Instructions for use LISINOPRIL PLUS

Lisinopril: active ingredients

The name of the drug is identical to its active substance - lisinopril dihydrate. Separately, you can find the drug under other trade names. As a rule, its cost under other names is significantly higher.

The following can be used as auxiliary components by various manufacturers:

• corn starch or pregelatinized;
• calcium hydrogen phosphate;
• mannitol;
• magnesium stearate;
• colloidal silicon dioxide;
• microcrystalline cellulose;
• talc.

The drug is produced in the form of oblong white tablets. Its edges are rounded and there is a risk in the center. Each tablet contains 5 mg, 10 mg or 20 mg of active ingredient. The medicine is packaged in 10 tablets in a blister. The package contains 30 doses (3 blisters).

How does Lisinopril work?

The drug acts on the renin-angiotensin system of the heart, interfering with dilatation of the left ventricle. At the same time, there is a decrease in the load on the myocardium. The substance reduces pressure in the capillaries of the lungs, as well as in peripheral vessels. When treated with Lisinopril, the tolerance of the cardiac myocardium to increased stress increases. In addition, the activity of renil in plasma increases.

After taking a single dose, the first positive effect occurs after 50-60 minutes. The manifestation of the therapeutic effect intensifies within 7 hours and persists throughout the day. Therapy lasting for several weeks achieves the maximum possible hypotensive effect.

Eating does not interfere with the absorption of the active substance, but at the same time does not contribute to it. Therefore, taking the medicine does not depend on the time of eating. Absorption of Lisinopril reaches 25%. The drug molecules bind weakly to blood proteins. Half-life occurs after 12 hours. Substances are excreted unchanged by the kidneys. Lisinopril does not form metabolites.

Optimal combination of lisinopril and amlodipine for the treatment of arterial hypertension

