Lizinopril - instructions for use, dose, side effects, contraindications

Active substance:
lisinopril dihydrate	5.44 mg	10.89 mg	21.78 mg
in terms of lisinopril	5 mg	10 mg	20 mg
Auxiliary substances:
lactose monohydrate	85.5 mg	113.56 mg	227.12 mg
microcrystalline cellulose	18.56 mg	20.0 mg	40.0 mg
corn starch	9.3 mg	13.95 mg	27.9 mg
magnesium stearate	1.2 mg	1.6 mg	3.2 mg

Description:

Tablets are white or almost white in color. It is allowed to have a light marble.

Tablets 5 mg - round, biconcave, without risks.

Tablets 10 mg - round, biconcave, with a risk.

Tablets 20 mg - round, biconcave, with a risk.

Pharmacotherapeutic group:ACE inhibitor

ATX: & nbsp

C.09.A.A.03 Lisinopril

C.09.A.A ACE Inhibitors

Pharmacodynamics:

Pharmacological action - antihypertensive, vasodilating, cardioprotective, natriuretic.

The ACE inhibitor reduces the formation of angiotensin II from angiotensin I. Reducing the concentration of angiotensin II leads to a direct reduction in the release of aldosterone. Reduces the degradation of bradykinin and increases the synthesis of prostaglandins. Reduces the overall peripheral vascular resistance, arterial pressure (BP), preload, pressure in the pulmonary capillaries, causes an increase in the minute volume of blood and increased tolerance of the myocardium to the load in patients with chronic heart failure (CHF). Expands arteries more than veins. Some effects are explained by the effect on the renin-angiotensin-aldosterone system (RAAS).With prolonged use, myocardial hypertrophy and the walls of arteries of resistive type decrease. Improved endothelial function and blood supply of the ischemic myocardium.

ACE inhibitors prolong life expectancy in patients with CHF, slow the progression of left ventricular dysfunction in patients who underwent myocardial infarction without clinical manifestations of heart failure. The beginning of the drug - after 1 hour, the maximum antihypertensive effect is achieved after 6-7 hours and persists for 24 hours. The duration of the effect also depends on the amount of the dose taken. With arterial hypertension, the effect is observed in the first days after the start of treatment, stable action develops after 1-2 months. therapy.

With a sharp reversal of lisinopril, there was no pronounced increase in blood pressure.

Lizinopril reduces the degree of albuminuria. Does not affect the concentration of glucose in the blood in patients with diabetes and does not increase the incidence of hypoglycemia.

Pharmacokinetics:

Suction. After oral administration lisinopril is absorbed from the gastrointestinal tract by an average of 30%, but the absorption can vary from 6 to 60%.Bioavailability is 25%. Simultaneous food intake does not affect the absorption of lisinopril.

Distribution. Lisinopril slightly binds to blood plasma proteins. The maximum concentration in the blood plasma (Stach) of 90 ng / ml is reached after 7 hours. Permeability through the blood-brain and placental barrier is low.

Metabolism. Lisinopril practically not metabolized in the body.

Excretion. It is excreted by the kidneys unchanged. The half-life (T_1/2) is 12 hours.

Pharmacokinetics in selected patient groups

In patients with CHF Absorption and clearance of lisinopril decreased. In patients with renal insufficiency (creatinine clearance less than 30 ml / min), the concentration of lisinopril is several times higher than the plasma concentration in healthy volunteers, with an increase in the time to reach the stachas in plasma and an increase in T_1/2.

In elderly patients the concentration of the drug in the blood plasma and the area under the "concentration-time" curve is 2 times greater than in patients of a young age.

In patients with cirrhosis of the liver bioavailability is reduced by 30% and QC by 50% compared to patients with normal liver function.

Indications:

- Arterial hypertension (in monotherapy or in combination with other antihypertensive drugs);

- chronic heart failure (as part of combination therapy to treat patients taking cardiac glycosides and / or diuretics);

- early treatment of acute myocardial infarction (within the first 24 hours with stable hemodynamic parameters to maintain these parameters and prevention of left ventricular dysfunction and heart failure);

- diabetic nephropathy (decrease in albuminuria in patients with type 1 diabetes mellitus at normal BP and in patients with type 2 diabetes mellitus with hypertension).

