Before you start, and also regularly in the process of treatment with the drug Kapoten® kidney function should be monitored. Patients from chronic heart failure under careful medical supervision.
When taking ACE inhibitors, a characteristic non-productive cough is observed, which stops after the withdrawal of therapy of ingibiACE inhibitors In rare cases, with the intake of ACE inhibitors, there is a syndrome that begins with the appearance of cholestatic jaundice, passing into a lightning hepatonecrosis, sometimes fatal. The mechanism of development of this syndrome is unknown. If a patient receiving ACE inhibitor therapy develops jaundice or a marked increase in the activity of hepatic enzymes, discontinue treatment with ACE inhibitors and establish patient monitoring. In some patients with kidney disease, especially with severe renal artery stenosis, there is an increase in the concentrations of urea nitrogen and creatinine in the blood serum after lowering blood pressure. This increase is usually reversible upon discontinuation of drug therapy Kapoten®. In these cases, a reduction in the dose of the drug may be required Kapoten® and / or cancellation of a diuretic.
On background of prolonged use of the drug Kapoten® approximately 20% of patientsentThere is an increase in the concentrations of urea and serum creatinine by more than 20% compared with the norm or baseline.
Less than 5% of patients, especially in severe nephropathies, require discontinuation of treatment due to increased creatinine concentrations.
It is not recommended to use a double blockade renin-angiotosinaldosterone system (RAAS), caused by the simultaneous administration of inhibitors ACE and angiotensin II receptor antagonists or aliskiren and aliskirecontaining drugs, since hebut associatedwith increased frequency of side effects, such as an arterial hypotension, giperkaliemiI, decreased kidney function (including acute renal failure). If simultaneous application of inhibitors APF and APA II (double blockade of RAAC) it is necessary, the treatment should be carried out under the supervision of the doctor and with the constant monitoring of kidney function, the content of electrolytes in the blood, and blood pressure.
It is not recommended to use joint inhibitors APF and angiotensin receptor antagonists II in patients with diabetic nephropathy.
In patients with hypertension with the drug Kapoten® severe arterial hypotension is observed only in rare cases; the probability of developing this condition increases with increased loss of fluid and salts (for example, after intensive treatment with diuretics), in patients with heart failure andland those on dialysis. The possibility of a sharp drop in blood pressure can be minimized by a preliminary cancellation (for 4-7 days) diuretic or increased intake of sodium chloride (about a week before the start of the intake), or by prescribing Kapoten® at the beginning of treatment in small doses (6.25-12.5 mg / day).
Be wary of patients on a low-salinity or salt-free diet (an increased risk of developing an arterial hypothesistion) and hypercalIemiah. Excessive reduction in blood pressure can be observed in patients during major surgical operations, as well as in the application of means for general anesthesia, which have an antihypertensive effect. In such cases, for the correction of reduced arterialpressure apply the measures nabout an increase in the volume of circulating blood.
Excessive reduction in blood pressure due to taking antihypertensive drugs may increase the risk of developing myocardial infarction or stroke in patients with coronary heart disease or cerebrovascular disease. When developing arterial hypotension, the patient should take a horizontal position with raised legs. You may need intravenous injection of 0.9% sodium chloride solution.
Care should be taken when taking ACE inhibitors in patients with mitral / aortic stenosis/ hypertrophic obstructive cardiomyopathy; in the case of cardiogenic shock and hemodynamically significantobstruction reception is not recommended.
In patients taking ACE inhibitors, there were neutropenia / agranulocytosis, thrombocytopenia and anemia. In patients with normal renal function and in the absence of other disorders neutropenia is rare. With renal failure, simultaneous administration of the drug Kapoten® and allopurinol led to neutropenia.
A drug Kapoten® It should be used very carefully naqientov with autoimmune diseases of connective tissue, in immunosuppressors, allopurinol and procainamide, especially if there is a previously existing renal dysfunction. Due to the fact that the majority lethal cases of neutropenia against the background of ACE inhibitors developed in thepatients, it is necessary to control the number of leukocytes blood before the beginning of treatment, in the first 3 months - every 2 weeks, then every 2 months.
