Accusid, 25 mg+20 mg, film-coated tablets, 30 pcs.

Nosological classification (ICD-10)

• D61.9 Aplastic anemia, unspecified
• D70 Agranulocytosis
• E14 Diabetes mellitus, unspecified
• E27.1 Primary adrenal insufficiency
• E73 Lactose intolerance
• E73.0 Congenital lactase deficiency
• E79.0 Hyperuricemia without signs of inflammatory arthritis and gouty nodes
• E83.5.0* Hypercalcemia
• E86 Decreased fluid volume [hypovolemia]
• E87.1 Hypoosmolarity and hyponatremia
• E87.5 Hyperkalemia
• E87.6 Hypokalemia
• H40.2 Primary angle-closure glaucoma
• I10 Essential (primary) hypertension
• I15 Secondary hypertension
• I35.0 Aortic (valvular) stenosis
• I50.0 Congestive heart failure
• I67 Other cerebrovascular diseases
• I79.8 Other lesions of arteries, arterioles and capillaries in diseases classified elsewhere
• K90 Intestinal malabsorption
• M10.9 Gout, unspecified
• M32 Systemic lupus erythematosus
• M34 Systemic sclerosis
• R34 Anuria and oliguria
• T78.3 Angioedema
• Z100.0* Anesthesiology and premedication
• Z49.1 Care including extracorporeal dialysis

Compound

Pharmacodynamics

Accusid® is a combination drug that contains an ACE inhibitor, quinapril, and a thiazide diuretic, hydrochlorothiazide.

ACE is an enzyme that catalyzes the conversion of angiotensin I to angiotensin II, which has a vasoconstrictor effect and controls vascular tone, incl. by stimulating the secretion of aldosterone by the adrenal cortex. Quinapril inhibits ACE circulating in the blood plasma and tissue and causes a decrease in vasopressor activity and aldosterone secretion. Elimination of the negative effect of angiotensin II on renin secretion via a feedback mechanism leads to an increase in plasma renin activity. In this case, a decrease in blood pressure is accompanied by a decrease in peripheral vascular resistance and renal vascular resistance, while changes in heart rate, cardiac output, renal blood flow, glomerular filtration rate and filtration fraction are insignificant or absent. Quinapril increases exercise tolerance. With long-term use, it promotes the reverse development of myocardial hypertrophy in patients with arterial hypertension; improves blood supply to ischemic myocardium. Strengthens coronary and renal blood flow. Reduces platelet aggregation.

In addition, quinapril slightly reduces the excretion of potassium caused by hydrochlorothiazide, which, due to its diuretic effect, also increases the activity of plasma renin, the secretion of aldosterone, reduces the potassium content in the blood serum and increases its excretion by the kidneys.

Hydrochlorothiazide is a diuretic that has a direct effect on the kidneys, increasing the excretion of sodium, chloride, fluid, as well as potassium and bicarbonates and decreasing the excretion of calcium. With long-term use, there is a decrease in peripheral vascular resistance.

Thus, the use of a combination of quinapril and hydrochlorothiazide leads to a more pronounced decrease in blood pressure than therapy with each drug separately.

The antihypertensive effect of quinapril develops within 1 hour after oral administration, reaches a maximum after 2–4 hours and persists for 24 hours with long-term treatment. In some cases, at least 2 weeks of therapy are required to achieve maximum antihypertensive effect.

The diuretic effect of hydrochlorothiazide develops within 2 hours, reaches a maximum after about 4 hours and persists for about 6–12 hours.

Accusid tablets - reviews

Nikolay
https://www.medsovet.info/herb/314

There was a persistent increase in blood pressure. Constant 160/110, age 52 years. Often the pressure was higher. Periodically I took various drugs. I no longer believed that I could lower my blood pressure. I found a good doctor and she advised me to take one Akkuzide tablet in the morning, and at 11:00 a Nebilet tablet. Within a week, the pressure began to decrease. 3 weeks have passed.

Now the pressure is constantly -140/84-90, and I see a downward trend

Alexey Sh

https://protabletky.ru/accuzide/

Previously, my father had to take two drugs: Accupro and hypothiazide, but now only one is enough - Accuzide. It reduces blood pressure well and keeps it normal. The main thing is to consult with your doctor - a cardiologist and choose the right dosage.