When treating patients with hypertension, the target blood pressure level should be less than 140/90 mmHg. Art., and if therapy is well tolerated, it is advisable to reduce blood pressure to lower values. In patients with a high and very high risk of cardiovascular complications, it is necessary to reduce blood pressure to 140/90 mm Hg. or less within 4 weeks. In the future, subject to good tolerance, it is recommended to reduce blood pressure to 130–139/80–89 mmHg. If blood pressure reduction is poorly tolerated, it can be reduced in several stages. At each stage, blood pressure decreases by 10–15% from the initial level in 2–4 weeks. followed by a break to allow the patient to adapt to lower blood pressure values. The next stage of lowering blood pressure and, accordingly, increasing antihypertensive therapy in the form of increasing doses or the number of drugs taken is possible only if the achieved blood pressure values ​​are well tolerated. The use of a step-by-step scheme for lowering blood pressure allows you to achieve the target blood pressure level and avoid episodes of hypotension, which are associated with an increased risk of developing myocardial infarction and cerebral stroke. When achieving the target blood pressure level, it is necessary to take into account the lower limit of reducing systolic blood pressure to 110–115 mm Hg. and diastolic blood pressure – up to 70–75 mm Hg. Particular care should be taken to reduce blood pressure in the elderly and patients who have suffered a myocardial infarction or stroke. Drug therapy for hypertension is based primarily on the use of the main classes of antihypertensive drugs, which include angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), diuretics, calcium antagonists (CA) and β-blockers. These drugs reduce blood pressure in the same way, and each has proven effects and its own contraindications in certain clinical situations. In most cases, effective blood pressure control can only be achieved using combination therapy [4]. It has been shown that combinations of drugs always have advantages over monotherapy in lowering blood pressure. The number of drugs prescribed depends on the initial blood pressure level and concomitant diseases. For example, with grade 1 hypertension and the absence of a high risk of complications, it is possible to achieve target blood pressure with monotherapy in approximately 50% of patients. For grade 2 and 3 hypertension and the presence of high-risk factors, in most cases a combination of two or three drugs may be required. Currently, it is possible to use two strategies for initial treatment of hypertension: monotherapy and low-dose combination therapy, followed by increasing the amount and/or doses of the drug if necessary. The advantages of combination therapy also include the following factors: the effect of drugs of different classes on different physiological systems; potentiation of the antihypertensive effects of two drugs due to synergistic action; neutralization of counter-regulatory mechanisms aimed at increasing blood pressure; reducing the number of required doctor visits; possibility of expanding indications for prescription. Recently, certain drug combinations have been shown to improve the prognosis of individuals with hypertension. These combinations are called rational and are mainly recommended for the treatment of these patients. Rational combinations of antihypertensive drugs include: • angiotensin-converting enzyme (ACE) inhibitors + calcium antagonists (CA); • ACE inhibitors + thiazide diuretics; • angiotensin receptor blockers (ARBs) + thiazide diuretics; • ARB + ​​AK; • thiazide diuretics + β-blockers; • thiazide diuretics + AK; • β-blockers + dihydropyridine AKs. The choice of a particular combination of antihypertensive drugs mainly depends on concomitant diseases. It seems rational to use fixed combinations of antihypertensive drugs with different mechanisms of action [6]. The advantage of such dosage forms over arbitrary combinations is the elimination of the possibility of using irrational combinations, as well as a reduction in the cost of treatment, given that the cost of combination drugs is often lower than the cost of components prescribed separately [7]. Fixed combinations reduce the number of pills taken by the patient and, by simplifying the therapeutic regimen, help increase adherence to treatment [8]. Advantage is given to long-acting antihypertensive drugs. Of the fixed combinations currently presented on the pharmaceutical market, the combination of an ACE inhibitor with an AK, the drug Equator (Gedeon Richter, Hungary), deserves special attention, which has successfully proven itself in the treatment of hypertension. Equator is a fixed combination of the AA amlodipine and the ACE inhibitor lisinopril in corresponding dosages of 5+10 mg and 10+20 mg. This combination is highly effective, has its own evidence of a beneficial effect on prognosis and is well tolerated by patients. An ACE inhibitor and an AA have radically different mechanisms of action, and their combined use potentiates each other’s action and provides an effective reduction in blood pressure levels. This combination is effective in patients with both high-renin and low-renin forms of hypertension [7]. Equator is also distinguished by a pronounced hypotensive effect in relation to both systolic and diastolic blood pressure due to its long half-life, which is about 35–50 hours. This allows Equator to evenly control blood pressure throughout the day. As a result, the drug is relatively more effective in controlling the early morning rise in blood pressure, regardless of the time of administration (morning or evening, 1 dose per day) [9]. The drug has a dose-dependent effect on blood pressure levels and is characterized by a linear dose-concentration relationship in blood plasma. It is important that with the development of the hypotensive effect of Equator, there is no change in heart rate. In addition, the drug is well tolerated by patients [10]. Lisinopril is an ACE inhibitor, part of the drug Equator, increases natriuresis, reduces sympathetic activity and