Before using Fosinopril-Teva and during its administration, blood pressure, renal function, the number of blood elements, potassium content, creatinine concentration and glucose in blood serum should be closely monitored.
A few days before the start of therapy with the drug Fosinoril-Teva, the previous antihypertensive treatment should be discontinued.
In severe CHF III and IV functional class according to the classification of NYNA and also in patients from other risk groups, treatment should be started under the supervision of a doctor. Patients with violations of water-electrolyte balance are recommended to correct water-electrolyte disorders before starting treatment with the drug Fozinopril-Teva. Patients who use insulin or hypoglycemic agents for oral administration,while concurrent administration of ACE inhibitors, it is necessary to monitor the concentration of glucose in the blood, especially during the first month of use. In conditions accompanied by a decrease in BCC (diuretic intake, salt-free diet, vomiting, diarrhea, hemodialysis), renin-dependent hyponatremia, cerebrovascular diseases, IHD, the risk of a sharp decrease in blood pressure increases.
With renovascular hypertension, bilateral stenosis of the renal arteries, or stenosis of the artery of a single functioning kidney, the risk of developing severe arterial hypotension and renal failure increases. In addition, during treatment with ACE inhibitors, the concentrations of urea and creatinine in serum can increase. These effects usually develop in patients with renal insufficiency, they are reversible and pass after discontinuation of treatment.
With systemic diseases of connective tissue (systemic lupus erythematosus, scleroderma) and immunosuppressant therapy (including after kidney transplantation), the risk of developing neutropenia, agranulocytosis increases.
With hyperkalemia, with stenosis of the aortic valve, hypertrophic obstructive cardiomyopathy,CHF III and IV of the functional class according to the classification of NYNA, when treating hypoglycemic drugs in patients with diabetes mellitus, the risk of developing hypoglycemia increases.
Against the background of taking ACE inhibitors, potassium levels in the serum can be increased. Patients with a risk of hyperkalemia, namely, patients with renal insufficiency, uncontrolled diabetes mellitus, taking potassium-sparing diuretics, potassium preparations or other medications that may lead to an increase in serum potassium (eg, heparin) may cause hyperkalemia.
When hemodialysis using high-flow polyacrylonitrile membranes, plasmapheresis with the use of dextran sulfate in patients with elevated levels of low-density lipoproteins, as well as specific desensitization to bee venom, the risk of allergic reactions increases. To prevent the development of anaphylactoid reactions in the conduct of plasmapheresis, the administration of an ACE inhibitor is temporarily stopped before the procedures are started.
Angioedema, swelling of the face, limbs, lips, mucous membranes, tongue,vocal folds and / or larynx can develop with the use of ACE inhibitors, especially during the first few weeks of therapy. In rare cases, severe angioedema may occur with prolonged use of the drug. In such cases
fosinopril should immediately be abolished and apply an antihypertensive drug of another pharmacological class.
In patients with arterial hypertension, symptomatic arterial hypotension with ACE inhibitors most often develops after intensive treatment with diuretics, diets restricting table salt, against diarrhea, vomiting, or in patients on hemodialysis.
In patients with heart failure with concomitant renal failure or without it, the risk of a sharp decrease in blood pressure on the background of hyponatremia, after previous intensive therapy with diuretics, as well as in elderly patients, increases.
Temporary arterial hypotension is not a contraindication for the use of the drug after taking measures aimed at increasing the BCC.
In order to reduce the risk of symptomatic arterial hypotension,who take diuretics, it is recommended to stop taking them 2-3 days before the start of treatment with the drug Fosinopril-Teva. If diuretics can not be canceled, the treatment should begin with a minimum dose of 10 mg. Further increase in the dose is carried out under the control of blood pressure.
In some patients with heart failure who initially had normal or low blood pressure, with the onset of Fosinopril-Teva, a further moderate decrease in systemic blood pressure is possible, which is a common effect at the beginning of the drug.
During the application of Fosinopril-Teva, a dry cough may appear, which disappears after the drug is withdrawn. If necessary, treatment can be continued.
In the case of jaundice or a significant increase in the activity of "liver" enzymes, the use of an ACE inhibitor should be discontinued and the patient should be carefully monitored.
During the administration of ACE inhibitors, edema of the intestinal mucosa was rarely seen, often in the absence of nausea and vomiting, which disappeared after the cessation of the use of ACE inhibitors. Swelling of the intestinal mucosa should be considered in differential diagnosis in patients withcomplaints of abdominal pain, developed against the background of treatment with ACE inhibitors.
In surgical intervention (general anesthesia), the possibility of developing arterial hypotension increases.
An anesthesiologist should be informed of the use of Fosinopril-Teva if an anesthetic or surgical procedure is planned for the patient. Treatment with an ACE inhibitor should be discontinued one day before surgery.
Patients taking the drug Fosinopril-Teva should be careful when doing physical exercises or in hot weather because of the risk of dehydration and arterial hypotension due to a decrease in BCC.
It is not recommended to use the drug Fosinopril-Teva concomitantly with preparations cast. If it is necessary to use such a combination, it is necessary to monitor the concentration of lithium in the blood plasma.
Children and adolescents under the age of 18 years (safety and efficacy not established).