropathy on the background of type 1 diabetes mellitus (with albuminuria more than 30 mg / day).

Hypersensitivity to captopril, other components of the drug or other ACE inhibitors (including history);

Hereditary angioedema edema or idiopathic edema; angioedema (against the background of previous therapy with other ACE inhibitors in history);

Severe impairment of kidney function, azotemia, hyperkalemia, bilateral renal artery stenosis or stenosis of a single kidney with progressive azotemia, condition after kidney transplantation, primary hyperaldosteronism;

Pregnancy;

-breastfeeding period;

-lactose intolerance, lactase deficiency or glucose-galactose malabsorption;

-simultaneous application ACE inhibitors (including captopril) or angiotensin II receptor antagonists with aliskiren and aliskiren-containing drugs in patients with type 2 diabetes mellitus or impaired renal function (glomerular filtration rate (GFR) less than 60 ml / min / 1.73 m 2) (see .section "Interaction with other drugs");

-age up to 18 years (efficacy and safety have not been established).

Hypertrophic obstructive cardiomyopathy, connective tissue diseases (especially systemic lupus erythematosus or scleroderma), medullar circulatory depression (risk of neutropenia and agranulocytosis), cerebrovascular disease, coronary heart disease, diabetes mellitus (increased risk of hyperkalemia), salt-restricted diet, conditions accompanied by a decrease in the volume of circulating blood (including diarrhea, vomiting, in patients on hemodialysis), mitral valve stenosis, stenosis of the aortic orifice and similar changes that impede the outflow of blood from the left ventricle of the heart, a history of angioedema, impaired liver function, chronic renal insufficiency, bilateral or solitary renal artery stenosis, black patients, surgery/general anesthesia, hemodialysis using high-flow membranes (eg, AN69®), desensitization therapy, low-density lipoprotein (LDL) apheresis, I eat potassium-sparing diuretics, potassium preparations, potassium-containing salt substitutes and lithium, renovascular hypertension, old age.

Patients with type I diabetes mellitus complicated by nephropathy, the recommended daily dose of captopril is 75-100 mg in 2-3 doses. If necessary, further lowering blood pressure may be prescribed in combination with other drugs.

In patients with impaired renal function, the dose of captopril should be adjusted: the dose of the drug should be reduced or the intervals of administration should be increased. If necessary, loop diuretics are additionally prescribed, and not thiazide diuretics.

Elderly patients should be given at an initial dose of 6.25 mg twice daily to prevent impairment of renal function. The dose of captopril is recommended to be constantly adjusted depending on the therapeutic response of the patient and kept as low as possible.

According to the World Health Organization (WHO), adverse reactions are classified according to their frequency of development as follows: very often (≥1/10), often (≥1/100,<1/10), нечасто (≥1/1000, <1/100), редко (≥1/10000, <1/1000) и очень редко (<1/10000); частота неизвестна - по имеющимся данным установить частоту возникновения не представлялось возможным.

From the blood and lymphatic system: very rarely: neutropenia; agranulocytosis; pancytopenia, especially in patients with impaired renal function; anemia (including aplastic, hemolytic), thrombocytopenia, lymphadenopathy, eosinophilia, autoimmune diseases and / or increased titer for antinuclear antibodies.

From the side of metabolism and nutrition: rarely: anorexia; very rarely: hyperkalemia, hypoglycemia.

From the side of the nervous system: often: taste disturbances, sleep disturbances, dizziness; rarely: drowsiness, headache, paresthesia, asthenia; very rarely: depression, cerebrovascular disorders, including stroke, syncope, impaired consciousness.

From the organ of vision very rarely:visual acuity disorders.

From the side of the cardiovascular system: infrequently: tachycardia, tachyarrhythmia, palpitations, angina pectoris, arrhythmia, orthostatic hypotension, Raynaud's syndrome, flushing of the face, pallor, peripheral edema; very rarely: cardiogenic shock, cardiac arrest.

From the respiratory system, chest organs and mediastinum I: often: dry, irritating (unproductive) cough, shortness of breath; very rarely: bronchospasm, rhinitis, allergic alveolitis, eosinophilic pneumonia.

From the digestive system: often: dryness of the oral mucosa, nausea, vomiting, abdominal pain, diarrhea, constipation; rarely: stomatitis, aphthous ulcers of the inner surface of the mucous membrane of the cheeks and tongue, anorexia; very rarely: glossitis, peptic ulcer, pancreatitis, abnormal liver function, cholestasis, jaundice, hepatitis, liver necrosis, increased activity of "liver" enzymes, increased serum bilirubin concentration, angioedema of the intestinal mucosa.

From the skin and subcutaneous tissues often:itchy skin with rashes and without, skin rash (maculo-papular, rarely vesicular or bullous), baldness; very rarely: urticaria, Stevens-Johnson syndrome, erythema multiforme, photosensitivity, exfoliative dermatitis, pemphigoid reactions.

