Before the onset, and also regularly during the treatment of Angiopril®-25, kidney function should be monitored. Patients with chronic heart failure are treated under close medical supervision.
Against the background of prolonged use of Angiopril®-25, approximately 20% of patients have an increase in urea and serum creatinine by more than 20% compared to the norm or the baseline value. Less than 5% of patients, especially in severe nephropathies, require discontinuation of treatment due to increased creatinine concentrations.
In patients with hypertension with Angiopril®-25, severe arterial hypotension is observed only in rare cases; the likelihood of developing this condition increases with increased loss of fluid and salts (eg, after intensive treatment with diuretics), in patients with heart failure or who are on dialysis.
The possibility of a sharp drop in blood pressure can be minimized by first canceling (for 4-7 days) a diuretic or increasing the intake of sodium chloride (about a week before the start of the intake) or by prescribing Angiopril®-25 at the start of treatment in small doses (6 , 25-12.5 mg / day).
In the first 3 months of therapy, the number of blood leukocytes is monitored monthly, then - once every 3 months; the patients with autoimmune diseases in the first 3 months - through every 2 weeks, then every 2 months. If the number of white blood cells is less than 4000 / mm3, a general blood test is performed, below 1000 / mkl - the drug is stopped.
In some cases, against the background of the use of ACE inhibitors, incl. Angiopril®-25, an increase in the concentration of potassium in the blood serum is observed. The risk of hyperkalemia in the use of ACE inhibitors is increased in patients with renal insufficiency and diabetes mellitus, and also taking potassium-sparing diuretics,potassium preparations or other drugs that cause an increase in the concentration of potassium in the blood (for example, heparin). You should avoid the simultaneous use of potassium-sparing diuretics and potassium preparations.
When hemodialysis is performed in patients receiving Angiopril®-25, dialysis membranes with high permeability should be avoided (for example, AN69), because in such cases the risk of anaphylactoid reactions increases.
In the case of angioedema, the drug is withdrawn and carefully monitored. If the edema is localized on the face, special treatment is usually not required (to reduce the severity of symptoms can be used antihistamines); if the swelling spreads to the tongue, throat or larynx and there is a threat of development of airway obstruction, you should immediately enter epinephrine (epinephrine) subcutaneously (0.5 ml in a dilution of 1: 1000).
When taking Angiopril®-25, a false positive reaction may occur when analyzing urine for acetone.
Be wary appoint patients who are on a low-salt or salt-free diet (increased risk of hypotension) and hyperkalemia.
In case of symptomatic arterial hypotension after taking Angiopril®-25, the patient should be placed in a horizontal position with raised legs.