Symptomatic hypotension
Most often, a marked decrease in blood pressure occurs with a decrease in fluid volume caused by diuretic therapy, a decrease in salt in the diet, dialysis, diarrhea, or vomiting (see INTERACTION WITH OTHER MEDICINES AND ADVERSE EFFECTS). In patients with chronic heart failure with simultaneous renal failure or without it, the development of symptomatic arterial hypotension is possible.It was more often detected in patients with a severe stage of heart failure, as a result of the use of large doses of diuretic, hyponatremia or impaired renal function. In such patients, treatment should be started under the strict supervision of a doctor (with care to select the dose of the drug and diuretics). Similar rules should be adhered to when assigning patients with coronary heart disease, cerebrovascular insufficiency, in which a sharp decrease in blood pressure can lead to myocardial infarction or stroke.
In the case of a pronounced decrease in blood pressure, the patient should be placed in a supine position and, if necessary, intravenously administered 0.9% sodium chloride solution. Transient hypotensive reaction is not a contraindication for taking the next dose of the drug.
With the use of the drug in some patients with chronic heart failure, a nose with normal or lowered blood pressure, there may be a decrease in blood pressure, which is usually not a reason for stopping treatment. In the event that arterial hypotension turns into symptomatic, it is necessary to reduce the dose of the drug or stop treatment with the drug.
With acute myocardial infarction
The use of standard therapy (thrombolytics, acetylsalicylic acid, beta-blockers).
IRUMED® can be used in conjunction with intravenous nitroglycerin or with the use of transdermal nitroglycerin systems.
Treatment with lisinopril should not begin in patients with acute myocardial infarction who have a risk of further serious hemodynamic deterioration after using vasodilators. These are patients with a systolic blood pressure of 100 mm Hg. or lower or with cardiogenic shock. During the first 3 days after a heart attack, the dose should be reduced if systolic blood pressure is 120 mm Hg. or lower. Maintenance doses should be reduced to 5 mg or temporarily to 2.5 mg if systolic blood pressure is 100 mm Hg or lower. If arterial hypotension persists (systolic blood pressure less than 90 mm Hg for more than 1 hour), then the preparation IRUMED® should not be used.
Impaired renal function
In patients with chronic heart failure, a marked decrease in blood pressure after initiation of treatment with ACE inhibitors may lead to further deterioration of renal function. Cases of acute renal failure are noted.
In patients with bilateral stenosis of the renal arteries or stenosis of the artery of a single night receiving ACE inhibitors, there was an increase in urea and serum creatinine, usually reversible after discontinuation of treatment. It was more common in patients with renal insufficiency.
Lizinopril is not used for acute infarction in patients with severe renal dysfunction, which is determined by a change in the serum creatinine concentration exceeding 177 mmol / l and / or proteinuria exceeding 500 mg / day. If renal dysfunction develops during the use of the drug (serum creatinine concentration greater than 265 mmol / L or doubling the value with pre-treatment values), the physician should assess the need for further use of the IRUMED® preparation.
Hypersensitivity / Angioedema
The angioedema of the face, limbs, lips, tongue, epiglottis and / or larynx that may occur during any treatment period was rarely seen in patients treated with an ACE inhibitor, including lisinopril. In this case, treatment with the drug should be stopped as soon as possible and for the patient to establish an observation until the symptoms regress completely.In cases where edema occurs only on the face and lips, the condition often passes without treatment, but it is possible to prescribe antihistamines. Angioedema with edema of the larynx can be fatal. Swelling of the tongue, epiglottis or larynx can be the cause of airway obstruction, therefore it is necessary to immediately carry out appropriate therapy (0.3-0.5 ml of 1: 1000 epinephrine (adrenaline) solution subcutaneously) and / or measures to ensure airway patency. It was noted that in patients of the Negroid race, taking ACE inhibitors, angioedema developed more often than in patients of other races.
Patients who have had an angioneurotic edema that is not associated with previous treatment with ACE inhibitors may be at increased risk of developing it during treatment with an ACE inhibitor (see also CONTRAINDICATIONS).
Anaphylactoid reactions during desensitization to the hymenoptera In patients taking ACE inhibitors during desensitization to the hymenoptera, it may very seldom appear a life-threatening anaphylactoid reaction. This can be avoided by temporarily discontinuing treatment with an ACE inhibitor before each desensitization.
Patients on hemodialysis
Anaphylactoid reactions are also observed in patients undergoing hemodialysis with a membrane of high permeability (NA 69), which simultaneously take ACE inhibitors. In such cases, one should consider the possibility of using another type of membrane for dialysis or another antihypertensive agent.
Cough
When an ACE inhibitor was used, a cough was noted. 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 ACE inhibitor.
Surgery / General Anesthesia
When using agents that reduce blood pressure in patients with extensive surgery or during general anesthesia lisinopril can block the formation of angiotensin II, secondary to the compensatory release of renin.
The pronounced decrease in blood pressure, which is considered a consequence of this mechanism, can be eliminated 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.
Serum potassium
In some cases, hyperkalemia was noted.
Risk factors for the development of hyperkalemia include renal failure, diabetes mellitus, and simultaneous use of potassium-sparing diuretics (spironolactone, triamterene or amiloride), potassium or salt substitutes containing potassium, especially in patients with impaired renal function.
If simultaneous use of lisinopril and the above mentioned drugs is considered necessary, they should be used with caution, regularly monitoring potassium in the serum.
In patients who have a risk of symptomatic hypotension (on a low-salt or salt-free diet) with or without hyponatremia, as well as in patients who received high doses of diuretics, the above conditions must be compensated before the start of treatment (loss of fluid and salts).
It is necessary to control the effect of the initial dose of the preparation IRUMED® on the value of blood pressure.