Ecquard - instructions for use, dose, side effects, contraindications

Excipients: lactose - 106.34 mg; corn starch - 58.86 mg; povidone 5.70 mg; talc - 3.80 mg; magnesium stearate - 1,950 mg; dye crimson (Ponceau 4R) - 0.10 mg

active vesubstance: amlodipine besylate, in terms of amlodipine 5 mg; lisinopril dihydrate, in terms of lisinopril 10.0 mg

Excipients: lactose - 100,625 mg; corn starch 58.66 mg; povidone - 5.70 mg; talc - 3.80 mg; magnesium stearate - 2.00 mg

Description:

Tablets 5 mg + 5 mg:

Round flat cylindrical tablets of pink color with a facet, with a risk on one side.

Tablets 5 mg + 10 mg:

Round flat cylindrical tablets of white color with a facet, with a risk on one side.

Pharmacotherapeutic group:Combined antihypertensive agent (angiotensin-converting enzyme + blocker of "slow" calcium channels)

ATX: & nbsp

C.09.A.A.03 Lisinopril

C.08.C.A.01 Amlodipine

Pharmacodynamics:

Combined drug containing active ingredients: lisinopril and amlodipine.

Lisinopril

The angiotensin-converting enzyme (ACE) inhibitor reduces the formation of angiotensin II from angiotensin I. Reducing angiotensin II leads to a direct reduction in the release of aldosterone. Reduces the degradation of bradykinin and increases the synthesis of prostaglandins. Reduces overall peripheral vascular resistance (OPCC), arterial pressure (BP), preload, pressure in the pulmonary capillaries, causes an increase in the minute volume of blood and increased tolerance of the myocardium to the load in patients with chronic heart failure. Expands arteries more than veins. Some of the affects are due to exposure to the renin-angiotensin-aldosterone system (RAAS).With prolonged use, myocardial hypertrophy and artery walls decrease in resistivity. We improve the blood supply of the ischemic myocardium.

ACE inhibitors prolong life expectancy in patients with chronic heart failure (CHF), slow the progression of left ventricular dysfunction in patients who underwent acute myocardial infarction without clinical manifestations of heart failure.

The beginning of the drug after 1 hour, the maximum antihypertensive affect is achieved after 6-7 hours and persists for 24 hours. The duration of the effect depends also on the value of the dose taken. With arterial hypertension, the effect is observed in the first days after the beginning of treatment, stable action develops after 1-2 months of therapy. With a sharp reversal of lisinopril, there was no pronounced increase in blood pressure. Lisinopril reduces albuminuria. Does not affect the concentration of glucose in the blood in patients with diabetes mellitus and does not increase the incidence of hypoglycemia.

Amlodipine

The blocker of "slow" calcium channels, the dihydropyridine derivative blocker of "slow" calcium channels (BCCC),we exert an anti-anginal and antihypertensive action, block calcium channels, reduce the transmembrane transition of calcium ions into the cell (mostly in the smooth muscle cells of the vessels than in the cardiomyocytes).

Antianginal effect is due to the expansion of coronary and peripheral arteries and arterioles: with angina decreases the severity of myocardial ischemia; expanding peripheral arterioles, reduces OPCC, reduces afterload on the heart, reduces the need for myocardium in oxygen. Expanding coronary arteries and arterioles in unchanged and ischemic zones of the myocardium, increases the flow of oxygen into the myocardium (especially with vasospastic angina); prevents spasm of the coronary arteries (including caused by smoking). In patients with stable angina, a single daily dose increases exercise tolerance, increases the time until the onset of an attack of angina and "ischemic" depression of the segment ST, reduces the incidence of angina attacks and consumption of nitroglycerin and other nitrates.

Has a long-term dose-dependent antihypertensive effect.Antihypertensive action is due to direct vasodilating effect on smooth muscle vessels. With arterial hypertension, a single dose provides a clinically significant reduction in blood pressure (BP) for 24 hours (in the patient's "lying" and "standing" position). Orthostatic hypotension in the appointment of amlodipine is rare. Does not cause a decrease in the fraction of the ejection of the left ventricle. Reduces the degree of myocardial hypertrophy of the left ventricle. Does not affect the contractility and conductance of the myocardium, does not cause a reflex increase in heart rate (HR), inhibits platelet aggregation, increases the rate of glomerular filtration, has a weak natriuretic effect.