Natasha A.

https://protabletky.ru/accuzide/

Akkuzid is a real salvation for my father. All his life he worked in manufacturing, either on the night or day shift. Constant lack of sleep and disruption of the general regime led to high blood pressure already in my 40s. By the age of 50, it was constantly jumping like mad. Only after starting to take Accusid did everything return to normal for my dad. The only minor drawback is frequent trips to the toilet.

Michael

https://www.apreka.ru/?l=akkuzid_tabletki

My husband began having attacks of arterial hypertension at the age of 30. At first he was prescribed Adelfan, Raunatin, Papazole and other nonsense, which is no longer used anywhere except in our country. As a result, his blood pressure often increased and he had to call an ambulance. I had hypertensive crises several times, at the age of 30! And when he was prescribed Akkuzid, all this disgrace immediately stopped. One tablet a day, in the morning on an empty stomach, and your blood pressure is normal all day. In principle, you can take it at any time of the day, the main thing is that this time is the same. After starting to take Accusid, he even returned to the shift work schedule that he initially had to leave. The drug perfectly maintains pressure all day long.

Perhaps, after prolonged use, some side effects will appear, but so far in three years there have been no problems from it, including a decrease in potency, which is what the instructions warn about.

A very effective long-acting drug. Under no circumstances should you take a second tablet; if your blood pressure even rises, the effect will be unpredictable. Do not take without a doctor's prescription, the drug is potent. Incompatible with alcohol.

Anton

The doctor prescribed Noliprel for my blood pressure when I was leaving for shift work for six months. In the north, they have never heard of such drugs, not because they are expensive, but because local doctors have not studied them. But when I started coughing from this medicine, the local cardiologist suggested either the expensive Diovan or the half-cheaper Accusid. Since the medicine is prescribed for the rest of my life, I decided to try a cheaper one. And I was lucky. It's action is no worse, and maybe even better, and I didn't get a cough from it.

Pharmacokinetics

Quinapril and hydrochlorothiazide do not affect each other's pharmacokinetics.

Quinapril

Tmax of quinapril in blood plasma when taken orally is 1 hour. Quinapril is quickly metabolized to quinapril by eliminating the ester group (the main metabolite is the dibasic acid of quinapril), which is a powerful ACE inhibitor.

Taking into account the excretion of quinapril and its metabolites by the kidneys, the degree of absorption is approximately 60%. About 38% of an oral dose of quinapril circulates in the blood plasma in the form of quinapril. T1/2 of quinapril from blood plasma is about 1 hour. Tmax of quinapril in blood plasma is approximately 2 hours after ingestion of quinapril. Quinapril is excreted mainly by the kidneys, T1/2 is about 3 hours. Approximately 97% of quinapril and quinaprilat circulate in the blood plasma in protein-bound form. Quinapril and its metabolites do not penetrate the BBB.

In patients with renal failure, T1/2 of quinaprilat increases as creatinine clearance decreases. The elimination of quinaprilat is also reduced in elderly patients (over 65 years of age) and closely correlates with the degree of renal dysfunction, however, in general, no differences in the effectiveness and safety of treatment were found in elderly and younger patients.

Hydrochlorothiazide

Absorbed somewhat more slowly (1–2.5 hours) and more completely (50–80%). Hydrochlorothiazide is not metabolized in the liver and is excreted unchanged by the kidneys. T1/2 is from 4 to 15 hours. About 61% of the dose taken orally is excreted unchanged within 24 hours. Hydrochlorothiazide penetrates the placenta and into breast milk, but does not pass through the BBB.

