Why teeth are exposed and how to treat. Bare gum treatment

ACE inhibitor.Drug Kapoten reduces the formation of angiotensin II from angiotensin I. A decrease in the content of angiotensin II leads to a direct decrease in the release of aldosterone. At the same time, OPSS, blood pressure, post- and preload on the heart are reduced. Expands arteries more than veins. It causes a decrease in the degradation of bradykinin (one of the effects of ACE) and an increase in the synthesis of Pg. The hypotensive effect does not depend on the activity of plasma 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 renin-angiotensin systems. Enhances coronary and renal blood flow. At long-term use reduces the severity of hypertrophy of the myocardium and the walls of the arteries of the resistive type. Improves blood supply to ischemic myocardium. Reduces platelet aggregation. Helps to reduce the content of Na + in patients with CHF. In doses of 50 mg / day, it exhibits angioprotective properties in relation to the vessels of the microvasculature and can slow down the progression of chronic renal failure in diabetic nephroangiopathy. A decrease in blood pressure, unlike direct vasodilators (hydralazine, minoxidil, etc.), is not accompanied by reflex tachycardia and leads to a decrease in myocardial oxygen demand. With HF in an adequate dose does not affect the magnitude of blood pressure. The maximum decrease in blood pressure after oral intake observed after 60-90 minutes. The duration of the hypotensive effect is dose-dependent and reaches optimal values within a few weeks.

Indications for use

For mild/moderate hypertension, as additional funds in the treatment of thiazide diuretics in patients who do not respond effectively enough to treatment with thiazide drugs alone. Severe hypertension when standard treatment fails.

Kapoten indicated for the treatment of congestive heart failure. The drug should be used together with diuretics and, where necessary, digitalis preparations.

Mode of application

Hypertension
Treatment with Capoten should be carried out using the lowest effective dose, which should be selected in accordance with the needs of the patient.

Mild/Moderate hypertension
With mild / moderate degree hypertension Kapoten should be used as an adjunct to thiazide diuretic treatment. The initial dose is 12.5 mg twice a day. The usual maintenance dose is 25 mg twice daily, which can be increased in steps over 2-4 weeks until the desired response to treatment is obtained, up to a maximum dose of 50 mg twice daily.

severe hypertension
In severe hypertension, the initial dose is 12.5 mg twice daily. The dose can be increased in stages up to a maximum dose of 50 mg three times a day. Kapoten can be used together with other antihypertensive drugs, however, the dose of such drugs should be selected individually. Usually do not exceed the daily dose Capotena equal to 150 mg/day.

Heart failure
Treatment with Capoten should be started under close medical supervision. Kapoten should be given when treatment with a diuretic (such as furosemide 40-80 mg or equivalent) fails to relieve symptoms. An initial dose of 6.25 mg or 12.5 mg may minimize the transient pressure drop. The possibility of such an effect can be reduced by canceling or reducing the dose of the diuretic, if possible, before starting treatment with Capoten. The usual maintenance dose is 25 mg two or three times a day, and the dose can be increased in stages, once every two weeks at least, until a satisfactory response is obtained. The usual maximum daily dose is 150 mg. Capoten should be administered in combination with a diuretic and, when necessary, with digitalis.

elderly patients
The dose should be selected depending on the change in blood pressure and kept at the minimum level necessary to achieve a sufficient result. Since renal function may be limited in elderly patients, and dysfunction of other organs may also be noted, a small dose should be used at the beginning of treatment. Capotena.

Children
Kapoten not recommended for the treatment of mild/moderate hypertension in children. Existing experience with neonates, especially preterm infants; is limited. Because renal function in neonates is not equivalent to that in older children or adults, Capoten should be used when patients are under medical supervision. The initial dose should be 0.3 mg per kg of body weight per day up to a maximum dose of 6 mg/kg of body weight per day in divided doses. The dose should be selected individually, depending on the patient's response to treatment and distributed over 2-3 doses throughout the day.

Patients with impaired renal function
Kapoten is not recommended for use in patients with impaired renal function. When its use is clinically indicated in patients with severe hypertension in the presence of impaired renal function, the dose should possibly be lower to ensure adequate control of blood pressure. The dose can be adjusted to the response of the patient, but sufficient time must elapse between dose changes. In such patients, the loop diuretic is the drug of choice, not the thiazide-type diuretic.
Kapoten is easily excreted from the body by hemodialysis.

Side effects

Blood
Neutropenia, anemia, thrombocytopenia.

kidneys
proteinuria, increased content blood urea, as well as creatinine, increased serum potassium and acidosis.

The cardiovascular system
Hypotension, tachycardia.

Availability side effects on captopril is mainly associated with renal function, since the drug is excreted from the body mainly through the kidneys. The dose should not exceed the value necessary to achieve an adequate result, and it should be reduced in patients with impaired renal function.

Leather
Eruptions, usually with itching. As a rule, they are mild, temporary, macular-papular in nature. IN rare cases- the nature of the urticaria. In some cases, rashes are associated with fever, and some patients developed angioedema. Itching, flushing, vesicular rash and photosensitivity have been reported.

Gastrointestinal tract
Reversible and usually self-limiting taste disturbance has been reported. Due to loss of taste, weight loss may occur. Aphthous ulcer-like stomatitis has been reported. In some patients, an increase in the activity of liver enzymes has been reported. In rare cases, hepatocellular damage and cholestatic jaundice have been reported. Stomach irritation and abdominal pain may occur.

Other
Paresthesias of the hands have been reported serum sickness, cough, bronchospasm and lymphadenopathy.

Contraindications

History of hypersensitivity to captopril.

Precautionary measures
Patient evaluation should include assessment of renal function prior to initiation of treatment and at appropriate intervals thereafter. Patients with impaired renal function should not usually be treated with captopril. Kapoten should not be used in patients with aortic stenosis or obstructive defects in the outflow tract of blood from the heart.

hypotension
After the first doses of the drug, some patients may experience symptomatic hypotension.

In most cases, the symptoms are relieved simply by moving the patient to the supine position. In patients with severe forms of renin-dependent hypertension (for example, renovascular hypertension) or in the presence of severe congestive heart failure receiving large doses diuretic, excessive hypotensive reactions were usually noted within one hour after taking the initial dose Capotena. In such patients, discontinuation of diuretic treatment or marked decline diuretic doses for 4-7 days before starting treatment Capoten, reduces the likelihood of such an effect. If you start treatment with Kapoten with small doses (6.25 mg or 12.5 mg), the duration of the possible hypotensive effect is reduced. In some patients, infusion physiological saline can give positive effect. The development of hypotension after taking the first dose does not remove the need for subsequent dose selection of Kapoten.