causes dilatation of peripheral vessels by reducing the formation of angiotensin II, norepinephrine and aldosterone. Lisinopril also increases the level of bradykinin, which has a vasodilatory effect. ACE inhibitors reduce left ventricular myocardial hypertrophy and have pronounced nephroprotection, which is associated with a decrease in increased intraglomerular pressure and an antiproteinuric effect. It has also been shown that drugs in this group significantly improve the elastic characteristics of large arteries, slow down vascular remodeling and normalize impaired endothelial function. The beneficial effect of ACE inhibitors on the vascular wall has been proven in many large studies [11]. Lisinopril is not a prodrug and does not require primary metabolic activation in the liver, which makes its use possible in cases of severe liver pathology. A dihydropyridine derivative, amlodipine, is also included in the drug Equator. Amlodipine is a third-generation dihydropyridine calcium channel antagonist that blocks slow calcium channels (L-type channels) and prevents the intracellular accumulation of calcium, producing a vasodilator effect. Amlodipine effectively lowers blood pressure without affecting heart rate in patients with hypertension. Amlodipine does not have a negative effect on metabolic processes, does not change the level of plasma lipids; amlodipine can be prescribed to patients with concomitant bronchial asthma, diabetes mellitus (DM) and gout. The prerequisites for the emergence of a fixed combination of amlodipine and lisinopril were the results of some clinical studies, which showed that combination therapy with these drugs in the form of separate tablet forms has a pronounced hypotensive effect and is well tolerated in patients with hypertension [12]. Subsequently, after the appearance of the drug Equator with a fixed combination of amlodipine and lisinopril, its clinical trials were carried out in patients with hypertension and other CVDs. The effectiveness and good tolerability of the drug Equator was confirmed in the Hungarian multicenter randomized study HAMLET, in which a positive therapeutic effect was achieved in the treatment of patients with hypertension in more than 90% of cases [13]. The aim of the study was to compare the effectiveness and tolerability of monotherapy with lisinopril 10 mg/day. or amlodipine 5 mg/day. with combined use of drugs in the same doses for 8 weeks. therapy. The study included patients aged 18 to 65 years with untreated or poorly controlled essential hypertension. The study showed that the fixed combination of amlodipine and lisinopril not only effectively lowers blood pressure, but also helps reduce the risk of cardiovascular events and is well tolerated and compliant. Another clinical, prospective, open-label, uncontrolled study included 442 patients aged 30 to 75 years with grade 1–3 hypertension, with a high or very high risk of cardiovascular complications, who had ineffective or absent antihypertensive therapy at the time of enrollment [ 14]. Equator was prescribed in a starting dose of 1 or 1/2 tablets per day. The target level was considered to be blood pressure <140/90 mm Hg. for persons who do not have diabetes and blood pressure <130/80 mm Hg. for patients with diabetes. If necessary, the doctor increased the dose of Equator and/or added another antihypertensive drug to therapy. The result showed that after 4 weeks. from the start of the study, 174 (48.9%) of 356 patients without diabetes achieved the target blood pressure level. After 12 weeks from the start of the study, satisfactory blood pressure control was achieved in 275 (77.3%) patients. Among patients suffering from diabetes (n=74), after 4 weeks. receiving Equator target blood pressure level <130/80 mm Hg. was achieved in 12 patients (16.2%), and by the end of the study - in 26 (35.1%). Adverse events were noted in 16 (3.7%) at the final visit, including swelling of the legs (4.7%), dry cough (1.9%) and palpitations (1.9%). Doctors rated the effectiveness of treatment as good (4 points) and excellent (5 points) in 97.7% of cases, and patients - in 97.2% of cases. Good and excellent tolerability of Equator was noted by doctors in 96.7% of cases, and by patients – in 97.2%. A total of 4 patients discontinued treatment due to side effects. The results of this study showed high efficacy and good tolerability of the drug Equator in the treatment of patients with hypertension. Subsequently, a significant decrease in blood pressure in patients with grade 2-3 hypertension during therapy with Equator was confirmed in a number of other clinical studies, including in patients with high cardiovascular risk with diseases such as diabetes and obesity [15 ]. Also, clinical studies have shown a positive effect of the drug Equator on target organs in hypertension. Thus, after 90 days of using Equator, a significant decrease in signs of left ventricular myocardial hypertrophy was recorded [10]. Similarly, data on a significant decrease in the mass of the left ventricular myocardium during 12-week therapy with Equator were obtained by other authors [16]. When hypertension is combined with other diseases, the positive effect of the drug Equator has also been demonstrated. Thus, in one of the studies, the effectiveness of using Equator in patients with hypertension and chronic obstructive pulmonary disease was shown. In this case, therapy with this drug for 16 weeks. not only made it possible to effectively lower blood pressure, but also to reduce systolic pressure in the pulmonary artery and the diastolic size of the right ventricle. In no case was a deterioration in respiratory function recorded [17]. Thus, the drug Equator - a fixed drug combination of amlodipine and lisinopril - effectively reduces blood pressure, has a beneficial effect on target organs, is metabolically neutral and is well tolerated by patients. The combination of amlodipine and lisinopril significantly exceeds the antihypertensive effect of each of the components used separately. The use of the drug Equator makes an irreplaceable contribution to the successful treatment of hypertension.

