Dosage form: tablets 25 mg and 50 mg. Tablets 25 mg: white, flat-cylindrical with a chamfer, with a risk on one side, with a specific odor; Tablets 50 mg: white, flat-cylindrical, chamfered, with a cruciform score on one side, with a specific odor

Read the entire package leaflet carefully before taking this medicine:

Do not throw away this leaflet. It may be necessary to re-read it.

If you have any questions, ask your doctor or pharmacist.

This medicine must be prescribed by your doctor. Do not pass it on to others. It can harm them even if their symptoms are the same as yours.

If any of the side effects get serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

What Captopril Pharmland is and what it is used for: Each tablet of Captopril Farmland contains the active substance - captopril 25 mg or 50 mg and excipients: corn starch, microcrystalline cellulose, povidone K-30, purified talc, magnesium stearate, anhydrous colloidal silicon dioxide, sodium starch glycolate. Belongs to the group of angiotensin-converting enzyme inhibitors (ACE inhibitors). Expands peripheral vessels, which facilitates the work of the heart and lowers blood pressure (BP). Normalization and control of blood pressure avoids such consequences of arterial hypertension as myocardial infarction and stroke.

Captopril Pharmland is used in the following cases:

Hypertension: the drug is indicated for the treatment of arterial hypertension.

Heart failure: the drug is indicated for the treatment of chronic heart failure with a decrease in left ventricular systolic function. May be used in combination with diuretics and, if necessary, digitalis preparations and beta-blockers.

Myocardial infarction:

Short-term (4 weeks) use: the drug is used for clinically stable patients during the first 24 hours after a heart attack.

Long-term prevention of symptomatic heart failure: Used for clinically stable patients with asymptomatic left ventricular dysfunction.

Type I diabetic nephropathy: the drug is indicated for the treatment of diabetic nephropathy in insulin-dependent diabetes mellitus.

Do not take Captopril Pharmland if:

hypersensitivity to captopril, excipients or other ACE inhibitors;

angioedema in the past (including during therapy with ACE inhibitors);

second and third trimester of pregnancy;

lactation period;

concomitant use of ACE inhibitors with angiotensin II blockers (ARB II) or aliskiren in the presence of diabetes mellitus or moderate/severe renal insufficiency (GFR)<60 мл/мин/1,73 м 2).

When prescribing Captopril Pharmland, be sure to inform your doctor if you are taking any of the medicines listed below. Perhaps, when they are taken together, a dose adjustment or additional examinations will be necessary:

Non-steroidal anti-inflammatory drugs (indomethacin, ibuprofen, etc.): an increase in serum potassium levels with a decrease in kidney function is possible. In patients with impaired renal function, the elderly or dehydrated, acute renal failure may develop. Long-term use of anti-inflammatory drugs may reduce the ability of ACE inhibitors to reduce blood pressure.

Medicines to treat gout (allopurinol), immunosuppressive drugs (azathioprine, cyclophosphamide, etc.): increased risk of a decrease in the number of white blood cells in the blood.

Potassium preparations, salt-substituting solutions with potassium, other drugs that increase the level of potassium in the blood (spironolactone, amiloride, etc.): ACE inhibitors reduce potassium loss, serum potassium increases significantly. Monitoring of potassium levels is recommended.

Medicines for the treatment of diabetes: their ability to lower sugar levels is enhanced, regular monitoring of blood glucose levels is recommended.

Medicines that dilate blood vessels (minoxidil, clonidine, etc.): risk of hypotension. BP control recommended.

Medicines for the treatment of psychiatric problems, including depression (lithium preparations, amitriptyline, etc.): may increase the hypotensive effect. BP control recommended. Co-administration with lithium preparations is not recommended.

Other drugs that reduce blood pressure (beta-blockers - propanolol, atenolol; calcium channel blockers - amlodipine, nifedipine): risk of hypotension. BP control recommended.

Medicines for the treatment of acute myocardial infarction or used in the post-infarction period: used simultaneously with acetylsalicylic acid (in cardiological doses), thrombolytics, beta-blockers and / or nitrates.

Applications of Captopril Pharmland during pregnancy and lactation:

Captopril is contraindicated in the second and third trimesters of pregnancy (toxic effect on the fetus) and during breastfeeding.

Influence on the ability to drive vehicles and control mechanisms:

As with other antihypertensive drugs, the ability to drive and use machines may decrease, especially at the beginning of treatment or when the dosage is changed. These effects depend on the individual sensitivity of the patient.

How to use Captopril Pharmland and recommended doses: The dosage regimen is set individually, taking into account the characteristics of the patient and the reaction from the side of blood pressure. The recommended maximum daily dose is 150 mg. It is taken with or without food.

Arterial hypertension: the recommended initial dose is 25-50 mg per day in two divided doses. If necessary, the dose is increased gradually, with an interval of at least 2 weeks, up to 100-150 mg per day in two divided doses to achieve the desired level of blood pressure. Captopril is used alone or in combination with other drugs, most often with thiazide diuretics, in which case a single daily dose is sufficient.

For patients with renovascular hypertension, hypovolemia, heart failure, the recommended single dose is 6.25 mg or 12.5 mg. Treatment begins under medical supervision. Gradually, with an interval of at least 2 weeks, the dose can be increased to 50 mg per day in one or two doses, and if necessary, up to 100 mg per day in one or two doses.

Heart failure: treatment with captopril for heart failure begins under the supervision of a physician. The initial dose is 6.25 mg - 12.5 mg two to three times a day. The maintenance dose (75-150 mg per day) is determined by the response to treatment, condition and tolerability. The maximum recommended daily dose is 150 mg in divided doses. The dose is increased gradually, at intervals of at least 2 weeks, to be able to evaluate the response to treatment.

Myocardial infarction:

Short-term treatment: treatment with captopril may be started in a hospital after the physician has assessed the stability of the patient's condition. First, a trial dose of 6.25 mg is taken, then after 2 hours - 12.5 mg and after 12 hours - 25 mg. From the next day, in the absence of adverse reactions, 100 mg of captopril per day is taken in two divided doses for 4 weeks. After 4 weeks of treatment, the patient's condition is reassessed and a decision is made to continue treatment in the postinfarction period.