Effects on the kidneys
Proteinuria in patients with pre-existing normal function kidneys are rare. When proteinuria is present, it is usually seen in patients with severe hypertension and indications of pre-existing kidney disease. Some of these patients have nephrotic syndrome. In patients with indications of pre-existing kidney disease during the first nine months of treatment, it is recommended to determine the protein in the urine monthly.

Blood
Neutropenia/agranulocytosis, thrombocytopenia and anemia have been reported in patients receiving Kapoten. In patients with normal renal function in the absence of other complicating factors, neutropenia is observed in rare cases.
Kapoten should not be used routinely in patients with pre-existing impaired renal function, vascular collagenoses, in patients treated with immunosuppressive drugs, allopurinol or procainamide, or a combination of these complicating factors, since neutropenia is almost exclusively associated with patients in this group. Some of these patients may develop serious infections, which in some cases do not respond to intensive antibiotic treatment. If Kapoten is used in such patients, it is recommended to count before starting treatment. shaped elements white blood, including the determination of the differential blood formula every two weeks during the first three months of treatment Capoten and periodically thereafter. During treatment, all patients should be instructed to report any sign of infection, such as sore throat, temperature increase when a differential count of white blood elements is carried out. Capoten and other prescribed drugs should be discontinued if neutropenia (neutrophils less than 1000/mm3) is noted or suspected. In most patients, the number of neutrophils quickly returns to normal after discontinuation of Kapoten.

Surgery/Anesthesiology
In patients undergoing major surgical operations or, under anesthesia with drugs that cause hypotension, captopril will block the formation of angiotenside II caused by compensatory renin secretion. This can lead to hypotension, which can be corrected by volume replacement.

Clinical Chemistry
Kapoten can give false positive test in urine for acetone.

Pregnancy

Capoten has been shown to have a lethal effect on rabbit and sheep fetuses. toxic effect on the fetus in hamsters and rats was not found.
Capoten is contraindicated for use during pregnancy and should not be used in women under childbearing age unless they are protected by effective contraceptives.

Since captopril is excreted in human milk, Capoten should not be used in nursing women.

Interaction with other drugs

Diuretics potentiate the antihypertensive effect of Kapoten. Potassium-sparing diuretics (triamterene, amiloride, and spironolactone) or potassium supplements can lead to a marked increase in serum potassium concentration.

When taken simultaneously with indomethacin, there may be a decrease in the antihypertensive effect. This is probably also noted with the use of other non-steroidal anti-inflammatory drugs.

Capoten has been reported to be synergistic with peripheral vasodilators such as minoxidil. Knowledge of this interaction may help avoid initial hypotensive reactions.

It is assumed that the antihypertensive effect of Kapoten may be slowed down when patients receiving clonidine are transferred to Kapoten.

Neutropenia and/or Stevens-Johnson syndrome have been reported in patients treated with Capoten in combination with allopurinol or procainamide. Although a causal relationship has not been identified, these combinations should be used with caution, especially in patients with impaired renal function.

The use of azathioprine and cyclophosphamide has been associated with blood dyscrasias in patients with kidney failure who simultaneously took Kapoten.

Excretion of Kapoten through the kidneys is reduced in the presence of probenecid.

Overdose

In case of overdose, blood pressure should be monitored and, if hypotension develops, volume replacement is the treatment of choice. Captopril is removed from the body by dialysis.

Release form

Blister packs containing 40 tablets of 25 mg each.
Blister packs containing 40 tablets of 50 mg each.

Storage conditions

Store at room temperature.
Release from pharmacies by prescription.

Synonyms

Captopril (Captopril)

Compound

1-[(2S)-3-mercapto-2-methyl-propionyl]-L-proline.
Tablets contain 25 mg or 50 mg of captopril.

Main settings

Name:	CAPOTIN

Article publication date: 05/02/2017

Article last updated: 12/18/2018

In this article, you will learn all important information about Kapoten tablets: from what and how they help. For what diseases they are prescribed, what symptoms they help relieve.

Capoten is an angiotensin-converting enzyme inhibitor (). Its main effect is to reduce pressure.

The drug has side effects and contraindications, so take it only as prescribed by the attending cardiologist or therapist.

These tablets are prescribed to patients suffering from the following diseases:

Kapoten for hypertension

Tablets help to significantly reduce arterial pressure through two mechanisms:

Don't let the blood vessels constrict. The drug blocks the enzyme that converts angiotensin 1 to angiotensin 2. Angiotensin 2 is a substance that constricts blood vessels, thereby increasing pressure. Since the blocking of the angiotensin-converting enzyme no longer produces the same amount of angiotensin 2, the pressure does not increase.
. This effect is achieved by increasing the level of bradykinin, prostaglandin E 2 and nitric oxide in the blood - bioactive substances that reduce vascular tone and expand them.

Mechanism of action ACE inhibitors

Thanks to this mechanism of action, Kapoten not only prevents the increase in pressure, but also reduces it if it has already risen.

This drug is especially effective for hypertension that has arisen against the background of kidney disease. With pathologies of the kidneys, their production of renin increases - a substance that, when combined with angiotensin produced by the liver, forms angiotensin 1. And angiotensin 1 turns into angiotensin 2 under the action of angiotensin-converting enzyme. Angiotensin 2 and causes an increase in blood pressure, by themselves, renin, angiotensin and angiotensin 1 do not have such an effect. Capoten, blocking the angiotensin-converting enzyme, prevents an increase in the level of angiotensin 2.

However, this does not help much with the kidney disease itself. This medicine only eliminates hypertension caused by kidney disease, and by reducing the pressure relieves excessive load on the kidneys. If you stop taking the pills, high blood pressure will again make itself felt. To completely get rid of nephrogenic hypertension, it is necessary to treat the underlying kidney disease, and take an ACE inhibitor as an addition to the main therapy - as symptomatic treatment increased pressure.

Capoten in chronic heart failure

How and from what the drug helps with chronic heart failure:

Lower blood pressure if it is elevated (mechanism this effect described in the previous section).
Remove swelling. Kapoten reduces the level of the adrenal hormone aldosterone, thereby reducing sodium retention, and, accordingly, water in the body.
Reduce shortness of breath and prevent. By reducing the pressure in the small (pulmonary) circle.
. Due to the expansion of blood vessels and an increase in the volume of blood ejected by the heart.

Dilated and spasmodic artery

Kapoten after a heart attack

It is not used in acute phase disease, but when the patient is already in a stable condition. Usually the remedy can be taken within 3 days after myocardial infarction.

Tablets are needed for the prevention of heart failure, provoked by necrosis of the myocardium. They improve blood circulation, prevent blood stasis in the small and big circles, as well as edema, increase the ejection fraction of the left ventricle.

Kapoten also prevents re-infarction, as it dilates blood vessels, including coronary ones, and normalizes the blood supply to the heart muscle.

