Lisinopril Prinivil Zestril
Lisinopril Prinivil Zestril Tablets
| Name of the drug | Form; dose; packaging | Manufacturer |
|
Availability | ||
|---|---|---|---|---|---|---|
| Lisinopril | tablets; 5 mg; 28 tabl. | Zestril | 41.50 | Yes, buy on MedicMex (this online pharmacy) here | ||
| Lisinopril | tablets; 10 mg; 28 tabl. | Generic | 11.00 | Yes, buy on MedicMex (this online pharmacy) here | ||
| Lisinopril | tablets; 20 mg; 28 tabl. | Zestril | 128.77 |
What is Zestril (Prinivil) Lisinopril?
A drug from the group of angiotensin-converting inhibitors, which, like all drugs in this group, inhibits the formation of angiotensin II, a substance that causes vascular spasm and stimulates the release of aldosterone.
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What does Zestril (Prinivil) Lisinopril contain and how does It work?
The active substance of the drug is lisinopril, which belongs to a group of drugs called angiotensin-converting agent inhibitors.
The General mechanism of action of drugs in this group is to inhibit the activity of the enzyme responsible for the formation of angiotensin II (this enzyme is the konwertaza of angiotensin, often referred to by the abbreviation ACE, which comes from the English name of the Angiotensin Converting Enzyme device).
Inhibition of the activity of this enzyme leads to restriction of conversion (conversion) of inactive angiotensin and to active angiotensin II. Angiotensin II plays an important role in the pathophysiology of hypertension. The result of angiotensin II is a spasm of blood vessels and increased release of aldosterone, which leads to increased blood PRESSURE.
The action of drugs from the group of angiotensin-converting inhibitors leads to a decrease in the concentration of angiotensin II and, consequently, to a decrease in blood PRESSURE. In addition, ACE inhibitors enhance bradykinin-dependent effects (a substance that has a diastolic effect on blood vessels), have a protective effect on blood vessels, and exhibit an anti-atherosclerotic effect.
They are used as drugs to reduce blood pressure, as well as for the treatment and prevention of diseases of the cardiovascular system, as well as for the treatment of kidney diseases (diabetic and non-diabetic nephropathy). Clinical trials have confirmed the effectiveness of many of them in reducing cardiovascular mortality.
In patients with heart failure, ACE inhibitors reduce vascular resistance, which improves hemodynamic conditions and increases physical performance, positively affecting the quality of life.
After oral administration, the maximum concentration of Zestril Lisinopril is reached within 6 years.- 8. hours. The antihypertensive effect begins between 1.-2. hour and strongest between 6.- 8. one hour after oral administration of the drug. Full development of antihypertensive action may require several weeks of use of the drug. Lisinopril is not metabolized in the liver. It is excreted unchanged, mainly in the urine.
When to use Zestril (Prinivil) Lisinopril?
The drug is indicated for treatment:
* spontaneous and renal vascular hypertension (monotherapy or combined treatment)
* heart failure (monotherapy or combined treatment)
* hemodynamically stable patients with a fresh heart attack, in order to prevent the development of left ventricular dysfunction and heart failure (treatment can be started within 24 hours after the onset of a heart attack)
* patients with diabetes mellitus, hypertension, and concomitant renal complications with microalbuminuria.
When not to use this drug?
Unfortunately, even if there are indications for the use of the drug, it can not always be used. You cannot use the drug if you are allergic (hypersensitive) to any component of the drug or other angiotensin-converting agent (ACE) inhibitor. You can also not use the drug if:
* have you ever had angioedema or congenital (hereditary) angioedema?
The drug is contraindicated during pregnancy and breastfeeding.
Do not use in parallel with aliskiren in patients with diabetes mellitus or with moderate or severe renal insufficiency(glomerular filtration coefficient GFR less than 60 ml / min / 1.73 m2).
When to take extra care when using Zestril Lisinopril?
Some diseases and other circumstances may serve as a contraindication to the use or indication for changing the dosage of the drug. In certain situations, certain checks may be required.
