Arterial hypotension
A marked decrease in blood pressure with the development of clinical symptoms may be observed in patients with a decrease in the volume of circulating blood and / or sodium content due to diuretics, fluid loss, or for other reasons, for example sweating, prolonged vomiting and / or diarrhea. In case of arterial hypotension, the patient should be laid and compensated for fluid loss (intravenous infusion of 0.9% sodium chloride solution), if necessary. Preferably, the recovery of fluid and / or sodium loss is performed prior to the initiation of Equator® treatment.It is necessary to monitor BP after taking the initial dose.
Aortic and mitral stenosis
Like all vasodilators, Equator® should be administered with caution to patients with obstruction of the left ventricular outflow tract and stenosis of the mitral valve.
Impaired renal function
In some patients with arterial hypertension without pronounced manifestations of renovascular diseases, an increase in creatinine and urea in the blood serum was observed, in most cases minimal or transitory, more pronounced with concurrent administration of ACE inhibitors and a diuretic. This is most typical for patients with a history of kidney disease.
To determine the optimal maintenance dose, it is necessary to determine the dosage regimen on an individual basis, using separately lisinopril and amlodipine, with simultaneous monitoring of kidney function. Equator® is indicated only for those patients in whom the optimal maintenance dose of lisinopril and amlodipine is titrated to 20 and 10 mg, respectively.
In the case of a decrease in renal function, the equator® should be withdrawn and replaced by monotherapy with drugs in adequate doses.In addition, a dose reduction or elimination of diuretics may be required.
Angioedema
Angioedema, swelling of the face, extremities, lips, tongue, vocal folds and / or larynx were recorded in patients taking inhibitors ACE, including lisinopril. In these cases, the taking of Equator® should be stopped immediately and the patient should be carefully monitored until the symptoms disappear completely.
Edema of the face, lips and extremities usually pass independently, however, to reduce the severity of symptoms should use antihistamines.
Angioedema, accompanied by swelling of the larynx, can lead to death. If you detect edema of the tongue, pharynx or larynx, which are the cause of airway obstruction, emergency measures should be urgently started. The appropriate measures include: subcutaneous injection of 0.3-0.5 mg or slow intravenous administration of 0.1 mg of a 0.1% solution of epinephrine (adrenaline), followed by intravenous administration of glucocorticosteroids and antihistamines and simultaneous monitoring of vital functions.
Patients taking ACE inhibitors rarely had edema of the gastrointestinal tract. These patients complained of abdominal pain (with or without nausea and vomiting); in some cases, the previous edema was not observed and the activity of C-1 esterase was within normal limits. Angioedema has been diagnosed by computed tomography of the gastrointestinal tract, or after ultrasound, or during surgery, the symptoms disappeared after discontinuation of the ACE inhibitor. Edema of the gastrointestinal wall should be included in the differential diagnosis of abdominal pain in patients taking ACE inhibitors.
Anaphylactic reactions in patients with hemodialysis
In patients who underwent hemodialysis through a polyacrylonitrile membrane (for example, AN 69®) and which simultaneously produced ACE inhibitors, cases of anaphylactic shock have been reported, so this combination should be avoided. Patients are recommended to use either another type of dialysis membrane, or another type of antihypertensive drug.
Anaphylactic reactions in patients during apheresis of low-density lipoproteins (LDL)
Rarely, life-threatening anaphylactic reactions developed in patients who received ACE inhibitors during low density lipoprotein (LDL) apheresis (LDL) dextrin sulfate. Such reactions were prevented by abolishing the administration of ACE inhibitors prior to each apheresis procedure.
Desensitization from aspen or bee venom
Sometimes anaphylactic reactions developed in patients taking ACE inhibitors when desiccating the venom of Hymenoptera (eg, wasps or bees). Such life-threatening situations can be avoided with the timely withdrawal of ACE inhibitors.
Hepatotoxicity
In rare cases, the administration of ACE inhibitors was accompanied by a syndrome that began with cholestatic jaundice or hepatitis and developed into fulminant liver necrosis and in several cases resulted in death. The mechanism of this syndrome is unclear. Patients who receive Equator® and who develop jaundice or have an increased activity of "liver" enzymes should cancel Equator® and then monitor their condition.
Liver failure
In patients with impaired hepatic function, the half-life of amlodipine is longer. At the moment, recommendations on the dosage regimen have not been developed, in connection with which this medication should be administered with caution, having previously determined the expected benefit and the potential risk of treatment.
Hematological toxicity
In rare cases of patients receiving ACE inhibitors, neutropenia, agranulocytosis, thrombocytopenia, and anemia. In patients with normal renal function and in the absence of other aggravating factors, neutropenia is rare. Neutropenia and agranulocytosis are reversible and disappear after the withdrawal of the ACE inhibitor. Equator® should be used with extreme caution in patients with vascular collagen, immunosuppressive therapy, during treatment with allopurinol or procainamide, or a combination of these aggravating factors, especially if there is a previous impairment of renal function. Some of these patients developed serious infectious diseases, which in a few cases did not undergo correction with antibiotic therapy.When assigning the Equator®, it is recommended to periodically check the level of white blood cells in such patients, and also to warn them about the need to report the appearance of the first signs of an infectious disease.
Cough
Cough was often recorded during the use of ACE inhibitors. As a rule, cough is unproductive, permanent, and stopped after the drug was discontinued. With a differential diagnosis of cough, one must also consider the cough caused by the use of ACE inhibitors.
Surgery / general anesthesia
In patients who undergo extensive surgery or during general anesthesia with drugs leading to hypotension, lisinopril can block the formation of angiotensin II after compensatory release of renin. If the arterial hypotension, probably as a result of the above mechanism, it is possible to correct the increase in the volume of circulating blood.
Elderly patients
Older patients with impaired renal function should be corrected for the dose of Equator®.
Hyperkalemia
In some patients who received ACE inhibitors, an increase in the serum potassium level was observed.The risk group for the development of hyperkalemia is patients with renal insufficiency, diabetes mellitus, acute heart failure, dehydration, metabolic acidosis or with simultaneous admission potassium-sparing diuretics, food additives with potassium, potassium-containing salt substitutes or any other medical, drugs, leading to an increase in the serum potassium level (for example, heparin). If it is necessary to simultaneously take the above drugs, you need to monitor concentration of potassium in blood serum.
Patients with low body weight, low growth patients and patients with severe liver dysfunction may need a dose reduction.
Equator® does not have any adverse effect on the metabolism and lipids of the blood plasma and can be used in the treatment of patients with bronchial asthma, diabetes and gout.
During treatment, it is necessary to control body weight and monitor the dentist (to prevent soreness, bleeding and gingival hyperplasia).