With diabetic nephropathy not increases the severity of microalbuminuria. Does not have any adverse effect on the metabolism and concentration of plasma lipids and can be used in the treatment of patients with bronchial asthma, diabetes and gout. A significant reduction in blood pressure is observed after 6-10 hours, the duration of the effect is 24 hours.

Ecquard®

The combination of lisinopril with amlodipine in a single medicine can prevent the development of possible undesirable effects caused by the contradiction of any of the active substances. So, the blocker of the "slow" calcium channels, directly expanding the arterioles, can lead to a delay in sodium and fluid in the body, and, therefore, can activate RAAS. The ACE inhibitor blocks this process, normalizes the reactions to the load with salts.

Pharmacokinetics:

Lisinopril

After oral administration lisinopril is absorbed from the gastrointestinal tract (GIT) on average by 25%, but the absorption can vary from 6 to 60%. Bioavailability is 29%. The maximum concentration in the blood plasma (C_m_Oh) is achieved after 7 hours. Reception food does not affect the absorption of lisinopril. Lisinopril slightly binds to blood plasma proteins. Permeability through the blood-brain and planetary barrier is low.

Lizinopril is not biotransformed in the body.

It is excreted by the kidneys unchanged. The half-life (T1 / 2) is 12.6 hours. The clearance of lisinopril is 50 ml / min. The decrease in serum concentration of lisinopril occurs in two phases.

In patients with chronic heart failure, the absorption and clearance of lisinopril are reduced, bioavailability is 16%.

In patients with renal insufficiency (creatinine clearance less than 30) ml / min), the concentration of lisinopril is several times higher than the plasma concentration in healthy volunteers, with an increase in the time to reach C_m_Oh in blood plasma and an increase in T1 / 2.

In elderly patients, the concentration of the drug in the blood plasma and the area under the concentration-time curve (AUC) in 2 times more, than at patients of young age.

In the case of the Nazis with liver cirrhosis, the bioavailability of lisinopril is reduced by 30%. and clearance by 50% compared with patients with normal liver function.

In elderly patients, the concentration of lisinopril in the blood is increased by an average of 60%.

Amlodipine

After oral administration amlodipine slowly absorbed from the digestive tract. The average absolute bioavailability is 64%, C_max in serum is observed after 6-9 hours. Equilibrium concentrations (C_ss) are achieved after 7-8 days of therapy.

Food intake does not affect the absorption of amlodipine. The average volume of distribution is 21 l / kg body weight, indicating that the bolted part of the drug is in the tissues, and the smaller in the blood.Most of the amlodipine in the blood (95%) binds to blood plasma proteins. Amlodipine is slow), active metabolism in the liver in the absence of a significant "primary passage" effect. Metabolites do not have significant pharmacological activity. After a single intake of T1 / 2, varies from 35 to 50 hours, with repeated use of T1 / 2 is approximately 45 hours. About 60% of the dose taken internally is excreted by the kidneys mainly in the form of metabolites, 10% unchanged, and 20-25% through the intestines with bile. The total clearance of amlodipine is 0.116 ml s / ct (7 ml / min / kg, 0.42 l / h / kg).

In elderly patients (over 65 years), amlodipine withdrawal is slowed (T1 / 2 is 65 hours) compared with young patients, but the difference is not clinically significant. Elongation of T1 / 2 in patients with hepatic insufficiency suggests that with prolonged use, the cumulation of the drug in the body will be higher (T1 / 2 to 60 h.). Renal failure does not significantly affect the kinetics of amlodipine. In patients with impaired renal function, changes in amlodipine concentration in the blood plasma do not correlate with the degree of renal failure. Possible slight increase T1 / 2.

Amlodipine penetrates the blood-brain barrier. When hemodialysis is not removed.