Long-term treatment: If treatment with captopril is not started within the first 24 hours after an acute myocardial infarction, it is expected that treatment of clinically stable patients will be initiated between 3 and 16 days after the infarction. Treatment should be started in a hospital with close monitoring of blood pressure until a dose of 75 mg is reached. The initial dose should be low, especially in normal or low blood pressure. Treatment begins with a dose of 6.25 mg, then 12.5 mg per day for 2 days, and then 25 mg 3 times a day, in the absence of adverse hemodynamic reactions. The recommended dose for long-term treatment is 75-150 mg per day in two to three divided doses. In the event of symptomatic hypotension, the dose of diuretics and/or vasodilators used concomitantly is reduced in order to achieve a stable dose of captopril. If necessary, the treatment regimen is adjusted depending on the response to treatment. The drug is used in conjunction with other drugs for the treatment of myocardial infarction, in particular thrombolytic agents, beta-blockers and acetylsalicylic acid.

Type I diabetic nephropathy: Patients with type I diabetic nephropathy are recommended captopril at a dose of 75-100 mg per day in divided doses.

Impaired renal function: since captopril is excreted mainly through the kidneys, in patients with renal insufficiency, the dose is reduced, and the interval between doses is increased. The level of potassium and creatinine in the blood is monitored:

Creatinine level > 40 ml / min / 1.73 m 3 - initial daily dose of 25-50 mg - maximum daily dose of 150 mg;

21-40 ml / min / 1.73 m 3 - initial daily dose of 25 mg - maximum daily dose of 100 mg;

10-20 ml / min / 1.73 m 3 - initial daily dose 12.5 mg - maximum daily dose 75 mg;

- < 10мл/мин/1,73 м 3 - начальная суточная доза 6,25мг - максимальная суточная доза 37,5мг.

If concomitant diuretic therapy is required, loop diuretics (eg, furosemide) are preferred. Thiazide diuretics should be avoided.

Elderly Patients: Elderly patients are advised to start treatment with captopril at the lowest dose (6.25 mg twice daily) as there may be decreased renal function or other comorbidities.

Children and adolescents: The efficacy and safety of captopril in children and adolescents under 18 years of age have not been studied. Captopril should only be given to children if other blood pressure-lowering drugs are not effective, and only under the supervision of a physician.

If you have taken a higher dose of Captopril Pharmland than recommended by your doctor: If the number of tablets per day that you have taken exceeds the number recommended by your doctor, or your child has swallowed the tablets, contact your doctor immediately or call an ambulance! An overdose is likely to cause a pronounced significant decrease in blood pressure, heart rate, stupor, impaired renal function, and changes in blood biochemical parameters. Stop taking the medicine! As a first aid, lay the patient on his back so that the head is lowered and the legs are raised. Control of blood pressure, heart rate. Gastric lavage, activated charcoal and sodium sulfate are recommended for 30 minutes after taking the tablets.

If you forget to take your next dose of Captopril Pharmland on time: Take the tablet at your next appointment. Do not take a double dose in case of a missed dose.

Possible side effects: Like all medicines, Captopril Pharmland can cause side effects, which vary in frequency, regardless of whether it has been used before.

Common (1 in 100 to 1 in 10 cases): dizziness, itching, rash, hair loss, change in taste, shortness of breath, dry mouth, sleep disturbance, loose stools or constipation, dry cough, stomach upset, abdominal pain.

Infrequently (1/1,000 - 1/100 cases): violation of the frequency and rhythm of heartbeats, low blood pressure, deterioration of blood circulation in the arms and legs, fatigue, deterioration in general condition, pallor, swelling of the eyes and lips.

Rarely (1/10,000 - 1/1,000 cases): loss of appetite, drowsiness, headache, numbness, paresthesia, ulceration of the oral mucosa, impaired renal function or renal failure, change in the frequency of urination.

Very rare (less than 1 in 10,000 cases): abnormal liver function, elevated liver enzymes, confusion, depression, fainting, transient cerebrovascular accident, blurred vision, heart attack, chest infections, inflammation of the pancreas, nasal discharge , swelling of the tongue, sexual dysfunction, Stevens-Jones syndrome, liver damage, jaundice, stomach ulcers, muscle and joint pain, shortness of breath, difficulty breathing, rash or skin reactions, swelling of the mammary glands in men, fever, increased sensitivity of the skin to light, changes in biochemical parameters of blood (potassium, sugar, etc.).

If you experience the following side effects, stop taking the medicine and immediately consult a doctor or call an ambulance: swelling of the hands, face, lips, tongue; difficulty breathing; sudden appearance of rashes, lesions, redness, peeling of the skin; sore throat; severe dizziness or weakness; acute pain in the abdomen; irregular or rapid heartbeat; yellowness of the skin or eyes.

Precautions while using Captopril Pharmland:

Hypotension: Rarely seen in patients with uncomplicated hypertension. Symptomatic hypotension is more typical of hypertensive patients with reduced blood volume and/or reduced blood sodium as a result of intensive diuretic therapy, low salt intake, diarrhea, vomiting, or hemodialysis. Decreased blood volume and sodium must be corrected before using captopril, and low starting doses are preferred.

It should be remembered that, as with all cases of the use of drugs that reduce blood pressure, the reduction of elevated blood pressure in patients with cardiovascular or cerebrovascular diseases is associated with an increased risk of myocardial infarction or stroke. With the development of hypotension, the patient should be brought to a horizontal position. Intravenous saline may be required to replenish blood volume in a hospital setting.

Renovascular hypertension: The initial dose of captopril is determined according to creatinine clearance.

Angioedema: in the treatment of patients with ACE inhibitors, especially in the first weeks of admission, Quincke's edema (swelling of the face, tongue, pharynx, larynx) may develop. In rare cases, it occurs after prolonged use of ACE inhibitors. In this case, the reception should be stopped immediately. Seek immediate medical attention or call an ambulance! Treatment must be carried out in a hospital! The condition is life-threatening!

Cough: often seen with ACE inhibitors. The cough is unproductive, disappears when the drug is stopped.

Liver failure: This rare complication of ACE inhibitors has been observed in association with jaundice and progressive fulminant hepatic necrosis. The mechanism of development of the syndrome is unknown. With the development of jaundice and a significant increase in the activity of liver enzymes, the use of ACE inhibitors stops!

Hyperkalemia: when taking ACE inhibitors, an increase in serum potassium is possible, which often develops in patients with renal insufficiency, diabetes mellitus, when using potassium-sparing diuretics and other drugs that increase potassium (for example, heparin). Recommended control of potassium in the blood.

Aortic and mitral stenosis/obstructive cardiomyopathy: ACE inhibitors are taken with caution.