Contraindications:

- Hypersensitivity to lisinopril, other components of the drug or other ACE inhibitors; angioedema in the anamnesis (including and from the use of other ACE inhibitors);

- Hereditary edema Quincke and / or idiopathic angioedema;

- age under 18 years (effectiveness and safety not established);

- pregnancy and the period of breastfeeding;

- lactose intolerance, lactase deficiency, glucose-galactose malabsorption syndrome (the preparation contains lactose);

- simultaneous use with aliskiren and aliskirenoderzhaschimi drugs in patients with diabetes mellitus and patients with impaired renal function of moderate and / or severe severity (SC less than 60 ml / min).

Carefully:

Severe renal dysfunction, bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney with progressive azotemia; condition after kidney transplantation; azotemia; hyperkalemia; aortic stenosis; hypertrophic obstructive cardiomyopathy; primary hyperaldosteronism; arterial hypotension; cerebrovascular diseases (including cerebral circulatory insufficiency); ischemic heart disease (IHD); coronary insufficiency; autoimmune diseases of connective tissue (including scleroderma, systemic lupus erythematosus); oppression of bone marrow hematopoiesis; conditions, accompanied by a decrease in the volume of circulating blood (bcc), hypovolemic conditions (including as a result of diarrhea, vomiting); use in patients on a diet with restriction of table salt; in elderly patients (over 65 years), mitral stenosis, simultaneous use of ACE inhibitors with drugs containing aliskiren, or angiotensin II receptor antagonists (with double blockade of RAAS, there is an increased risk of developing arterial hypotension, hyperkalemia and renal insufficiency), diabetes mellitus, the use of Negroid races in patients, desensitizing therapy for Hepaticoptera venom, hemodialysis, low density lipoprotein apheresis using dextran sulfate, acute myocardial infarction.

Pregnancy and lactation:

The use of LIZINOPRIL during pregnancy, in women planning pregnancy, as well as in women of reproductive age who do not use reliable methods of contraception, is contraindicated.

When establishing the fact of pregnancy, the drug should be stopped as soon as possible. Lisinopril penetrates the placenta. Admission of ACE inhibitors in the II and III trimesters of pregnancy has an adverse effect on the fetus (there may be a marked decrease in blood pressure, renal failure, hyperkalemia, hypoplasia of the skull bones, fetal death).

Data on the negative effect of the drug on the fetus in case of application in the I trimester is not present. For newborns and infants,which have undergone the intrauterine effect of ACE inhibitors, it is recommended to carefully monitor for the timely detection of a marked decrease in blood pressure, oliguria, and hyperkalemia.

Women planning a pregnancy should not take ACE inhibitors, including lisinopril. Women of childbearing age should be warned about the potential dangers of using ACE inhibitors, including lisinopril. Cases of oligohydramnion, presumably due to impaired fetal kidney function, have been described. This complication can lead to limb contracture, craniofacial deformity, and hypoplastic lung development.

There is no data on the penetration of lisinopril into breast milk. If it is necessary to use the drug Lisinopril During lactation breastfeeding should be discontinued.

Dosing and Administration:

Inside, once in the morning, regardless of the time of ingestion, with a sufficient volume of liquid (for example, a glass of water), preferably at the same time.

To ensure the dosage regimen LYZINOPRILA in a dose of 2.5 mg is recommended LIZINOPRIL in tablets of 2.5 mg or 5 mg with the risk of other manufacturers.

Arterial hypertension (patients who do not receive other antihypertensive drugs): the initial dose is 5 mg / day. In the absence of effect, the dose is increased every 2-3 days by 5 mg / day to an average therapeutic dose of 20-40 mg / day (a dose exceeding 40 mg / day usually does not lead to a further decrease in blood pressure). The usual maintenance dose is 20 mg once a day. The maximum daily dose is 40 mg.

The therapeutic effect develops in 2-4 weeks from the beginning of treatment, which should be taken into account when increasing the dose. With insufficient clinical effect, it is possible to combine the drug with other antihypertensive drugs.

If the patient received prior treatment with diuretics, then the medication should be stopped 2-3 days before the drug is started LIZINOPRIL. If this is not possible, then the initial dose of the drug should not exceed 5 mg per day. In this case, after taking the first dose, medical supervision is recommended for several hours (maximum effect is achieved after about 6 hours), since there may be a pronounced decrease in blood pressure.