Ecquard®

Pharmacokinetic interaction between active ingredients in the formulation is unlikely. AUC, the time of reaching and the value of the maximum concentration, the half-lives do not undergo changes in comparison with the indices of each individual active substance. Receiving PLook for no influencet on the absorption of active substances. Long circulation in the body of both active substances makes it possible to take the drug 1 time per day.

Indications:Essential hypertension (patients who are shown combined therapy).

Contraindications:

Hypersensitivity to any of the components of the drug or to other derivatives of dihydropyridine, other inhibitors of AMP; angioedema in history, including those caused by the use of other ANP inhibitors. hereditary and / or idiopathic angioedema; hemodynamically significant stenosis of the aorta or mitral valve or hypertrophic obstructive cardiomyopathy; severe arterial hypotension (systolic blood pressure less than 60 mm Hg); cardiogenic shock; pregnancy; lactation period; age to 18 years,acute myocardial infarction (within the first 28 days), unstable angina (with the exception of Prinzmetal angina); lactose intolerance, lactase deficiency and glucose-galactose malabsorption.

Carefully:

Cerebrovascular diseases (including cerebrovascular insufficiency), coronary heart disease, coronary insufficiency, arterial hypotension, systemic connective tissue diseases (including scleroderma, systemic lupus erythematosus), oppression of bone marrow hematopoiesis, hyperkalemia, condition after kidney transplantation , renal and / or hepatic insufficiency, weak syndrome

sinus node (pronounced bradycardia, tachycardia), CHF of non-ischemic myology III-IV functional class by classification NYHA, heart failure in the stage of decompensation, aortic stenosis, mitral stenosis, acute myocardial infarction (after the first 28 days), elderly age, bilateral renal artery stenosis or arterial stenosis of a single kidney with progressive azotemia, hemodialysis using high-flow dialysis membranes (AN69®), azotemia, primary hyperaldosteronism, conditions accompanied by a decrease in the volume of circulating blood (BCC) (including as a result of diarrhea, vomiting); use in patients on a diet with restriction of table salt.

Pregnancy and lactation:

The use of the drug Ecquard ® is not recommended during pregnancy.

When diagnosing a pregnancy, taking Ecuquard® should be stopped as soon as possible.

Taking inhibitors APF in the II and III trimester of pregnancy has an adverse effect on the fetus (there may be a marked decrease in blood pressure, renal failure, hyperkalemia, hypoplasia of the skull bones, fetal death). Data on the negative effects of the drug on the fetus in case of application during the I trimester are not present. For newborns and infants who have undergone intrauterine exposure to ACE inhibitors, careful monitoring is recommended to timely detect a marked decrease in blood pressure, oliguria, and hyperkalemia.

The safety of amlodipine during pregnancy is not established, so use in pregnancy is possible only if the benefit to the mother exceeds the potential risk to the fetus.

Lizinopril penetrates the placenta.There is no data on the penetration of lisinopril into breast milk.

There is no evidence of the isolation of amlodipine in breast milk. However, it is known that other BCCC - dihydropyridine derivatives are excreted in breast milk.

The use of the drug Ecquard ® during breast-feeding is not recommended.

If the drug is needed during lactation, then breastfeeding should be discontinued.

Dosing and Administration:

Tablets of the drug Ecquard ® are taken orally once a day, regardless of the time of eating, squeezed with enough liquid.

Adults the recommended dose is 1 tablet of the drug Ecquard ® once a day.

At the beginning of therapy with the drug Ecquard may develop symptomatic arterial hypotension, which is more likely to occur in patients with violations of water electrolyte balance due to previous therapy with diuretics. Admission diuretikov should be discontinued 2-3 days before the start of therapy with the drug Ecquard ®.

In cases where the elimination of diuretics is not possible, the initial dose of the drug Ecquard ® is 1/2 tablet (5 mg15 mg) once a day, after which,for several hours should be monitored for the patient because of the possible development of symptomatic arterial hypotension.

