Active ingredients Captopril:
Who is shown Captopril?
Captopril is used in hypertension, symptomatic arterial hypertension, chronic heart failure, diabetic nephropathy in insulin-dependent diabetes mellitus, as well as in complex therapy of myocardial infarction, angina pectoris, chronic renal failure.
How to use captopril?
Take inside 1 hour before meals.
Children prescribe the drug is extremely rare, only in cases of ineffectiveness of other medicines!
For young children, the initial dose is 0.3 mg / kg per day, the maximum dose is 3 mg / kg / day.in several receptions.
For adults with hypertension: the initial dose is 25 mg 2 - 3 times a day. If necessary, a single dose can be gradually increased to 50 mg 2 - 3 times a day. The maximum daily dose is 150 mg. If the therapeutic effect is insufficient, thiazide diur
For heart failure: the initial dose is 6.25 mg - 12.5 mg 3 times a day with a gradual( as necessary) increase in the dose to 25 mg 3 times a day.
With diabetic nephropathy, captopril is given at a dose of 75-100 mg / day.
In case of renal failure, if creatinine clearance is at least 30 ml / min / 1, 73 m2, the dose of captopril is 75 mg - 100 mg per day. With a more severe degree of renal dysfunction( CC less than 30 ml / min / 1, 73 m2), the initial dose is no more than 12.5 mg per day( possibly a gradual increase, but in smaller doses than usual).With pronounced impairment of kidney function, the lowest dose is individually selected, which maintains a sufficient therapeutic effect.
The dose and duration of treatment is determined by the physician( individually depending on the patient's response to treatment).
Caaptopril should be used with caution in patients with autoimmune diseases due to an increased risk of neutropenia and agranulocytosis. The number of leukocytes in the blood in the first 3 months of treatment should be monitored every 2 weeks, then every 2 months.
Before starting treatment with captopril, it is necessary to compensate for the loss of fluid and salts, since there is a risk of severe arterial hypotension.
Caution is prescribed for captopril in patients with severe renal disease. Before the onset, and also regularly during the treatment with captopril, kidney function should be monitored.
Patients with chronic heart failure Captopril is administered under close medical supervision.
When taking captopril, a false positive reaction is possible when analyzing urine for acetone.
Care should be taken when driving vehicles or doing other work that requires attention, because dizziness is possible, especially after the initial dose of captopril.
During treatment with captopril, a low-sodium diet is indicated.
Side effects of captopril.
- From the central nervous system: dizziness, headache, fatigue, asthenia.
- From the side of the cardiovascular system: orthostatic hypotension, rarely - tachycardia;
- On the part of the digestive system: nausea, decreased appetite, rarely - abdominal pain, diarrhea, impaired renal function, increased activity of hepatic transaminases;
- On the part of the hematopoiesis system: rarely - neutropenia, very rarely in patients with autoimmune diseases - agranulocytosis;
- On the part of the respiratory system: dry cough;
- Laboratory variables change: hyperkalaemia, proteinuria;
- Allergic reactions: skin rash, rarely - angioedema, Quincke's edema, bronchospasm.
Who is contraindicated with captopril?
- With hypersensitivity to the drug or to other ACE inhibitors;
- With Quincke's edema( including in anamnesis after the use of ACE inhibitors, hereditary);
- In pregnancy( can cause severe dysplasia and even fetal death);
- With stenosis of the aortic or other obstructions, the outflow of blood from the left ventricle of the heart;
- When breastfeeding( for the period of treatment stop);
- With bilateral renal artery stenosis or stenosis of the artery of a single kidney with progressive azotemia;
- With hyperkalemia;
- In condition after kidney transplantation;
- With primary hyperaldosteronism.
With simultaneous administration of captopril with diuretics, vasodilators, ganglion blockers and beta-blockers, the hypotensive effect of captopril is enhanced;with indomethacin and other non-steroidal anti-inflammatory drugs( NSAIDs) - it is possible to reduce the hypotensive effect of captopril, with probenecid - a possible slowing of the withdrawal of captopril with urine, with lithium salts - an increase in the concentration of lithium in the serum is possible, which is accompanied by symptoms of lithium intoxication. Simultaneous use with potassium-sparing diuretics, potassium preparations, potassium supplements to the diet, potassium-containing salt substitutes can lead to hyperkalemia.
The administration of captopril to patients taking immunosuppressants( eg, azathioprine or cyclophosphamide) increases the risk of developing hematologic disorders.
Overdose of captopril.
Is manifested by severe hypotension, the development of myocardial infarction, acute impairment of cerebral circulation and thromboembolic complications against the background of a sharp drop in blood pressure.
Treatment: the patient should be in a horizontal position( legs should be raised) and administer intravenously an isotonic solution of sodium chloride or another plasma-substituting fluid to correct the volume of circulating blood( BCC), apply hemodialysis.