From the side of the musculoskeletal system: very rarely: myalgia, arthralgia.

From the genitourinary system rarely: impaired renal function, acute renal failure, polyuria, oliguria, increased frequency of urination; very rarely: nephrotic syndrome, impotence, gynecomastia.

General disorders and disorders at the injection site: infrequently: chest pain, fatigue, weakness / very rarely: fever.

Laboratory indicators: very rarely: proteinuria, hyperkalemia, hyponatremia, increased concentration of urea nitrogen and creatinine in blood plasma; increased activity of "liver" transaminases, increased serum concentration of bilirubin, decreased hemoglobin, hematocrit, increased erythrocyte sedimentation rate (ESR), metabolic acidosis.

The simultaneous use of ACE inhibitors with other drugs that affect the RAAS, including angiotensin II receptor antagonists (ARA II) and aliskiren, leads to an increase in the incidence of cases of a pronounced decrease in blood pressure, hyperkalemia, impaired renal function (including acute renal failure ). It is necessary to monitor blood pressure, kidney function, and plasma electrolytes when using captopril with other drugs that affect the RAAS. The simultaneous use of ACE inhibitors (including captopril) with aliskiren and aliskiren-containing drugs should be avoided in patients with severe renal impairment (GFR less than 60 ml / min / 1.73 m 2).

Simultaneous use of ACE inhibitors (including captopril) with aliskiren and aliskiren-containing drugs contraindicated in patients with type 2 diabetes.

Combined application Withpotassium-sparing diuretics, potassium supplements, potassium supplements, salt substitutes (contain significant amounts of potassium ions) increases the risk of developing hyperkalemia. If necessary, their simultaneous use with captopril should control the plasma content of potassium.

When using high doses of diuretics (thiazide diuretics, "loop" diuretics) simultaneously with captopril, due to reduced volume of circulating blood increases the risk of arterial hypotension, especially at the beginning of therapy with captopril.

Antihypertensive effect Captopril is potentiated when administered concomitantly aldesleukin, alprostadil, beta-blockers, alpha1-blockers, central alpha2-adrenergic agonists, diuretics, cardiotonics, slow calcium channel blockers, minoxidil, muscle relaxants, nitrates and vasodilators. Antidepressants, neuroleptics, anxiolytics and hypnotics may also enhance the antihypertensive effect of captopril.

With prolonged use the antihypertensive effect of captopril is weakened indomethacin and other non-steroidal anti-inflammatory drugs (NSAIDs), incl. selective cyclooxygenase-2 inhibitors(sodium ion retention, decreased prostaglandin synthesis, especially against the background of low renin activity) and estrogens.

NSAIDs and ACE inhibitors have been described to have an additive effect on increasing serum potassium while decreasing renal function. These effects are reversible. Rarely, acute renal failure may occur, especially in patients with pre-existing impaired renal function, in elderly patients or with a reduced volume of circulating blood (with dehydration).

The use of ACE inhibitors in patients undergoing surgical intervention using general anesthesia can lead to a pronounced decrease in blood pressure, especially when using general anesthesia agents that have an antihypertensive effect.

Slows down excretionlithium preparations, increasing the concentration of lithium in the blood. If necessary the simultaneous use of captopril and lithium preparations should carefully monitor the serum concentration of lithium.

When using captopril while taking allopurinol or procainamide increases the risk of developing Stevens-Johnson syndrome and neutropenia.

Concomitant use of ACE inhibitors and gold preparations(in / in) a symptom complex is described, including flushing of the face, nausea, vomiting and a decrease in blood pressure.

Sympathomimetics may reduce antihypertensive effect captopril.

Insulin and hypoglycemic agents for oral administration increase the risk of hypoglycemia.

Concomitant use of captopril withfood or antacids slows down the absorption of captopril in the gastrointestinal tract (GIT).

Antihypertensive effect captopril weakens epoetins, estrogens and combined oral contraceptives, carbenoxolone, glucocorticosteroids and naloxone.

probenecid reduces the renal clearance of captopril and increases its serum concentrations in the blood.

The use of captopril in patients taking immunosuppressants(for example, or), increases the risk of developing hematological disorders.

Increases concentration digoxin in blood plasma by 15-20%.

Increases bioavailability propranolol.

Cimetidine, slowing down the metabolism in the liver, increases the concentration of captopril in the blood plasma.

Clonidine reduces the severity of the antihypertensive effect.

Blood pressure and kidney function should be regularly monitored before starting and regularly during treatment with Sandoz®. In patients with chronic heart insufficiency, the drug is used under close medical supervision.

Arterial hypotension

In patients with arterial hypertension when using Sandoz®, severe arterial hypotension is observed only in rare cases, the likelihood of developing this condition increases with a decrease in circulating blood volume and a violation of water and electrolyte balance (for example, after treatment with high doses of diuretics), in patients with chronic heart failure or on hemodialysis. The possibility of a sharp decrease in blood pressure can be minimized by prior cancellation (4-7 days) of the diuretic or replenishment of circulating blood volume (about a week before the start of use), or the use of Sandoz® in small doses (6.25-12. 5 mg/day) at the beginning of treatment.