With Renovascular Hypertension or other conditions with increased activity of RAAS (hypovolemia, diet with restriction of consumption of table salt, cardiac decompensation or severe arterial hypotension), the initial dose is 2.5-5 mg per day (blood pressure, kidney function, potassium content). The maintenance dose, continuing strict regular monitoring, should be determined depending on the dynamics of blood pressure.

With chronic heart failure the initial dose of 2.5 mg per day, the dose is gradually increased (no more than 2.5 mg with an interval of 3-5 days) to a maintenance dose of 5-20 mg, depending on blood pressure. The maximum daily dose should not exceed 20 mg.

In elderly patients (over 65 years), a more prolonged antihypertensive effect is often observed, which is associated with a decrease in the rate of excretion of lisinopril. It is recommended to start therapy with 2.5 mg / day.

In the early treatment of acute myocardial infarction with stable parameters of hemodynamics (systolic blood pressure not less than 100 mm Hg) on the first day of the dose is 5 mg, then 5 mg every other day, 10 mg after two days and then 10 mg per day as maintenance therapy. In patients with acute myocardial infarction, the drug should be used for at least 6 weeks. At the beginning of treatment or within the first 3 days after myocardial infarction in patients with low systolic blood pressure (120 mm Hg or lower) a smaller dose of the drug - 2.5 mg is used. If the systolic blood pressure is less than or equal to 100 mm Hg. the daily dose of 5 mg should be reduced temporarily to 2.5 mg, and with blood pressure lower or equal to 90 mm Hg. the drug is not recommended.

With diabetic nephropathy In patients with type 1 diabetes mellitus, LYZINOGHTRIL is administered at a dose of 10 mg per day. If necessary, the dose can be increased to 20 mg per day in order to achieve diastolic blood pressure below 75 mm Hg. Art. in the "sitting" position. Patients with type 2 diabetes mellitus the drug is used in the same dose, in order to achieve a diastolic blood pressure below 90 mm Hg. in the "sitting" position.

With renal insufficiency and in patients on hemodialysis, the initial dose is set depending on the SC. The maintenance dose is determined depending on blood pressure (under the control of kidney function, potassium and sodium in the blood serum).

Creatinine clearance kk (ml / min.)	Initial dose (mg / day)
30-80	5-10
10-29	2,5-5
less than 10 (including patients on hemodialysis)	2,5

With persistent arterial hypertension long-term maintenance therapy of 10-15 mg / day is shown.

Side effects:

The incidence of side effects is classified according to the recommendations of the World Health Organization: very often - not less than 10%; often - not less than 1%, but less than 10%; infrequently - not less than 0,1%, but less than 1%; rarely - not less than 0.01%, but less than 0.1%; very rarely - less than 0.01%; frequency is unknown - the incidence of adverse events can not be estimated from the available data.

The most common side effects: dizziness, headache (5-6% of patients), weakness, diarrhea, dry cough (3%), nausea, vomiting, orthostatic hypotension, skin rash, chest pain (1-3%).

From the side of the cardiovascular system

Often - marked decrease in blood pressure, orthostatic hypotension; infrequently - acute myocardial infarction, tachycardia, palpitation; Raynaud's syndrome; rarely - bradycardia, tachycardia, aggravation of symptoms of CHF flow, violation of atrioventricular conduction; frequency unknown - chest pain.

From the central nervous system

Often - dizziness, headache; infrequently - lability of mood, paresthesia, sleep disturbance, stroke; rarely - confusion, asthenic syndrome,convulsive twitching of the muscles of the limbs and lips, drowsiness; frequency is unknown - depression, confusion.

From the digestive system

Often - diarrhea, vomiting; infrequently - nausea, dyspepsia, changes in taste, abdominal pain; rarely dryness of the oral mucosa; very rarely - pancreatitis, jaundice (hepatocellular or cholestatic), hepatitis, hepatic insufficiency, intestinal edema, anorexia.

From the side of the musculoskeletal system

Rarely - arthralgia / arthritis, myalgia.

On the part of the hematopoiesis system

Rarely - a decrease in hemoglobin, hematocrit; very rarely - leukopenia, neutropenia, agranulocytosis, thrombocytopenia, eosinophilia, erythropenia, hemolytic anemia, lymphadenopathy, autoimmune diseases, oppression of bone marrow function.

From the respiratory system

Often - cough, infrequently - rhinitis, very rarely - sinusitis, bronchospasm, dyspnea, allergic alveolitis / eosinophilic pneumonia, dyspnea.