Literature 1. Oganov R.G., Maslennikova G.Ya. Mortality from cardiovascular and other chronic non-infectious diseases among the working population of Russia // Cardiovasc. ter. and prof. 2002. No. 3. P. 4–8. 2. Shalnova S.A., Deev A.D., Oganov R.G. Factors influencing mortality from cardiovascular diseases in the Russian population // Cardiovascular Ter. and prof. 2005. No. 4(1). pp. 4–9. 3. Mancia G., De Backer G., Dominiczak A. et al. 2007. Guidelines for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) // J Hypertens. 2007. Vol. 25. R. 1105–1187. 4. Russian Medical Society for Arterial Hypertension (RMAS), All-Russian Scientific Society of Cardiologists (VNOK). Diagnosis and treatment of arterial hypertension. Russian recommendations (4th revision), 2010. 5. Waeber B. Treatment strategy to control blood pressure optimally in hypertensive patients // Blood Pressure. 2001. Vol. 10. R. 62–73. 6. Mancia G., Laurent S., Agabiti-Rosei E. et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document // J. Hypertens. 2009. Vol. 27 (11). R. 2121–2158. 7. Preobrazhensky D.V., Sidorenko B.A., Skorik A.V., Nekrasova N.I. Advantages of combination therapy for arterial hypertension: a new fixed combination of an angiotensin-converting enzyme inhibitor and calcium antagonist // Consilium Medicum. 2007:. No. 9 (11). pp. 38–45. 8. Gradman AH, Basile JN, Carter BL, Bakris GL; American Society of Hypertension Writing Group. Combination therapy in hypertension // J. Am. Soc. Hypertens. 2010. Vol. 4(1). R. 42–50. 9. Davidovich I.M., Petrichko T.A. Combination therapy with amlodipine and lisinopril in the treatment of patients with arterial hypertension: the effectiveness of a low-dose combination // Ter. archive. 2006. T. 78 (5). pp. 65–68. 10. Morozov S.N., Donskaya A.A., Morozova E.A. The effectiveness of equator therapy for patients with arterial hypertension (on the example of Yakutsk) // Yakut Medical Journal. 2008. No. 4 (24). pp. 9–12. 11. Kotovskaya Yu.V., Lobankova L.A. Lisinopril: main clinical studies // Klin. Pharmacol. and therapy. 2002. T. 11. No. 4. P. 49–51. 12. Naidu MU, Usha PR, Rao TR, Shobha JC Evaluation of amlodipine, lisinopril, and a combination in the treatment of essential hypertension // Postgrad Med J. 2000 Jun. Vol. 76 (896). R. 350–353. 13. Farsang Csaba a HAMLET Vizsgalok neveben. A lisinopril es az amlodipin kombinaciojanak elonyei az antihypertensiv terapiaban. A Hypertoniaban adott AMlodipin 5 mg es Lisinopril 10 mg tablettak hatekonysaganak es toleralhatosaganak osszehasonlito vizsgalata kulon es Egyutt alkalmazott Terapiakent (HAMLET). Multicentrikus vizsgalat eredmenyei // Hypertonia es nephrologia. 2004. Vol. 8(2). R. 72–78. 14. Protasov K.V., Sinkevich D.A., Dzizinsky A.A. Fixed combination of lisinopril and amlodipine in the treatment of arterial hypertension in patients with high cardiovascular risk // Siberian Medical Journal. 2009. No. 5. pp. 137–140. 15. Tsoi S.O., Zhampeisov N.K., Gaipov A.E., Magzumova G.E. The effectiveness of combination antihypertensive therapy in the treatment of patients with type 2 diabetes mellitus and obesity. In: VI conference of RDO // Clinical nephrology. Nephrology and dialysis. 2009. No. 11 (4). P. 335. 16. Nechesova T.A., Liventseva M.M., Korobko I.Yu., Kalinina T.V. The influence of combined antihypertensive therapy with the drug Equator on the condition of target organs in patients with arterial hypertension // Ukr. honey. clock-writer 2008. No. 6 (68). XI/XII. pp. 21–31. 17. Kimeeva M.G., Khodarev S.V., Anisimova E.A. The use of the equator in patients with arterial hypertension in combination with obstructive pulmonary disease. In: III National Congress of Therapists. M., 2008. pp. 113–114.