Contraindications

hypersensitivity to active substances, other auxiliary components of the drug, sulfonamide derivatives;

history of angioedema as a result of previous therapy with ACE inhibitors;

idiopathic and hereditary angioedema;

severe renal failure (creatinine Cl less than 30 ml/min);

anuria;

severe liver failure;

Addison's disease;

refractory hypokalemia, hypercalcemia and hyponatremia;

obstruction of the outflow tract of the left ventricle of the heart;

diabetes mellitus with the presence of chronic kidney disease with moderate renal failure (glomerular filtration rate (GFR) <60 ml/min);

lactose intolerance, lactase deficiency, glucose-galactose malabsorption;

simultaneous use of aliskiren and Accusid® in patients with diabetes mellitus, impaired renal function (GFR <60 ml/min/1.73 m2), hyperkalemia (≥5 mmol/l), chronic heart failure with low blood pressure;

concomitant use with angiotensin II receptor antagonists or other ACE inhibitors in patients with diabetes mellitus and end-stage target organ damage, moderate to severe renal dysfunction (GFR <60 ml/min/1.73 m2), hyperkalemia ( ≥5 mmol/l), chronic heart failure with low blood pressure;

children under 18 years of age (efficacy and safety have not been established).

With caution: patients who have previously taken diuretics and are on a salt-restricted diet or are on hemodialysis; severe chronic heart failure in patients with or without concomitant renal failure; conditions accompanied by a decrease in blood volume (including vomiting and diarrhea); inhibition of bone marrow hematopoiesis; aortic stenosis; cerebrovascular diseases (a sharp decrease in blood pressure during therapy with ACE inhibitors can worsen the course of these diseases); condition after kidney transplantation; bilateral renal artery stenosis or stenosis of the artery of a single kidney; severe autoimmune systemic connective tissue diseases (including systemic lupus erythematosus, scleroderma); liver dysfunction or progressive liver disease; diabetes; extensive surgical interventions and general anesthesia; simultaneous use of other antihypertensive drugs, as well as inhibitors of mTOR and DPP-4 enzymes; disturbance of water and electrolyte balance (hyperkalemia, hypokalemia, hyponatremia, hypercalcemia); gout; symptomatic hyperuricemia; elderly age; simultaneous use of cardiac glycosides and other drugs that can lead to the development of ventricular tachycardia of the “pirouette” type; systemic lupus erythematosus, angle-closure glaucoma).

Use during pregnancy and breastfeeding

The use of Accusid® is contraindicated during pregnancy, women planning pregnancy, and women of reproductive age who do not use reliable methods of contraception.

Women of reproductive age taking Accusid® should use reliable methods of contraception.

If pregnancy is diagnosed, Accusid® should be discontinued as soon as possible.

The prescription of ACE inhibitors during pregnancy is accompanied by an increased risk of developing abnormalities of the cardiovascular system and the nervous system of the fetus. In addition, with the use of ACE inhibitors during pregnancy, cases of oligohydramnios, premature birth, birth of children with arterial hypotension, impaired renal function, including acute renal failure, hypoplasia of the skull bones, contractures of the limbs, craniofacial anomalies, hypoplasia of the lungs, intrauterine retardation have been described. development, patent ductus arteriosus, as well as cases of intrauterine fetal death and neonatal death. Often, oligohydramnios is diagnosed after the fetus has been irreversibly damaged.

Neonates exposed in utero to ACE inhibitors should be monitored for hypotension, oliguria, and hyperkalemia. If oliguria occurs, blood pressure and renal perfusion should be maintained.

Thiazides cross the placenta and are found in the umbilical cord blood. Non-teratogenic effects of thiazides include jaundice and thrombocytopenia in the fetus and/or newborn, and there may be other adverse effects observed in the mother.

ACE inhibitors, including quinapril, pass into breast milk to a limited extent. Thiazides pass into breast milk. Given the possibility of serious adverse events in a newborn, the drug Accusid® should be discontinued during lactation or breastfeeding should be stopped.

Side effects

Adverse events occurring in more than 1% of patients receiving quinapril in combination with hydrochlorothiazide

Headache, dizziness, cough, non-productive persistent cough (resolved after cessation of therapy), fatigue, myalgia, viral infections, rhinitis, nausea, vomiting, upper respiratory tract infections, insomnia, bronchitis, dyspepsia, asthenia, pharyngitis, symptoms of vasodilation, vertigo , chest pain, abdominal pain, back pain. In general, adverse events were mild and transient and did not depend on age, gender, race, or duration of therapy.