When using antihypertensive drugs, a pronounced decrease in blood pressure in patients with brain disorders circulatory, cardiovascular disease, may increase the risk of myocardial infarction or stroke. If arterial hypotension has developed, the patient should be placed in a supine position with legs raised. Sometimes it may be necessary to replenish the volume of circulating blood.

Renovascular hypertension

There is an increased risk of arterial hypotension and renal failure in patients with bilateral renal artery stenosis or stenosis of the artery of a single kidney when using ACE inhibitors.

Impaired renal function can occur with a moderate change in the concentration of creatinine in the blood serum. In such patients, therapy should be initiated under close medical supervision at low doses, carefully titrated and with monitoring of renal function. The use of ACE inhibitors - including captopril - with aliskiren should be avoided in patients with severe renal insufficiency (GFR less than 60 ml / min / 1.73 m).

Proteinuria

Proteinuria may occur in patients, especially those with impaired renal function or in combination with relatively high doses of ACE inhibitors, who take Sandoz®. AT In most cases, proteinuria improved or disappeared within 6 weeks, regardless of whether captopril treatment was continued or not. Renal function parameters such as residual blood nitrogen and creatinine rarely changed in patients with proteinuria.

Hyperkalemia

In some cases, when using the drug Sandoz®, an increase in the content of potassium in the blood serum is observed. The risk of developing hyperkalemia with the use of ACE inhibitors is increased in patients with renal insufficiency and diabetes mellitus, as well as taking potassium-sparing diuretics, potassium preparations and other drugs that cause an increase in the content of potassium in the blood (for example, heparin). The simultaneous use of potassium-sparing diuretics and potassium preparations should be avoided. Use with caution in patients on a low-salt or salt-free diet (increased risk of arterial hypotension) and hyperkalemia.

Neutropenia/agranulocytosis

In the first 3 months of therapy, the number of leukocytes in the blood is monitored monthly, then - 1 time in 3 months. Neutropenia/agranulocytosis, anemia and thrombocytopenia have been reported in patients taking ACE inhibitors, including . In patients with normal renal function and no other complicating factors, neutropenia rarely occurs. Sandoz should be used with great caution in patients with connective tissue disease and concomitantly receiving immunosuppressive therapy (or), especially in existing renal impairment. In such patients, in the first 3 months, a clinical blood test is monitored every 2 weeks, then every 2 months. If the number of leukocytes is below 4.0 x 10 9 /l, a complete blood count is shown once a week, below 1.0 x 10 9 /l - the use of Sandoz® is stopped. These patients may develop severe infections that are not amenable to intensive antibiotic therapy. During treatment, all patients should be instructed that if they develop signs of infection (eg, sore throat, fever), they should inform their physician and perform a complete blood count with leukocyte count. In most patients, the number of leukocytes quickly returns to normal upon discontinuation of treatment with captopril.

Anaphylactoid reactions

In patients taking the drug Sandoz® against the background of desensitizing therapy with hymenoptera venom, etc., the risk of developing anaphylactoid reactions is increased. This can be avoided by temporarily interrupting the drug beforehand.

When performing hemodialysis in patients receiving Sandoz®, the use of dialysis membranes with high permeability (for example,AN69®), since in such cases the risk of developing anaphylactoid reactions.

In rare cases, patients receiving ACE inhibitors during low-density lipoprotein (LDL) apheresis (LDL) using dextran sulfate may develop life-threatening anaphylactoid reactions. To prevent anaphylactoid reactions, ACE inhibitor therapy should be discontinued before each LDL apheresis procedure using high-flow membranes.

Angioedema

In patients taking the drug Sandoz® with the appearance of abdominal pain, it is necessary to differentiate with intestinal angioedema.

In case of development of angioedema, the drug is canceled and careful medical supervision is provided. If the edema is localized on the face, special treatment is usually not required (to reduce severity of symptoms, antihistamines may be used); in the event that the edema spreads to the tongue, pharynx or larynx and there is a threat of airway obstruction and a threat to the life of the patient, you should immediately inject (adrenaline) subcutaneously (0.5 ml at a dilution of 1:1000), and also make sure that there is free patency respiratory tract. It is recommended to stop taking ACE inhibitors, including Sandoz®, 12 hours before surgery, having warned the anesthetist surgeon about the use of ACE inhibitors.

Cough

The development of unproductive prolonged cough with ACE inhibitors is reversible and resolves after discontinuation of treatment.

Diabetes

In diabetic patients taking hypoglycemic means for oral administration or insulin, you should regularly monitor the concentration of glucose in the blood during the first month of treatment with Sandoz®.