Renal impairment

In patients with impaired renal function, it is recommended to use the drug Ecquard ® at a dose of 5 mg + 5 mg (increase in the half-life of lisinopril). The maintenance dose is selected depending on the tolerability of the therapy, the function of the nights, the content of potassium and sodium in the blood plasma is required.

Dysfunction of the liver

In patients with impaired hepatic function it is recommended to use the drug Ecquard ® in a dose of 5 mg + 5 mg (increase in the half-life of amlodipine).

Side effects:

The frequency of adverse reactions listed below was determined according to the following (classification of the World Health Organization): very often - not less than 10%; often not less than 1%, but less than 10%; infrequently not less than 0.1%, but less than 1%; rarely not less than 0.01%, but less than 0.1%; very rarely less than 0.01%, including individual reports.

Lisinopril

From the cardiovascular system: often marked decrease in blood pressure. orthostatic hypotension; infrequently acute myocardial infarction, tachycardia,a feeling of palpitations; Raynaud's syndrome; rarely bradycardia, tachycardia, aggravation of symptoms of CSI, violation of atrioventricular conduction, chest pain.

From the central nervous system: often dizziness, headache, infrequent lability of mood, paresthesia, sleep disturbance, stroke; rarely confusedconsciousness, asthenic syndrome, convulsive twitching of the muscles of the limbs and lips, drowsiness.

From the hemopoietic system and lymphatic system: rarely decreased hemoglobin, hematocrit; very rarely leukopenia, neutropenia, agranulocytosis, thrombocytopenia, eosinophilia, erythropenia, haemolytic anemia, lymphadenopathy, autoimmune diseases.

Co the respiratory system: often cough, rhinitis, rarely, very rarely sinusitis, bronchospasm, allergic alveolitis / eosinophilic pneumonia, shortness of breath.

From the digestive system: often diarrhea, vomiting; infrequently dyspepsia, and imputing of taste, abdominal pain; rarely dryness of the oral mucosa: very rarely pancreatitis, jaundice (hepatocellular and cholestatic), hepatitis, liver failure, interstitial edema, anorexia.

Co skin: infrequent itching, rash; rarely angioedema, swelling of the face, limbs, lips. tongue, larynx, urticaria, alopecia, psoriasis; very rarely increased sweating, vasculitis, pemphigus, photosensitivity, toxic epidermal necrolysis (Lyell's syndrome), erythema multiforme, Stevens-Johnson syndrome.

Co side of the urinary system: often impaired renal function; infrequently uremia, acute renal failure; very rarely anuria, oliguria, proteinuria.

Co side of the reproductive system: infrequently - impotence, rarely gynecomastia.

Co side of metabolism: very rarely hypoglycemia.

From the laboratory indicators: infrequent increase in urea concentration in the blood, hypercreatinemia, hyperkalemia, increased activity of "hepatic" transaminases, rarely hyperbilirubinemia, hyponatremia, increased erythrocyte sedimentation rate, false positive results of the test for antinuclear antibodies.

Co side of the musculoskeletal system: rarely - arthralgia / arthritis, myalgia.

Amlodipine

From the central nervous system: often headache (especially at the beginning of treatment), dizziness, fatigue, drowsiness: infrequent general malaise, hypoesthesia, asthenia, paresthesia, peripheral neuropathy, tremor, insomnia, emotional lability, unusual dreams, nervousness, increased excitability, depression, anxiety, increased sweating; rarely cramps, apathy, agitation; very rarely ataxia, amnesia.

From the digestive system: often nausea, abdominal pain: infrequent vomiting, change in the bowel movement (including constipation, flatulence), dyspepsia, diarrhea, anorexia, dryness of the oral mucosa, thirst; rarely hyperplasia of the gums, increased appetite; very rarely pancreatitis, gastritis, jaundice (usually cholestatic), hyperbilirubinemia, increased activity of "hepatic" transaminases, hepatitis.

From the cardiovascular system: often peripheral edema (ankles and feet), palpitations, "hot flashes" of blood to the skin of the face; infrequently excessive decrease in blood pressure, orthostatic hypotension, vasculitis; rarely - development or aggravation course of CHF; very seldom faint, shortness of breath, heart rhythm disturbances (including bradycardia, ventricular tachycardia and atrial fibrillation), myocardial infarction, chest pain, pulmonary edema, migraine.