Capoten in diabetic nephropathy

Diabetic nephropathy is damage to the blood vessels of the kidneys that occurs against the background of diabetes.

The drug in this pathology is prescribed to improve blood circulation in the kidneys by relieving vasospasm. And also to lower the pressure, increased due to kidney damage.

Taking an ACE inhibitor diabetic nephropathy significantly improves the prognosis: reduces the risk of needing hemodialysis or kidney transplantation.

Hypertension affects 20-30% of the population, and with age the figure increases to 50-60%. To date, this is the most common disease of the CVS.

Develops gradually, fraught with serious consequences: irreversible lesions the most important organs: heart, blood vessels, brain, fundus and kidneys.

On late stages there is a violation of coordination, weakness in the limbs appears, vision deteriorates, memory is significantly reduced intelligence. This disease can cause stroke, heart attack.

Medication alone is not enough to treat hypertension. The patient will have to reconsider his lifestyle: to establish healthy eating quit smoking and alcohol, exercise. Increasing pressure on different reasons. Clinical researches showed that with mild and medium hypertension, as well as with a hypertensive crisis, the drug capoten helps well and is easily tolerated by patients.

Kapoten - medicinal product, used to treat hypertension, refers to ACE inhibitors. The active ingredient is captopril (25 mg per tablet). The drug blocks the converting enzyme angiothesin, which increases blood pressure. Due to the action of capoten, the production of aldosterone by the adrenal glands, which also increases blood pressure, decreases. The drug promotes vasodilation, excretion from the body excess fluid, lowering pressure in the pulmonary circulation and the right ventricle of the heart.

The preparation Kopoten is produced in the form of tablets of white color with a cream shade, square shape with rounded edges. Dosage tablets 25 mg, 50 mg in blisters of 14 tablets, 1-4 blisters in a carton. Producer - JSC HFC AKRIKHIN, Russia. Cost: in Moscow 110-130 rubles. (packing of 14 pcs.), 160-180 rubles. (packing of 28 pcs.), 230-250 rubles (40 pcs.); in Ukraine average price 160-280 UAH

The tablet is rapidly absorbed in the gastrointestinal tract (about 75%) and begins to act after 10 minutes, full effect occurs within 1-1.5 hours, therapeutic effect lasts 6 hours. It is excreted from the body by the kidneys with urine.

pharmachologic effect

The drug (ACE inhibitor) produces hypotensive action, prevents the production of angiotensin II, reducing its tendency to constrict arterial and (to a lesser extent) venous vessels.

The active substance is captopril, Excipients: starch, lactose, stearic acid, MCC. Store at 15-25 O C, shelf life 3 years. Released by prescription. Read more: Appointmentcapoten instructions for his application and at what pressureyou need to drink it.

Indications for use and doses

The treatment is carried out under the supervision of a doctor, the dosage and schedule of administration is developed for each patient individually. It is necessary to determine the cause of hypertension, whether the patient has contraindications.

Appointed capoten at complex therapy diseases:

myocardial infarction;
arterial hypertension;
heart failure;
nephropathy against the background of diabetes of the 1st degree.

The main purpose of taking capoten is to stabilize high blood pressure.

A arterial hypertension (AH) - an increase in pressure, has three degrees of development:

optimal pressure - 120/80;
normal - 120-130 / 80-85;
increased - 130-139 / 85-89;
hypertension of the 1st degree - 140-159 / 90-99;
hypertension of the 2nd degree - 160-179 / 100-109;
hypertension of the 3rd degree - above 180 / above 110.

How to take Kapoten

The medicine should be taken orally after meals 2-3 times a day. The initial dosage of one dose is 12.5 mg, the doctor can increase the dose of one dose to 25-50 mg, taking into account the severity of the disease, but not more than 150 mg per day.

With a hypertensive crisis, they drink one tablet of 25 mg, which lowers the pressure within 10-20 minutes. If an insufficient effect is achieved, then you can drink another tablet after 1-2 hours. When taking a tablet under the tongue, followed by resorption, the effect of the drug is more active and faster. But during resorption, a mucosal burn may occur, so care must be taken.

Usually from capoten pressure is taken 2-3 times a day as prescribed by a doctor (25 mg per day). In some cases (with mild and average form hypertension), appoint one dose per day to maintain optimal pressure. The main thing is not to exceed allowable dose(50 mg in 2 divided doses)! The age of the patient should be taken into account. For the elderly, the prescribed dose should be slightly lower. In general, this drug is rarely prescribed to patients after 65 years of age.

Take the medicine daily. The course of therapy usually lasts from several weeks to a month. If sudden surges in pressure continue, you should immediately consult a cardiologist, as the cause of this may be a serious reason (pathology of blood vessels and heart).

With the simultaneous intake of capoten and alcohol, pressure can drop dramatically and hypotension can provoke headache, nausea and vomiting.

Contraindications

Use the hood when high blood pressure it is forbidden:

the patient has pathologies that impede the outflow of blood (stenosis of the aortic mouth);
2-sided stenosis of the arteries of the kidneys;
dysfunction of the liver or kidneys;
hyperkalemia;
age up to 18;
pregnancy and lactation;
angioedema;
after kidney transplant
intolerance to the components that make up the drug;

Side effects

Kapoten is used in complex therapy in combination with other drugs: diuretics, antihypertensive drugs calcium receptor blockers.

When taking the drug, the following side effects may occur:

orthostatic hypotension (low blood pressure);
tachycardia;
peripheral edema;
dry cough, bronchospasm;
swelling of the lungs, face, limbs, mucous membranes of the larynx, tongue, lips;
hyperkalemia, hyponatremia, a high concentration of nitrogen in the urine;
rash accompanied by itching, flushing of the face, sometimes fever;
dry mouth, taste disturbance, gum hyperplasia;
anemia, neutropenia, thrombocytopenia;
ataxia, drowsiness, headaches, dizziness, blurred vision;
rarely abdominal pain, diarrhea.

Combination of capoten with other medicines

The hood is compatible with concor, their simultaneous reception is allowed. But it is better to have a capoten in the first aid kit to stop an attack in case hypertensive crisis rather than drinking constantly. Regular intake of Concor is sufficient to maintain normal pressure.

Perindopril is also an ACE inhibitor, both drugs are identical. And there is no point in combining them in complex therapy. You need to choose one of them, perindopril is less popular and common, but it can also be used to treat hypertension.

Physiotenzom - tablets for pressure, are used for regular intake (usually in the morning and evening) with hypertension to maintain normal pressure. Capoten is used to quickly reduce pressure, as emergency assistance. Pressure surges often occur at the beginning of hypertension treatment.

Amlodipine is used in complex therapy. He often enters combined preparations. If, against the background of the therapy, the pressure rises sharply, then it is quickly reduced by a capoten tablet (placed under the tongue).

