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

Lisinopril is an angiotensin converting enzyme (ACE) reduces formation of angiotensin II from angiotensin I. Reducing the concentration of angiotensin II leads to a direct decrease in aldosterone release, which can lead to an increase in the potassium content in the blood plasma. Reduces the degradation of bradykinin and increases the synthesis of prostaglandins. , Decreases total peripheral vascular resistance (TPR), blood pressure (BP), preload on the heart,pressure in the pulmonary capillaries, causes an increase in the minute volume of blood and an increase in myocardial tolerance to loads in patients with chronic heart failure (CHF). Expands arteries more than veins. Some of the effects are explained by exposure to tissue renin-angiotensin-aldosterone system (RAAS). With prolonged use, myocardial hypertrophy and the walls of arteries of resistive type decrease. Improves the 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.

After taking lisinopril inside, the antihypertensive effect begins to appear after approximately 1 hour. The maximum antihypertensive effect is observed after 6-7 hours and persists for 24 hours. The duration of the effect depends on the dose value. With arterial hypertension, the effect is observed in the first days after the start of treatment, stable action develops after 1-2 months. With a sharp withdrawal of the drug, there was no pronounced increase in blood pressure.

In addition to reducing blood pressure lisinopril reduces the degree of albuminuria. In patients with hyperglycemia contributes to the normalization of the function of the damaged glomerular endothelium.

Pharmacokinetics:

Suction

After oral administration lisinopril is absorbed from the gastrointestinal tract (GIT) on average by 25%, but the absorption can vary from 6% to 60%. Bioavailability averages 25%. Eating does not affect the absorption of lisinopril.

Distribution

Virtually does not bind to blood plasma proteins. The maximum concentration in the blood plasma (C_max) in healthy volunteers (90 ng / ml) is achieved after 6-7 hours. Permeability through the blood-brain and placental barrier is low.

Metabolism

Lizinopril is practically not metabolized.

Excretion

It is excreted by the kidneys unchanged. Half-life (T_1/2) is 12.6 hours.

Pharmacokinetics in specific patient groups

In patients with CHF, absorption and clearance of lisinopril are reduced, bioavailability is 16%.

In patients with renal insufficiency (creatinine clearance 5 to 30 ml / min), the concentration of lisinopril is several times higher than the concentration in the blood plasma in healthy volunteers, with an increase in the time to reach the maximum concentration in the blood plasma and an increase T_1/2.

In patients with severe impairment of liver function (including cirrhosis of the liver), about 30% of lisinopril is absorbed from the digestive tract, and bioavailability is increased by 50% compared to patients with normal liver function.

In elderly patients C_max and the area under the concentration-time curve (AUC) is 2 times greater than in young patients.

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 as part of combination therapy (in the first 24 hours in patients 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 with normal arterial pressure and in patients with type 2 diabetes mellitus with arterial hypertension).

Contraindications:

- Hypersensitivity to lisinopril, other ACE inhibitors or other components of the drug;

- angioedema in history, including with the use of ACE inhibitors;

- Hereditary edema Quincke or idiopathic angioedema;

- Pregnancy;

- the period of breastfeeding;

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

- lactase deficiency, lactose intolerance, glucose-galactose malabsorption syndrome;

- hemodialysis or hemofiltration using high-permeability dialysis membranes with high permeability (for example, AN69®);

- apheresis of low density lipoproteins using dextran sulfate;

- desensitizing therapy to the venom of Hymenoptera insects (bees, wasps);

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

Carefully:

- Impaired renal function;

- 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 arterial hypotension, hyperkalemia and renal failure);

acute myocardial infarction;

- cardiogenic shock;

- bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney;

- condition after kidney transplantation;

- azotemia;

- Hyperkalemia;

stenosis of the aortic aperture;

- mitral stenosis;

- hypertrophic obstructive cardiomyopathy;

- primary hyperaldosteronism;

- arterial hypotension;

- cerebrovascular diseases (including insufficiency of cerebral circulation);

- Ischemic heart disease (CHD);

- autoimmune systemic diseases of connective tissue (including scleroderma, systemic lupus erythematosus);

- oppression of bone marrow hematopoiesis;

- Diet with restriction of table salt;

- hypovolemic conditions (including as a result of diarrhea, vomiting);

- Older age (over 65 years);

- use of Negroid race in patients;

- diabetes.

Pregnancy and lactation:

Pregnancy

Application of the drug Lisinopril during pregnancy is contraindicated. Lisinopril penetrates the placenta. When pregnancy is established, taking the drug Lisinopril you must stop as soon as possible. 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 during the I trimester are not present. For newborns and infants who have undergone intrauterine exposure to ACE inhibitors, careful monitoring is recommended to timely detect 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.