Special care should be taken, as the drug may cause a sudden and significant decrease in blood PRESSURE. The increased risk of hypotension after taking the drug especially affects people:
* with low circulating blood volume, dehydrated, or electrolyte deficiencies (for example, taking diuretics, dieting with low salt content, sodium deficiency, dialysis, diarrhoea, or vomiting)
* increased activation of renin–angiotensin–aldosterone (RAA), which can be suspected in severe hypertension, congestive heart failure, hemodynamically significant disruption of blood flow or outflow from the left ventricle of the heart (for example, aortic or mitral valve stenosis [mitral valve]), unilateral renal artery stenosis with another active kidney), a person with cirrhosis of the liver and/or wodobrzuszem, persons who are exposed to or znieczulanych
* in severe congestive heart failure (oliguria, progressive azotemia, and acute renal failure may also occur)
* at an increased risk of myocardial or brain ischemia in severe hypotension (for example, in people with coronary heart disease or cerebral vascular stenosis, in whom hypotension can cause a heart attack, stroke).
In the above cases, treatment can only be started under strict medical supervision.
Due to the increased risk of hypotension, special medical supervision and careful monitoring is required, especially at the initial stage of treatment and each time the dose is increased.
If symptomatic hypotension occurs, the patient should lie on his back and seek medical help. The occurrence of transient arterial hypotension after taking the first dose of the drug is not a contraindication for further use of the drug, but it is necessary to achieve stabilization of blood PRESSURE and fluid volume.
Caution should be exercised in patients with impaired blood outflow from the left ventricle of the heart (for example, aortic or mitral valve stenosis, hypertrophic cardiomyopathy) due to the risk of severe hypotension.
Do not start using the drug in people with a fresh heart attack if the systolic blood PRESSURE is below 100 mmHg. the patient may have symptoms of cardiogenic shock due to the risk of further deterioration of the patient's condition.
In patients with renal failure and severe heart failure, the use of drugs acting on the renin-angiotensin-aldosterone system can exacerbate existing disorders. Acute renal failure may occur, usually transient after discontinuation of the drug. Before and during treatment, the doctor will prescribe monitoring of kidney function and adjust the dosage accordingly.
After treatment in patients with bilateral renal artery stenosis or stenosis of the artery only kidneys active, you may experience increased levels of urea and creatinine in the blood, especially if the drug is used in conjunction with a diuretic. If necessary, your doctor will recommend that you reduce the dose or stop using the diuretic. The risk of these disorders is increased in people with pre-existing kidney failure. Treatment can only be carried out under strict medical supervision.
After using the drug, patients with hypertension without impaired renal function may experience an increase in urea and creatinine levels in the blood, especially if the drug is used in parallel with a diuretic. If necessary, the doctor will recommend reducing the dosage or discontinuing diuretic and / or Lisinopril (Zestril). The risk of these disorders is further increased in patients with impaired renal function.
The drug can cause hematological disorders, including neutropenia (a decrease in the number of neutrophils) and agranulocytosis. The doctor prescribes regular blood monitoring, especially at the beginning of treatment and in people with impaired kidney function, people with connective tissue disease (for example, systemic lupus erythematosus or scleroderma), as well as people who use other drugs that can cause changes in the blood (allopurinol, immunosuppressants, GCS, procainamide, cytostatyki). In case of any signs of infection (for example, infection). fever, swollen lymph nodes, sore throat) it is necessary to consult a doctor and make sure that there was no decrease in the body's immunity.
The drug can cause angioedema (swelling of the face, mouth, tongue, throat, and larynx, which can make breathing difficult and may be life-threatening). If the first symptoms of edema appear, stop taking the drug and immediately seek medical help. Hospitalization, observation of the patient (at least 12-24 hours), and sometimes appropriate treatment is required. After the occurrence of angiotensin converting swelling, you should not reuse the drug or other inhibitors of angiotensin-converting means. The risk of angioedema is increased in people who have a history of angioedema, and in black people.