From the hematopoietic and lymphatic systems: very rarely thrombocytopenic purpura, leukopenia, thrombocytopenia.

From the urinary system: infrequently pollakiuria, painful urge to urinate, nocturia; very rarely dysuria, polyuria.

On the part of the reproductive system and mammary glands: infrequently gynecomastia, impotence.

From the respiratory system: infrequently shortness of breath, rhinitis; very rarely cough.

Co side of the musculoskeletal system: infrequently muscle cramps, myalgia. arthralgia, back pain, arthrosis; rarely myasthenia gravis.

From the skin: infrequently alopecia; rarely dermatitis; very rarely alopecia, xeroderma, cold sticky notes, a violation of skin pigmentation.

Allergic reactions: rarely itching, rash (including erythematous, maculopapular rash); very rarely - hives, angioedema, erythema multiforme.

From the sense organs: infrequent ringing in the ears, impaired vision, diplopia, accommodation disorder, xerophthalmia, conjunctivitis, pain in the eyes; very rarely parasymia.

From the side of metabolism: very rarely hyperglycemia.

Other: infrequently - weight loss, weight gain, taste distortion, epistaxis, chills.

Overdose:

Lisinopril

Symptoms: marked decrease in blood pressure, dryness of the oral mucosa. disturbance of water-electrolyte balance, renal failure, rapid breathing, tachycardia, palpitations, bradycardia, dizziness, anxiety, irritability, cough, drowsiness, urinary retention, constipation. Treatment: there is no specific antidote. Gastric lavage, application of enterosorbents and laxatives. Intravenous introduction of 0.9% sodium chloride solution was shown. In the case of a sustained bradycardia, the use of an artificial pacemaker is necessary. It is necessary to monitor blood pressure, indicators of water-electrolyte balance. Hemodialysis is effective.

Amlodipine

Symptoms: marked decrease in blood pressure with possible development of reflex tachycardia and excessive peripheral vasodilation (risk of development of severe and persistent arterial hypotension, including with the development of shock and death). Treatment: gastric lavage,the use of activated carbon (especially in the first 2 hours after an overdose), maintaining the function of the cardiovascular system, elevating the position of the lower extremities, monitoring the heart and lung function, monitoring the volume of circulating blood (BCC) and diuresis. To restore the vascular tone - the use of vasoconstrictor (in the absence contraindications to their use); to eliminate the effects of calcium channel blockade, intravenous calcium gluconate. Hemodialysis is not effective.

Interaction:

Lisinopril

FROM caution should be applied lisinopril simultaneously with potassium-sparing diuretics (spironolactone, triamterene, amiloride, eplerenone), potassium preparations, salt substitutes, containing potassium, cyclosporine - the risk is increased Hyperkalemia, especially with impaired renal function. Therefore, these combinations should be used only on the basis of the individual solutions at regular physician monitoring the potassium content in blood serum and renal function.

With simultaneous use with diuretics and other antihypertensive drugs, the antihypertensive affect of lisinopril is enhanced.

When used simultaneously with non-steroidal anti-inflammatory drugs (NSAIDs) (including selective inhibitors of cyclooxygenase-2 (COX-2)). estrogens, as well as sympathomimetics, reduces the antihypertensive effect of lisinopril. NSAIDs, including COX-2, and ACE inhibitors increase serum potassium levels and can worsen renal function. This effect is usually reversible.

Lizinopril slows down the excretion of lithium preparations, therefore, with simultaneous application, a reversible increase in its concentration in the blood plasma occurs, which can increase the likelihood of unwanted phenomena, therefore, the concentration of lithium in serum should be monitored regularly.

With simultaneous use with antacids and colestyramin, suction of lisinopril from the digestive tract decreases.

Ethanol enhances the action of lisinopril.

With simultaneous use with insulin and hypoglycemic agents for oral administration, the risk of developing hypoglycemia increases.

