Symptomatic hypotension
In rare cases, symptomatic hypotension occurs in patients with arterial hypertension. Most often, a marked decrease in blood pressure occurs with a decrease in the volume of circulating blood caused by diuretic therapy, limiting the amount of salt in the food, dialysis, diarrhea, vomiting, or in patients with severe renin-induced arterial hypertension. This group of patients should regularly monitor the level of electrolytes in the blood serum. In patients who have risk factors for symptomatic hypotension, it is necessary to begin treatment and adjust the dose under the strict supervision of a physician.Similar rules should be adhered to when prescribing a drug for patients with coronary heart disease and cerebrovascular insufficiency, in which a sharp decrease in blood pressure can lead to myocardial infarction or stroke.
In the case of the development of severe arterial hypotension, the patient should assume the position of "lying" on the back, and, if necessary, initiate an intravenous injection of isotonic solution. A short-term reduction in blood pressure is not a contraindication for taking the next dose of Lysinoton N. The drug may be taken after a dose reduction after the recovery of circulating blood and the normalization of blood pressure. It is also possible to take the components of the drug (lisinopril and hydrochlorothiazide) separately. Like other vasodilators, Lisotonon H should be taken with caution in patients with aortic stenosis or hypertrophic cardiomyopathy.
Impaired renal function
Thiazide diuretics are not indicated for admission to patients with impaired renal function and may be ineffective in CC less than 30 mL / min.
In patients with bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney treated with ACE inhibitors, there was an increase in urea and serum creatinine, usually reversible after discontinuation of treatment. It was more common in patients with renal insufficiency.
Kidney Transplantation
There is no experience of using the drug in patients with recent kidney transplantation, so it is recommended that this group of patients be taken with caution.
Anaphylactoid reactions and patients on hemodialysis and apheresis of low-density lipoproteins
Preparations containing lisinopril, are not indicated for use in patients requiring dialysis in view of renal insufficiency.
In patients on hemodialysis (eg, using dialysis membranes with high permeability AN 69 and with the apheresis of low-density lipoproteins with dextran-sulfate absorption), which simultaneously take ACE inhibitors, anaphylactoid reactions are noted. In such cases, one should consider the possibility of using another type of membrane for dialysis or another antihypertensive agent.
Surgery / general anesthesia
With the use of agents that reduce blood pressure in patients with extensive surgery or during general anesthesia, lisinopril can block the formation of angiotensin II.
The pronounced decrease in blood pressure, which is considered a consequence of this mechanism, can be eliminated by increasing the volume of circulating blood.
Before surgery (including dentistry), it is necessary to alert the surgeon / anesthesiologist about the use of ACE inhibitors.
Metabolic and endocrine effects
Thiazide diuretics can influence glucose tolerance, so you need to adjust the dose of funds for the treatment of diabetes. In patients with diabetes mellitus and taking antidiabetic oral drugs and insulin, the blood glucose concentration should be monitored regularly during the first month of treatment with ACE inhibitors. In people with latent diabetes mellitus during treatment with thiazide diuretics, clinical signs of diabetes mellitus may appear.
Therapy with thiazide diuretics can cause hyperuricemia and / or gout in some patients. In the same time lisinopril can increase the urea content in the urine and thereby weaken the hyperuricemic effect of hydrochlorothiazide.
Violation of electrolyte balance
Every patient receiving diuretics should periodically monitor the concentration of electrolytes in the blood serum.
Hydrochlorothiazide can cause a change in the volume of circulating blood and disturb the electrolyte balance (hypokalemia, hyponatremia and hypochloraemia). Signs of lack of fluid in the body and electrolyte imbalance are the following: dryness in the mouth, thirst, fatigue, lethargy, drowsiness, muscle aches or cramps, muscle fatigue, arterial hypotension, oliguria, tachycardia, gastrointestinal disorders (nausea or vomiting).
Thiazide diuretics can reduce the excretion of calcium in the urine and cause a slight increase in calcium in the serum. Expressed hypercalcemia may be a symptom of latent hyperparathyroidism, it is recommended that treatment with thiazide diuretics be stopped before the parathyroid function test.
Hypersensitivity / angioedema
In rare cases, patients taking ACE inhibitors, including lisinopril, angioedema of the face, limbs, lips, tongue, epiglottis and / or larynx was noted (can occur during any treatment period). In this case, the treatment with lisinopril should be stopped immediately, and the patient should be monitored until the symptoms regress completely. Even in cases where the swelling only covers the tongue, without disrupting the airway patency, the patient may need long-term follow-up, since therapy with antihistamines and glucocorticosteroids may not be sufficient.
Neutropenia / agranulocytosis
In the course of treatment with ACE inhibitors, neutropenia / agranulocytosis, thrombocytopenia and anemia were reported. In patients with normal renal function without other risk factors, neutropenia occurred in very rare cases. Neutropenia and agranulocytosis were reversible and passed after discontinuation of ACE inhibitors.
During the period of treatment, it is not recommended to drink alcoholic beverages, since alcohol increases the antihypertensive effect of the drug.
Care should be taken when doing physical exercises, hot weather (the risk of dehydration and excessive blood pressure lowering due to a decrease in the volume of circulating blood).