Extracorporeal blood circulation procedures (hemodialysis, hemofiltracja, low-density LDL lipoprotein apheresis), during which the blood is exposed to contact with electrically negatively charged surfaces, can lead to the development of severe reactions rzekomoanafilaktycznych, revealing themselves as facial edema, hypertension, dusznością, a sudden feeling of heat.
To prevent these reactions, the doctor will recommend appropriate treatment.
The use of the drug is associated with an increased risk of anaphylactic reactions to insect venom and other allergens, as well as during desensitization (in the case of planned desensitization, you should consult a doctor who, as far as possible, will prescribe a temporary discontinuation of the drug).
Very rarely, the use of the drug may be associated with the onset of cholestatic jaundice, which can lead to lightning-fast liver necrosis, sometimes ending in death. If you experience cholestatic jaundice or increased hepatic transaminases, you should immediately consult a doctor, as you may need to stop using the drug and conduct appropriate treatment.
The drug may cause hyperkalemia (increased blood potassium levels). Hyperkalemia can cause serious heart rhythm problems. The doctor prescribes monitoring of potassium concentration in the blood, especially in people who have an increased risk of developing hyperkalemia (people with kidney failure, diabetic patients, taking medications that increase the concentration of potassium in the blood, including potassium salts, diuretics, potassium or heparin residents, a person who is dehydrated, a person with heart failure or metabolic acidosis).
For diabetics taking oral diabetes medications or insulin, your doctor will recommend that you monitor your blood glucose levels, especially during the initial period of use of the drug. There is a risk of hypoglycemia, that is, a decrease in blood glucose.
ACE inhibitors can also cause a persistent cough (a consequence of the increased action of bradykinin), without expectoration, which passes after discontinuation of the drug.
Tell your doctor about using the drug if you are planning an operation or other procedure that requires anesthesia. The use of the drug in parallel with anesthetics can lead to significant hypotension and even shock.
In people of the black race, the drug may be less effective in reducing blood pressure.
Combined use of various drugs acting on the renin-angiotensin-aldosterone system is not recommended. Therefore, it is not recommended to use the drug in combination with other drugs acting on the renin–angiotensin–aldosterone system (for example, with drugs from the angiotensin II receptor antagonist group or with aliskirenem) because of the risk of hypotension, increased blood potassium concentration (hyperkalemia), and kidney function disorders, including acute renal failure.
However, if the doctor considers this combination treatment absolutely necessary, it should be carried out under the supervision of a specialist, and kidney function, electrolyte concentration, and blood pressure should be carefully monitored. In patients with diabetic nephropathy, ACE inhibitors and angiotensin II receptor antagonists should not be used in parallel.
The use of the drug in parallel with aliskiren is contraindicated in patients with diabetes mellitus or with impaired renal function(glomerular filtration coefficient GFR less than 60 ml / min / 1.73 m2).
Does this drug affect your ability to drive?
The drug can lead to hypotension, along with dizziness, visual impairment, weakening, omdleniami and other symptoms that can disrupt the performance of psychophysical practices and the ability to drive vehicles and maintain machinery and equipment. This effect of the drug is usually enhanced at the beginning of treatment and if alcohol is consumed in parallel.
Lisinopril Zestril Prinivil Dosage
The drug is available in the form of tablets for oral use. The drug should be taken once a day, daily at the same time of day. Can be taken regardless of food intake. Do not exceed the recommended doses, as this will not increase the effectiveness of the drug and may harm your health and life. If you have any doubts about using the drug, contact your doctor.
Adults:
Arterial hypertension is spontaneous in patients who do not take diuretics: initially, 10 mg 1 time per day. The maintenance dose is usually 20-40 mg once a day. The doctor will adjust the maintenance dose depending on the blood pressure value. For a complete antihypertensive effect, it may take 2-4 weeks to use maintenance doses.