Nifedipine (a blocker calcium channels) can be taken instead of capoten in hypertensive crisis, jump pressure. A tablet placed under the tongue begins to act within a few minutes. This remedy is also used in the complex therapy of hypertension.

Analgin at arterial hypertension It is not recommended to take either together with Kapoten or separately. These drugs do not mix well and give a lot side effects. To date, analgin is attributed negative impacts on the body than positive.

Analogues and substitutes

Dilaprel is available as gelatin capsules with powder content. Active substance- ramipril. It is used to treat arterial hypertension, heart failure. It is recommended to take in the morning, regardless of the meal, with water.

Initial dose of 2.5 mg. If pressure does not normalize within 3 weeks, the doctor may increase the dose to 5 mg per day. If this dose does not work, increase to 10 mg per day. Treatment should be under constant surveillance the attending physician.

Prenesa - a drug (a group of inhibitors) reduces peripheral vascular resistance, blood pressure, increases cardiac output. The drug improves renal and cardiac blood flow, increases the elasticity of arteries, and reduces the load on the myocardium. Can be taken to prevent cardiovascular complications after a heart attack. The composition of 1 tablet of the drug prenesa 2 mg includes: active substance- perindopril - 2 mg and additional substances. Produced in the form of tablets in blisters of 10 pcs.

Diroton (Lizinopril) reduces precardiac resistance without affecting the heart rate, increases ocular and cardiac blood flow, and produces a vasodilating effect. It is used for mono- and complex therapy of hypertension and concomitant cardiovascular pathologies. It is released according to the prescription in the form of tablets of 5, 10, 20 mg. The active ingredient is lisinopril

Enap (Slovenia, KRKA company). Available in the form of tablets and solutions (for injection). The tablet contains 2.5, 5, 10 or 20 mg of enalapril maleate. It is used to treat cardiovascular diseases. It works effectively, the quality is high, side effects are extremely rare.

Lipril (ACE inhibitor) - the drug has the same indications for use and similar side effects. The active substance is lisinopril (lisinopril dihydrate), available in the form of tablets. It is usually taken once a day, in the morning at the same time, regardless of the meal. Initial dose of 5 mg, but do not exceed the permissible maximum dose of 40 mg / day.

Capoten and captopril are almost identical in composition and effects on the body. Used in the treatment of hypertension and heart failure.

Capozid is prescribed if the capoten did not give the desired result. Caposide contains captopril and diuretics: 50 mg of captopril and 25 mg of hydroclothisiade, which enhances the effect of reducing pressure. The duration of its action is longer, so it can be drunk once a day.

All drugs reduce blood pressure and are quite effective, each has certain contraindications. The hood is one of the best. Such medicines can not be taken on its own, you can worsen your condition. An overdose may lead to sad consequences. A sharp drop in pressure is very dangerous for health and even life. If this happens, the person may lose consciousness, he will need quick help physicians.

The need for appointment, dose, schedule of administration, as well as the choice of the drug is determined by the doctor. Its task is to take into account the accompanying chronic diseases and all the risks in the selection of drugs for complex therapy.

He must observe the patient's response to the initial dose of the drug, reduce or increase it. Treatment takes place under the close attention of doctors in order to avoid the development of complications.

ACE inhibitor

Active substance

Release form, composition and packaging

Pills white to creamy white, square with rounded edges, biconvex with a cross cut on one side and the word "SQUIBB" and the number "452" embossed on the other, with characteristic odor; light marbling is allowed.

Excipients: microcrystalline cellulose - 40 mg, corn starch - 7 mg, stearic acid - 3 mg, lactose monohydrate - 25 mg.

10 pieces. - blisters (4) - packs of cardboard.
14 pcs. - blisters (2) - packs of cardboard.
14 pcs. - blisters (4) - packs of cardboard.

pharmachologic effect

ACE inhibitor. Suppresses the formation of angiotensin II and eliminates it vasoconstrictor action on arterial and venous vessels.

Reduces OPSS, afterload, lowers blood pressure. Reduces preload, reduces pressure in the right atrium and pulmonary circulation.

Reduces the secretion of aldosterone in the adrenal glands.

The maximum hypotensive effect is observed within 60-90 minutes after ingestion. The degree of decrease in blood pressure is the same in the position of the patient standing and lying down.

The efficacy and safety of captopril in children have not been established. The literature describes limited experience with captopril in children. Children, especially neonates, may be more susceptible to hemodynamic side effects. There have been cases of development of excessive, prolonged and unpredictable increase in blood pressure, as well as associated complications, including oliguria and convulsions.

Pharmacokinetics

Suction

When taken orally, it is rapidly absorbed from the gastrointestinal tract. C max in the blood is reached approximately 1 hour after ingestion. The bioavailability of captopril is 60-70%. Simultaneous reception food slows down the absorption of the drug by 30-40%.

Distribution

Binding to blood proteins is 25-30%.

breeding

T1 / 2 is 2-3 hours. The drug is excreted from the body mainly in the urine, up to 50% unchanged, the rest - in the form of metabolites.

Indications

- arterial hypertension, incl. renovascular;

— chronic insufficiency(as part of combination therapy);

- dysfunction of the left ventricle after myocardial infarction in a clinically stable condition;

- diabetic nephropathy against the background of type 1 diabetes mellitus (with albuminuria> 30 mg / day).

Contraindications

- angioedema (Quincke's edema) in history associated with the use of ACE inhibitors;

- hereditary / idiopathic angioedema;

- severe renal dysfunction;

- severe liver dysfunction;

- refractory hyperkalemia;

- bilateral stenosis renal arteries or stenosis of the artery of a single kidney with progressive azotemia;

- condition after kidney transplantation;

- stenosis of the aortic orifice and similar obstructive changes that impede the outflow of blood from the left ventricle;

- simultaneous use with aliskiren and aliskiren-containing drugs in patients with diabetes mellitus or impaired renal function (GFR less than 60 ml / min);

- lactose intolerance, lactase deficiency and glucose-galactose malabsorption syndrome;

- pregnancy;

- lactation period breastfeeding);

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

— hypersensitivity to the components of the drug and other ACE inhibitors.

WITH caution should be prescribed for severe autoimmune diseases connective tissue(including SLE, scleroderma); oppression of bone marrow hematopoiesis (risk of developing neutropenia and agranulocytosis); cerebral ischemia; diabetes(increased risk of developing hyperkalemia); primary hyperaldosteronism; ischemic heart disease; conditions accompanied by a decrease in BCC (including vomiting, diarrhea); arterial hypotension; impaired renal and / or liver function; chronic heart failure; surgery/general anesthesia; patients on hemodialysis; patients on a sodium-restricted diet; during hemodialysis using high-strength membranes (for example, AN69), desensitizing therapy, LDL apheresis; simultaneous application potassium-sparing diuretics, potassium preparations, potassium-containing substitutes, lithium preparations, allopurinol, procainamide (risk of developing neutropenia, agranulocytosis); elderly patients (dose adjustment required); black patients.