Neutropenia/agranulocytosis: Rare cases of a decrease in the number of blood cells and hemoglobin have been observed with the use of ACE inhibitors, including captopril. The risk of these complications is increased in patients with collagenoses, vascular disease, immunosuppressive therapy, treatment with allopurinol or procainamide, or a combination of these complicating factors, especially if pre-existing renal impairment is present. In these cases, it is taken with caution. These patients may develop serious infections. It is recommended to control the number of leukocytes before starting treatment, and then every 2 weeks during the first 3 months of therapy, periodically thereafter. Tell your doctor about any signs of infection (sore throat, fever)! If the number of neutrophils in the blood is less than 1000 / ml 3, captopril is also canceled. In most patients, the neutrophil count quickly returns to normal when captopril is discontinued.

Proteinuria: Protein in the urine may occur in patients with renal insufficiency or when taking high doses of ACE inhibitors (>150 mg/day). In most cases, proteinuria decreases or disappears after 6 months, regardless of the use of captopril.

Anaphylactoid reactions during desensitization: In rare cases, life-threatening anaphylactic reactions have been observed in patients undergoing desensitization while taking captopril. In this regard, caution should be exercised when conducting desensitization while taking captopril. Recommended temporary cancellation of captopril during the period of desensitization.

Surgery/Anesthesia: With major surgery, blood pressure may decrease with the use of anesthetics. Correction of the circulating blood volume is recommended.

Patients with diabetes: in the first months of taking ACE inhibitors, patients with diabetes need careful monitoring of blood sugar levels.

Double blockade of the renin-angiotensin-aldosterone system (RAAS): is associated with an increased risk of hypotension, hyperkalemia and renal dysfunction (including acute renal failure) compared with monotherapy. Dual blockade of the RAAS with an ACE inhibitor, ARB II, or Apipiren cannot be recommended for any patient, especially those with diabetic nephropathy. In some cases, when the combined use of an ACE inhibitor and ARB II is absolutely indicated, careful observation by a specialist and mandatory monitoring of kidney function, water and electrolyte balance, and blood pressure are necessary. This refers to the use of candesartan or valsartan as add-on therapy to ACE inhibitors in patients with chronic heart failure.

Race: Like other ACE inhibitors, captopril is less effective in lowering blood pressure in dark-skinned patients than in Caucasians due to the predominance of low renin fractions in dark-skinned patients.

Package: 10 tablets in a blister pack of aluminum foil or 20 or 50 tablets in a polymer jar. 1 can, 2 or 5 blister packs, together with the leaflet, are placed in a secondary packaging made of boxed cardboard

Storage conditions: Store in a place protected from light at a temperature not exceeding 25°C.

Keep out of the reach of children.

Best before date: 3 years. Do not use the medicinal product after the expiration date.

Conditions for dispensing from pharmacies: On prescription.

Producer: Belarusian-Dutch joint venture limited liability company "Pharmland", Republic of Belarus. Republic of Belarus, Nesvizh, st. Leninskaya, 124-. 3, tel/fax 288-96-64.

When a patient is diagnosed with hypertension, in any case, he must take medication to normalize the pressure.

Large selection of drugs used to reduce pressure. One of them is Captopril.

When ingested, Captopril relaxes dilated vessels. Reduces the risk of stroke and heart attack.

The drug is prescribed not only for hypertensive patients. It has many other effects. Doctors prescribe it as a prophylactic against diabetes and oncological pathologies.

What is the effect of captopril

First you need to figure out how the drug acts on the body in order to conclude what it helps from. The main feature of Captopril is that it blocks the enzymes that are responsible for the metabolism and processing of the oligopeptide hormone.

Oligopeptide hormones constrict blood vessels, while increasing blood pressure.

If you use captopril at elevated pressure, you can quickly lower it. Also, the drug is often used to treat hypertension. It can be used for a long time.

The drug is prescribed to treat kidney failure caused by diabetes.

One of the main features of Captopril is that it has an anti-inflammatory effect.

Therefore, it is prescribed in the treatment of cancer, but benign. Treatment of malignant neoplasms will be meaningless.

What does captopril treat?

First of all, Captopril is designed to lower blood pressure and reduce cardiac workload. Therefore, it is prescribed for heart disease, arterial hypertension, diabetic nephropathy (damage to the kidney vessels).

It is prescribed to patients after myocardial infarction.

Captopril inhibits the activity of enzymes that provide angiotensin 1 to angiotensin 2. Thus, the drug is in the group of angiotensin-converting enzymes.

When ingested, the drug forms substances that dilate blood vessels, as a result of which blood pressure rises. If there is no formation of angiotensin 2 in the body, then the vessels continue to be dilated. Because of this, the pressure has been normal for a long time.

Due to the effective effect on the vessels, Captopril is taken regularly, and after the pressure returns to normal, it can be stopped. The pressure decreases as much as an hour or two after taking the pill, it depends on the individuality of the organism.

To achieve a stable decrease in blood pressure, doctors recommend drinking the medicine for a month. In addition to lowering pressure, the drug is able to reduce cardiac stress. This occurs due to the expansion of the lumen of the vessels. It is easier for the heart muscles to work and pass blood flow from the heart to the aorta and pulmonary artery.

Captopril helps people with heart failure to endure physical and emotional stress calmly and without consequences.

If you take a drug to prevent heart failure, then the blood pressure will not change.

Due to its properties, Captopril is used to enhance renal blood flow and cardiac blood supply. Doctors prescribe it as a medicine for the complex treatment of heart diseases and vascular lesions of the kidneys.

Together with Captopril, antihypertensive drugs are prescribed. Captopril differs from such drugs in that when it is used, fluid in the body does not linger.

This means that additional use of diuretics is not needed. And this is important, taking antihypertensive drugs causes swelling.

Indications

What are captopril blood pressure tablets prescribed for? First of all, the drug helps to prevent a hypertensive crisis and reduces pressure.

Captopril is prescribed for:

• renal hypertension, this is the highest form of renal failure;
• essential hypertension (high blood pressure for no particular reason);
• malignant hypertension at high pressure;
• diabetic nephropathy. With lesions of the renal vessels and with the diagnosis of type 1 diabetes mellitus;
• malfunction of the ventricles, especially the left;
• past myocardial infarctions.

When not to take captopril

Tablets are taken for cardiological diseases. There are situations when captopril should not be taken:

• narrowed aorta;
• primary hyperaldosteronism;
• narrowed mitral valves;
• pregnancy and during lactation;
• renal artery stenosis;
• after a kidney transplant;
• individual sensitivity to at least one component that is part of the drug;
• myocardiopathy;

The drug is not prescribed for children under the age of 15 years. It is not recommended to take drivers, it can increase attention disorders.

captopril high blood pressure

There are many ways to take pills correctly. The dosage depends on the indications for taking the medication.

