Before the beginning of treatment it is required to conduct an analysis of previous antihypertensive therapy, the degree of increase in blood pressure, restriction of ration for salt and / or fluid and other clinical circumstances.
Patients with severe hypertension or concomitant decompensated chronic heart failure should begin treatment with Focicard in a hospital setting.
Before and during treatment, the drug requires control of blood pressure, kidney function, potassium content, hemoglobin, creatinine, urea concentration, electrolyte concentration and activity of "hepatic" transaminases in the blood.
Angioedema
It was reported on the development of angioedema in patients with Fozicard. With edema of the tongue, throat or larynx, it can develop - airway obstruction with possible fatal outcome. In case of development of similar reactions, patients should stop taking the drug and subcutaneous injection of epinephrine (adrenaline) solution (1: 1000), as well as taking other measures of emergency therapy.
Swelling of the intestinal mucosa .
During the administration of ACE inhibitors, edema of the intestinal mucosa was rarely observed. These patients complained of abdominal pain (with nausea and vomiting may not be), in some cases, edema of the intestinal mucosa appeared without edema of the face, the level of Cl-esterases was normal.Symptoms disappeared after the cessation of the use of ACE inhibitors. Swelling of the intestinal mucosa should be included in the differential diagnosis of patients taking ACE inhibitors who complain of abdominal pain.
Anaphylactic reactions during dialysis using high-permeability membranes can lead to anaphylactic reactions in patients using ACE inhibitors during hemodialysis through high-permeability membranes, as well as during apheresis of low-density lipoproteins adsorbed to dextran sulfate.
In these cases, one should consider the possibility of using dialysis membranes of a different type or other antihypertensive therapy.
Neutropenia / agranulocytosis
Perhaps the development of agranulocytosis and suppression of bone marrow function during treatment with ACE inhibitors. These cases are noted more often in patients with impaired renal function, especially in the presence of systemic connective tissue diseases (systemic lupus erythematosus or scleroderma). Before the beginning of therapy with ACE inhibitors, and during the treatment, the total number of leukocytes and the leukocyte formula is determined (once a month for the first 3-6 months of treatment and the firstyear of use of the drug in patients with an increased risk of neutropenia).
Arterial hypotension
Patients with uncomplicated form of hypertension may develop arterial hypotension due to the use of the drug Fozicard.
Symptomatic arterial hypotension with ACE inhibitors most often develops in patients after intensive treatment with diuretics, a diet limiting intake of table salt; or with renal dialysis. Transient arterial hypotension is not a contraindication for the use of the drug after taking measures to restore BCC.
In patients with chronic heart failure, treatment with ACE inhibitors can cause an excessive antihypertensive effect, which can lead to oliguria or azotemia with a fatal outcome. Therefore, in the treatment of chronic heart failure with Fosicard, patients should be closely monitored, especially during the first 2 weeks of treatment, as well as with any increase in the dose of the drug Fosicard or diuretic.
It may be necessary to reduce the dose of diuretic in patients with hyponatremia and patients previously intensively treated with diuretics.Arterial hypotension is not a contraindication for further use of the drug Fosicard. Some, lowering systemic BP is a common and desirable effect at the beginning of the drug in heart failure. The degree of this decrease is maximal at early stages of treatment and stabilizes within one or two weeks from the start of treatment. BP usually returns to the values of the period before the start of treatment without decreasing the therapeutic effectiveness.
Impaired liver function
If there is a noticeable icterus and a marked increase in the activity of liver enzymes, treatment with Fosicard should be discontinued and appropriate treatment should be prescribed. .
Impaired renal function
In patients with arterial hypertension with bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney, and also with the simultaneous use of diuretics without signs of renal dysfunction during treatment with ACE inhibitors, concentration of blood urea nitrogen and serum creatinine may result. These effects are usually reversible and pass after discontinuation of treatment. You may need to reduce the dose of a diuretic and / or Fosicard.
In patients with severe chronic heart failure, with altered activity of the renin-angiotensin-aldosterone system, treatment with ACE inhibitors can lead to oliguria, progressive azotemia and, in rare cases, acute renal failure and possible fatal outcome.
Surgical interventions / general anesthesia
ACE inhibitors can enhance the antihypertensive effect of agents used for general anesthesia. Before surgery (including dentistry), it is necessary to alert the surgeon / anesthesiologist about the use of ACE inhibitors.
Care must be taken when driving vehicles or doing other work that requires increased attention, since it may cause dizziness; especially after the initial dose of an ACE inhibitor in patients taking diuretics. Caution should be exercised when performing physical exercises or in hot weather due to the risk of dehydration and arterial hypotension due to a decrease in BCC.
Safety and efficacy of Fosicard in children is not established.