Patients with chronic heart failure are treated under close medical supervision.
Before the onset, and also regularly during the treatment with the drug Captopril-FPO®, kidney function should be monitored. Against the background of long-term use of the drug Captopril-FPO, approximately 20% of patients have a stable increase in the concentrations of 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 an increase in the serum creatinine concentration.
In patients with hypertension with the use of the drug Captopril-FPO, expressed arterial hypotension is observed only in rare cases; The likelihood of developing this condition increases with deficiency of fluid and salts (incl.after intensive treatment with diuretics), in patients with chronic heart failure or who are on dialysis.
The probability of a sharp decrease in blood pressure can be minimized by a preliminary cancellation (for 4-7 days) of a diuretic, or by administration of captopril at the start of treatment in small doses (6.25-12.5 mg / day).
When therapy in outpatient settings, the patient should be warned 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 4 times in 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. If the first symptoms of a secondary infection occur against a background of myeloid hypoplasia, an extensive blood test should be performed immediately.
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 ACE inhibitors is increasedin patients with renal insufficiency and diabetes mellitus, and also taking potassium-sparing diuretics, potassium preparations or other drugs that cause an increase in the concentration of potassium in the blood (for example, heparin). You should avoid the simultaneous use of potassium-sparing diuretics and potassium preparations.
When hemodialysis is carried out in patients receiving Captopril-FPO®, 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. With the localization of edema on the face of special treatment is not required (to reduce the severity of symptoms - antihistamines); in case of spread of edema to the tongue, throat or larynx with the threat of airway obstruction, immediately enter epinephrine subcutaneously (0.5 ml at a dilution of 1: 1000).
When taking the drug Captopril-FPO®, a false positive reaction can be observed when analyzing urine for acetone.
Caution should be exercised when performing physical exercises or in hot weather (risk of dehydration and excessive blood pressure lowering due to decreased circulating blood volume).