Laboratory indicators: an increase (more than 1.25 times compared to ULN) in the concentration of creatinine and urea nitrogen in the blood, respectively, in 3 and 4% of patients receiving quinapril and hydrochlorothiazide.

Adverse events occurring in 0.5–1% of patients receiving quinapril in combination with hydrochlorothiazide

From the hematopoietic system: hemolytic anemia, thrombocytopenia, leukopenia, agranulocytosis.

From the nervous system: increased excitability, paresthesia, depression, drowsiness.

From the cardiovascular system: palpitations, tachycardia, marked decrease in blood pressure, orthostatic hypotension, fainting, cardiac arrhythmia, myocardial infarction, ischemic stroke, peripheral edema (including generalized), hypertensive crisis, angina pectoris, heart failure.

From the respiratory system: shortness of breath, sinusitis.

From the digestive system: dryness of the mucous membrane of the mouth and throat, constipation or diarrhea, flatulence, pancreatitis, hepatitis, angioedema intestinal edema, gastrointestinal bleeding, impaired liver function tests.

Allergic reactions: skin rash, itching, urticaria, angioedema, photosensitivity, exudative erythema multiforme, exfoliative dermatitis, pemphigus, Stevens-Johnson syndrome, anaphylactic reactions, increased sweating.

From the musculoskeletal system and connective tissue: joint pain.

From the genitourinary system: urinary tract infections, impaired renal function, acute renal failure, decreased potency.

From the organ of vision: visual impairment.

Other: alopecia, hyperkalemia.

With the simultaneous use of ACE inhibitors and gold preparations (sodium aurothiomalate, IV), a symptom complex has been described, including facial flushing, nausea, vomiting, decreased blood pressure and a flu-like syndrome.

Adverse reactions observed with the use of hydrochlorothiazide

Metabolic: hypokalemia, hypomagnesemia, hypercalcemia and hypochloremic alkalosis (dry oral mucosa, thirst, heart rhythm disturbances, changes in mood or psyche, cramps and muscle pain, nausea, vomiting, increased fatigue or weakness). Hypochloremic alkalosis can cause hepatic encephalopathy or hepatic coma. Hyponatremia (confusion, convulsions, lethargy, slow thinking, increased fatigue, excitability, muscle cramps).

Metabolic disorders: hyperglycemia, glycosuria, hyperuricemia with the development of an attack of gout. Treatment with thiazides may reduce glucose tolerance, and latent diabetes mellitus may become manifest. When using high doses, plasma lipid concentrations may increase.

From the digestive system: cholecystitis, sialadenitis, anorexia.

From the cardiovascular system: arrhythmias, orthostatic hypotension, vasculitis.

From the nervous system: temporarily blurred vision.

From the hematopoietic organs: aplastic anemia.

Allergic reactions: purpura, necrotizing vasculitis, respiratory distress syndrome (including pneumonitis and non-cardiogenic pulmonary edema), photosensitivity, anaphylactic reactions up to shock.

From the organ of vision: transient acute myopia and acute open-angle glaucoma.

Other: decreased potency, impaired renal function, interstitial nephritis.

Post-marketing studies

From the cardiovascular system: bradycardia, cor pulmonale, vasculitis, deep vein thrombosis.

From the digestive system: gastrointestinal tumors, cholestatic jaundice, hepatitis, esophagitis, vomiting, diarrhea.

From the hematopoietic system: anemia.

Metabolism: weight loss.

From the musculoskeletal system: myopathy, myositis, arthritis.

From the nervous system: paralysis, hemiplegia, speech impairment, gait disturbance, meningism, amnesia.

From the respiratory system: pneumonia, bronchial asthma.

From the skin: urticaria, maculopapular rash, petechiae.

From the urinary system: albuminuria, pyuria, hematuria, nephrosis.

Other: shock, accidental injury, inflammation of subcutaneous fat, generalized edema, hernia.