Breastfeeding period

There is no data on the penetration of lisinopril into breast milk. If you need to use the drug during lactation, breastfeeding should be discontinued.

Dosing and Administration:

Inside, 1 time per day, regardless of the time of food intake, preferably in the morning.

To ensure the dosage regimen of lisinopril in a dose of 2.5 mg, it is recommended that lisinopril in tablets of 2.5 mg or 5 mg with the risk of other manufacturers. With hypertension, patients who do not receive other antihypertensive drugs, the recommended initial dose of the drug Lisinopril is 5-10 mg once a day, depending on the patient's condition. In the absence of effect, the dose is increased every 2 weeks by 5 mg to an average therapeutic dose of 20-40 mg per day (increasing the dose above 40 mg per day does not usually lead to a further decrease in blood pressure). The usual daily maintenance dose is 20 mg. The maximum daily dose is 40 mg. The therapeutic effect usually develops in 2-4 weeks after the start 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, the use of such drugs should be stopped 2-3 days before the drug is started Lisinopril. If this is not possible, the initial dose of the drug Lisinopril should not exceed 5 mg per day. In this case, after taking the first dose, medical control is recommended for several hours (the 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, it is advisable to prescribe a lower initial dose of the drug Lisinopril -2,5-5 mg per day, carefully monitoring the patient's condition (control of blood pressure, kidney function, potassium content in blood plasma). The maintenance dose, continuing regular monitoring, should be selected depending on the dynamics of blood pressure.

In case of violations of kidney function due to the fact that lisinopril is excreted by the kidneys, the initial dose should be determined depending on the QC (see Table 1). Further, the choice of doses should be made depending on individual reactions with regular monitoring of kidney function, potassium content, sodium in blood plasma.

Table 1

Creatinine clearance, ml / min	Initial dose of lisinopril, mg per day
30-80	5-10
10-30	2,5-5
less than 10 *	2,5

*including patients on hemodialysis

With persistent arterial hypertension, prolonged maintenance therapy at a dose of 10-15 mg per day is indicated.

With CHF, the initial dose of the drug Lisinopril - 2.5 mg per day, followed by an increase in the dose by 2.5 mg 1-2 weeks before the usual, maintaining a daily dose of 5-20 mg. The maximum daily dose is 20 mg.

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

Early treatment of acute myocardial infarction (in the first 24 hours in patients with stable hemodynamic parameters to maintain these parameters and prevent the development of left ventricular dysfunction and heart failure) as part of combination therapy

Treatment with drug Lisinopril can be started in the first 24 hours from the onset of symptoms of myocardial infarction. Initial dose of the drug Lisinopril the first day - 5 mg, then -5 mg after 24 hours after the first dose, 10 mg - after 48 hours and then 10 mg once a day. The course of treatment should be at least 6 weeks.

At the beginning of treatment or within the first 3 days after acute myocardial infarction in patients with baseline low systolic BP (120 mm Hg or lower), a smaller dose of 2.5 mg should be given. In the case of a systolic blood pressure lower than 100 mm Hg. The daily dose of 5 mg can be reduced to 2.5 mg if necessary. In the case of a long pronounced decrease in systolic blood pressure less than 90 mm Hg. Art. for more than 1 hour the drug should be discontinued.

In diabetic nephropathy in patients with type 2 diabetes mellitus, the dose of the drug Lisinopril 10 mg once a day. The dose may optionally be increased to 20 mg once a day in order to achieve diastolic blood pressure values of less than 75 mm Hg. Art. in the "sitting" position. In patients with type 1 diabetes mellitus, the same dose is used to achieve diastolic blood pressure values of less than 90 mm Hg. Art. in the "sitting" position.

Side effects:

Classification of the incidence of adverse events according to the recommendations of the World Health Organization (WHO):

very often> 1/10;

often from> 1/100 to <1/10;

infrequently from> 1/1000 to <1/100;

rarely from> 1/10000 to <1/1000;

very rarely <1/10000, including individual messages;

the frequency is unknown - it is not possible to establish the frequency of occurrence from the available data.

From the side of the blood and lymphatic system: rarely - reduction of hemoglobin, decrease in hematocrit; very rarely - oppression of bone marrow function, anemia, thrombocytopenia, leukopenia, neutropenia, agranulocytosis, hemolytic anemia, lymphadenopathy, autoimmune diseases.