What is lisinopril prescribed for?

The name of the drug suggests that it belongs to the so-called group of “by-catch”, the action of which is primarily aimed at lowering blood pressure in the fight against hypertension. However, a doctor may prescribe treatment with Lisinopril in other cases:

• for chronic heart failure;
• in acute myocardial infarction not accompanied by arterial hypotension;
• to combat nephropathy of diabetic etiology, both type 1 and type 2.
• with arterial hypertension.

Self-administration of the drug is unacceptable. The dose, frequency of doses and duration of treatment are determined only by the doctor.

Lisinopril, 10 mg, tablets, 30 pcs.

Treatment with lisinopril for chronic heart failure should be started in a hospital setting with combination therapy with diuretics or diuretics in high doses (for example, more than 80 mg of furosemide), fluid or salt deficiency (hypovolemia or hyponatremia: serum sodium less than 130 mmol/l), low blood pressure , unstable heart failure, reduced renal function, therapy with high doses of vasodilators, patient age over 70 years.

The concentration of electrolytes and creatinine in the blood serum and blood cell counts should be monitored, especially at the beginning of therapy and in risk groups (patients with renal failure, connective tissue diseases), as well as with the simultaneous use of immunosuppressants, cytostatics, allopurinol and procainamide.

Arterial hypotension.

The drug can cause a sharp decrease in blood pressure, especially after the first dose. Symptomatic hypotension in patients with high blood pressure without complications is rare. Symptomatic hypotension occurs more often in patients with electrolyte or fluid deficiency, receiving diuretics, following a low-salt diet, after vomiting or diarrhea, or after hemodialysis. Symptomatic hypotension has been observed primarily in patients with chronic heart failure with or without resulting renal failure, as well as in patients receiving high doses of loop diuretics, hyponatremia or impaired renal function. In such patients, therapy should be initiated under strict medical supervision, preferably in a hospital setting, with low doses and dosage adjustments should be made with caution. At the same time, monitoring of renal function and serum potassium levels is necessary. If possible, treatment with diuretics should be discontinued.

Caution is also necessary in patients with angina or cerebral vascular disease, in whom an excessive decrease in blood pressure can lead to myocardial infarction or stroke.

The risk of symptomatic hypotension during lisinopril therapy can be reduced by discontinuing the diuretic before starting lisinopril treatment.

If arterial hypotension occurs, the patient should be placed down, given fluids, or given intravenous fluid (fluid replacement). Atropine may be required to treat associated bradycardia. After successful elimination of arterial hypotension caused by taking the first dose of the drug, there is no need to abandon the subsequent careful increase in dose. If arterial hypotension in a patient with heart failure becomes systematic, a dose reduction and/or discontinuation of the diuretic and/or lisinopril may be required. If possible, diuretic treatment should be discontinued 2–3 days before starting lisinopril therapy.

Arterial hypotension in acute myocardial infarction.