Side effects of the drug Accusid

When using quinapril and hydrochlorothiazide, the following adverse reactions were observed with a frequency of over 1%: headache, dizziness, cough, fatigue. It should be noted that the cough is usually dry, persistent and disappears after cessation of therapy. Adverse reactions were usually minor, short-lived, and were not related to age, gender, race, or duration of use (see SPECIAL INSTRUCTIONS section for more information). Discontinuation of the drug due to side effects was observed in 2% of patients. The most common reason for discontinuation of the drug was headache, accompanied by cough and nausea and/or vomiting. Headache, dizziness, cough, fatigue, myalgia, viral infection, rhinitis, nausea and/or vomiting, abdominal pain, back pain, diarrhea, upper respiratory tract infection, insomnia, drowsiness have been observed in controlled studies with quinapril/hydrochlorothiazide. , bronchitis, dyspepsia, asthenia, pharyngitis, vasodilation, vertigo, chest pain.

Interaction

Tetracycline and other drugs that interact with magnesium. With the simultaneous use of Accusid® and tetracycline, the absorption of the latter is reduced by approximately 28–37% due to the presence of magnesium carbonate as a filler in Accusid®. This interaction should be taken into account when using Accusid® simultaneously with tetracycline or other drugs that can interact with magnesium.

Lithium. In general, lithium should not be used in combination with diuretics because the latter reduce the renal clearance of lithium and increase the risk of adverse effects. In patients taking lithium preparations and ACE inhibitors, there is an increase in serum lithium concentrations and symptoms of lithium intoxication. These changes are associated with sodium loss under the influence of ACE inhibitors. When using the drug Accusid®, the risk of lithium intoxication may be increased. These drugs should be used together with caution.

Diuretics. With simultaneous use of quinapril with diuretics, an increase in antihypertensive effect is observed (see “Special Instructions”).

Ethanol, barbiturates and narcotic analgesics. When used simultaneously with the drug Accusid®, the risk of orthostatic hypotension may increase (the drug contains a thiazide diuretic - hydrochlorothiazide).

Hypoglycemic agents (oral hypoglycemic agents and insulin). Dosage adjustment of hypoglycemic agents may be required. Hyperglycemia induced by thiazide diuretics may impair control of plasma glucose concentrations. A decrease in potassium content in the blood plasma leads to an increase in glucose tolerance. The concentration of glucose in the blood plasma should be monitored, potassium supplements should be prescribed as necessary to maintain potassium levels in the blood plasma, and hypoglycemic therapy should be adjusted.

Other antihypertensive drugs. The thiazide diuretic included in the drug Accusid® may enhance the effect of other antihypertensive drugs, especially ganglion blockers or beta-blockers. Due to the content of hydrochlorothiazide, the hypotensive effect of Accusid® may increase after sympathectomy.

GCS, corticotropin (ACTH). Increased loss of electrolytes, especially potassium.

Pressor amines (eg norepinephrine). The therapeutic effect of pressor amines may be reduced (clinical significance is negligible).

Non-depolarizing muscle relaxants (eg tubocurarine chloride). The effect of muscle relaxants may be enhanced.

NSAIDs. In some patients, NSAIDs may weaken the diuretic, natriuretic and hypotensive effects of loop, potassium-sparing and thiazide diuretics. In this regard, when using these drugs simultaneously with Accusid®, patients should be monitored to assess the effectiveness of the therapy.

In addition, in elderly patients, patients with reduced blood volume (including patients receiving diuretic therapy) or with impaired renal function, the simultaneous use of NSAIDs (including selective COX-2 inhibitors) with ACE inhibitors, incl. quinapril may lead to deterioration of renal function, including possible acute renal failure. Renal function should be regularly monitored in patients receiving concomitant NSAIDs and quinapril. There may also be a weakening of the antihypertensive effect of ACE inhibitors, incl. quinapril, when used simultaneously with NSAIDs.

Drugs that can cause hyperkalemia. Quinapril is an ACE inhibitor that reduces aldosterone concentrations, which in turn can lead to hyperkalemia. In this regard, when treating with Accusid®, potassium preparations and salt substitutes containing potassium should be used with caution, monitoring the potassium level in the blood serum. Considering that Accusid® contains a diuretic, the addition of a potassium-sparing diuretic is not recommended.

Digoxin. Fluid and electrolyte disturbances caused by thiazide diuretics (i.e., hypokalemia, hypomagnesemia) increase the risk of developing symptoms of digoxin toxicity, which can lead to fatal RI abnormalities.

