Most often, a marked decrease in blood pressure occurs with a decrease in fluid volume caused by diuretic therapy, a decrease in table salt in the diet, dialysis, diarrhea, or vomiting. In patients with chronic heart failure with simultaneous renal failure or without it, the development of symptomatic arterial hypotension is possible.
It is more often detected in patients with a severe stage of chronic heart failure, as a result of the use of large doses of diuretics, hyponatremia or impaired renal function. In such patients, treatment with Lizakard 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 appointing patients with coronary heart disease, cerebrovascular insufficiency, in which a sharp decrease in blood pressure can lead to myocardial infarction or stroke.
Transient decrease in blood pressure is not a contraindication for taking the next dose of the drug.
When using the drug Lizakard, in some patients with chronic heart failure, but with normal or low blood pressure, there may be a decrease in blood pressure, which is usually not a reason for stopping treatment.
Before starting treatment with Lizakard, if possible, normalize the sodium concentration and / or replace lost fluid, carefully monitor the effect of the initial dose of the drug on the patient.
In the case of stenosis of the renal artery (especially with bilateral stenosis, or in the presence of stenosis of the artery of a single kidney), as well as inadequate blood circulation due to lack of sodium and / or liquid, the use of lisinopril can lead to impaired renal function, acute renal failure, irreversible after drug discontinuation.
The drug Lizakard can be used together with intravenous administration or with the use of therapeutic transdermal systems of nitroglycerin.
ACE inhibitors can be used together with beta-blockers, thrombolytic agents and antiplatelet agents, including acetylsalicylic acid in doses no more than 300 mg / day.
In elderly patients, the same dose leads to a higher concentration of the drug in the blood, therefore special caution is required when determining the dose.
Because the potential risk of agranulocytosis can not be ruled out, periodic monitoring of the blood picture is required. Anaphylactic shock can develop in hemodialysis patients using high-flow dialysis membranes (AN69®) that take ACE inhibitors, so either a different type of dialysis membrane or other antihypertensive agents is recommended.
Sometimes anaphylactic reactions developed in patients taking ACE inhibitors when desiccating the venom of Hymenoptera (eg, wasps or bees). These reactions were avoided in the same patients by temporarily stopping the administration of ACE inhibitors, but after an inadvertent re-use of the drug, the reactions were restored.
Very rarely, ACE inhibitors were associated with a syndrome that begins with cholestatic jaundice and progresses rapidly to liver necrosis and (sometimes) death. The mechanism of this syndrome is not established. Patients who have developed jaundice with lisinopril or have a significant increase in hepatic enzymes should be withdrawn and appropriate medical care should be provided.
After the application of ACE inhibitors, a cough may appear. Usually, cough is unproductive and stops after the treatment is canceled. Cough caused by ACE inhibitors should be considered in the differential diagnosis of cough as one of the possible options.
In patients with diabetes mellitus, taking oral antidiabetics or insulin, it is necessary to carry out constant glycemic control during the first month of therapy with ACE inhibitors.
In apheresis with dextrin sulfate, the use of ACE inhibitors can lead to anaphylactic reactions that can threaten life. Before prescribing the drug should carefully assess the risk / benefit ratio in the following cases: anaphylactoid reactions,angioedema in history; severe violations of the liver and kidneys, including bilateral stenosis of the renal arteries or stenosis of the renal artery of a single kidney, a condition after a kidney transplant; stenosis of the aortic or mitral valve, or other obstructive changes that hinder the flow of blood from the heart; collagenoses; oppression of bone marrow function; cerebrovascular insufficiency, hypotension; gout; hypercalcemia or a high risk of its development (diabetes mellitus, concurrent use with potassium-sparing diuretics); hyponatremia or restriction of sodium in the diet, hyperuricemia.
With special care (in a hospital), the drug is prescribed to patients with malignant hypertension or hypertension of renal origin, in conditions accompanied by a decrease in BCC. The drug should be treated under regular medical supervision. In acute myocardial infarction with ST segment elevation, treatment with lisinopril should be started within the first 24 hours after the onset of symptoms, provided there is no arterial hypotension, hypovolemia, renal insufficiency,In patients with clinical signs of heart failure, with a reduced fraction of left ventricular ejection, hypertension, diabetes mellitus lisinopril is the drug of choice. During therapy with the drug, regular monitoring of blood pressure, kidney function, hemogram parameters, body weight, as well as protein and potassium levels in blood plasma, urea and creatinine, and diet compliance are necessary. Angioneurotic edema of the face, extremities, lips, tongue, larynx in patients taking ACE inhibitors is very rare, with patients with angioedema edema of any etiology in history. Angioedema of the larynx can be fatal and requires urgent therapy. If swelling occurs only on the face and lips, it usually passes by itself. Anti-histamines have a positive effect. If the edema in the area of the tongue, throat or larynx is localized and the threat of the development of airway obstruction should be immediately introduced sc: epinephrine rp 1: 1000 (0.3-0.5 ml) or 0.1 ml iv. When used simultaneously with anesthetics that have an antihypertensive effect, during surgery lisinopril can block the formation of angiotensin II, increasing (secondary) renin activity of blood plasma, which can be eliminated by increasing the BCC. Before surgery (including dental surgery), the surgeon / anesthesiologist should be alerted to the use of lisinopril by the patient. During treatment it is recommended to refrain from drinking alcoholic beverages because of the risk of increasing the antihypertensive effect. Care should be taken with physical exertion, especially in hot weather, because of the risk of developing dehydration and increasing antihypertensive effect as a result of a decrease in bcc.