Impaired liver function

During therapy with ACE inhibitors, several cases of liver dysfunction with cholestatic jaundice, fulminant necrosis of the liver (in some cases) with a fatal outcome.

If, during therapy with Sandoz®, a jaundice or increased activity of "liver" transaminases, Sandoz should be discontinued immediately; the patient should be closely monitored and, if necessary, receive appropriate therapy.

hypokalemia

The simultaneous use of an ACE inhibitor and a thiazide diuretic does not exclude the possibility of hypokalemia. Recommended regularly monitor the content of potassium in the blood.

Surgery / Anesthesia

Arterial hypotension may occur in patients undergoing extensive surgical interventions or during the use of anesthetics known to lower blood pressure. If arterial hypotension occurs, it is recommended to replenish the volume of circulating blood.

ethnic differences

ACE inhibitors, including Sandoz®, have a less pronounced antihypertensive effect in patients of the Negroid race, which, apparently, is associated with the frequent occurrence of low renin activity in this group of patients.

Laboratory data

Captopril may cause a false positive urine test for acetone.

During the period of treatment, it is necessary to refrain from driving vehicles and engaging in potentially hazardous activities that require an increased concentration of attention and speed of psychomotor reactions, because. dizziness is possible, especially after taking the initial dose.

Tablets 6.25 mg, 12.5 mg, 25 mg, 50 mg, 100 mg.

On 1,2,3,4,5 or 10 blisters together with the application instruction in a cardboard pack.

Dosage 6.25 mg/25 mg/50 mg: 3 years.

Dosage 12.5 mg/100 mg: 5 years.

Captopril Sandoz: instructions for use and reviews

It can be normalized with various drugs, including Captopril Sandoz. This drug has a rapid and effective hypotensive effect. Can be used for both hypertension and heart failure.

What is the drug?

Captopril Sandoz belongs to the group of ACE inhibitors, and its main purpose is to lower blood pressure. It works on the principle of competitive inhibition of ACE, which helps to reduce the rate of production of the hormone angiotensin II, which constricts blood vessels and stimulates the production of another hormone, aldosterone. Due to this, the load on the heart muscle is reduced, thereby normalizing the pressure.

The drug has been known since the 70s of the 20th century and is used in the complex therapy of many diseases. Basically, he has established himself as, but is also used to normalize heart failure. The general list of indications for its reception is as follows:

• arterial hypertension, including;
• chronic heart failure;
• dysfunction of the left ventricle after, but the clinical condition must be stable;
• nephropathy in a type 1 diabetic.

Captopril Sandoz is available in 25 mg tablets. One carton contains 20 tablets. The manufacturer is Salutas Pharma GmbH, Germany, and the representative office is Sandoz, Switzerland. The price is about 150 rubles.

Compound

1 tablet contains 25 mg of captopril. This is the main active ingredient, which is supplemented with auxiliary elements in the form of:

• milk sugar;
• microcrystalline cellulose;
• corn starch;
• magnesium stearate.

Therapeutic action

The therapeutic actions of the drug are as follows:

• Reduces the release of aldosterone. Due to this, there is a decrease in vascular resistance, so the arteries expand, blood pressure drops, and the load on the heart decreases.
• Promotes increased blood flow and coronary and renal.
• It has a positive effect on the heart muscle with long-term use, reducing myocardial hypertrophy. It also improves the blood supply to the heart, although it is prone to ischemia due to atherosclerosis of the vessels.
• Prevents agglutination of red blood cells, the formation of blood clots.
• Reduces the presence of sodium ions, which is very important for people with heart failure.

The main function of Captopril Sandoz is to lower blood pressure, while heart palpitations are not observed, and the heart's need for oxygen also decreases.

Pharmacokinetic processes

After the drug has been taken orally, about 75% is absorbed from the gastrointestinal tract. With the simultaneous intake of food, absorption decreases significantly. The drug reaches its maximum effect in the blood plasma within 30-60 minutes after administration. The active substance is metabolized in the liver, and the metabolites are pharmacologically inactive. Excreted by the kidneys.

Instructions for taking the drug

The dosage of the drug is prescribed by the attending physician. As a rule, it is taken for the following purpose:

1. At first, drink a small dose (6.25-12.5 mg) 2-3 times a day. Receptions should be carried out in 30-60 minutes, washed down with water.
2. If the effect of treatment is insufficient, gradually increase the dose to 25-50 mg per day. It is recommended to use 3 times a day.

If kidney function is impaired, then the dose is adjusted, but per day it cannot exceed a maximum of 150 mg. The pressure will gradually decrease to a normal value after 30 minutes or 1 hour.

If the drug is taken for several weeks without interruption, the pressure becomes normal and remains stable.