From the skin

Infrequent - itchy skin, rash; rarely - angioedema, swelling of the face, extremities, lips, tongue, larynx, urticaria, alopecia, psoriasis,vasculitis; Very rarely - increased sweating, pemphigus, photosensitivity, toxic epidermal necrolysis (Lyell's syndrome), erythema multiforme, Stevens-Johnson syndrome, pseudolymphoma of the skin.

From the urinary system

Often - a violation of kidney function; infrequently uremia, acute renal failure; very rarely - anuria, oliguria; frequency unknown - proteinuria.

From the side of the reproductive system

Infrequent - impotence, rarely - gynecomastia.

From the side of metabolism

Very rarely - hypoglycemia.

From the laboratory indicators

Infrequent increase in urea concentration in the blood, hypercreatinemia, hyperkalemia, increased activity of "liver" transaminases, rarely - hyperbilirubinemia, hyponatremia, increased erythrocyte sedimentation rate (ESR), false positive results of the test for antinuclear antibodies; very rarely - a decrease in glucose concentration.

Other

Fever (there are reports of the development of lupus-like syndrome, which may include fever, myalgia, arthralgia / arthritis, an increase in the titer of antinuclear antibodies, an increase in ESR, eosinophilia, leukocytosis,possibly development of skin rashes, photosensitivity reactions or other skin manifestations), impaired development of the fetus, syndrome of inadequate secretion of antidiuretic hormone.

Overdose:

Symptoms:

A pronounced decrease in blood pressure, dry mouth, drowsiness, urinary retention, constipation, anxiety, increased irritability, palpitations, bradycardia, tachycardia, cough, disturbances in water-electrolyte balance, hyperventilation of the lungs.

Treatment:

Symptomatic therapy, intravenous fluid administration, blood pressure control, water-electrolyte balance and its normalization, control of the cardiovascular and respiratory system.

Lizinopril can be removed from the body by hemodialysis.

Interaction:

Caution should be applied lisinopril simultaneously with potassium-sparing diuretics (spironolactone, triamterene, amiloride, eplerenone), potassium preparations, salt substitutes, containing potassium, cyclosporine - increases the risk of hyperkalemia, especially with impaired renal function. Therefore, these combinations should be used only on the basis of the individual solutions at regular physician monitoring the potassium content in blood serum and renal function.

With simultaneous use with diuretics and other antihypertensive drugs, the antihypertensive effect of lisinopril is enhanced.

When used simultaneously with non-steroidal anti-inflammatory drugs (NSAIDs) (including selective inhibitors of cyclooxygenase-2 (COX-2)), acetylsalicylic acid at a dose of more than 3 g / day, estrogens, and sympathomimetics, the antihypertensive effect of lisinopril decreases. NSAIDs, including COX-2, and ACE inhibitors increase serum potassium levels and can worsen renal function. This effect is usually reversible. Lisinopril slows the excretion of lithium preparations, so with simultaneous use there is a reversible increase in its concentration in the blood plasma, which can increase the likelihood of unwanted phenomena, so you should regularly monitor the lithium content in serum.

With simultaneous use with antacids and colestyramin, suction of lisinopril from the digestive tract decreases.

Ethanol enhances the action of lisinopril.

With simultaneous use with insulin and hypoglycemic agents for oral administration, the risk of developing hypoglycemia increases.

With the simultaneous use of lisinopril with vasodilators, barbiturates, antipsychotic agents (antipsychotics), tricyclic antidepressants, blockers of "slow" calcium channels, beta-adrenoblockers, an increase in the antihypertensive effect is possible.

With simultaneous use of ACE inhibitors and preparations of gold intravenously (sodium aurotomy malate) describes a symptom complex, which includes facial flushing, nausea, vomiting and lowering blood pressure.

Joint application with allopurinol, procainamide, cytostatics can lead to leukopenia.

Simultaneous administration of ACE inhibitors and aliskiren-containing drugs in patients with diabetes mellitus or renal dysfunction (glomerular filtration rate less than 60 ml / min / 1.73 m² surface area of the body) increases the risk of hyperkalemia, worsening kidney function and increasing the incidence of cardiovascular morbidity and mortality.