Captopril is prescribed for high blood pressure, in order to reduce it. Captopril tablet is drunk 40 minutes before a meal. This is important, food significantly reduces the intended effect of the drug.

Rules for taking Captopril:

1. For each patient, the doctor selects the dosage individually. Therefore, taking the drug on its own is highly undesirable. In the instructions for use, the dosage depends on the tablet format. They are available in 12.5 and 25 mg. Almost always, patients need to drink 50 mg per day. The medicine is taken twice a day. If you bought 12.5 mg tablets, then you need to drink two tablets in the morning and in the evening, and if 25, then one, respectively.
2. If the patient does not have side effects, then the dosage is increased. This happens after a month of treatment, but no matter what the indications, more than 150 mg per day, it is absolutely impossible to drink. Otherwise, irreversible reactions in the body may begin.
3. You can use the drug as a rapid decrease in blood pressure. If, when measuring pressure, you notice indicators of 145/105 or more, then you should immediately drink one tablet. If after 40 minutes the pressure has not decreased, then you can drink another one. Thus, you can reduce pressure and save yourself the risk of problems with the cardiovascular system.
4. Captopril can be taken as a prophylactic for high blood pressure. In this case, a dosage of not more than 25 mg is acceptable.

Recall that the dose of the drug is selected exclusively by specialists. You can only make the situation worse. Self-treatment can cause headaches, migraines, nausea, weakness, depression, attention disorders, impaired performance.

If, while taking the medicine, you notice one of the side effects, then the treatment with Captopril is stopped. After consulting with your doctor, he may prescribe you another medicine, such as Capoten.

Features of the drug and indications

The drug is not prescribed until the age of 15, but if necessary, the doctor will prescribe it. Again, only a doctor can determine the dosage for a child. In this case, the dosage is not standard. It is calculated in accordance with the body weight of the child, according to the formula 1-1.5 mg per kilogram of weight. The dosage received is for one day.

There are times when, for some reason, I didn’t take a pill in the morning, this does not mean that you need to take two in the evening.

When your doctor prescribes Captopril, before you start taking it, you must restore the volume of water necessary for good health.

During treatment, you must carefully monitor the work of the kidneys. In some patients, during treatment with Captopril, protein in the urine appeared. The protein disappears on its own, without additional therapy, after a month. But if its level exceeds 1000 mg per day, then Captopril is replaced by another drug.

If the patient has:

• inflammation or expansion of the vascular walls;
• diffuse disorders in connective tissues;
• bilateral damage to the vessels and arteries of the kidneys;
• if the patient is taking immunosuppressants;
• when desensitizing therapy is given.

Then Captopril is taken under the strict supervision of the attending physician.

During the first time of treatment, which is approximately three to four months, the patient donates blood every 10 days for a general analysis. After four months, you need to donate blood less often. If the tests showed that the number of leukocytes decreases to a level of 1 g / l or less, then the drug is replaced with another one. As a rule, the level of leukocytes returns to normal in 10-14 days.

Throughout the treatment, the patient periodically takes tests to determine the creatine, urea, protein, and potassium concentrations in the blood and urine. If the protein concentration is increased, then the drug is canceled, and if the level of creatinine and urea is increased, then the doctor reduces the dosage. In order to prevent a sharp reducing effect of the drug, before taking the first pill, exclude all diuretic drugs. Or, their dosage is simply reduced several times. If you notice that after taking the pill, your blood pressure drops sharply, then most likely you begin to develop hypotension. In this case, lie on your back and raise your legs so that they are higher than your head. In this position, you need to lie down for at least half an hour. If the pressure does not rise, then sterile saline, which is administered intravenously, will help you.

Very often, the first tablets of Captopril cause a sharp drop in pressure, so doctors always recommend staying in hospital for the first few days to observe the body's reaction.

Special attention should be paid to surgical intervention. When the patient is taking Captopril, then any surgery is not recommended. And if surgery cannot be avoided, then you need to be careful, since general anesthesia during treatment with Captopril can dramatically lower blood pressure. Therefore, immediately warn the anesthesiologist who will administer anesthesia to you.

When the patient begins to develop jaundice, the medicine is immediately canceled.

When a patient undergoes therapy with Captopril, the use of alcoholic beverages is strictly prohibited.

Captopril can cause false positive results when testing urine for acetone.

If you notice signs of:

• infectious disease, this also applies to the common cold;
• increased fluid loss, which is caused by vomiting, diarrhea, profuse sweating,

Then contact your doctor immediately.

There are cases when taking the drug can cause hyperkalemia. This is when the level of potassium in the blood increases. More often it is diagnosed in patients suffering from diabetes mellitus or kidney failure.

All of the above consequences, this is a reason to consult a doctor, you may have an individual intolerance to the drug.

Name:

Captopril (Captopril)

Pharmacological
action:

Antihypertensive agent, ACE inhibitor.
The mechanism of antihypertensive action is associated with competitive inhibition of ACE activity, which leads to a decrease in the rate of conversion of angiotensin I to angiotensin II (which has a pronounced vasoconstrictor effect and stimulates the secretion of aldosterone in the adrenal cortex).
In addition, captopril appears to affects the kinin-kallikrein system preventing the breakdown of bradykinin. Hypotensive effect does not depend on the activity of plasma renin, a decrease in blood pressure is noted at normal and even reduced concentrations of the hormone, which is due to the effect on the tissue RAAS. Increases coronary and renal blood flow.

Due to the vasodilating effect, it reduces OPSS (afterload), wedge pressure in the pulmonary capillaries (preload) and resistance in the pulmonary vessels; increases cardiac output and exercise tolerance.
With prolonged use reduces the severity of left ventricular myocardial hypertrophy, prevents the progression of heart failure and slows down the development of left ventricular dilatation.
Helps reduce sodium levels in patients with chronic heart failure.
Dilates arteries more than veins.
Improves blood supply to ischemic myocardium. Reduces platelet aggregation.
Lowers toneefferent arterioles of the glomeruli of the kidneys, improving intraglomerular hemodynamics, prevents the development of diabetic nephropathy.

Pharmacokinetics

After oral administration, at least 75% rapidly absorbed from the gastrointestinal tract.
Simultaneous food intake reduces absorption by 30-40%. Cmax in blood plasma is reached in 30-90 minutes.
Protein binding, mainly to albumin, is 25-30%.
Excreted in breast milk.
Metabolized in the liver with the formation of a disulfide dimer of captopril and captopril-cysteine ​​disulfide. Metabolites are pharmacologically inactive.