From the nervous system: often - dizziness, headache; infrequently - mood lability, paresthesia, vertigo, sleep disturbance,perversion of taste; rarely - oppression of consciousness; the frequency is unknown - depression, syncope, confusion, drowsiness, convulsive twitching of the muscles of the extremities and lips.

From the cardiovascular system: often - orthostatic hypotension; infrequently, myocardial infarction, impaired cerebral circulation (due to a marked decrease in blood pressure in patients at increased risk), tachycardia, Raynaud's syndrome; the frequency is unknown - marked decrease in blood pressure, chest pain, bradycardia, worsening of symptoms of heart failure, violation of atrioventricular conduction.

From the respiratory system: often - a "dry" cough; infrequently - rhinitis; very rarely - sinusitis, dyspnea, bronchospasm, allergic alveolitis / eosinophilic pneumonia.

From the digestive system: often - diarrhea, vomiting; infrequently - nausea, dyspepsia, pain in the abdomen; rarely dryness of the oral mucosa; very rarely - pancreatitis, hepatitis, hepatic-cell or cholestatic jaundice, hepatic insufficiency.

From the skin and mucous membranes: infrequently - skin rash, itching; rarely - hives, alopecia, psoriasis, photosensitivity,hyperemia of the facial skin; very rarely - increased sweating, pemphigus (pemphigus), Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome), exudative erythema multiforme, pseudolymphoma of the skin.

From the genitourinary system: often - renal dysfunction; infrequent - decreased potency; rarely uremia, acute renal failure, gynecomastia; very rarely - oliguria, anuria; frequency unknown - proteinuria.

Laboratory indicators: infrequently - increased urea concentration, increased creatinine concentration, increased activity of "hepatic" transaminases, hyperkalemia; rarely - an increase in the concentration of bilirubin in the blood, hyponatremia; very rarely - a decrease in the concentration of glucose in the blood, an increase in the titer of antinuclear antibodies, an increase in the rate of erythrocyte sedimentation (ESR).

Other: infrequently - asthenia, increased fatigue; rarely - myalgia, arthralgia / arthritis, vasculitis, angioedema, facial edema, extremities, lips, tongue, epiglottis and / or larynx; very rarely - intestinal angioedema; frequency unknown - anorexia,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, skin rash, photosensitivity reactions or other skin manifestations), inadequate secretion syndrome antidiuretic hormone.

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

Overdose:

Symptoms

The pronounced decrease in blood pressure, dryness of the oral mucosa, drowsiness, urinary retention, constipation, anxiety, increased irritability, renal failure, tachycardia, palpitations, bradycardia, dizziness, dry cough, disturbance of water-electrolyte balance, collapse, hyperventilation of the lungs.

Treatment

There is no specific antidote. If the drug Lisinopril was adopted recently, it is necessary to take measures to remove it from the digestive tract (provocation of vomiting, gastric lavage, use of enterosorbents and laxatives).With a pronounced decrease in blood pressure, it is necessary to transfer the patient to the position of "lying on his back with his legs raised" (Trendelenburg position). It is further shown to fill the volume of circulating blood (BCC) by intravenous administration of 0.9% sodium chloride solution or other plasma-substituting solutions. If necessary, decide on the use of vasopressor drugs. In the case of development of a bradycardia resistant to treatment, it is necessary to use an artificial pacemaker. It is necessary to monitor the function of the cardiovascular and respiratory systems, blood pressure, urea concentration, QA, water-electrolyte balance. Hemodialysis is effective.

Interaction:

With the simultaneous use of lisinopril 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, so they can be used together only with regular monitoring of potassium content in blood plasma and control of kidney function.

Simultaneous use of lisinopril with beta-blockers,blockers of "slow" calcium channels, diuretics, tricyclic antidepressants / neuroleptics and other antihypertensive drugs increases the severity of antihypertensive action.

Lizinopril slows the withdrawal of lithium preparations, which can increase the risk of side effects. Therefore, when they are used together, it is necessary to regularly monitor the lithium content in the blood plasma.

Antacids and colestramine reduce the absorption of lisinopril in the digestive tract.

When combined with insulin and hypoglycemic agents for oral administration, the risk of developing hypoglycemia increases.

Non-steroidal anti-inflammatory drugs (NSAIDs) (including selective inhibitors of cyclooxygenase-2), acetylsalicylic acid (at a dose of more than 3 g per day), estrogens, adrenomimetics reduce the antihypertensive effect of lisinopril.

NSAIDs and ACE inhibitors increase the level of potassium in the blood plasma and can worsen kidney function. This effect is usually reversible.