In acute myocardial infarction, therapy with lisinopril should not be initiated if, due to previous treatment with vasodilators, there is a risk of further serious deterioration of hemodynamic parameters. This applies to patients with SBP 100 mmHg. Art. and below or with cardiogenic shock. With SBP 100 mm Hg. Art. and below the maintenance dose should be reduced to 5 mg or 2.5 mg. In acute myocardial infarction, taking lisinopril can lead to severe arterial hypotension. In case of persistent arterial hypotension (SBP less than 90 mm Hg for more than 1 hour), lisinopril therapy should be discontinued.

In patients with chronic heart failure after acute myocardial infarction, lisinopril should be prescribed only if hemodynamic parameters are stable.

Renovascular hypertension/renal artery stenosis (see “Contraindications”).

In renovascular hypertension and bilateral (or unilateral in the case of a solitary kidney) renal artery stenosis, the use of lisinopril is associated with an increased risk of excessive reduction in blood pressure and renal failure. This risk may be exacerbated by the use of diuretics. Even in patients with unilateral renal artery stenosis, renal failure may be accompanied by only minor changes in serum creatinine levels. Therefore, treatment of such patients should be carried out in a hospital under close medical supervision, starting with a low dose, and increasing the dose should be gradual and careful. During the first week of therapy, diuretic treatment should be interrupted and renal function monitored.

Renal dysfunction.

Use with caution in patients with reduced renal function. Such patients require a lower dose or a longer interval between doses (see "Dosage and Administration").

Reports of an association between lisinopril therapy and renal failure relate to patients with chronic heart failure or existing renal dysfunction (including renal artery stenosis). With timely diagnosis and proper treatment, renal failure associated with lisinopril therapy is usually reversible.

In some patients with arterial hypertension without obvious renal dysfunction, an increase in blood urea and creatinine was observed during simultaneous therapy with lisinopril and diuretics. In this situation, it may be necessary to reduce the dose of the ACE inhibitor or discontinue the diuretic, and the possible presence of undiagnosed renal artery stenosis should also be considered.

Lisinopril therapy for acute myocardial infarction should not be prescribed to patients with signs of renal dysfunction: serum creatinine concentration more than 177 µmol/l (2 mg/dl) and/or proteinuria more than 500 mg per day. Lisinopril should be discontinued if renal dysfunction develops during therapy (serum creatinine Cl <30 ml/min or a doubling of the serum creatinine level compared to its level before treatment).

Elevated serum potassium levels (hyperkalemia).

Lisinopril therapy may lead to increased levels of potassium ions in the blood serum (hyperkalemia), especially in the presence of existing renal or heart failure. Prescribing additional therapy with potassium-sparing diuretics or potassium supplements is undesirable, because this can cause a significant increase in serum potassium ion levels. However, if therapy is considered appropriate, regular monitoring of serum potassium levels is necessary during treatment.

Elderly patients.

In elderly patients, the effect of ACE inhibitors may be more pronounced than in younger patients. Therefore, treatment of elderly patients should be carried out with caution. For patients over 65 years of age, an initial dose of lisinopril of 2.5 mg/day is recommended, as well as monitoring of blood pressure and renal function.

Children.

The effectiveness and safety of lisinopril in children has not been sufficiently studied, so its use is not recommended.

Primary hyperaldosteronism.

In primary aldosteronism, antihypertensive drugs whose action is based on inhibition of the renin-angiotensin system are usually ineffective, so the use of lisinopril is not recommended.

Proteinuria.

Rare cases of proteinuria have been reported, especially in patients with reduced renal function or after taking sufficiently high doses of lisinopril. For clinically significant proteinuria (more than 1 g/day), the drug should be used only after careful comparison of the expected benefits and potential risks and with regular monitoring of clinical and laboratory parameters.

LDL pheresis/desensitization.

During LDL pheresis using dextran sulfate, concomitant therapy with ACE inhibitors can lead to life-threatening anaphylactic reactions. These reactions (for example, a drop in blood pressure, difficulty breathing, vomiting, allergic skin reactions) are also possible when lisinopril is prescribed against the background of desensitizing therapy for insect bites (for example, bees or wasps).