Dosage

The drug is taken orally 1 hour before meals. The dosing regimen is set individually.

At arterial hypertension the initial dose is 12.5 mg (1/2 tab. 25 mg) 2 times / day. If necessary, the dose is increased gradually (with an interval of 2-4 weeks) until the optimal effect is achieved. At mild to moderate hypertension the maintenance dose is 25 mg 2 times / day; maximum dose is 50 mg 2 times / day. At severe arterial hypertension the initial dose is 12.5 mg (1/2 tab. 25 mg) 2 times / day. The dose is gradually increased to a maximum daily dose of 150 mg (50 mg 3 times / day).

At chronic heart failure the initial daily dose is 6.25 mg (1/4 tab. 25 mg) 3 times / day. If necessary, the dose is increased gradually (at intervals of at least 2 weeks). The maintenance dose is 25 mg 2-3 times / day. The maximum daily dose is 150 mg. If before the appointment of the drug Kapoten diuretic therapy was carried out, it is necessary to exclude the presence of a pronounced decrease in the content of electrolytes and BCC.

At left ventricular dysfunction after myocardial infarction in patients who are in a clinically stable state, the use of the drug Kapoten can be started as early as 3 days after myocardial infarction. The initial dose is 6.25 mg / day (1/4 tab. 25 mg), then daily dose can be increased to 37.5-75 mg in 2-3 doses (depending on the tolerability of the drug) up to a maximum of 150 mg / day.

At diabetic nephropathy the drug is prescribed in a dose of 75-100 mg, divided into 2-3 doses. At type 1 diabetes mellitus with microalbuminuria(albumin clearance 30-300 mg / day) the dose of the drug is 50 mg 2 times / day. With proteinuria more than 500 mg / day, the drug is effective at a dose of 25 mg 3 times / day.

Patients with moderate renal impairment (CC ≥ 30 ml / min / 1.73 m 2) Kapoten is prescribed at a dose of 75-100 mg / day. At severe violations kidney function (KK<30 мл/мин/1.73 м 2) the initial dose is not more than 12.5 mg / day (1/2 tab. 25 mg). In the future, if necessary, the dose is gradually increased (with sufficiently large intervals), but a smaller daily dose of the drug is used than usual.

Elderly patients the dose is selected individually. Treatment is recommended to start with a dose of 6.25 mg (1/4 tab. 25 mg) 2 times / day and, if possible, maintain it at this level.

If necessary, "loop" diuretics are additionally prescribed, and not diuretics of the thiazide series.

Side effects

Determining the frequency of adverse reactions: often (≥1 / 100,<1/10); нечасто (≥1/1000, <1/100), редко (≥1/10 000, <1/1000), очень редко (<1/10 000).

From the side of the cardiovascular system: infrequently - tachycardia or arrhythmia, angina pectoris, palpitations, orthostatic arterial hypotension, excessive decrease in blood pressure, Raynaud's syndrome, flushing of the skin of the face, pallor; very rarely - cardiac arrest, cardiogenic shock.

From the respiratory system: often - dry unproductive cough, shortness of breath; very rarely - bronchospasm, eosinophilic pneumonitis, rhinitis, pulmonary edema.

From the skin and subcutaneous tissues: often - skin itching, with or without rashes, skin rashes, alopecia.

Allergic reactions: infrequently - angioedema of the extremities, face, lips, mucous membranes, tongue, pharynx and larynx; rarely - angioedema of the intestine; very rarely - urticaria, Stevens-Johnson syndrome, erythema multiforme, photosensitivity, erythroderma, pemphigoid reactions, exfoliative dermatitis, allergic alveolitis, eosinophilic pneumonia.

From the nervous system: often - drowsiness, dizziness, insomnia; infrequently - headache, paresthesia; rarely - ataxia; very rarely - confusion, depression, cerebrovascular accidents, including stroke and syncope, blurred vision.

From the hematopoietic system: very rarely - neutropenia, agranulocytosis, pancytopenia, lymphadenopathy, eosinophilia, thrombocytopenia, anemia (including aplastic and hemolytic forms).

From the immune system: very rarely - increased titer of antinuclear antibodies, autoimmune diseases.

From the digestive system: often - nausea, vomiting, irritation of the gastric mucosa, abdominal pain, diarrhea, constipation, taste disturbance, dryness of the oral mucosa, dyspepsia; infrequently - anorexia; rarely - stomatitis, aphthous stomatitis; very rarely - glossitis, gastric ulcer, pancreatitis, gingival hyperplasia, abnormal liver function and cholestasis (including jaundice), increased activity of liver enzymes, hepatitis (including rare cases of hepatonecrosis), hyperbilirubinemia.

From the musculoskeletal system: very rarely - myalgia, arthralgia.

From the urinary system: rarely - impaired renal function (including renal failure), polyuria, oliguria, frequent urination; very rarely - nephrotic syndrome.

From the reproductive system: very rarely - impotence, gynecomastia.

Other: infrequently - peripheral edema, chest pain, increased fatigue, a feeling of general malaise, asthenia; rarely - hyperthermia.

Laboratory indicators: very rarely - proteinuria, eosinophilia, hyperkalemia, hyponatremia, increased levels of urea nitrogen, bilirubin and creatinine in the blood, decreased hematocrit, decreased hemoglobin, leukocytes, platelets, hypoglycemia.

Overdose

Symptoms: a sharp decrease in blood pressure, shock, stupor, bradycardia, disturbances in water and electrolyte balance, renal failure.

Treatment: gastric lavage, the introduction of adsorbents and sodium sulfate within 30 minutes after taking the drug, the introduction of a 0.9% solution or other plasma-substituting drugs (the patient should first be transferred to a horizontal position with a low headboard, then measures should be taken to replenish the BCC), hemodialysis. With bradycardia or severe vagal reactions - the introduction of atropine. The use of an artificial pacemaker may be considered. Peritoneal dialysis is not effective in removing captopril from the body.

drug interaction

In patients taking diuretics, the drug Kapoten may potentiate the hypotensive effect. A similar effect is also exerted by a strict restriction of salt intake (salt-free diets), hemodialysis. Usually, an excessive decrease in blood pressure occurs within the first hour after taking the first prescribed dose of Kapoten.

Vasodilators (for example, nitroglycerin) in combination with Kapoten should be used at the lowest effective doses due to the risk of excessive reduction in blood pressure.