Ethanol enhances the action of lisinopril.

Co-administration with selective serotonin reuptake inhibitors can lead to severe hyponatraemia.

Co-administration with allopurinol, procainamide, cytostatics may increase the risk of leukopenia.

The use of lisinopril in combination with acetylsalicylic acid as an antiplatelet agent, thrombolytic agents, beta-blockers and / or nitrates is not contraindicated.

Contraindicated simultaneous use of ACE inhibitors with aliskiren and aliskirenoderzhaschimi drugs in patients with diabetes mellitus and patients with impaired renal function of moderate and / or severe severity (creatinine clearance less than 60 ml / min); simultaneous use of ACE inhibitors with drugs containing aliskiren, or angiotensin II receptor antagonists in other patient groups can lead to a double blockade of RAAS (risk of hypotension, hyperkalemia and renal insufficiency), so care must be taken.

Special instructions:

Symptomatic arterial hypotension

Most often, a marked decrease in blood pressure occurs with a decrease in bcc caused by diuretic therapy, a decrease in the amount of salt in the diet, dialysis, diarrhea, or vomiting. In patients with CHF with simultaneous renal failure or without it, a marked decrease in blood pressure is possible.

Patients with IHD, cerebrovascular insufficiency, in whom a sharp decrease in blood pressure can lead to myocardial infarction or to a stroke, the drug Lisinopril can be administered only under strict medical supervision. Transient arterial hypotension is not a contraindication for taking the drug Lisinopril after stabilization of blood pressure.

When using the drug Lisinopril in some patients with CHF, but with normal or low blood pressure, there may be a decrease in blood pressure, which is usually not the reason for discontinuing treatment.

Before the start of treatment with the drug, if possible, should normalize the sodium content and / or make up the BCC, carefully monitor the effect of the initial dose of the drug Lisinopril on the patient.

Acute myocardial infarction

The use of standard therapy (thrombolytics, acetylsalicylic acid as an antiaggregant agent, beta-blockers). A drug Lisinopril can be used in conjunction with intravenous administration or with the use of nitroglycerin sublingually. In the first three days after myocardial infarction, a smaller dose should be used if the systolic blood pressure does not exceed 120 mm Hg. Art. With stable arterial hypotension (systolic blood pressure below 90 mm Hg for more than 1 hour), the drug Lisinopril necessary cancel.

Impaired renal function

In patients with impaired renal function (KK less than 80 ml / min), the initial dose of lisinopril should be changed in accordance with the QC (see section "Dosing and Administration"). Regular monitoring of potassium content and creatinine concentration in the blood plasma is an obligatory tactic for treating 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.

In the case of stenosis of the renal arteries (in particular, with bilateral stenosis or in the presence of stenosis of the artery of a single kidney), as well as in case of circulatory failure due to lack of sodium and / or liquid, the drug Lisinopril may lead to impaired renal function, acute renal failure, which usually regresses after drug withdrawal.

With acute myocardial infarction, drug therapy Lisinopril should not be started in patients with signs of impaired renal function, i.e. with a creatinine concentration of 177 μmol / L and / or proteinuria of more than 500 mg / day. If the kidney function is violated against the background of the drug Lisinopril (the concentration of creatinine exceeds 265 μmol / l or doubles its value before the start of treatment), it is necessary to decide whether to cancel the drug.

Hyperkalemia

During treatment 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, amiloride), as well as preparations of potassium or potassium-containing substitutes for edible salt and the use of other drugs that increase the level of potassium in the blood plasma (for example, heparin).Hyperkalemia can lead to serious heart rhythm disturbances, sometimes with a fatal outcome. Combined use of the above drugs should be done with caution.

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.

Increased sensitivity / angioedema

With the use of ACE inhibitors, including lisinopril, in rare cases development of angioedema of the face, lips, tongue, tongue of the upper palate and / or larynx can be observed. If these symptoms appear, the drug should be stopped immediately, the patient should be under the supervision of the doctor until the symptoms disappear completely. If angioedema affects only the face and lips, then its manifestations usually go away alone or antihistamines may be used to treat its symptoms.Angioedema, accompanied by swelling of the tongue and larynx, can lead to airway obstruction and death. When such symptoms occur, immediately enter subcutaneously epinephrine (epinephrine) in a dilution of 1: 1000 (0.3 ml or 0.5 ml) and / or provide airway patency. Patients with a history of angioedema not associated with the administration of ACE inhibitors may be at increased risk of developing it with the drugs of this pharmacotherapeutic group. In rare cases, against the background of therapy with ACE inhibitors, angioedema develops in the intestine. 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 with a normal C content₁-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, the differential diagnosis should take into account the possibility of angioedema edema development.