In patients who are particularly at risk of hypotension, treatment should start with a lower dose. If there is a violation of kidney function, dehydration, a decrease in the volume of circulating blood or electrolyte disorders, the doctor will recommend appropriate treatment before using the drug. In those patients, as well as those who can not stop taking diuretics or in patients with renal vascular hypertension, it is necessary to adjust the dosage by a doctor and use a lower initial dose.
Spontaneous hypertension in people taking diuretics in parallel: in this group of patients, the risk of symptomatic hypotension is increased. In addition, in this group of patients, there may be dehydration and electrolyte disturbances, and therefore an individual dose adjustment by a doctor is required. If possible, the doctor will recommend that you stop taking diuretics 2-3 days before starting the drug. If you cannot stop using a diuretic, use of the drug should be started under strict medical supervision.
The initial dose in these patients is usually 5 mg per day. It is necessary to monitor blood pressure until the expected clinical effect is achieved and additionally for another 1 hour. It is necessary to monitor kidney function and blood potassium levels. Your doctor will adjust the further dosage individually, depending on the blood pressure value.
Patients with renal vascular hypertension may experience a significant decrease in blood pressure, as well as kidney failure and renal failure. The recommended initial dose in this group of patients is 2.5-5 mg per day. Then the doctor will determine the dose, adapting it to the value of blood pressure.
Heart failure: the initial dose is 2.5 mg once a day in the morning, and treatment should be started under strict medical supervision. The doctor will adjust the dose based on the patient's individual response to treatment. If necessary, it will increase the dose at intervals of several weeks. The maintenance dose is usually 5-20 mg.
For patients, especially at risk of symptomatic hypotension, who experience dehydration, a decrease in the volume of circulating blood or electrolyte disturbances (hyponatremia), the doctor will recommend equalizing existing disorders before starting the drug and regular monitoring of kidney function and blood potassium concentration. If possible, your doctor will recommend that you reduce your dose or stop using diuretics before starting the drug. If the systolic pressure is below 100 mmHg. The greatest decrease in blood PRESSURE occurs after about 6 years.- 8. hours since the initial dose. It is necessary to monitor the value of blood pressure before it stabilizes.
For patients with heart failure and kidney failure or hyponatremia, special care should be taken, and treatment can only be started under strict medical supervision with a dose of 2.5 mg per day.
Fresh heart attack: inpatient treatment can be started within 24 hours of the onset of heart attack symptoms. The initial dose is 5 mg, followed by another 5 mg after 24 hours, 10 mg after 48 hours, and then 10 mg once a day for 6 weeks. In patients with low systolic pressure below 120 mmHg. for example, the doctor will recommend using a lower dose (usually 2.5 mg per day initially).
If the systolic blood pressure drops to 100 mm Hg during the period of use of the drug. if it becomes less, the doctor will recommend reducing the dose to 2.5-5 mg per day. In the event of hypotension (systolic pressure less than 90 mm Hg. if the drug persists for more than 1 hour, the doctor will advise you to stop using the drug. Treatment can continue for 6 weeks, after which the patient's condition will be re-evaluated. On its basis, the doctor will make further therapeutic decisions.
Special care should be taken in patients with heart attack and kidney failure. The doctor will determine the dosage based on creatinine clearance, a parameter that characterizes kidney function. The dosage is not established in patients after a heart attack with severe renal failure.
Diabetic nephropathy: in patients with hypertension and type 2 diabetes and incipient diabetic nephropathy, the initial dose is usually 10 mg 1 time per day. The size of the maintenance dose will be determined by the doctor individually.
If kidney function is impaired, the dosage should be adjusted. The doctor will determine the dosage based on creatinine clearance, a parameter that characterizes kidney function.
If the creatinine clearance is within 30-70 ml / min, the initial dose is 5-10 mg; if the creatinine clearance is within 10-30 ml / min, the initial dose is 2.5-5 mg; if the creatinine clearance is less than 10 ml / min, the initial dose is 2.5 mg. the Maximum dose in patients with renal failure is 40 mg / day.
