Before starting, and also regularly during the treatment with captopril, kidney function should be monitored. Patients with chronic heart failure are treated under close medical supervision.
Against the background of prolonged use of Captopril, approximately 20% of patients have a stable increase in serum urea and serum creatinine by more than 20% compared to the norm or the baseline value. Less than 5% patients, especially in severe nephropathies, require discontinuation of treatment due to the increase in creatinine concentration.
In patients with arterial hypertension with the use of Captopril, severe arterial hypotension is observed only in rare cases; the likelihood of developing this condition increases with a loss of fluid and salt loss (for example, after intensive treatment with diuretics), in patients with heart failure or who are on dialysis.
The possibility of a sharp drop in blood pressure can be minimized by first canceling (for 4-7 days) a diuretic or an increase the intake of sodium chloride (about a week before the start of the intake), or by the appointment of captopril at the beginning of treatment in small doses (6.25-12.5 mg / day).
When therapy in outpatient settings, warn the patient about the possible appearance of symptoms of an infection requiring a follow-up medical examination, a clinical and laboratory examination. In the first 3 months of therapy, the number of blood leukocytes is monitored monthly, then - once every 3 months; in patients with autoimmune diseases in the first 3 months - every 2 weeks, then every 2 months. If the number of white blood cells is less than 4000 / μL, a general blood test is performed, below 1000 μL - the drug is stopped. If the first symptoms of a secondary infection occur against a background of myeloid hypoplasia, an extensive blood test should be performed immediately.
It is necessary to exclude self-termination of the drug and an independent significant increase in the intensity of physical exertion.
In some cases, against the background of the use of ACE inhibitors, incl. captopril, there is an increase in the concentration of potassium in the blood serum. The risk of developing hyperkalemia with the use of ACE inhibitors is increased in patients with renal insufficiency and diabetes mellitus, and also taking potassium-sparing diuretics, potassium preparations or other drugs.drugs that increase the concentration of K + in the blood (for example, heparin). You should avoid the simultaneous use of potassium-sparing diuretics and potassium preparations.
When conducting hemodialysis in patients receiving Captopril, dialysis membranes with high permeability should be avoided (for example, AN69), because in such cases the risk of anaphylactoid reactions increases.
In case of development of angioedema, the drug is canceled and careful medical supervision and symptomatic therapy are carried out.
When taking Captopril, a false positive reaction can be observed when analyzing urine for acetone.
Be wary appoint patients who are on a low-salt or salt-free diet (increased risk of hypotension) and hyperkalemia.