In elderly patients and patients with impaired renal function, simultaneous use of ACE inhibitors with sulfamethoxazole / trimethoprim was accompanied by severe hyperkalemia, which is believed to be caused by trimethoprim,therefore the drug should be used with caution with preparations containing trimethoprim, regularly monitoring the potassium content in blood plasma, the double blockade of RAAS.

The simultaneous use of ACE inhibitors with angiotensin II receptor antagonists (APA II) in patients with diabetic nephropathy is not recommended.

Special instructions:

Arterial hypotension

Most often, a marked decrease in blood pressure occurs with a decrease in bcc caused by diuretic therapy, a decrease in the content of table salt in food, dialysis, diarrhea, or vomiting. In patients with CHF with concurrent renal failure or without it, there may be a marked decrease in blood pressure. This is more often detected in patients with severe CHF, as a consequence of the use of large doses of diuretics, hyponatremia or impaired renal function. In such patients, treatment with LYZINOPRIL should be started under the strict supervision of a doctor (with care to select a dose of the drug and diuretics).

Similar rules should be adhered to in the appointment of patients with IHD, cerebrovascular insufficiency, in which a sharp decrease in blood pressure can lead to myocardial infarction or stroke.

Transient hypotensive reaction is not a contraindication for taking the next dose of the drug after stabilizing blood pressure.

When using LIZINOPRILA in some patients with CHF, 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 the start of treatment, LIZINOPRIL, if possible, should normalize the sodium content and / or make up the BCC, carefully monitor the effect of the initial dose of LIZINOPRIL on the patient.

Impaired renal function

In patients with renal impairment (creatinine clearance less than 80 mL / min) initial dose of lisinopril to be changed in accordance with QC (see. The section "Method of administration and dose"). Regular monitoring of the potassium content and creatinine concentration in the blood plasma is an obligatory tactic for the treatment of such patients. In patients with CHF, arterial hypotension can lead to impaired renal function. In such patients, there were cases of acute renal failure, usually reversible.

Stenosis of the renal artery

In particular 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 the drug may lead to impaired renal function, acute renal failure, which is usually irreversible after drug withdrawal.

With acute myocardial infarction

The use of standard therapy (thrombolytics, acetylsalicylic acid as an antiplatelet agent, beta-blockers). LIZINOPRIL it is possible to use together with intravenous administration or with the use of therapeutic transdermal systems of nitroglycerin, nitroglycerin under the tongue.

Surgery / general anesthesia

With extensive surgical interventions, as well as with the use of other drugs that cause a decrease in blood pressure, lisinopril blocking the formation of angiotensin II, can cause a pronounced unpredictable decrease in blood pressure.

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.

Anaphylactoid reactions are also observed in patients on hemodialysis using high-flow dialysis membranes (for example, AN69®), which simultaneously take ACE inhibitors. In such cases, one should consider the possibility of using another type of membrane for dialysis or another antihypertensive drug.

Mitral stenosis / aortic stenosis / hypertrophic obstructive cardiomyopathy

Lizinopril, like other ACE inhibitors, should be administered with caution to patients with obstruction of the left ventricular outflow tract (aortic stenosis, hypertrophic obstructive cardiomyopathy), and also to patients with mitral stenosis.

Anaphylactic reactions during apheresis of low-density lipoproteins (LDL)

In rare cases in patients receiving ACE inhibitors, during the procedure of apheresis of LDL with the use of dextran sulfate may develop life threatening anaphylactoid reactions. To prevent the anaphylactoid reaction, therapy with ACE inhibitors should be temporarily discontinued before each apheresis procedure.

Anaphylactoid reactions during desensitization

There are some reports of the development of anaphylactoid reactions in patients receiving ACE inhibitors during desensitizing therapy, for example, by the venom of Hymenoptera. ACE inhibitors should be used with caution in patients prone to allergic reactions undergoing desensitization procedures. The use of ACE inhibitors should be avoided for patients receiving immunotherapy with bee venom. However, this reaction can be avoided by the temporary withdrawal of the ACE inhibitor before the desensitization procedure begins.

Hypersensitivity / angioedema

Angioedema of the face, extremities, lips, tongue, epiglottis and / or larynx that may occur at any time of treatment has rarely been seen in patients taking an ACE inhibitor, including lisinopril. In this case, treatment with the drug should be stopped as soon as possible, and the patient should be monitored until the symptoms regress completely. Angioedema with edema of the larynx can be lethal. Swelling of the tongue, epiglottis or larynx may be the cause of airway obstruction,therefore it is necessary to immediately carry out appropriate therapy (0.3-0.5 ml of 1: 1000 epinephrine (adrenaline) solution subcutaneously) and / or measures to ensure airway patency. In cases where the edema is localized only on the face and lips, the condition usually passes without treatment, but antihistamines can be used.