If LDL pheresis or desensitization therapy for insect bites is necessary, lisinopril should be temporarily replaced with another drug (but not an ACE inhibitor) for the treatment of hypertension or heart failure.

Tissue swelling/angioedema (see “Contraindications”).

There are rare reports of angioedema of the face, extremities, lips, tongue and nasopharynx in patients receiving ACE inhibitors, including lisinopril. Edema can develop at any stage of therapy, which in such cases should be stopped immediately and the patient's condition monitored.

If the swelling is limited to the face and lips, it usually goes away without treatment, although antihistamines may be used to relieve symptoms.

The risk of developing angioedema during therapy with ACE inhibitors is higher in patients who have a history of angioedema not associated with the use of ACE inhibitors.

Angioedema of the tongue and nasopharynx is life-threatening. In this case, emergency measures are indicated, including immediate subcutaneous administration of 0.3–0.5 mg of epinephrine or slow intravenous administration of 0.1 mg of epinephrine while monitoring ECG and blood pressure. The patient must be hospitalized. Before discharge, the patient should be observed for at least 12–24 hours until all symptoms disappear completely.

Aortic stenosis/hypertrophic cardiomyopathy.

ACE inhibitors should be prescribed with caution to patients with obstruction of blood outflow from the left ventricle. In case of hemodynamically significant obstruction, lisinopril is contraindicated.

Neutropenia/agranulocytosis.

Rare cases of neutropenia or agranulocytosis have been reported in patients with arterial hypertension receiving ACE inhibitors. They were rarely observed in uncomplicated arterial hypertension, but were more common in patients with renal failure, especially with concomitant lesions of vascular or connective tissues (for example, systemic lupus erythematosus or dermatosclerosis) or with simultaneous therapy with immunosuppressants. Regular monitoring of blood leukocytes is indicated for such patients. After discontinuation of ACE inhibitors, neutropenia and agranulocytosis disappear.

If there is an increase in body temperature, enlarged lymph nodes and/or sore throat during treatment, you should immediately consult a doctor and determine the concentration of leukocytes in the blood.

Surgical interventions/general anesthesia.

In patients undergoing major surgery and receiving general anesthesia with drugs that lower blood pressure, lisinopril blocks the formation of angiotensin II due to compensatory secretion of renin. If arterial hypotension develops as a result, it can be corrected by replenishing fluid volume (see “Interactions”).

In case of malignant hypertension or chronic heart failure, the initiation of therapy, as well as dose changes, should be done in a hospital setting.

If you take the drug at a dose lower than prescribed or skip a dose of the drug, it is unacceptable to double the dose at the next dose. Only a doctor can increase the dose.

In case of temporary interruption or cessation of therapy in patients with heart failure, symptoms may reappear. Do not interrupt treatment without consulting your doctor.

There are no studies of the effect of this drug on the ability to drive vehicles. However, one should take into account the possibility of impaired ability to drive vehicles and machinery, as well as to work without reliable support due to dizziness and increased fatigue that sometimes occur.

Contraindications to the use of Lisinopril

Contraindications to the use of Lisinopril are pregnancy and breastfeeding. If the expectant mother suffers from hypertension, her condition is monitored in a hospital setting. High blood pressure in such cases is corrected with safe doses of diuretics.

If replacing the drug during breastfeeding is not possible, you should definitely transfer the child to artificial feeding or feeding with donor milk.

Other contraindications are:

• excess potassium in the blood;
• renal dysfunction;
• gout;
• renal artery stenosis;
• elderly age;
• cerebrovascular insufficiency;
• hypotension;
• childhood;
• tissue obstruction that interferes with normal outflow;
• availability of a donor kidney.

Lisinopril: instructions for use

The drug is taken once a day. It is important to observe the time interval between medication doses. Superimposing the effect of one dose on another threatens severe hypotension, up to loss of consciousness.

If the first tablet was taken at lunch, then the second tablet should not be taken in the morning hours of the next day. It is important to keep taking your medication at lunchtime.