Caution should be exercised when co-administering Kapoten (without or with a diuretic) and drugs that affect the sympathetic nervous system (for example, ganglioblockers, alpha-blockers).

With the combined use of the drug Kapoten and indomethacin (and possibly other NSAIDs, for example,) there may be a decrease in the hypotensive effect, especially in arterial hypertension, accompanied by low renin activity. In patients with risk factors (old age, hypovolemia, simultaneous use of diuretics, impaired renal function), the simultaneous use of NSAIDs (including COX-2 inhibitors) and ACE inhibitors (including captopril) can lead to a deterioration in renal function, up to acute renal failure. Usually, renal dysfunction in such cases is reversible. Renal function should be checked periodically in patients taking Kapoten and NSAIDs.

During therapy with Kapoten, potassium-sparing diuretics (eg, triamterene, spironolactone, amiloride), potassium preparations, potassium supplements, salt substitutes (contain significant amounts of potassium ions) should be prescribed only with proven hypokalemia, tk. their use increases the risk of developing hyperkalemia.

With the simultaneous use of ACE inhibitors (especially in combination with diuretics) and lithium preparations, it is possible to increase the content of lithium in the blood serum, and, consequently, the toxicity of lithium preparations. It is necessary to periodically determine the content of lithium in the blood serum.

With the simultaneous use of insulin and oral hypoglycemic agents, such as sulfonylurea derivatives, with ACE inhibitors, including Kapoten, an excessive decrease in blood glucose concentration is possible. It is necessary to control the concentration of glucose in the blood at the beginning of therapy with Kapoten and, if necessary, adjust the dose of the hypoglycemic drug.

Dual blockade of the RAAS, caused by the simultaneous use of ACE inhibitors and angiotensin II receptor antagonists or aliskiren and aliskiren-containing drugs, was associated with an increased incidence of side effects such as arterial hypotension, hyperkalemia, decreased renal function (including acute renal failure).

The use of Kapoten in patients receiving allopurinol or procainamide increases the risk of developing neutropenia and / or Stevens-Johnson syndrome.

The use of the drug Kapoten in patients receiving immunosuppressants (for example, cyclophosphacin or azathioprine) increases the risk of developing hematological disorders.

special instructions

Before starting, as well as regularly during treatment with Kapoten, kidney function should be monitored. In patients with chronic heart failure, Kapoten should be used under close medical supervision.

When using ACE inhibitors, a characteristic unproductive cough is noted, which stops after discontinuation of therapy with ACE inhibitors.

In rare cases, with the use of ACE inhibitors, a syndrome is noted that begins with the appearance of cholestatic jaundice, turning into fulminant hepatonecrosis, sometimes with a fatal outcome. The mechanism of development of this syndrome is unknown. If a patient on ACE inhibitor therapy develops jaundice or a marked increase in liver enzymes, the ACE inhibitor treatment should be discontinued and the patient monitored.

In some patients with kidney disease, especially those with severe renal artery stenosis, there is an increase in serum urea nitrogen and creatinine concentrations after a decrease in blood pressure. This increase is usually reversible after discontinuation of therapy with Kapoten. In these cases, it may be necessary to reduce the dose of Kapoten and / or cancel the diuretic.

Against the background of long-term use of the drug Kapoten, approximately 20% of patients have an increase in the concentration of urea and serum creatinine by more than 20% compared with the norm or baseline. Less than 5% of patients, especially with severe nephropathies, require discontinuation of treatment due to an increase in creatinine concentration.

The use of dual blockade of the RAAS caused by the simultaneous use of ACE inhibitors and angiotensin II receptor antagonists or aliskiren and aliskiren-containing drugs is not recommended, since it was associated with an increased incidence of side effects such as arterial hypotension, hyperkalemia, decreased renal function (including acute renal failure). If the simultaneous use of ACE inhibitors and angiotensin II receptor antagonists (double blockade of the RAAS) is necessary, then treatment should be carried out under the supervision of a physician and with constant monitoring of kidney function, electrolytes in the blood, and blood pressure.

In patients with arterial hypertension when using the drug Kapoten, severe arterial hypotension is observed only in rare cases; the likelihood of developing this condition increases with increased loss of fluid and salts (for example, after intensive treatment with diuretics), in patients with heart failure or on dialysis. The possibility of a sharp decrease in blood pressure can be minimized by prior cancellation (4-7 days) of the diuretic or an increase in the intake of sodium chloride (approximately a week before the start of administration), or by prescribing Kapoten at the beginning of treatment in low doses (6.25-12.5 mg /day).

With caution, the drug is prescribed to patients on a low sodium or salt-free diet (increased risk of hypotension and hyperkalemia).

An excessive decrease in blood pressure can be observed in patients during major surgical operations, as well as when using anesthetics that have a hypotensive effect. In such cases, measures to increase BCC are used to correct low blood pressure.

Excessive reduction in blood pressure due to the use of antihypertensive drugs may increase the risk of myocardial infarction or stroke in patients with coronary artery disease or cerebrovascular disease. With the development of arterial hypotension, the patient should be transferred to a horizontal position with a low headboard. It may be necessary to / in the introduction of 0.9% sodium chloride solution.

Caution should be exercised when using ACE inhibitors in patients with mitral/aortic stenosis/hypertrophic obstructive cardiomyopathy; in case of cardiogenic shock and hemodynamically significant obstruction, the use of the drug is not recommended.

Neutropenia/agranulocytosis, thrombocytopenia, and anemia have been reported in patients taking ACE inhibitors. In patients with normal renal function and in the absence of other disorders, neutropenia is rare. In renal failure, the simultaneous use of the drug Kapoten and allopurinol led to neutropenia.

Kapoten should be used very cautiously in patients with autoimmune connective tissue diseases who are taking immunosuppressants, allopurinol and procainamide, especially in the presence of pre-existing renal dysfunction. Due to the fact that the majority of lethal cases of neutropenia during the use of ACE inhibitors developed in such patients, their blood leukocyte count should be monitored before starting treatment, in the first 3 months - every 2 weeks, then - every 2 months.

In all patients, the number of leukocytes in the blood should be monitored monthly in the first 3 months after the start of therapy with Kapoten, then every 2 months. If the number of leukocytes is below 4000 / μl, a repeated general blood test is indicated, below 1000 / μl - the drug is stopped, continuing to monitor the patient. Usually, the recovery of the number of neutrophils occurs within 2 weeks after discontinuation of the drug Kapoten. In 13% of cases of neutropenia, a lethal outcome was noted. In almost all cases, the lethal outcome of neutropenia was noted in patients with connective tissue diseases, renal or heart failure, against the background of taking immunosuppressants, or a combination of both of these factors.

