Patients with malignant hypertension or concomitant decompensated chronic heart failure should begin treatment in a hospital setting.
Before the beginning of therapy with ACE inhibitors and during treatment, the total number of leukocytes and the leukocyte count are calculated (once a month for the first 3-6 months of treatment and at periodic intervals up to year I in patients with an increased risk of neutropenia: in case of impaired renal function, systemic connective tissue diseases, in those receiving high doses), as well as at the first signs of infection. Before and during treatment, it is necessary to monitor blood pressure, kidney function, potassium (K +) content in blood plasma, hemoglobin and creatinine, urea, electrolyte content and activity of "liver" enzymes in the blood.
Based on the results of epidemiological studies, it is assumed that simultaneous administration of ACE inhibitors and insulin, as well as hypoglycemic drugs for oral administration may lead to the development of hypoglycemia. The greatest risk of development is observed during the first weeks of combination therapy, as well as in patients with impaired renal function.Patients with diabetes require careful monitoring of glycemia, especially during the first month of therapy with an ACE inhibitor.
Care should be taken when prescribing to patients on a low-salt or salt-free diet (an increased risk of developing hypotension).
Safety and efficacy in pediatric practice: for newborns who have been exposed to intrauterine exposure to ACE inhibitors, careful monitoring is recommended to identify hypotension, oliguria, and hyperkalemia.
Caution should be exercised when performing physical exercises or in hot weather due to the risk of dehydration and a decrease in blood pressure due to a decrease in fluid volume.
Before surgery (including dentistry), it is necessary to alert the surgeon / anesthesiologist about the use of ACE inhibitors.
With the use of ACE inhibitors in the II-III trimesters of pregnancy, there may be oligohydroamnion, arterial hypotension of the fetus and newborn, oliguria and lethal outcomes.
It was reported on the development of angioedema in patients with fosinopril.When swelling of the tongue, throat or larynx, airway obstruction may develop with possible fatal outcome. If such reactions develop, patients should stop taking the drug and subcutaneously inject epinephrine (epinephrine) (1: 1000), as well as taking other emergency measures.
During the administration of ACE inhibitors, edema of the intestinal mucosa was rarely observed. In such cases, 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 C1-esterases was normal. Symptoms disappeared after the cessation of the use of ACE inhibitors. Swelling of the intestinal mucosa should be taken into account in differential diagnosis in patients with complaints of abdominal pain while treating with ACE inhibitors.
Against the background of therapy with ACE inhibitors, it is possible to develop anaphylactic reactions during hemodialysis through highly permeable membranes, as well as during LDL apheresis with adsorption to dextran sulfate. In such cases, the use of dialysis membranes of a different type or other medication should be considered.
Perhaps the development of agranulocytosis and suppression of bone marrow function during treatment with ACE inhibitors. These cases are more common 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 are determined (once a month for the first 3-6 months of treatment and in the first year of use in patients with an increased risk of neutropenia).
When there is noticeable icterus and a marked increase in the activity of liver enzymes, treatment with fosinopril should be discontinued and appropriate treatment prescribed.
In patients with 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 vascular disease during treatment with ACE inhibitors, the concentration of blood urea nitrogen and serum creatinine may increase. These effects are usually reversible and pass after discontinuation of treatment.You may need to reduce the dose of a diuretic and / or fosinopril.
Patients with uncomplicated form of hypertension may develop arterial hypotension due to the use of the drug
fosinopril.
Symptomatic arterial hypotension with the use of ACE inhibitors is most often developed in patients after intensive treatment with diuretics, a diet limiting the intake of salt, or in the conduct of renal dialysis. Temporary arterial hypotension is not a contraindication for the use of the drug after carrying out measures for hydration of the body.
In patients with severe chronic heart failure, with altered RAAS activity, treatment with ACE inhibitors can cause an excessive antihypertensive effect, which can lead to oliguria, progressive azotemia and, in rare cases, acute renal failure with possible fatal outcome. Therefore, in the treatment of chronic heart failure with fosinopril, patients should be closely monitored, especially during the first 2 weeks of treatment, as well as with any increase in the dose of fosinopril or diuretic.
Some reduction in 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 1-2 weeks from the beginning of treatment. BP usually returns to the values of the period before the start of treatment without decreasing the therapeutic effectiveness.
ACE inhibitors can enhance the antihypertensive effect of agents used for general anesthesia. Before surgery (including dentistry), a doctor should be warned about the use of ACE inhibitors.