In this case, the method of admission can be adjusted depending on the exact diagnosis:

1. Arterial hypertension. Start treatment with a small dose equal to 1/2 tablet at a dose of 25 mg. It is recommended to take 2 times a day, and at the same time, adhering to the interval of 12 hours. For 2 weeks, increase the dose until the pressure normalizes.
2. Moderate hypertension. A maintenance dose of 1 tablet of 25 mg in the morning and evening is prescribed. If the pressure is stable, then there may be dosages of 2 tablets 3 times a day, which is a daily dose of 150 mg. If the drug is first prescribed to a patient in old age, then the initial dose is 1/4 tablet 2 times a day.
3. Chronic heart failure. It is necessary to carefully approach the dosing of the drug, given that the patient is taking diuretics, which help reduce pressure. So, when prescribing Captopril Sandoz, you need to reduce their dose or cancel it altogether. First, drink 1/4 tablet 2 times a day, and then gradually increase the dose by 25 mg in the morning and evening.
4. After a myocardial infarction, when the function of the left ventricle is impaired. Captopril can be given as early as day 3 if the patient is clinically stable. The initial dose is 1/4 tablet. Then increase it to 25 mg 2-3 times a day. In severe cases, a maximum dose of 150 mg is allowed (drink 2 tablets 3 times a day). Very often, with this diagnosis, in addition to Captopril, other drugs are taken, namely: Aspirin, beta-blockers, thrombolytics.
5. diabetic nephropathy. A dose of 25 mg 3 times a day is prescribed. The drug can be drunk alone or in combination with other antihypertensive drugs.

You can not abruptly stop taking Captopril Sandoz, but you need to gradually reduce its dosage. Only then can you switch to another drug, because otherwise the pressure may rise sharply.

Is it accepted during pregnancy and breastfeeding?

Like most antihypertensive drugs, Captopril Sandoz is contraindicated in expectant mothers. ACE inhibitors have been found to reduce amniotic fluid and contribute to poor kidney function. In addition, they adversely affect the development of the fetus and can even lead to its death. Especially dangerous are considered in the 2nd and 3rd trimesters.

If a child is born, he may suffer from kidney disease, high potassium content. So, if you had to take the drug even before pregnancy, you need to do an ultrasound of the fetus.

Nursing mothers should be aware that the active ingredients can get into the milk, so in order to protect the child from negative consequences, they will have to switch to artificial feeding. An alternative solution is to stop taking this drug.

Interaction with other drugs

When treating with Captopril, it is advisable to be careful with taking other drugs, as they can enhance or reduce its therapeutic effect:

• there is a risk of developing leukopenia while taking it with immunosuppressants;
• when taken with diuretics, low blood pressure may occur;
• the bioavailability of the inhibitor decreases when taken simultaneously with magnesium hydroxide or carbonate, aluminum hydroxide;
• acetylsalicylic acid interferes with lowering blood pressure, so it is necessary to adjust the dosage while taking Captopril;
• it is not recommended to take the drug together with Indomethacin, as the therapeutic effect of the drug in lowering blood pressure decreases;
• when a patient is prescribed Captopril after Clonidine, the effect of the drug may not appear immediately, but gradually (Clonidine cannot be abruptly canceled - it must be drunk for some time in a small dose);
• when taken simultaneously with lithium carbonate, there is an increase in lithium in the blood serum, and it begins to have a toxic effect on the body;
• co-administration with Orlistat can lead to a jump in pressure, that is, to a hypertensive crisis, since this drug reduces the hypotensive effect of Captopril.

Overdose

There are cases when patients do not follow the exact prescriptions of doctors, and in order to reduce high blood pressure, they drink a large dosage, as a result of which the condition worsens.

An overdose is diagnosed with the following symptoms:

• critically low blood pressure;
• impaired blood circulation of the brain;
• there is a low pulse;
• insufficient functioning of the kidneys.

To help such a patient, you must perform the following actions:

1. Lay him down on the bed with your legs up.
2. It is advisable to wash the stomach until half an hour has passed after taking the medicine.
3. Increase low pressure with special drugs, for example, Dopamine or. In this case, you need to keep under control the work of the heart and kidneys.
4. Administer sodium chloride intravenously to increase blood circulation.
5. With a slow pulse, enter Atropine.

Side effects

This drug can cause a number of adverse reactions from the internal organs and systems:

1. Kidneys, especially in case of impaired functioning:

• neutropenia (agranulocytosis);
• anemia.

1. Exchange processes:

• hypoglycemia;
• hyperkalemia.

1. Nervous system:

• sleep problems;
• change in taste preferences;
• headache;
• dizziness.

1. Eye: impaired visual acuity.
2. Respiratory organs:

• dyspnea;
• dry cough;
• bronchospasm (in rare cases).

In addition, in some, taking the drug causes such reactions:

• the appearance of a rash, itching, urticaria on the skin;
• pallor of the skin;
• and the increase in his beats ();
• swelling;
• hypotension;
• fatigue and weakness.

In laboratory studies, some deviations were also found:

• increased bilirubin in the blood serum;
• decrease in hemoglobin;
• change in the indication of the erythrocyte sedimentation rate (ESR) in a big way.