The risk of developing angioedema is increased in patients who have a history of angioedema, not associated with previous treatment with ACE inhibitors.

In rare cases, against the background of therapy with ACE inhibitors, intestinal edema develops. In this case, patients have abdominal pain as an isolated symptom or in combination with nausea and vomiting, in some cases without a previous angioedema and a normal content of C1-esterase. The diagnosis is established by means of computed tomography of the abdominal cavity, ultrasound examination or at the time of surgical intervention. Symptoms disappear after stopping the intake of ACE inhibitors. In patients with abdominal pain taking ACE inhibitors, a differential diagnosis should take into account the possibilitydevelopment of angioedema.

Dry cough

Cough was used in the use of ACE inhibitors. Cough is dry, prolonged, which disappears after discontinuing treatment with an ACE inhibitor. With a differential diagnosis of cough, one should also consider a cough caused by the use of an ACE inhibitor.

Ethnic differences

It should be borne in mind that in patients of the Negroid race the risk of angioedema development is higher. Like other ACE inhibitors, LIZINOPRIL It is less effective in reducing blood pressure in patients of the Negroid race. This effect is probably associated with a marked predominance of low-grade status in patients of the Negroid race with arterial hypertension.

Double blockade of RAAS

Arterial hypotension, fainting, stroke, hyperkalemia and renal dysfunction (including acute renal failure) have been reported in susceptible patients, especially when used with medications that affect this system.

Therefore, a double blockade of RAAS due to a combination of an ACE inhibitor with ARA II or aliskiren is not recommended.

Patients with diabetes mellitus

When the drug is administered to patients with diabetes mellitus receiving hypoglycemic agents for ingestion or insulin, during the first month of therapy it is necessary to regularly monitor the concentration of glucose in the blood.

Impaired liver function

The use of ACE inhibitors can lead to the development of cholestatic jaundice with progression up to fulminant liver necrosis, therefore it is necessary to stop taking the drug with an increase in the activity of "liver" transaminases and the appearance of symptoms of cholestasis.

Hyperkalemia

During therapy with ACE inhibitors, including lisinopril, hyperkalemia may develop. Risk factors for hyperkalemia include renal failure, advanced age, diabetes mellitus, certain concomitant conditions (eg, reduced bcc, acute heart failure, metabolic acidosis), simultaneous intake of potassium-sparing diuretics (such as spironolactone, eplerenone, triamterene, amilodide), as well as preparations of potassium or potassium-containing substitutes for edible salt and the use of other drugs, which promote an increase in the potassium content in the blood plasma (for example, heparin).Hyperkalemia can lead to serious heart rhythm disturbances, sometimes with a fatal outcome. The simultaneous use of the above drugs should be done with caution.

Effect on the ability to drive transp. cf. and fur:

There is no evidence of the effect of lisinopril on the ability to drive vehicles and manage the mechanisms used in therapeutic doses, but it must be borne in mind that dizziness may occur, so be careful.

Form release / dosage:

Tablets of 5 mg, 10 mg, 20 mg.

Packaging:

7 tablets per contour cell packaging made of polyvinylchloride film and aluminum foil. 2, 3, 4 contour mesh packages together with instructions for use are placed in a pack of cardboard.

10 tablets per contour cell packaging made of polyvinylchloride and aluminum foil. 1, 2, 3, 4, 5 contour mesh packages together with instructions for use are placed in a pack of cardboard.

Storage conditions:

Store in a dry, dark place at a temperature of no higher than 25 ° C.

Keep out of the reach of children.

Shelf life:

3 years.

Do not use after the expiry date printed on the package.

Terms of leave from pharmacies:On prescription

Registration number:LP-003753

Date of registration:26.07.2016

Expiration Date:26.07.2021

The owner of the registration certificate:PRANAFARM, LLC PRANAFARM, LLC Russia

Manufacturer: & nbsp

PRANAFARM, LLC Russia

Information update date: & nbsp25.02.2018

Illustrated instructions

Instructions

Lisinopril (Lisinopril)