T1 / 2 is less than 3 hours and increases with renal failure (3.5-32 hours). More than 95% is excreted by the kidneys, 40-50% is unchanged, the rest is in the form of metabolites.
In chronic renal failure cumulates.

Indications for
application:

Essential hypertension (including resistant to other antihypertensive drugs, malignant hypertension) and renovascular hypertension (as monotherapy or in combination with calcium ion antagonists, β-adrenergic blockers or diuretics);
- relief of hypertensive crises (with intolerance or insufficient effectiveness of nifedipine);
- congestive heart failure (especially with insufficient effectiveness of treatment with cardiac glycosides in combination with diuretics);
- dysfunction of the left ventricle after myocardial infarction (ejection fraction<40%);
- some forms of cardiomyopathy;
- diabetic nephropathy;
- hypertension and renal failure in scleroderma.

Captopril is the drug of choice in hypertension in patients with asthma, diabetes mellitus and in elderly patients, and is also used as a diagnostic tool for renovascular hypertension and Conn's syndrome.

Mode of application:

The dose is selected individually.
For hypertension in adults usually prescribed 12.5 mg 3 times a day; if, after 2 weeks of captopril use, blood pressure has not decreased enough, then the dose can be gradually increased to 50 mg 3 times a day.
To further reduce blood pressure, it is recommended to additionally prescribe thiazide diuretics, β-adrenergic blockers and / or other antihypertensive drugs.
When taking captopril at a dose of > 300 mg / day, the frequency of side effects increases sharply, and the hypotensive effect does not increase, therefore, it is not recommended to exceed a dose of 300 mg / day.

For relief of hypertensive crisis administered sublingually (the tablet should first be chewed and kept under the tongue until completely resorbed).
With renovascular and renal hypertension appoint 6.25-12.5 mg 3 times a day. The maintenance dose may be increased to 25 mg 3-4 times daily.
For congestive heart failure at the beginning of treatment is usually prescribed 6.25 mg 2-3 times a day, then the dose is gradually increased.

Use captopril in pediatric practice should be done with great caution and only after a thorough justification of the treatment (especially with renovascular hypertension). The recommended daily dose is 1-2 mg/kg body weight.
Captopril should be taken 1 hour before meals.
Dose selection if possible, it should be carried out in a hospital setting.
When prescribing captopril on an outpatient basis, it is necessary to determine the effect after taking the first dose (6.25 or 12.5 mg), for which blood pressure should be measured every 30 minutes for 3 hours.
In the future, it is necessary to conduct regular examination of the patient for dose adjustment.
Doses of other drugs in the case of combined treatment should be determined individually.

Side effects:

From the side of the central nervous system and peripheral nervous system: dizziness, headache, fatigue, asthenia, paresthesia.
From the side of the cardiovascular system: orthostatic hypotension; rarely - tachycardia.
From the digestive system: nausea, decreased appetite, impaired taste sensations; rarely - abdominal pain, diarrhea or constipation, increased activity of hepatic transaminases, hyperbilirubinemia; signs of hepatocellular damage (hepatitis); in some cases - cholestasis; in isolated cases - pancreatitis.
From the hematopoietic system: rarely - neutropenia, anemia, thrombocytopenia; very rarely in patients with autoimmune diseases - agranulocytosis.
From the side of metabolism: hyperkalemia, acidosis.
From the urinary system: proteinuria, impaired renal function (increased concentration of urea and creatinine in the blood).
From the respiratory system: dry cough.
allergic reactions: skin rash; rarely - angioedema, bronchospasm, serum sickness, lymphadenopathy; in some cases - the appearance of anti-nuclear antibodies in the blood.

Contraindications:

Hypersensitivity to the drug;
- tendency to edema;
- stenosis (narrowing) of the renal arteries, condition after kidney transplantation;
- narrowing of the aorta, narrowing of the mitral valve;
- myocardiopathy (heart disease of unclear or controversial origin of non-inflammatory nature);
- primary hyperaldosteronism (increased secretion of the hormone aldosterone due to hyperplasia or tumors of the adrenal cortex, accompanied by edema, fluid accumulation in the abdominal cavity, increased blood pressure);
- pregnancy, breastfeeding;
- Children under 14 years of age are not prescribed the drug.

Patients whose activities are associated with the need for quick concentration and quick reaction (drivers of vehicles, operators, etc.), be careful when taking medication.
Should abstain from alcohol during drug treatment.

Should be used with cautionwith a history of angioedema during therapy with ACE inhibitors, hereditary or idiopathic angioedema, with aortic stenosis, cerebro- and cardiovascular diseases (including cerebrovascular insufficiency, coronary artery disease, coronary insufficiency), severe autoimmune connective tissue diseases (including SLE, scleroderma), with oppression of bone marrow hematopoiesis, with diabetes mellitus, hyperkalemia, bilateral stenosis of the renal arteries, stenosis of the artery of a single kidney, condition after kidney transplantation, renal and / or liver failure, against the background of a diet with sodium restriction , conditions accompanied by a decrease in BCC (including with diarrhea, vomiting), in elderly patients.

In patients with chronic heart failure captopril is used under close medical supervision.
Hypotension that occurs during surgery while taking captopril is eliminated by replenishing the volume of fluid.
The simultaneous use of potassium-sparing diuretics and potassium preparations should be avoided, especially in patients with renal insufficiency and diabetes mellitus.
When taking captopril, you may experience false positive reaction in the analysis of urine for acetone.
The use of captopril in children is possible only if other drugs are ineffective..

Interaction
other medicinal
by other means:

With simultaneous use with immunosuppressants, cytostatics increases risk of developing leukopenia.
With simultaneous use with potassium-sparing diuretics (including spironolactone, triamterene, amiloride), potassium preparations, salt substitutes and dietary supplements containing potassium, hyperkalemia may develop (especially in patients with impaired renal function), because. ACE inhibitors reduce the content of aldosterone, which leads to a retention of potassium in the body against the background of limiting the excretion of potassium or its additional intake into the body.

With the simultaneous use of ACE inhibitors and NSAIDs increases risk of developing renal dysfunction; rarely observed hyperkalemia.
With simultaneous use with "loop" diuretics or thiazide diuretics, it is possible severe arterial hypotension, especially after taking the first dose of a diuretic, apparently due to hypovolemia, which leads to a transient increase in the antihypertensive effect of captopril.
There is a risk of developing hypokalemia. Increased risk of developing renal dysfunction.