When using ACE inhibitors, proteinuria may occur, mainly in patients with impaired renal function, as well as when using the drug in high doses. In most cases, proteinuria with the use of the drug Kapoten disappeared or its severity decreased within 6 months, regardless of whether the drug was discontinued or not. Indicators of kidney function (blood urea nitrogen and creatinine concentrations) in patients with proteinuria were almost always within the normal range. In patients with kidney disease, the protein content in the urine should be determined before starting treatment and periodically throughout the course of therapy. In some cases, against the background of the use of ACE inhibitors, incl. the drug Kapoten, there is an increase in the content of potassium in the blood serum. The risk of developing hyperkalemia with the use of ACE inhibitors is increased in patients with renal insufficiency and diabetes mellitus, as well as those taking potassium-sparing diuretics, potassium supplements, or other drugs that cause an increase in blood potassium (for example, heparin). The simultaneous use of potassium-sparing diuretics and potassium preparations should be avoided. In addition, when using ACE inhibitors simultaneously with thiazide diuretics, the risk of developing hypokalemia is not excluded, therefore, in such cases, regular monitoring of the content of potassium in the blood during therapy should be carried out.

When carrying out hemodialysis in patients receiving ACE inhibitors, the use of dialysis membranes with high permeability (for example, AN69) should be avoided, since in such cases the risk of developing anaphylactoid reactions increases. Anaphylactoid reactions have also been reported in patients undergoing LDL apheresis with dextran sulfate. Consideration should be given to either another class of antihypertensive drugs or another type of dialysis membrane.

In rare cases, against the background of therapy with ACE inhibitors, life-threatening anaphylactoid reactions were noted in patients undergoing desensitization with Hymenoptera venom (bees, wasps). In these patients, these reactions were prevented by temporarily discontinuing ACE inhibitor therapy. Special care should be taken when desensitizing such patients.

In the event of angioedema, the drug is canceled and careful medical supervision is carried out until the symptoms disappear completely. Angioedema of the larynx can be fatal. If the edema is localized on the face, special treatment is usually not required (antihistamines may be used to reduce the severity of symptoms); in the event that the edema spreads to the tongue, pharynx or larynx and there is a threat of airway obstruction, epinephrine (adrenaline) s / c (0.3-0.5 ml at a dilution of 1:1000) should be immediately injected. In rare cases, patients after taking ACE inhibitors noted angioedema of the intestine, which was accompanied by pain in the abdominal cavity (with or without nausea and vomiting), sometimes with normal values of C-1-esterase activity and without previous swelling of the face. Intestinal edema should be included in the spectrum of differential diagnosis of patients with complaints of pain in the abdominal cavity when using ACE inhibitors.

In representatives of the Negroid race, cases of angioedema were noted with a higher frequency than in representatives of the Caucasian race.

ACE inhibitors are less effective in blacks than in whites, which may be due to the greater prevalence of low renin activity in blacks.

In patients with diabetes mellitus receiving hypoglycemic drugs (hypoglycemic agents for oral administration or insulin), glycemic levels should be carefully monitored, especially during the first month of therapy with ACE inhibitors.

During major surgery or when using general anesthesia agents that have a hypotensive effect, patients taking ACE inhibitors may experience an excessive decrease in blood pressure. In these cases, you can increase the BCC.

When using the drug Kapoten, a false positive reaction may be observed in the analysis of urine for acetone.

Influence on the ability to drive vehicles and control mechanisms

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.

Pregnancy and lactation

The use of the drug Kapoten is contraindicated during pregnancy.

The drug Kapoten should not be used in the first trimester of pregnancy. Appropriate controlled studies of the use of ACE inhibitors in pregnant women have not been conducted. The limited data available on the effects of the drug in the first trimester of pregnancy indicate that the use of ACE inhibitors does not lead to fetal malformations associated with fetotoxicity. Epidemiological evidence suggesting a risk of teratogenicity following exposure to ACE inhibitors in the first trimester of pregnancy has not been conclusive, but some increased risk cannot be ruled out. If the use of an ACE inhibitor is considered necessary, patients planning a pregnancy should be switched to an alternative antihypertensive therapy that has an established safety profile for use in pregnancy.

It is known that prolonged exposure to ACE inhibitors on the fetus in the II and III trimesters of pregnancy can lead to a violation of its development (decrease in kidney function, oligohydramnios, slowing of the ossification of the skull bones) and the development of complications in the newborn (such as renal failure, arterial hypotension, hyperkalemia) . If the patient received the drug Kapoten in the II and III trimesters of pregnancy, it is recommended to conduct an ultrasound examination to assess the condition of the bones of the skull and the function of the kidneys of the fetus.

The use of ACE inhibitors during pregnancy can cause developmental disorders (including arterial hypotension, neonatal hypoplasia of the skull bones, anuria, reversible or irreversible renal failure) and fetal death. When establishing the fact of pregnancy, the use of the drug Kapoten should be discontinued as soon as possible.

Approximately 1% of the accepted dose of captopril is found in breast milk. Due to the risk of developing serious adverse reactions in the child, breastfeeding should be discontinued or therapy with Kapoten should be discontinued in the mother for the period of breastfeeding.

Use in the elderly

WITH caution the drug should be prescribed to elderly patients (dose adjustment is required).

Terms of dispensing from pharmacies

The drug is dispensed by prescription.

Terms and conditions of storage

The drug should be stored out of the reach of children, in a dry place at a temperature not exceeding 25°C. Shelf life - 5 years.

In this article, you can read the instructions for using the drug Kapoten. Reviews of site visitors - consumers of this medicine, as well as opinions of doctors of specialists on the use of Kapoten in their practice are presented. We kindly ask you to actively add your reviews about the drug: the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not declared by the manufacturer in the annotation. Kapoten's analogues in the presence of existing structural analogues. Use for the treatment of arterial hypertension and the reduction of high blood pressure in adults, children, as well as during pregnancy and lactation.

Kapoten- ACE inhibitor. The active substance is Captopril. Suppresses the formation of angiotensin 2 and eliminates its vasoconstrictive effect on arterial and venous vessels.

Reduces OPSS, afterload, lowers blood pressure. Reduces preload, reduces pressure in the right atrium and pulmonary circulation.

Reduces the secretion of aldosterone in the adrenal glands.

Pharmacokinetics

When taken orally, the bioavailability of captopril is 60-70%. Simultaneous food intake slows down the absorption of the drug by 30-40%. The drug is excreted from the body mainly with urine, up to 50% unchanged.

Indications

arterial hypertension, incl. renovascular;
chronic heart failure (as part of combination therapy);
dysfunction of the left ventricle after myocardial infarction in a clinically stable condition;
diabetic nephropathy against the background of type 1 diabetes mellitus (with albuminuria> 30 mg per day).

Release form

Tablets 25 mg and 50 mg.

Instructions for use and dosage

Capoten is prescribed orally 1 hour before meals. The dosing regimen is set individually.