Contraindications

Contraindications include:

• sensitivity to the components of the drug;
• renal failure and other disorders of kidney function;
• period and lactation;
• lactose intolerance;
• angioedema during therapy with other ACE inhibitors, as well as idiopathic edema.

There are also age restrictions. The drug can be used only from the age of 18, and also with caution in old age.

Captopril Sandoz is an indispensable drug for the normalization of blood pressure. It is also an excellent remedy for acute, so it is advisable to have it in the medicine cabinet for people with hypertension. The correct dosage can only be determined by a doctor after examining the patient.

Composition and form of release of the drug

10 pieces. - cellular contour packings (1) - packs of cardboard.
10 pieces. - cellular contour packings (2) - packs of cardboard.
10 pieces. - cellular contour packings (3) - packs of cardboard.
10 pieces. - cellular contour packings (5) - packs of cardboard.
10 pieces. - cellular contour packings (10) - packs of cardboard.

pharmachologic effect

Antihypertensive agent, ACE inhibitor. The mechanism of antihypertensive action is associated with competitive inhibition of ACE activity, which leads to a decrease in the rate of conversion of angiotensin I to angiotensin II (which has a pronounced vasoconstrictive effect and stimulates the secretion of aldosterone in the adrenal cortex). In addition, captopril appears to have an effect on the kinin-kallikrein system, preventing the breakdown of bradykinin. The hypotensive effect does not depend on the activity of renin, a decrease in blood pressure is noted at normal and even reduced concentrations of the hormone, which is due to the effect on the tissue RAAS. Increases coronary and renal blood flow.

Due to the vasodilating effect, it reduces OPSS (afterload), wedge pressure in the pulmonary capillaries (preload) and resistance in the pulmonary vessels; increases cardiac output and exercise tolerance. With prolonged use, it reduces the severity of left ventricular myocardial hypertrophy, prevents the progression of heart failure and slows down the development of left ventricular dilatation. Helps reduce sodium levels in patients with chronic heart failure. Expands arteries more than veins. Improves blood supply to ischemic myocardium. Reduces platelet aggregation.

It lowers the tone of the glomerular efferent arterioles of the kidneys, improving intraglomerular hemodynamics, and prevents the development of diabetic nephropathy.

Pharmacokinetics

After oral administration, at least 75% is rapidly absorbed from the gastrointestinal tract. Simultaneous food intake reduces absorption by 30-40%. C max in blood plasma is reached in 30-90 minutes. Protein binding, mainly with, is 25-30%. It is allocated with breast milk. It is metabolized in the liver to form a disulfide dimer of captopril and captopril-cysteine ​​disulfide. Metabolites are pharmacologically inactive.

T 1/2 is less than 3 hours and increases with renal failure (3.5-32 hours). More than 95% is excreted by the kidneys, 40-50% is unchanged, the rest is in the form of metabolites.

In chronic renal failure cumulates.

Indications

Arterial hypertension (including renovascular), chronic insufficiency (as part of combination therapy), left ventricular dysfunction after myocardial infarction in patients who are in a clinically stable condition. Diabetic nephropathy in type 1 diabetes mellitus (with albuminuria more than 30 mg / day).

Contraindications

Pregnancy, lactation, age up to 18 years, hypersensitivity to captopril and other ACE inhibitors.

Dosage

When taken orally, the initial dose is 6.25-12.5 mg 2-3 times / day. With insufficient effect, the dose is gradually increased to 25-50 mg 3 times / day. In case of impaired renal function, the daily dose should be reduced.

Maximum daily dose is 150 mg.

Side effects

From the side of the central nervous system and peripheral nervous system: dizziness, headache, fatigue, asthenia, paresthesia.

From the side of the cardiovascular system: orthostatic hypotension; rarely - tachycardia.

From the digestive system: nausea, loss of appetite, impaired taste sensations; rarely - abdominal pain, diarrhea or constipation, increased activity of hepatic transaminases, hyperbilirubinemia; signs of hepatocellular damage (hepatitis); in some cases - cholestasis; in isolated cases - pancreatitis.

From the hematopoietic system: rarely - neutropenia, anemia, thrombocytopenia; very rarely in patients with autoimmune diseases - agranulocytosis.

From the side of metabolism: hyperkalemia, acidosis.

From the urinary system: proteinuria, impaired renal function (increased concentration of urea and creatinine in the blood).

From the respiratory system: dry cough.

Allergic reactions: skin rash; rarely - angioedema, bronchospasm, serum sickness, lymphadenopathy; in some cases - the appearance of anti-nuclear antibodies in the blood.

drug interaction

With simultaneous use with cytostatics, the risk of developing leukopenia increases.