When used simultaneously with anesthetics possible severe hypotension.
When used concomitantly with azathioprine possible development of anemia, which is due to the inhibition of erythropoietin activity under the influence of ACE inhibitors and azathioprine.
Cases are described development of leukopenia, which may be associated with additive inhibition of bone marrow function.
With simultaneous use with allopurinol, it increases risk of developing hematological disorders; described cases of severe hypersensitivity reactions, including Stevens-Johnson syndrome.

With the simultaneous use of aluminum hydroxide, magnesium hydroxide, magnesium carbonate decreased bioavailability of captopril.
Acetylsalicylic acid in high doses may reduce the antihypertensive effect of captopril.
It has not been conclusively established whether acetylsalicylic acid reduces the therapeutic efficacy of ACE inhibitors in patients with coronary artery disease and heart failure. The nature of this interaction depends on the course of the disease.
Acetylsalicylic acid, inhibiting COX and prostaglandin synthesis, can cause vasoconstriction, which leads to a decrease in cardiac output and deterioration in patients with heart failure receiving ACE inhibitors.

There are reports of an increase in the concentration of digoxin in the blood plasma with simultaneous use captopril with digoxin. The risk of drug interactions is increased in patients with impaired renal function.

With simultaneous use with indomethacin, ibuprofen decreases the antihypertensive effect of captopril, apparently due to inhibition under the influence of NSAIDs of the synthesis of prostaglandins (which are believed to play a role in the development of the hypotensive effect of ACE inhibitors).
With simultaneous use with insulins, hypoglycemic agents, sulfonylurea derivatives possible development of hypoglycemia by increasing glucose tolerance.
With the simultaneous use of ACE inhibitors and interleukin-3, there is risk of developing arterial hypotension.

When used simultaneously with interferon alfa-2a or interferon beta, cases of severe granulocytopenia.
During the transition from clonidine to captopril the antihypertensive effect of the latter develops gradually. In the event of a sudden withdrawal of clonidine in patients receiving captopril, a sharp increase in blood pressure is possible.
With the simultaneous use of lithium carbonate the concentration of lithium in the blood serum increases, accompanied by symptoms of intoxication.

With simultaneous use with minoxidil, sodium nitroprusside enhanced antihypertensive effect.
With simultaneous use with orlistat, a decrease in the effectiveness of captopril is possible, which can lead to an increase in blood pressure, a hypertensive crisis, and a case of cerebral hemorrhage is described.
With the simultaneous use of ACE inhibitors with pergolide, an increase in the antihypertensive effect is possible.

When used concomitantly with probeneciddecreased renal clearance of captopril.
With simultaneous use with procainamide, an increased risk of developing leukopenia is possible.
When used simultaneously with trimethoprim there is a risk of hyperkalemia, especially in patients with impaired renal function.
When used concomitantly with chlorpromazine risk of developing orthostatic hypotension.
When used simultaneously with cyclosporine there are reports of the development of acute renal failure, oliguria.
It is believed that it is possible to reduce the effectiveness of antihypertensive agents when used simultaneously with erythropoietins.

Pregnancy:

It should be borne in mind that the use of captopril in the II and III trimesters of pregnancy can cause developmental disorders and fetal death. If pregnancy is established, captopril should be discontinued immediately.
Captopril is excreted in breast milk. If necessary, use during lactation should decide on the termination of breastfeeding.

Overdose:

Symptoms: acute arterial hypotension, cerebrovascular accident, myocardial infarction, thromboembolism, angioedema.
Treatment: dose reduction or complete withdrawal of the drug; gastric lavage, transferring the patient to a horizontal position, taking measures to increase the BCC (introduction of isotonic sodium chloride solution, transfusion of other blood-substituting fluids), symptomatic therapy: epinephrine (s / c or / in), antihistamines, hydrocortisone (in / in ).
Carrying out hemodialysis, if necessary, the use of an artificial pacemaker.

Release form:

Tablets 25, 50 and 100 mg in a package of 20-5000 pieces.

Storage conditions:

In a dry, dark place, at a temperature not exceeding 25 °C.
Keep out of the reach of children.
Best before date- 3 years.

1 tablet of Kaptopres 25 mg contains:
- active substance: captopril - 25 mg;
- Excipients: lactose monohydrate, microcrystalline cellulose, corn starch, stearic acid.

Captopril is an angiotensin-converting enzyme inhibitor. Produced in the form of tablets.

Pharmacological action of Captopril

In accordance with the instructions for Captopril, the active ingredient of the drug is captopril. The auxiliary substances that make up the drug are corn starch, lactose, magnesium stearate, talc.

Captopril has antihypertensive, cardioprotective, vasodilatory and natriuretic effects. The drug promotes vasoconstriction and the release of aldosterone, prevents the inactivation of endogenous vasodilators.

When using Captopril, there is an increase in the activity of the kallikrein-kinin system, an increase in the release of biologically active components that have a vasodilating effect, and also improve renal blood flow. The drug Captopril significantly reduces the release of norepinephrine from the nerve endings, reduces the formation of arginine-vasopressin and endothelin-1, which have vasoconstrictor properties.

In reviews of Captopril, it is noted that the hypotensive effect of the drug appears already 20-60 minutes after oral administration, reaches a maximum after 1-1.5 hours and lasts for 6-12 hours. The duration of the therapeutic effect of taking Captopril depends mainly on the dose taken, and reaches its maximum value with repeated use.

The use of Captopril helps to reduce the total peripheral vascular resistance, the load on the heart, pressure in the small circle and pulmonary vascular resistance. Due to the active component of the drug, an increase in cardiac output occurs without affecting the heart rate.

In patients with heart failure, according to reviews, Captopril increases exercise tolerance, reduces capillary wedge pressure in the lungs, improves general condition and increases life expectancy due to cardioprotective action. With long-term treatment, there is a decrease in the size of the dilated myocardium.

When taking Captopril tablets in high doses, angioprotective properties are observed in relation to the vessels of the microvasculature. The drug affects the size of peripheral arteries, and also blunts the progression of renal failure in diabetes mellitus.

In accordance with the instructions, Captopril is completely and rapidly absorbed from the gastrointestinal tract. When taken on an empty stomach, the drug is detected in the blood plasma within 15 minutes. The maximum concentration in blood serum reaches in 30-90 minutes. Metabolized in the liver. The period of complete elimination of the drug is 2-6 hours, excreted by the kidneys.