With arterial hypertension, the initial dose is 12.5 mg 2 times a day. If necessary, the dose is increased gradually (with an interval of 2-4 weeks) until the optimal effect is achieved. With mild and moderate arterial hypertension, the average therapeutic dose is 25 mg 2 times a day; the maximum dose is 50 mg 2 times a day. In severe hypertension, the initial dose is 12.5 mg 2 times a day. The dose is gradually increased to a maximum daily dose of 150 mg (50 mg 3 times a day).

In chronic heart failure, Kapoten is prescribed in cases where the use of diuretics does not provide an adequate effect. The initial dose is 6.25 mg 3 times a day. If necessary, the dose is increased every 2 weeks. Maintenance dose - 25 mg 2-3 times a day. The maximum daily dose is 150 mg.

In patients with impaired left ventricular function after myocardial infarction in patients who are in a clinically stable state, the use of Kapoten can be started as early as 3 days after myocardial infarction. The initial dose is 6.25 mg per day, then the daily dose can be increased to 37.5-75 mg in 2-3 doses (depending on the tolerability of the drug) up to a maximum of 150 m per day.

In diabetic nephropathy, the daily dose is from 75 mg to 100 mg, divided into 2-3 doses. In insulin-dependent diabetes mellitus with microalbuminuria (albumin clearance 30-300 mg per day), the dose of the drug is 50 mg 2 times a day. With a total protein clearance of more than 500 mg per day, the drug is effective at a dose of 25 mg 3 times a day.

For elderly patients, the dose is selected individually. Treatment is recommended to start with the lowest therapeutic dose of 6.25 mg 2 times a day and, if possible, maintain it at this level.

If necessary, "loop" diuretics are additionally prescribed, and not diuretics of the thiazide series.

Side effect

orthostatic hypotension;
tachycardia;
peripheral edema;
dry cough (usually disappearing after discontinuation of the drug);
bronchospasm;
pulmonary edema;
angioedema of the extremities, face, lips, mucous membranes, tongue, pharynx or larynx;
headache, dizziness;
paresthesia;
drowsiness;
visual impairment;
hyperkalemia, hyponatremia;
neutropenia, agranulocytosis, thrombocytopenia, anemia;
taste disorder;
dry mouth;
stomatitis;
stomach ache;
diarrhea.

Contraindications

angioedema (hereditary or associated with the use of ACE inhibitors in history);
severe renal dysfunction;
severe liver dysfunction;
hyperkalemia;
bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney with progressive azotemia;
condition after kidney transplantation;
stenosis of the aortic orifice and similar obstructive changes that impede the outflow of blood from the left ventricle;
pregnancy;
lactation period (breastfeeding);
age up to 18 years;
hypersensitivity to the drug and other ACE inhibitors.

Use during pregnancy and lactation

The drug is contraindicated for use during pregnancy and lactation.

special instructions

Against the background of long-term use of Kapoten, approximately 20% of patients have an increase in the content of urea and creatinine in the blood serum by more than 20% compared with the norm or baseline. Less than 5% of patients, especially with severe nephropathies, require discontinuation of treatment due to an increase in creatinine concentration.

In patients with arterial hypertension, when using Kapoten, severe arterial hypotension is observed only in rare cases; the likelihood of developing this condition increases with increased loss of fluid and salts (for example, after intensive treatment with diuretics), in patients with heart failure or on dialysis.

The possibility of a sharp decrease in blood pressure can be minimized by prior cancellation (4-7 days) of the diuretic or an increase in the intake of sodium chloride (approximately a week before the start of administration), or by prescribing Capoten at the beginning of treatment in small doses (6.25-12.5 mg per day). day).

In the first 3 months therapy, the number of blood leukocytes should be monitored monthly, then 1 time in 3 months. In patients with autoimmune diseases, the number of leukocytes in the first 3 months. treatment should be monitored every 2 weeks, then every 2 months. If the number of leukocytes is less than 4000 / μl, a complete blood count is indicated, if less than 1000 / μl, the drug is stopped.

In some cases, against the background of the use of ACE inhibitors, incl. Kapoten, there is an increase in the concentration of potassium in the blood serum. The risk of developing hyperkalemia with the use of ACE inhibitors is increased in patients with renal insufficiency and diabetes mellitus, as well as those taking potassium-sparing diuretics, potassium preparations, or other drugs that cause an increase in the concentration of potassium in the blood (for example, heparin). The simultaneous use of potassium-sparing diuretics and potassium preparations with Kapoten should be avoided.

When carrying out hemodialysis in patients receiving Kapoten, the use of dialysis membranes with high permeability (for example, AN 69) should be avoided, since in such cases the risk of developing anaphylactoid reactions increases.

In case of development of angioedema, the drug is canceled and careful medical supervision is carried out. If the edema is localized on the face, special treatment is usually not required (antihistamines may be used to reduce the severity of symptoms); in the event that the edema spreads to the tongue, pharynx or larynx and there is a threat of airway obstruction, 0.5 ml of a 0.1% solution of epinephrine (adrenaline) should be injected immediately.

When taking Kapoten, a false-positive reaction may be observed in the analysis of urine for acetone.

With caution, Kapoten should be prescribed to patients on a low-salt or salt-free diet, because. in this case, the risk of arterial hypotension increases.

If symptomatic arterial hypotension occurs after taking Kapoten, the patient should take a horizontal position with raised legs.

Pediatric use

The safety and efficacy of the drug in children and adolescents under the age of 18 have not been established.

Influence on the ability to drive vehicles and control mechanisms

drug interaction

Diuretics, vasodilators (for example, minoxidil) enhance the antihypertensive effect of the drug Kapoten.

Indomethacin and other NSAIDs may reduce the antihypertensive effect of Kapoten.

Simultaneous use of Kapoten with potassium-sparing diuretics (triamterene, amiloride and spironolactone) or potassium preparations can lead to hyperkalemia.

The simultaneous use of lithium salts and Kapoten can lead to an increase in the concentration of lithium in the blood serum.

Against the background of the simultaneous use of Kapoten with allopurinol and procainamide, neutropenia and / or Stevens-Johnson syndrome may be observed.

With the simultaneous use of immunosuppressants (for example, azathioprine and cyclophosphamide) with Kapoten, the risk of developing hematological disorders increases.

Kapoten's analogs

Structural analogues for the active substance:

Alcadil;
Angiopril-25;
Blockordil;
Vero-Captopril;
Captopril;
Captopril Sandoz;
Captopril-AKOS;
Captopril-Acri;
Captopril-Ferein;
Catopyl;
Epsitron.

In the absence of analogues of the drug for the active substance, you can follow the links below to the diseases that the corresponding drug helps with and see the available analogues for the therapeutic effect.