Before the start, and also regularly, during the treatment with the drug should monitor the function of the kidneys. Patients with chronic heart failure are treated with under careful medical supervision.
Against the background of prolonged use of the drug, approximately 20% of patients have an increase in urea and serum creatinine by more than 20% compared to the norm or the baseline value. Less than 5% of patients, especially in severe nephropathies, require discontinuation of treatment due to increased creatinine concentrations.
In patients with arterial hypertension with the use of Captopril-Ferein®, severe arterial hypotension is observed only in rare cases; the likelihood of developing this condition increases with increased loss of fluid and salts (eg, after intensive treatment with diuretics), in patients with heart failure or who are on dialysis.
The possibility of a sharp reduction in blood pressure can be minimized by first canceling (for 4-7 days) a diuretic or increasing the intake of sodium chloride (about a week before the start of the intake) or by the appointment of Captopril-Ferene® at the start of treatment in small doses (6 , 25-12.5 mg / day).
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 / mm3, a general blood test is performed, below 1000 / mkl - the drug is stopped.
In some cases, with the use of angiotensin-converting enzyme inhibitors, including Captopril-Ferein®, an increase in the serum potassium concentration is observed. The risk of developing hyperkalemia with angiotensin-converting enzyme inhibitors is increased in patients with renal insufficiency and diabetes mellitus, and also taking potassium-sparing diuretics, potassium preparations or other drugs that cause an increase in the potassium concentration in the blood (eg, heparin). You should avoid the simultaneous use of potassium-sparing diuretics and potassium preparations.
When hemodialysis in patients receiving Captopril-Ferein®, the use of dialysis membranes with high permeability should be avoided (for example, AN69), because in such cases the risk of anaphylactoid reactions increases.
In the case of angioedema, the drug is withdrawn and carefully monitored. 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, you should immediately enter epinephrine (epinephrine) subcutaneously (0.5 ml in a dilution of 1: 1000).
When taking the drug, a false positive reaction can be observed when analyzing urine for acetone.
With caution, the drug is prescribed to patients on a low-salt or salt-free diet (increased risk of hypotension) and hyperkalemia.
In case of occurrence, after taking the drug symptomatic arterial hypotension, the patient should take a horizontal position with raised legs.