Indications for use of Captopril

Indications for Captopril are:

• congestive heart failure;
• dysfunction of the left ventricle in a stabilized state in patients after myocardial infarction;
• cardiomyopathy;
• nephropathy, which arose against the background of type 1 diabetes mellitus;
• arterial hypertension (as monotherapy or as part of combination therapy).

Method of application and dosage

Captopril tablets are intended for oral administration 1 hour before a meal. It is prescribed in the initial dose of 25 g 2 times a day. To achieve the maximum therapeutic effect and in the presence of indications, Captopril is taken in a gradually increased dose (within 2-4 weeks).

With moderate and mild arterial hypertension, a maintenance dose of 25-50 mg 2 times a day is recommended; in severe hypertension, Captopril tablets should be taken at a dose of 50 mg 3 times a day.

In the treatment of chronic heart failure, the average maintenance dose is 25 mg 2-3 times a day, the dose of Captopril, according to indications, can be gradually increased. The maximum daily dose of the drug should not exceed 150 mg.

The instructions for Captopril indicate that if the patient has impaired renal function to a moderate degree, the drug is prescribed in a daily dosage of 75-100 mg. In severe renal dysfunction, the initial daily dose should not exceed 25 mg, if necessary, it is increased gradually.

For elderly patients, the dosage of Captopril is prescribed and adjusted by the attending physician. As a rule, the initial dose does not exceed 6.25 mg 2 times a day.

Side effects of Captopril

When using Captopril, side effects from the organs and systems of the body may occur:

• Sense organs and nervous system: dizziness, fatigue, headaches, depression of the central nervous system, drowsiness, confusion, ataxia, depression, convulsions, tingling and numbness in the extremities, disruption of the organs of vision;
• Cardiovascular and hematopoietic systems: angina pectoris, hypotension, myocardial infarction, cardiac arrhythmia, cerebral circulatory disorders, lymphadenopathy, peripheral edema, anemia, pulmonary embolism, chest pain, neutropenia, thrombocytopenia, agranulocytosis;
• Respiratory system: shortness of breath, bronchospasm, bronchitis, dry cough, interstitial pneumonitis;
• Gastrointestinal tract: taste disturbances, anorexia, stomatitis, xerostomia, difficulty swallowing, glossitis, nausea, dyspepsia, vomiting, abdominal pain, diarrhea, liver damage, pancreatitis;
• Genitourinary system: oliguria, impotence, proteinuria, impaired renal function;
• Skin: rash, redness of the skin of the face, shingles, itching, photodermatitis, alopecia, urticaria, Stevenson-Johnson syndrome.

In reviews of Captopril, it is also reported that fever, sepsis, chills, hyperkalemia, arthralgia, acidosis may occur.

Contraindications for use

Captopril is contraindicated in the presence of:

• Violations of the liver;
• Angioedema and cardiogenic shock;
• Mitral stenosis, stenosis of the aortic mouth;
• arterial hypotension;
• Hypersensitivity to the components of the drug.

Captopril tablets are not intended for use by children under the age of 18, as well as women during pregnancy and lactation.

Captopril should be used with caution in patients with severe autoimmune diseases, bone marrow circulatory depression, cerebral ischemia, diabetes mellitus, coronary heart disease, as well as people on a sodium-restricted diet, and elderly patients.

Overdose

In reviews of Captopril, there are reports that when taking the drug in amounts exceeding those prescribed, there may be a decrease in blood pressure, myocardial infarction, thromboembolic complications, and acute circulatory disorders of the brain.

Terms and conditions of storage

According to the instructions Captopril should be stored in a cool place. The shelf life of the drug is 36 months.

From pharmacies, Captopril is dispensed by prescription.

Captopril- an angiotensin-converting enzyme (ACE) inhibitor.

The mechanism of antihypertensive action is associated with competitive inhibition of ACE activity, which leads to a decrease in the rate of conversion of angiotensin I to angiotensin II and eliminates its vasoconstrictive effect.

As a result of a decrease in the concentration of angiotensin II, there is a secondary increase in plasma renin activity due to the elimination of negative feedback on renin release and a direct decrease in aldosterone secretion.

Due to the vasodilating action, it reduces the total peripheral vascular resistance (afterload), wedge pressure in the pulmonary capillaries (preload) and resistance in the pulmonary vessels; increases cardiac output and exercise tolerance. Does not affect lipid metabolism.

Pharmacokinetics

After oral administration, at least 75% of the drug is rapidly absorbed and the maximum concentration is observed in the blood after 50 minutes. Protein binding, mainly albumin, is 25 - 30%. Captopril is metabolized in the liver to form the disulfide dimer of captopril and captopril-cysteine ​​disulfide. Metabolites are pharmacologically inactive. The half-life is about 3 hours. The half-life in chronic renal failure is 3.5-32 hours. Cumulates in chronic renal failure. More than 95% of the drug is excreted in the urine, of which 40-50% is unchanged, the rest is excreted as metabolites. The duration of the drug is about 5 hours.

Indications for use

Indications for the use of the drug Captopril are: arterial hypertension (including renovascular); chronic heart failure (as part of combination therapy).

Mode of application

Captopril prescribed one hour before meals. The dosing regimen is set individually.

In arterial hypertension, the drug is prescribed in an initial dose of 25 mg 2 times a day. If necessary, the dose is gradually (with an interval of 2-4 weeks) increased until the optimal effect is achieved. For mild or moderate arterial

hypertension, the usual maintenance dose is 25 mg 2 times a day; the maximum dose is 50 mg 2 times a day. In severe hypertension, the maximum dose is 50 mg 3 times a day. The maximum daily dose is 150 mg.

For the treatment of chronic heart failure, captopril is prescribed in cases where the use of diuretics does not provide an adequate effect. The initial daily dose is 6.25 mg 3 times a day, if necessary, the dose is increased

at intervals of at least 2 weeks. The average maintenance dose is 25 mg 2-3 times a day. In the future, if necessary, the dose is gradually (with an interval of at least 2 weeks) increased. The maximum dose is 150 mg per day.

Patients with impaired renal function: with a moderate degree of impaired renal function (creatinine clearance (CC) of at least 30 ml / min / 1.73 m2), captopril can be prescribed at a dose of 75-100 mg / day. With a more pronounced degree of renal dysfunction (CC less than 30 ml / min / 1.73 m2), the initial dose should be no more than 12.5 - 25 mg / day; in the future, if necessary, with sufficiently long intervals, the dose of captopril is gradually increased, but a lower than usual daily dose of the drug is used.