Zestril Lisinopril is removed during hemodialysis; in patients on dialysis, the appropriate dose of Lisinopril is administered after dialysis.
In elderly patients, special care should be taken when increasing the dose.
Children 6.-16. year of life:
Hypertension: if the body weight is 20-50 kg initially 2.5 mg 1 time per day, the maximum dose is 20 mg per day; if the body weight is 50 kg or more, initially 5 mg 1 time per day, the maximum dose is 40 mg per day. In children with impaired kidney function, the doctor will recommend reducing the initial dose or increasing the interval between successive doses.
Do not use the drug in children for indications other than hypertension.
In children with kidney failure, the doctor will recommend reducing the initial dose or increasing the interval between doses.
Do not use the drug in children with severe renal failure (glomerular filtration coefficient GFR less than 30 ml / min / 1.73 m2).
Do not use the drug in children under 6 years of age. year of life.
Can Zestril Lisinopril Prinivil be used during pregnancy and breastfeeding?
During pregnancy, do not use any medications without consulting your doctor!
It is very important to consult your doctor before using any medication during pregnancy or breastfeeding and to clarify beyond any doubt the potential risks and benefits of using this medication. If you are pregnant or planning to become pregnant, tell your doctor who prescribes this medicine.
The use of the drug during pregnancy is contraindicated. Before starting treatment, make sure that the woman is not pregnant. If a woman is planning a pregnancy, it is recommended to change the method of antihypertensive treatment. If you suspect or confirm pregnancy while taking the drug, you should contact your doctor as soon as possible, since you need to immediately stop using the drug. Your doctor may recommend that you use other antihypertensive medications.
If the doctor considers it necessary to use the drug in a woman of childbearing age, she should consult a doctor about using an effective method of preventing pregnancy during treatment.
The use of the drug is contraindicated during breastfeeding.
Can I use other medications in parallel?
Tell your doctor about all the medications you have been taking recently, including those that are given without a prescription.
Diuretics enhance the antihypertensive effect of Lisinopril.
Previous use of diuretics may increase the risk of hypotension after starting treatment with Zestril Lisinopril. If possible, your doctor will recommend that you stop using diuretics before starting the drug.
Non-steroidal anti-inflammatory drugs (for example, acetylsalicylic acid, Ibuprofen, COX-2 inhibitors) can reduce the antihypertensive effect of the drug and cause kidney function disorders, including acute renal failure and increased blood potassium levels. These disorders are especially likely to occur in people with kidney failure, dehydrated people, and the elderly.
During the use of the drug, it is not recommended to use Sartans (angiotensin receptor antagonists), due to the risk of severe symptomatic hypotension, hyperkalemia and renal failure due to increased inhibition of the renin-angiotensin-aldosterone system. If the doctor considers this combination treatment absolutely necessary, it is necessary to monitor kidney function, potassium levels, and blood pressure.
Combined use of various drugs acting on the renin-angiotensin-aldosterone system is not recommended. Therefore, it is not recommended to use the drug in combination with other drugs acting on the renin–angiotensin–aldosterone system (for example, with drugs from the group of angiotensin II receptor antagonists or with aliskirenem) because of the risk of symptomatic hypotension, increased blood potassium concentration (hyperkalemia) and renal dysfunction, including acute renal failure.
However, if the doctor considers this combination treatment absolutely necessary, it should be carried out under the supervision of a specialist, and kidney function, electrolyte concentration, and blood pressure should be carefully monitored. In patients with diabetic nephropathy, ACE inhibitors and angiotensin II receptor antagonists should not be used in parallel.
The use of the drug in parallel with aliskiren is contraindicated in patients with diabetes mellitus or with impaired renal function(glomerular filtration coefficient GFR less than 60 ml / min / 1.73 m2).
The drug may increase the toxic effect of lithium salts. Parallel use of lithium is not recommended, and if such combined treatment is necessary, the lithium concentration should be monitored; if necessary, the doctor will recommend reducing the lithium dose used.
Parallel use of diuretics increases the risk of toxic effects of lithium.