With simultaneous use with potassium-sparing diuretics (including spironolactone, triamterene, amiloride), potassium preparations, salt substitutes and dietary supplements containing potassium, hyperkalemia may develop (especially in patients with impaired renal function), because. ACE inhibitors reduce the content of aldosterone, which leads to a retention of potassium in the body against the background of limiting the excretion of potassium or its additional intake into the body.

With the simultaneous use of ACE inhibitors and NSAIDs, the risk of developing impaired renal function increases; rarely observed hyperkalemia.

With simultaneous use with "loop" diuretics or thiazide diuretics, severe arterial hypotension is possible, especially after taking the first dose of the diuretic, apparently due to hypovolemia, which leads to a transient increase in the antihypertensive effect of captopril. There is a risk of developing hypokalemia. Increased risk of developing renal dysfunction.

With simultaneous use with drugs for anesthesia, severe arterial hypotension is possible.

With simultaneous use with azathioprine, anemia may develop, which is due to the inhibition of erythropoietin activity under the influence of ACE inhibitors and azathioprine. Cases of the development of leukopenia are described, which may be associated with additive inhibition of bone marrow function.

With simultaneous use with increases the risk of developing hematological disorders; described cases of severe hypersensitivity reactions, including Stevens-Johnson syndrome.

With the simultaneous use of aluminum hydroxide, magnesium hydroxide, magnesium carbonate, the bioavailability of captopril decreases.

In high doses, it can reduce the antihypertensive effect of captopril. It has not been conclusively established whether acetylsalicylic acid reduces the therapeutic efficacy of ACE inhibitors in patients with coronary artery disease and heart failure. The nature of this interaction depends on the course of the disease. Acetylsalicylic acid, by inhibiting COX and prostaglandin synthesis, can cause vasoconstriction, which leads to a decrease in cardiac output and worsening of the condition of patients with heart failure receiving ACE inhibitors.

There are reports of an increase in the concentration of digoxin in the blood plasma with the simultaneous use of captopril with digoxin. The risk of drug interactions is increased in patients with impaired renal function.

With simultaneous use with indomethacin, ibuprofen, the antihypertensive effect of captopril 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 insulins, hypoglycemic agents, sulfonylurea derivatives, hypoglycemia may develop due to an increase in glucose tolerance.

With the simultaneous use of ACE inhibitors and interleukin-3, there is a risk of arterial hypotension.

With simultaneous use with interferon alfa-2a or interferon beta, cases of severe granulocytopenia have been described.

When switching from taking clonidine to captopril, the antihypertensive effect of the latter develops gradually. In the event of a sudden withdrawal of clonidine in patients receiving captopril, a sharp increase in blood pressure is possible.

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

With simultaneous use with minoxidil, sodium nitroprusside, the antihypertensive effect is enhanced.

With simultaneous use with orlistat, a decrease in the effectiveness of captopril is possible, which can lead to an increase in blood pressure, a hypertensive crisis, and a case of cerebral hemorrhage is described.

With the simultaneous use of ACE inhibitors with pergolide, an increase in the antihypertensive effect is possible.

With simultaneous use with probenecid, the renal clearance of captopril decreases.

With simultaneous use with procainamide, an increased risk of developing leukopenia is possible.

With simultaneous use with trimethoprim, there is a risk of developing hyperkalemia, especially in patients with impaired renal function.

With simultaneous use with chlorpromazine, there is a risk of developing orthostatic hypotension.

With simultaneous use with cyclosporine, there are reports of the development of acute renal failure, oliguria.

It is believed that it is possible to reduce the effectiveness of antihypertensive agents when used simultaneously with erythropoietins.

special instructions

Caution should be used when indicating a history of angioedema during therapy with ACE inhibitors, hereditary or idiopathic angioedema, with aortic stenosis, cerebro- and cardiovascular diseases (including cerebrovascular insufficiency, coronary artery disease, coronary insufficiency), severe autoimmune connective tissue diseases (including SLE, scleroderma), with suppression of bone marrow hematopoiesis, diabetes mellitus, hyperkalemia, bilateral renal artery stenosis, stenosis of the artery of a single kidney, condition after kidney transplantation, renal and / or liver failure, against the background of diets with sodium restriction, conditions accompanied by a decrease in BCC (including diarrhea, vomiting), in elderly patients.

In patients with chronic heart failure, captopril is used under close medical supervision.

Hypotension that occurs during surgery while taking captopril is eliminated by replenishing the volume of fluid.

The simultaneous use of potassium-sparing diuretics and potassium preparations should be avoided, especially in patients with renal insufficiency and diabetes mellitus.

When taking captopril, a false positive reaction can be observed in the analysis of urine for acetone.

The use of captopril in children is possible only if other drugs are ineffective.

Influence on the ability to drive vehicles and control mechanisms

Care must be taken when driving vehicles or performing other work that requires increased attention, because. dizziness is possible, especially after the initial dose of captopril.

Caution should be used in the condition after kidney transplantation, renal failure.

In case of impaired renal function, the daily dose should be reduced.