If necessary, loop diuretics are additionally prescribed, and not thiazide diuretics.

Side effects

From the side of the cardiovascular system: a pronounced decrease in blood pressure, tachycardia, orthostatic hypotension, peripheral edema.

From the urinary system: proteinuria, impaired renal function (increased levels of urea and creatinine in the blood).

From the side of water-electrolyte and acid-base balance: hyperkalemia, acidosis.

From the hemopoietic system: rarely - neutropenia, anemia, thrombocytopenia, agranulocytosis.

From the side of the central nervous system: dizziness, headache, fatigue, asthenia, ataxia, drowsiness, blurred vision.

On the part of the respiratory system: "dry" cough, passing after discontinuation of the drug, bronchospasm, pulmonary edema.

Allergic and immunopathological reactions: angioedema, serum sickness, lymphadenopathy, in rare cases, the appearance of antinuclear antibodies in the blood.

Dermatological reactions: rash, usually maculo-papular in nature, less often vasicular or bullous, itching, increased photosensitivity.

From the gastrointestinal tract, liver, pancreas: taste disturbance, dry mouth, stomatitis, nausea, loss of appetite, rarely diarrhea, abdominal pain, increased activity of liver enzymes, signs of hepatocellular damage and cholestasis (in rare cases) .

Other: paresthesia.

Contraindications

Contraindications to the use of the drug Captopril are: hypersensitivity to captopril and other ACE inhibitors; angioedema in history (incl.

in history after the use of other ACE inhibitors); severe renal dysfunction, azotemia, hyperkalemia, bilateral renal artery stenosis or stenosis of a single kidney with progressive azotemia, condition after kidney transplantation, primary hyperaldosteronism; stenosis of the mouth of the aorta, mitral stenosis, the presence of other obstructions to the outflow of blood from the left ventricle of the heart; severe liver dysfunction; arterial hypotension; cardiogenic shock; pregnancy and lactation; age up to 18 years (efficacy and safety have not been established).

Use with caution: severe autoimmune diseases (including systemic lupus erythematosus, scleroderma), depression of bone marrow circulation (risk of developing neutropenia and agranulocytosis), cerebral ischemia, diabetes mellitus (increased risk of developing hyperkalemia), patients on hemodialysis, diet with sodium restriction, coronary heart disease, conditions accompanied by a decrease in circulating blood volume (including diarrhea, vomiting), old age.

Pregnancy

Take the drug during pregnancy Captopril contraindicated.

Interaction with other drugs

Diuretics and vasodilators (eg minoxidil) potentiate the hypotensive effect of captopril.

With the combined use of captopril with indomethacin (and, possibly, with other non-steroidal anti-inflammatory drugs), there may be a decrease in the hypotensive effect.

The hypotensive effect of captopril may be delayed when administered to patients receiving clonidine.

Simultaneous use with potassium-sparing diuretics or potassium preparations can lead to hyperkalemia.

With the simultaneous use of lithium salts, an increase in the concentration of lithium in the blood serum is possible.

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

The use of captopril in patients taking immunosuppressive drugs (eg, cyclophosphamide or azathioprine) increases the risk of developing hematological disorders.

Overdose

Symptoms of drug overdose Captopril: a pronounced decrease in blood pressure, up to collapse, myocardial infarction, acute cerebrovascular accident, thromboembolic complications.

Treatment: lay the patient with raised lower limbs; measures aimed at restoring blood pressure (increasing the volume of circulating blood, including intravenous infusion of saline), symptomatic therapy.

Perhaps the use of hemodialysis; peritoneal hemodialysis is ineffective.

Storage conditions

In a dry, dark place at a temperature not exceeding 25 ° C. Keep out of the reach of children.

Release form

Captopril - tablets 25 mg.

10, 20, 30, 40, 50 tablets in a blister pack made of PVC film and printed lacquered aluminum foil.

10, 20, 30, 40, 50 or 100 tablets in a polymeric drug container or glass bottle with screw-on plastic or aluminum caps.

One container (bottle) or 1, 2, 3, 4, 5, 6, 7, 8, 9 or 10 blister packs together with instructions for use are placed in a cardboard pack.

10 or 20 containers (vials) or 20, 40, 60, 80 and 100 blisters, together with the appropriate number of instructions for use, are placed in a cardboard box (for hospitals).

Compound

One captopril tablet contains the active substance captopril - 25 mg.

Excipients: microcrystalline cellulose - 24.5 mg, lactose (milk sugar) - 47.0 mg, corn starch - 2.5 mg, magnesium stearate - 1.0 mg.

Additionally

Before starting and regularly during treatment with the drug Captopril kidney function should be monitored.

In chronic heart failure, the drug is used under the condition of careful medical supervision.

With extreme caution, captopril is prescribed to patients with diffuse connective tissue diseases or systemic vasculitis; patients receiving immunosuppressants, especially in the presence of impaired renal function (risk of developing serious infections that cannot be treated with antibiotics). In such cases, it is necessary to monitor the picture of peripheral blood before starting the use of captopril, every 2 weeks during the first 3 months of therapy and periodically - during the subsequent period of treatment.

The drug is used with caution during treatment with allopurinol or procainamide, as well as against the background of treatment with immunosuppressants (including azathioprine, cyclophosphamide), especially in patients with impaired renal function.

Use with caution in patients with a history of kidney disease, as the risk of proteinuria increases. In such cases, during the first 9 months of treatment with captopril, the amount of protein in the urine should be monitored monthly. If the level of protein in the urine exceeds 1 g / day, it is necessary to decide on the advisability of further use of the drug. With caution, captopril is prescribed to patients with renal artery stenosis, tk. there is a risk of developing impaired renal function; in the event of an increase in the level of urea or creatinine in the blood, it may be necessary to reduce the dose of captopril or discontinue the drug.

The likelihood of developing arterial hypotension during treatment can be reduced if, 4-7 days before the start of treatment with captopril, the use of diuretics is stopped or their dose is significantly reduced.

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

In the case of severe arterial hypotension, a positive effect is observed with intravenous administration of an isotonic sodium chloride solution.

In case of development of angioedema, the drug is canceled and careful medical supervision is carried out.

If the edema is localized on the face, special treatment is usually not required (antihistamines may be used to reduce the severity of symptoms); in the event that edema extends to the tongue, pharynx or larynx and there is a threat of airway obstruction, epinephrine (INN epinephrine) should be immediately injected subcutaneously (0.5 ml at a dilution of 1:1000).