Parallel use of drugs that affect the concentration of potassium in the blood (potassium salts, some diuretics and antihypertensives such as spironolactone, triamteren, amiloryd, eplerenon, potassium supplements, trimetoprym, tacrolimus, cyclosporine, heparin), as well as potassium-containing salt substitutes can lead to an increase in the concentration of potassium in the blood (hyperkalemia). Parallel use of Lisinopril with the above drugs is not recommended. If necessary, the doctor will prescribe regular monitoring of the level of potassium in the blood.
If the drug is used in parallel with antihypertensive drugs or other drugs that can reduce blood pressure (for example, nitroglycerin and other nitrates, tricyclic antidepressants, anesthetics, antipsychotics, barbiturates, opioids), there may be an increase in antihypertensive action and hypotension.
In parallel, drugs used to reduce the immune response (for example, some anti-cancer drugs, corticosteroids used in General) increase the risk of hematological disorders associated with excessive reduction in the number of white blood cells.
The drugs used for General anesthesia enhance the antihypertensive effect of the drug; severe hypotension is possible.
Parallel use of nitrates, propanolol, digoxin, and hydrochlorothiazide usually does not cause clinically significant interactions.
The use of the drug in parallel with antidiabetic drugs (oral medications, insulin) can increase the decrease in blood glucose levels and increase the risk of hypoglycemia. Blood glucose levels should be carefully monitored, especially during the first weeks of treatment and in patients with kidney failure.
Parallel use of gold preparations in the blood (for example, aurotiojabłczan sodium) can cause symptoms like after taking nitrates, including potentially severe symptoms of vasodilatation, including sudden redness of the face, nausea, dizziness, and hypotension.
What Zestril Lisinopril Prinivil side effects can occur?
Like any drug, also Prinivil, it can cause side effects, although they will not occur in all patients using this drug. Remember that the expected benefit of the drug is usually greater than the harm from the appearance of side effects.
Common side effects include pain and dizziness, a dry persistent cough, diarrhea, nausea, and a feeling of excessive fatigue.
Rarely possible: symptoms caused by an orthostatic decrease in blood pressure (for example, blood pressure). dizziness, fainting, imbalance, fatigue, weakness, visual impairment), skin rash, angioedema (swelling of the face, lips, tongue, pharynx, larynx, in rare cases can cause narrowing of the Airways, make breathing difficult and endanger life), chest pain, myocardial ischemia, including pain in the dławicowe or myocardial infarction, heart rhythm disorders, rapid heartbeat, increased heart rate (tachycardia), ischemic stroke (secondary to excessive hypotension), transient ischemic attack of the brain, dryness of the oral mucosa, nausea, vomiting, dyspepsia, abdominal pain, increased activity of liver enzymes, cholestatic jaundice, hepatitis, pancreatitis, constipation, syndrome of improper secretion of antidiuretic hormone, decreased blood glucose concentration (hypoglycemia), muscle and joint pain, mood disorders, sleep disorders, depression, ligament conditions, tingling or numbness (paresthesia), violation of sexual function (impotence), bronchospasm, sinusitis, laryngitis, sore throat, infiltrates in the lungs, increased creatinine and urea concentrations in the blood, increased potassium concentration in the blood (hyperkalemia), impaired kidney function (oliguria, anuria, uremia, urinary tract infections), hematological disorders (decreased number of white blood cells [leukopenia], decreased number of neutrophilic granulocytes [neutropenia], agranulocytosis, thrombocytopenia, impaired bone marrow function, hemolytic anemia, enlarged lymph nodes), profuse sweating, severe skin reactions (necrosis, toxic epidermal necrolysis, Stevens and Johnson syndrome, erythema multiforme, a syndrome that includes one or more of the following symptoms: fever, vasculitis, muscle and joint pain, arthritis, an increased OB value, an increase in the number of white blood cells, eosinophilia, that is, an increase in the number of acidophilic granulocytes [eosinophils], a rash, and other dermatological symptoms.