Ion exchange resins. The absorption of hydrochlorothiazide is reduced in the presence of cholestyramine and colestipol. With a single use, these drugs bind hydrochlorothiazide and reduce its absorption in the gastrointestinal tract by 85 and 43%, respectively.

Medicines for the treatment of gout (allopurinol, uricosuric drugs, xanthine oxidase inhibitors). Hyperuricemia induced by thiazide diuretics may interfere with the control of allopurinol and probenecid in patients with gout. Concomitant use of hydrochlorothiazide and allopurinol may increase the incidence of hypersensitivity reactions to allopurinol.

Other drugs. There were no signs of clinically significant pharmacokinetic interaction of quinapril with propranolol, hydrochlorothiazide or cimetidine.

The use of quinapril 2 times a day did not significantly affect the anticoagulant effect of warfarin when administered once (assessed based on PT).

Simultaneous repeated use of atorvastatin at a dose of 10 mg with quinapril at a dose of 80 mg did not lead to significant changes in the equilibrium pharmacokinetic parameters of atorvastatin.

Antihypertensive drugs, narcotic analgesics, drugs for general anesthesia enhance the antihypertensive effect of quinapril.

Quinapril increases the risk of developing leukopenia when used simultaneously with allopurinol, cytostatic agents, immunosuppressants, and procainamide.

With the simultaneous use of ACE inhibitors and gold preparations (sodium aurothiomalate, IV), a symptom complex has been described, including facial flushing, nausea, vomiting, decreased blood pressure and a flu-like syndrome.

With the simultaneous use of cardiac glycosides and other drugs that can lead to the development of ventricular tachycardia of the “pirouette” type, caution should be exercised due to the possibility of developing hypokalemia and, as a result, increasing the toxic effect of these drugs.

The use of angiotensin II receptor antagonists, ACE inhibitors or aliskiren can lead to double blockade of RAAS activity. This effect may be manifested by a decrease in blood pressure, hyperkalemia and changes in renal function (including acute renal failure) compared with monotherapy.

Quinapril and hydrochlorothiazide should not be used concomitantly with aliskiren in patients with diabetes mellitus, moderate to severe renal impairment (GFR <60 ml/min/1.73 m2), hyperkalemia (≥5 mmol/l), CHF with reduced Blood pressure (see “Contraindications”).

Do not use quinapril and hydrochlorothiazide concomitantly with angiotensin II receptor antagonists or other ACE inhibitors in patients with diabetes mellitus and end-stage end-organ damage, moderate to severe renal impairment (GFR <60 ml/min/1.73 m2), hyperkalemia (≥5 mmol/l), CHF with low blood pressure (see “Contraindications”).

Patients receiving concomitant therapy with mTOR enzyme inhibitors (eg temsirolimus) and DPP-4 (eg vildagliptin) may be at greater risk of developing angioedema. Caution should be exercised when using these drugs simultaneously with Accusid®.

Akkuzid

During treatment with ACE inhibitors, cases of angioedema of the head and neck have been described, incl. in 0.1% of patients, or angioedema of the face, tongue or glottis, the drug should be discontinued immediately. Antihistamines can be used to reduce symptoms. Angioedema affecting the larynx can be fatal. If swelling of the tongue, glottis or larynx threatens the development of airway obstruction, emergency treatment is necessary - subcutaneous administration of a solution of epinephrine 1:1000 (0.3-0.5 ml).

During treatment with ACE inhibitors, cases of intestinal angioedema have been described: pain in the abdomen (with/without nausea and vomiting), with/without previous angioedema of the face and normal C-1 esterase activity, which was confirmed by computed tomography of the abdominal region, ultrasound, or at the time of surgery. interventions. Symptoms disappeared after stopping the ACE inhibitors.

Prescribing ACE inhibitors against the background of desensitizing therapy with Hymenoptera (heminoptera) venom can lead to anaphylactoid reactions.

Anaphylactoid reactions can develop when ACE inhibitors are prescribed to patients after LDL apheresis by absorption of dextran sulfate or during hemodialysis using high-flow membranes (polyacrylonitrile); It is recommended to avoid prescribing the drug or use alternative membranes for hemodialysis.