Anaphylactoid reactions

In patients with the use of ACE inhibitors and hemodialysis using high-flow membranes (for example, AN69®), anaphylactoid reactions were noted. Therefore, it is desirable to use membranes of a different type or to use an antihypertensive drug of another pharmacotherapeutic group. In rare cases, when an apheresis of low density lipoproteins using dextran sulfate occurs in patients receiving ACE inhibitors, life-threatening anaphylactoid reactions may develop. To prevent the development of an anaphylactoid reaction, the use of an ACE inhibitor should be discontinued before each apheresis session. There are separate reports on the development of long-term, life-threatening anaphylactoid reactions in patients taking ACE inhibitors during desensitizing therapy to the venom of Hymenoptera insects (bees, wasps). The use of ACE inhibitors by patients should be avoided when desensitizing therapy is administered to the venom of Hymenoptera. Nevertheless, the development of anaphylactoid reactions can be avoided by the temporary withdrawal of the ACE inhibitor at least 24 hours before the desensitization procedure begins.

"Dry cough

Against the background of treatment with ACE inhibitors, a "dry" cough may occur, which disappears after the withdrawal of the drugs of this pharmacotherapeutic group. If the doctor believes that therapy with an ACE inhibitor is necessary, taking the drug Lisinopril can be continued.

Hypoglycemic drugs

With the simultaneous use of ACE inhibitors and insulin, as well as hypoglycemic drugs for oral administration, hypoglycemia may develop. The greatest risk of developing hypoglycemia is observed during the first two weeks of combination therapy, as well as in patients with impaired renal function. Patients with diabetes require careful monitoring of the glycemic profile, especially during the first month of therapy with ACE inhibitors.

Neutropenia / agranulocytosis

Neutropenia / agranulocytosis caused in patients with normal renal function receiving ACE inhibitors are generally reversible. With extreme caution, it is necessary to apply the drug Lisinopril in patients with connective tissue diseases receiving immunosuppressive therapy, in combination with allopurinol and procainamide, especially in patients with impaired renal function.In such patients, because of the greater likelihood of developing severe neutropenia and agranulocytosis, the risk of developing a severe infection is increased. Therefore, it is necessary to regularly monitor the clinical analysis of blood with the counting of the formed elements, and also recommend to the patient at the appearance of the first clinical signs of infection to immediately consult a doctor.

Patients of the Negroid race

Lizinopril and other ACE inhibitors are less effective in patients of the Negroid race, due to the prevalence of patients with hypertension with low renin activity. In patients of the Negroid race angioneurotic edema with lisinopril is more common than in patients of other races.

Surgery / general anesthesia

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

It is recommended to stop taking ACE inhibitors, including lisinopril, 12 hours before surgery, warning the anesthesia doctor about the use of ACE inhibitors.

In elderly patients before starting the drug Lisinopril should evaluate the function of the kidneys and the content of potassium in the blood plasma. Initial dose of the drug Lisinopril are selected depending on the degree of BP reduction, especially with a decrease in BCC and weighting of CHF flow (IV functional class according to the NYHA classification). Such measures allow to avoid a sharp decrease in blood pressure.

Effect on the ability to drive transp. cf. and fur:No data on the effect of the drug Lisinopril on the ability to drive vehicles and mechanisms used in therapeutic doses, but it must be borne in mind that at the beginning of treatment there may be a marked decrease in blood pressure that can affect the ability to drive vehicles and work with potentially dangerous mechanisms, and also the occurrence of dizziness and drowsiness , so you should be careful.

Form release / dosage:Tablets 5 mg, 10 mg or 20 mg.

Packaging:

10, 15 or 30 tablets in a planar cell packaging made of a polyvinylchloride film and aluminum foil.

1, 2 or 3 contour packs of 10 tablets, 2 or 4 contour packs of 15 tablets, 1 or 2 contour packs of 30 tablets together with instructions for use inpack of cardboard.

Storage conditions:

Store in a 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 expiry date.

Terms of leave from pharmacies:On prescription

Registration number:LP-000093

Date of registration:17.12.2010 / 11.04.2016

Expiration Date:Unlimited

The owner of the registration certificate:VERTEKS, AO VERTEKS, AO Russia

Manufacturer: & nbsp

VERTEKS, AO Russia

Information update date: & nbsp25.02.2018

Illustrated instructions

Instructions

Lisinopril (Lisinopril)