With the simultaneous use of lisinopril with vasodilators. Barbiturates, antipsychotic drugs (neuroleptics), tricyclic antidepressants.LMCK, beta-blockers may increase the antihypertensive affect.

With the simultaneous use of inhibitors of AIF and gold preparations intravenously (sodium aurotomy malate) describes a symptom complex, which includes facial flushing, nausea, vomiting and lowering blood pressure.

Joint application with allopurinol, procainamide, cytostatics can lead to leukopenia.

Amlodipine

Amlodipine can be safely used for the therapy of arterial hypertension along with thiazide diuretics, alpha-adrenoblockers or ACE inhibitors.

In contrast to other BCCC, clinically significant interaction of amlodipine was not detected when combined with NSAIDs, including with indomethacin. It is possible to strengthen the anti-anginal and antihypertensive action of BCCC with compatible use with thiazide and "loop" diuretics, inhibitors APF and nitrates, as well as the intensification of their antihypertensive action with simultaneous use with alpha-blockers.

Erythromycin in a joint application increases C_m_a_x Amlodipine in young patients by 22%, and in elderly patients - by 50%.

Beta-adrenoblockers with simultaneous application with amlodipine may cause an exacerbation of chronic heart failure.

Although no negative inotropic effects were usually observed in the study of amlodipine, nevertheless, some BCCCs can increase the severity of the negative inotropic effect of antiarrhythmic agents that cause lengthening of the interval QT (eg, amiodarone and quinidine).

A single dose of 100 mg of sildenafil from the Nazis with hypertension nc influences the pharmacokinetics of amlodipine.

The repeated use of amlodipine in a dose of 10 mg and atorvastatin at a dose of 80 mg is not accompanied by significant changes in the pharmacokinetics of atorvastatin.

Ethanol (drinks containing alcohol): amlodipine at a single and repeated application in a dose of 10 mg does not affect the pharmacokinetics of ethanol.

Antiretroviral agents (ritonavir) increases plasma concentrations of BCCC, including amlodipine.

Neuroleptics and isoflurane increased hypotensive effect of dihydropyridine derivatives.

Calcium preparations can reduce the effect of BCCC.

When amlodipine is used together with lithium preparations, it is possible to intensify manifestations of neurotoxicity (nausea, vomiting, diarrhea, ataxia, tremor, noise and ears). Amlodipine does not change the pharmacokinetics of cyclosporine.

Does not affect the concentration of serum digoxin and its renal clearance.

Has no significant effect on the effect of warfarin (prothrombin time). Cimetidine does not affect the pharmacokinetics of amlodipine.

In studies in vitro Amlodipine ns affects the binding of blood plasma proteins digoxin, phenytoin. warfarin and indomethacin.

Grapefruit juice: simultaneous single intake of 240 mg of grapefruit juice and 10 mg of amlodipine inwards is not accompanied by a significant change in the pharmacokinetics of amlodipine.

Aluminum- or magnesium-containing antacids: their single administration does not have a significant effect on the pharmacokinetics of amlodipine.

Special instructions:

Treatment with Ecquard® can begin only after correction of hyponatremia and recovery of circulating blood volume.

After taking the first dose of the drug, careful monitoring of blood pressure is recommended: a significant reduction in blood pressure with the development of symptomatic arterial hypotension is possible.Most often, a marked decrease in blood pressure occurs with a decrease in bcc caused by diuretic therapy, a decrease in table salt content in food, dialysis, diarrhea, or vomiting.

With arterial hypotension, the patient is given a horizontal position and, if necessary, intravenously injected a solution that replenishes the volume of the circulating fluid (infusion of 0.9% sodium chloride solution).

Similar rules should be followed when using the drug Ecquard ® y patients with IHD, cerebrovascular insufficiency, in whom a sharp decrease in blood pressure can lead to myocardial infarction or stroke.

With stenosis of the aorta, hypertrophic obstructive cardiomyopathy, the appointment of a vasodilator requires caution.