A single dose is prescribed by the attending physician based on the following studies:

• blood pressure conditions;
• heart function;
• vascular health;
• risk factors.

If an increase in the single dose is not required, as a rule, a single dose of 2.5 mg of Lisinopril is sufficient to normalize the patient's condition. Dose adjustments can be made no earlier than after 4 weeks of continuous use of the drug, since it is after this time that the maximum possible therapeutic effect is achieved.

If increasing the dose does not give the required result, a similar drug from a different pharmacological group is prescribed, the action of which in a different way will help normalize blood pressure.

If treatment of an insulin-dependent patient is required, Lisinopril is taken under the strict supervision of a specialist in a hospital setting.

Directions for use and doses

Inside, regardless of food intake. For arterial hypertension, patients not receiving other antihypertensive drugs are prescribed 5 mg 1 time per day. If there is no effect, the dose is increased every 2–3 days by 5 mg to an average therapeutic dose of 20–40 mg/day (increasing the dose above 40 mg/day usually does not lead to a further decrease in blood pressure). The usual daily maintenance dose is 20 mg. The maximum daily dose is 40 mg.

The full effect usually develops within 2–4 weeks from the start of treatment, which should be taken into account when increasing the dose. If the clinical effect is insufficient, it is possible to combine the drug with other antihypertensive drugs.

If the patient has received prior treatment with diuretics, then taking such drugs should be stopped 2-3 days before starting lisinopril. If this is not feasible, then the initial dose of lisinopril should not exceed 5 mg/day. In this case, after taking the first dose, medical supervision is recommended for several hours (the maximum effect is achieved after approximately 6 hours), because A pronounced decrease in blood pressure may occur.

In case of renovascular hypertension or other conditions with increased activity of the RAAS, it is also advisable to prescribe a low initial dose of 2.5–5 mg per day, under enhanced medical supervision (monitoring blood pressure, renal function, potassium concentration in the blood serum). The maintenance dose, while continuing strict medical supervision, should be determined depending on the dynamics of blood pressure.

In case of renal failure, due to the fact that lisinopril is excreted through the kidneys, the initial dose should be determined depending on creatinine clearance, then, in accordance with the response, a maintenance dose should be set under conditions of frequent monitoring of renal function, potassium and sodium levels in the blood serum.

* Including patients undergoing hemodialysis treatment.

For persistent arterial hypertension, long-term maintenance therapy of 10–15 mg/day is indicated.

For CHF, the initial dose is 2.5 mg 1 time per day, followed by an increase by 2.5 mg after 3–5 days to the usual maintenance daily dose of 5–20 mg. The dose should not exceed 20 mg/day.

In elderly people, a more pronounced and prolonged hypotensive effect is often observed, which is associated with a decrease in the rate of elimination of lisinopril (it is recommended to start treatment with 2.5 mg/day).

Acute myocardial infarction (as part of combination therapy). On the first day - 5 mg orally, then 5 mg every other day, 10 mg after two days and then 10 mg once a day. The course of treatment is at least 6 weeks.

At the beginning of treatment or during the first 3 days after acute myocardial infarction in patients with low sBP (120 mmHg or lower), a lower dose of 2.5 mg should be prescribed. If blood pressure decreases (sBP is less than or equal to 100 mm Hg), the daily dose of 5 mg is temporarily reduced to 2.5 mg if necessary. In case of prolonged pronounced decrease in blood pressure (sBP below 90 mm Hg for more than 1 hour), treatment with lisinopril should be discontinued.

Diabetic nephropathy. In patients with non-insulin-dependent diabetes mellitus, 10 mg of lisinopril is used once a day. If necessary, it is possible to increase the dose to 20 mg 1 time per day in order to achieve DBP values ​​below 75 mmHg. Art. in a sitting position. In patients with insulin-dependent diabetes mellitus, the dosage is the same in order to achieve DBP values ​​below 90 mmHg. Art. in a sitting position.