The drug may cause symptomatic arterial hypotension. Symptomatic hypotension is rare when treating uncomplicated arterial hypertension with quinapril, but can develop in patients with reduced blood volume (diuretic therapy, salt-restricted diet, hemodialysis). A transient pronounced decrease in blood pressure is not a contraindication to further use of the drug, but it is advisable to reduce its dose.

In rare cases, therapy with ACE inhibitors may be accompanied by agranulocytosis and suppression of bone marrow function, more often in patients with impaired renal function due to autoimmune diseases (control of blood leukocytes is necessary).

Thiazide diuretics can cause exacerbation of SLE with azotemia.

In susceptible patients, suppression of the RAAS may lead to changes in renal function. In severe CHF, renal function may depend on the activity of the RAAS; quinapril can lead to oliguria and/or progressive azotemia, and in rare cases, acute renal failure and/or death. Treatment of such patients should begin under close medical supervision and monitoring during the first 2 weeks and with an increase in the dose of the drug.

T1/2 of quinaprilat increases with a decrease in CC. In patients with CC less than 60 ml/min, quinapril should be prescribed at a lower initial dose; if necessary, the dose can be increased under monitoring of renal function.

In all patients with arterial hypertension, renal function should be monitored during treatment. A transient increase in the concentration of urea nitrogen and blood creatinine is possible without obvious damage to the renal vessels (but is more likely with initial renal dysfunction and requires a dose reduction), as well as in the case of bilateral or unilateral renal artery stenosis. Monitoring of renal function is necessary during the first few weeks of treatment.

The drug is used with caution in case of renal failure or progressive liver diseases - there is a risk of developing hepatic coma. Concentrations of quinapril are reduced in patients with alcoholic cirrhosis due to impaired deesterification of quinapril.

In order to identify possible electrolyte imbalances, serum electrolyte concentrations should be regularly monitored. Risk factors for the development of hyperkalemia (due to quinapril) are chronic renal failure, diabetes mellitus and concomitant use of potassium-sparing diuretics, K+ preparations and/or salt substitutes containing K+. Treatment with thiazide diuretics is accompanied by hypokalemia, hyponatremia and hypochloremic alkalosis.

Risk factors for hypokalemia (due to hydrochlorothiazide) include liver cirrhosis, forced diuresis, inadequate oral electrolyte intake, and concomitant therapy with corticosteroids and ACTH. The opposite effects of the components of the drug on the concentration of K+ in plasma lead in most cases to the absence of changes in its value. In some cases, the effect of one component may prevail over the other.

Hypochloremia caused by hydrochlorothiazide is usually mild and in exceptional cases requires special treatment (for liver or kidney diseases).

Hydrochlorothiazide reduces Ca2+ excretion; in rare cases, with long-term use, pathological changes in the parathyroid glands are possible, accompanied by hypercalcemia and hypophosphatemia. More serious complications of hyperparathyroidism (nephrolithiasis, bone resorption and peptic ulcer) have not been described. Before testing the function of the parathyroid glands, the drug should be discontinued.

Hydrochlorothiazide increases the excretion of Mg2+ in urine with the development of hypomagnesemia.

Hydrochlorothiazide reduces glucose tolerance and causes hypercholesterolemia, hypertriglyceridemia and hyperuricemia, which can provoke the development or exacerbation of gout or diabetes mellitus.

Therapy with ACE inhibitors may be accompanied by the development of hypoglycemia in patients with diabetes mellitus receiving insulin or oral hypoglycemic drugs, which requires careful monitoring of blood glucose concentrations.

When treated with ACE inhibitors, including quinapril, cough may develop, which is usually non-productive, persistent and resolves after discontinuation of therapy. In the differential diagnosis of cough, its possible connection with the use of ACE inhibitors should be taken into account.

In the case of surgery and general anesthesia, ACE inhibitors should be used with caution, because they block the formation of angiotensin II caused by compensatory secretion of renin, which can lead to a pronounced decrease in blood pressure, which is eliminated by fluid administration.

Patients should be warned that insufficient fluid intake, increased sweating or dehydration can lead to an excessive decrease in blood pressure due to a decrease in blood volume. Dr. causes of dehydration,

such as vomiting or diarrhea can also lead to a drop in blood pressure. In such cases, patients should consult a doctor.