The concomitant use of potassium-sparing diuretics and potassium preparations should be avoided in patients with renal insufficiency.

For impaired liver function

Caution should be used in liver failure.

Use in the elderly

Caution should be used in elderly patients.

Instructions for use Captopril 25
Buy Captopril 25tb 25mg
Dosage forms
tablets 25mg
Manufacturers
Geksal/Salyutas Pharma (Germany)
Group
Antihypertensive - angiotensin-converting enzyme inhibitors
Compound
The active substance is Captopril.
International non-proprietary name
Captopril
Synonyms
Angiopril-25, Blockordil, Vero-Captopril, Capocard, Capoten, Capto, Captopril, Captopril Sandoz, Captopril Stada International, Captopril-Akos, Captopril-Acri, Captopril-Biosynthesis, Captopril-MIC, Captopril-N.S., Captopril- STI, Captopril-Ferein, Captopril-FPO, Katopil, Rilcapton, Tenziomin
pharmachologic effect
Hypotensive, vasodilating, cardioprotective, natriuretic. Inhibits ACE, prevents the transition of angiotensin I to angiotensin II and prevents the inactivation of endogenous vasodilators. The hypotensive effect manifests itself 15-60 minutes after oral administration, reaches a maximum after 60-90 minutes and lasts 6-12 hours. does not change). It has a cardioprotective effect. Rapidly and completely absorbed from the gastrointestinal tract. Sublingual use improves bioavailability and accelerates onset of action. It passes through the blood-tissue barriers, excluding the BBB, through the placenta and into breast milk. The half-life is 2-3 hours. Excreted mainly by the kidneys.
Indications for use
Arterial hypertension (mono- and combination therapy), congestive heart failure, cardiomyopathy, dysfunction of the left ventricle in a stable condition in patients after myocardial infarction, diabetic nephropathy against the background of type 1 diabetes mellitus.
Contraindications
Hypersensitivity, the presence of anamnestic information about the development of Quincke's edema with the previous appointment of ACE inhibitors, hereditary or idiopathic Quincke's edema, primary hyperaldosteronism, pregnancy, lactation. 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 stenosis of the renal arteries or stenosis of the artery of a single kidney; the presence of a transplanted kidney; hyperkalemia; childhood.
Side effect
From the nervous system and sensory organs: fatigue, dizziness, headache, CNS depression, drowsiness, confusion, depression, ataxia, convulsions, numbness or tingling in the extremities, visual and / or smell disturbances. From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): hypotension, incl. orthostatic, angina pectoris, myocardial infarction, cardiac arrhythmias (atrial tachycardia or bradycardia, atrial fibrillation), palpitations, acute cerebrovascular accident, peripheral edema, lymphadenopathy, anemia, chest pain, pulmonary embolism, neutropenia, agranulocytosis (in patients with impaired renal function, against the background of collagenoses), thrombocytopenia, eosinophilia. From the respiratory system: bronchospasm, shortness of breath, interstitial pneumonitis, bronchitis, unproductive dry cough. On the part of the digestive tract: anorexia, taste disturbance, stomatitis, ulcerative lesions of the oral and stomach 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: impaired renal function, oliguria, proteinuria, impotence. On the part of the skin: redness of the skin of the face, rash, itching, exfoliative dermatitis, toxic epidermal necrolysis, pemphigus, herpes zoster, alopecia, photodermatitis. Allergic reactions: Stevens-Johnson syndrome, urticaria, angioedema, anaphylactic shock, etc. Others: fever, chills, sepsis, arthralgia, hyperkalemia, gynecomastia, serum sickness, increased blood levels of liver enzymes, urea nitrogen, acidosis, positive reaction during a test for antibodies to a nuclear antigen.
Interaction
Potentiates the hypoglycemic effect of oral antidiabetic drugs, enhances 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. Potassium-sparing diuretics, cyclosporine, potassium-containing drugs and supplements, salt substitutes, 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. Enhances 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 the BCC (introduction of isotonic sodium chloride solution, transfusion of other blood-substituting fluids), symptomatic therapy: epinephrine (s / c or / in), antihistamines, hydrocortisone (in / in ). Carrying out hemodialysis, if necessary, the use of an artificial pacemaker.
special instructions
Treatment is carried out under regular medical supervision. During therapy, it is necessary to monitor blood pressure, peripheral blood patterns, protein levels, plasma potassium, urea nitrogen, creatinine, kidney function, body weight, and diet. With the development of hyponatremia, dehydration, correction of the dosing regimen is necessary. Caution is required when performing surgical interventions (including dental), especially when using general anesthetics that have a hypotensive effect. It is recommended to exclude the use of alcoholic beverages during treatment. Use with caution during work for drivers of vehicles and people whose profession is associated with increased concentration of attention. If a dose is missed, do not double the next dose. When conducting a test for acetonuria, a positive result is possible.
Storage conditions
At a temperature of 15-25 C.