All patients should be monitored monthly lof white blood cells in the blood in the first 3 months after initiation of therapy with the drug Kapoten®, then every 2 months. If the number of white blood cells is less than 4000 / μl, a repeated blood test is performed, below 1000 / μL - the drug is stopped while continuing to monitor the patient. Usually restoring the number of neutrophils occurs within 2 weeks after discontinuation of the drug Kapoten®. At 13% cases of neutropeniathe marked a lethal outcome. In almost all cases, lethal outcome was noted in patients with diseases of connective tissue, renal andheart failure, nand the reception background andmmunosuppressorov or a combination of both of these factors.
When using inhibitors of APThere may be proteinuria, mainly inpatients with impaired renal function, as well asWhen using high doses of drugs. In most cases, proteinuria when taking the drug Kapoten® disappeared or the degree of its severity decreased within 6 months, regardless of whether the drug was stopped or not. Indices of kidney function (concentration of urea nitrogen in the blood and creatinine) in patients with proteinuria almost always were within normal limits. Patients with kidney disease should determine the protein content in the urine before the treatment and periodically during the course of therapy. AT some casesand the background of the use of inhibitors APF, incl. preparation Kapoten®, an increase in the potassium content in serum is observed. The risk of developing hyperkalemia with inhibitors APF is elevated in patients with renal insufficiency and sugar diabet, and also the host fecesiceberggaydiuretics, potassium preparations, or other drugs that cause an increase in the potassium content in the blood (for example,PaRandm). You should avoid the simultaneous use of potassium-sparing diuretics and potassium preparations. In addition, with the use of ACE inhibitors simultaneously with thiazide diureticse no risk of development hypokalemia, so in such cases, regular monitoring of the potassium content in the blood during therapy should be carried out.
When hemodialysis in patients receiving ACE inhibitors, the use of dialysis membranes with high permeability should be avoided (for example, AN69), because in such cases the risk of developing anaphylactoid reactions. Anaphylactoid reactions were also observed in patients who underwentPof low density (apheresis) proteins with dextran sulfate.One should consider the use of either antihypertensive drugs of another class, or elsetype of dialysis membranes.
In rare cases, against the background of therapy with ACE inhibitors, life-threatening anaphylactoid reactions in patients undergoing a course of desensitization with the help of venom of Hymenoptera (bees, wasps). In such patients, these reactions were prevented by temporarily discontinuing therapy with an ACE inhibitor. Care should be taken when desensitizing such patients.
In the case of angioedema, the drug is withdrawn and carefully monitored until the symptoms disappear completely. Angioneurotic edema of the larynx can lead to death. If the edema is localized on the face, special treatment is usually not required (to reduce the severity of symptoms can be used antihistamines); If the swelling spreads to the tongue, throat or larynx and there is a threat of development of airway obstruction;pinephrin (addressonlin) subcutaneously (0.3-0.5 ml in a 1: 1000 dilution). In rare cases, patients after the administration of ACE inhibitors, angioedema of the intestine was noted, accompanied by abdominal paintand (with nausea and vomiting andwhether without them), sometimes - at normal values of activity of C-1-esterase and without a previous edema of the face. Bowel edema should be included in the spectrum of differential diagnosis of patients with complaints of abdominal pain when taking ACE inhibitors.
In representatives of the Negroid race, cases of angioedema development were noted with greater frequency in comparison with representatives of the European race.
Patients with diabetes who receive hypoglycemic drugs (hypoglycemic agents for ingestion or insulin) should carefully monitor the level of glycemia, especially during the first month of therapy with ACE inhibitors.
ACE inhibitors are less effective in representatives of the Negroid than in the patients of the European race, which may be due to the greater prevalence of low renin activity in representatives of the Negroid race.
PIn the conduct of extensive surgical operations or in the application of agents for general anesthesiaand, possessing the hypothesisMr.In patients receiving ACE inhibitors, an excessive decrease in blood pressure may be noted. And these cases can increase the volume of circulatingthe blood.
When taking the drug Kapoten® a false positive reaction can be observed when analyzing urine for acetone.