Symptomatic hypotension.
Most often, a marked decrease in blood pressure arises with a decrease in the volume of circulating blood (BCC), caused by diuretic therapy, reduction of table salt in food, dialysis, diarrhea, or vomiting.In patients with chronic heart failure with concurrent renal failure or without it, a marked decrease in blood pressure is possible. Under the strict supervision of a physician, use the preparation Lizinopril Organica in patients with coronary heart disease, cerebrovascular insufficiency, in which a sharp decrease in blood pressure can lead to myocardial infarction or stroke. Transient arterial hypotension is not a contraindication for taking the next dose of the drug.
When using the drug Lysinopril Organica, 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 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 Lysinopril Organic on the patient.
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 ions,the use of the drug Lizinopril Organica can lead to impaired renal function, acute renal failure, which is usually irreversible even after drug withdrawal.
In acute myocardial infarction, the use of standard therapy (thrombolytics, acetylsalicylic acid, beta-adrenoblockers) Lysinopril Organic can be used in conjunction with intravenous administration or with the use of therapeutic transdermal systems of nitroglycerin.
Surgical intervention / general anesthesia: with extensive surgical interventions, as well as using other means of reducing blood pressure, Lysinopril Organica, blocking the formation of angiotensin II, can cause a pronounced unpredictable decrease in blood pressure.
Angioedema, edema of the face, limbs, lips. tongue, epiglottis and / or larynx was rarely seen in patients treated with ACE inhibitors that may occur at any time of treatment. In this case, treatment with Lysinopril Organic should be stopped as soon as possible and for the patient to establish an observation until the symptoms regress completely.In cases where there was only edema of the face and lips, the condition usually passes without treatment, however, it is possible to prescribe antihistamines. Angioedema with edema of the larynx can be lethal. When the tongue, epiglottis or larynx are swollen, airway obstruction may occur. Therefore, immediately appropriate therapy (0.3-0.5 ml epinephrine (adrenaline) 1: 1000 subcutaneously, administration of glucocorticosteroids, antihistamines) and / or measures to ensure airway patency. Patients who have had an angioneurotic edema in the anamnesis and who were not associated with previous treatment with ACE inhibitors may have a higher risk of developing it during treatment with an inhibitor of AMP. Anaphylactic reaction was noted in patients on hemodialysis using high-flow dialysis membranes (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 agent. Possible occurrence of anaphylactic reactions during apheresis of low density lipoproteins with dextran sulfate.
In some cases, the desensitisation of the venom of Hymenoptera, treatment with ACE inhibitors was accompanied by hypersensitivity reactions. This can be avoided by interrupting the administration of ACE inhibitors.
In patients of the Negroid race, the risk of developing angioedema is higher. Like other ACE inhibitors, lisinopril It is less effective in reducing blood pressure in patients of the Negroid race. This effect, perhaps, is associated with a marked predominance of low-grade status in patients of the Negroid race with arterial hypertension.
In rare cases on the background of therapy with ACE inhibitors intestinal edema of the intestine 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 C1-esterase content. 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 pain in the abdomen, taking ACE inhibitors.when carrying out a differential diagnosis, it is necessary to take into account the possibility of developing angioedema of the intestine.
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.
Cough was used in the use of ACE inhibitors. Cough is dry, prolonged, which disappears after discontinuation of treatment with ACE inhibitors. With a differential diagnosis of cough, one must also consider the cough caused by the use of ACE inhibitors. Based on the results of epidemiological studies, it is assumed that simultaneous administration of ACE inhibitors and insulin, as well as hypoglycemic agents for oral administration may lead to the development of hypoglycemia. The greatest risk of development is observed during the first weeks of combination therapy, as well as in patients with impaired renal function. Patients with diabetes require careful monitoring of glycemia, especially during the first month of therapy with an ACE inhibitor.
In some cases, hyperkalemia was noted. Risk factors for the development of hyperkalemia include renal failure, diabetes mellitus, intake of potassium preparations, intake of potassium-sparing diuretics (spironolactone. eplerenone, triamterene, amiloride) or other drugs that cause an increase in potassium in the blood (eg, heparin), especially in patients with impaired renal function. During the treatment with the drug, regular monitoring of potassium, glucose, urea, and lipid ions in patients with blood plasma is necessary.
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.
There have been cases of development of neutropenia / agranulocytosis, thrombocytopenia and anemia in patients receiving ACE inhibitors. Such cases are quite rare in patients with normal renal function. Neutropenia and agranulocytosis disappear after the withdrawal of ACE inhibitors. Lisinopril should be used with extreme caution in patients with systemic connective tissue diseases receiving immunosuppressive therapy, treatment with allopurinol or procainamide, especially in patients with impaired renal function. In such patients, in some cases, infectious diseases resistant to antibiotic therapy can develop.In the case of lisinopril in these patients, regular monitoring of blood leukocytes should be carried out.
If any symptoms of infection (eg, sore throat, fever) appear, the patient should consult a doctor immediately, as they may be a manifestation of neutropenia.
During the period of treatment it is not recommended to drink alcoholic beverages, since alcohol enhances the hypotensive effect of the drug.
Because the potential risk of agranulocytosis can not be ruled out, periodic monitoring of the blood picture is required.