During the period of therapy with the drug Ecquard ® it is necessary to control body weight and consumption of table salt, the purpose of the appropriate diet is indicated.

It is necessary to maintain oral hygiene and supervision at the dentist (to prevent soreness, bleeding and gingival hyperplasia).

During the period of therapy, periodic monitoring of peripheral blood is necessary, becauseit is impossible to exclude the potential risk of agranulocytosis, periodic monitoring of peripheral blood is required.

In case of renal dysfunction, for example, with stenosis of the renal artery (especially bilateral or stenosis of the arteries of a single night), hyponatremia, dehydration, circulatory insufficiency, taking the drug may provoke impaired renal function and acute renal failure, reversible after discontinuation of treatment. It is necessary to monitor patients with impaired renal function.

In elderly patients, T1 / 2 amlodipine may increase and the clearance of the drug may decrease. More careful monitoring of patients of this category is necessary.

If there is a violation of the liver, the half-life of amlodipine increases, such patients are prescribed with caution, after assessing the benefits and risks.

With the use of ACE inhibitors, it is possible to develop an angioedema of the face, extremities, lips, tongue, epiglottis or larynx, requiring immediate cessation of treatment with the drug and establishing a medical observation until the symptoms regress completely. Angioedema with edema of the larynx can be fatal.Swelling of the tongue, epiglottis or larynx can cause airway obstruction, therefore, immediately appropriate therapy (0.3-0.5 ml of 1: 1000 epinephrine (epinephrine) solution subcutaneously) and / or measures to ensure airway patency. In cases where the edema is localized only on the face and lips, the condition usually passes without treatment, but antihistamines can be used.

The risk of angioedema development is increased in patients who have at history of angioedema from the use of ACE inhibitors.

In patients taking ACE inhibitors during the desensitization procedure for venom of Hymenoptera, extremely rare, life-threatening anaphylactoid reactions can develop. This can be avoided if the treatment with an ACE inhibitor is temporarily discontinued before each desensitization procedure on the hymenoptera.

Surgical intervention / general anesthesia: with general anesthetics with antihypertensive action and extensive surgery lisinopril inhibits the formation of angiotensin-II in response to compensatory renin release.With such arterial hypotension, blood pressure is normalized by increasing the volume of circulating blood.

Before surgery (including dental surgery), the surgeon / anesthesiologist should be informed of the use of an ACE inhibitor.

Anaphylactoid reactions are also observed in patients on hemodialysis using high-flow dialysis membranes (AN69®), which simultaneously take ACE inhibitors. In such cases, one should consider the possible use of another type of membrane for dialysis or another antihypertensive drug. When choosing a dose, it should be borne in mind that in elderly patients, both active substances are detected in the blood in a higher concentration, while the effectiveness does not change.

Cough was used in the use of ACE inhibitors. Cough is dry, prolonged, which disappears after discontinuing treatment with an ACE inhibitor. With a differential diagnosis of cough, one should also consider a cough caused by the use of an inhibitor APF.

Effect on the ability to drive transp. cf. and fur:Care should be taken with the use of the drug Ecquard ® due to the fact that it is possible to develop arterial hypotension, dizziness and snotty,which may affect the ability to drive vehicles and work) with potentially dangerous machinery.

Form release / dosage:

Tablets of 5 mg each + 5 mg and 5 mg + 10mg.

Packaging:10 tablets per blister of A1 / A1. 1, 2, 3 or 10 blisters together with instructions for use in a cardboard box.

Storage conditions:

In the dark place at a temperature of no higher than 25 ° C.

Keep out of the reach of children.

Shelf life:

3 years.

Do not use the product after the expiry date printed on the package.

Terms of leave from pharmacies:On prescription

Registration number:LP-001284

Date of registration:25.11.2011

The owner of the registration certificate:Micro Labs LimitedMicro Labs Limited India

Manufacturer: & nbsp

MICRO LABS, Limited India

Representation: & nbspMICRO LABS LIMITED MICRO LABS LIMITED India

Information update date: & nbsp02.08.2013

Illustrated instructions

Instructions

Ecquard® (Ekvacard®)