If symptoms of infection develop (including sore throat, fever), patients should consult a doctor to rule out neutropenia.

Caution should be exercised when driving vehicles or engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions, especially at the beginning of treatment.

Directions for use and doses

Orally 1 time per day, regardless of meals.

For patients not receiving diuretics (regardless of whether previously monotherapy with quinapril was carried out or not), the recommended initial dose is 1 table. Accusid® drug (12.5 mg + 10 mg) 1 time per day. Subsequently, if necessary, the dose can be increased to a maximum of 25 mg + 20 mg once a day.

Effective blood pressure control is usually achieved when using Accusid® in a dose range from 12.5 mg + 10 mg to 12.5 mg + 20 mg.

Special patient groups

Renal dysfunction. In patients with mild renal impairment (creatinine clearance ≥60 ml/min), the initial dose of Accusid® is 12.5 mg + 10 mg. Accusid® should not be prescribed as initial therapy in patients with impaired renal function with creatinine Cl <60 ml/min. In patients with moderate renal impairment (creatinine clearance 60–30 ml/min), quinapril should be used at an initial dose of 5 mg with further titration.

Elderly patients. No dose adjustment of Accusid® is required in elderly patients. The initial dose of Accusid® is 1 tablet. (12.5 mg + 10 mg).

Use of the drug Accusid

For patients who have not previously used a diuretic and who were prescribed quinapril monotherapy, the recommended initial dose of Accusid is 10/12.5 mg. According to the clinical effect, the dose can be increased to 20/12.5 mg. Effective blood pressure control in most cases is achieved when taking from 10/12.5 mg to 20/12.5 mg of the drug. The dosage range of the drug allows you to flexibly select the ratio of components depending on clinical needs. In patients who have previously used a diuretic, to prevent an excessive decrease in blood pressure, the recommended initial dose of quinapril is 5 mg. In the future, the dose of the drug is selected individually. If the selected ratio of quinapril and hydrochlorothiazide corresponds to that in the tablet, you can switch to Accuside 10 or Accuside 20. Accuside should not be used as a starting drug in patients with impaired renal function (creatinine clearance less than 60 ml/min). In patients with moderate renal failure (creatinine clearance within 30–60 ml/min), therapy begins with the appointment of 5 mg of quinapril with further dose titration. If additional prescription of diuretics is necessary, their dose can be titrated using Accusid. The starting dose is 10/12.5 mg. When it becomes necessary to use diuretics in combination with quinapril in patients with severe kidney damage (creatinine clearance less than 30 ml/min), loop diuretics should be preferred over thiazide diuretics. The therapeutic effect of the drug when using the same doses was similar in both elderly and mature patients. There was no increase in the incidence of side effects in elderly patients. The safety and effectiveness of Accusid in the treatment of children has not been established.

Overdose

There is no information about an overdose of the drug Accusid® and no special measures for its treatment.

Symptoms: pronounced decrease in blood pressure, disturbance of water and electrolyte balance - hyponatremia, hypochloremia, hypokalemia (with simultaneous use with cardiac glycosides, the risk of developing arrhythmia increases), decrease in blood volume due to forced diuresis.

Treatment: discontinuation of the drug, gastric lavage, administration of activated charcoal, intravenous administration of 0.9% sodium chloride solution, restoration of water and electrolyte balance in the blood, symptomatic and supportive therapy. Hemodialysis and peritoneal dialysis have little effect on the excretion of quinapril and quinaprilat.

Accusid overdose, symptoms and treatment

There is no information about an overdose of Accusid during the treatment of people. The main clinical manifestations of hydrochlorothiazide motor therapy are symptoms associated with loss of electrolytes (hypokalemia, hypochloremia, hyponatremia) and dehydration due to stimulation of diuresis. With concomitant use of digitalis preparations, hypokalemia may increase cardiac arrhythmia. There is no information on specific treatment for quinapril/hydrochlorothiazide overdose. The effectiveness of hemodialysis and peritoneal dialysis is insignificant. Treatment is symptomatic.