Symptomatic arterial hypotension
Most often, a marked decrease in blood pressure occurs with a decrease in the volume of circulating blood (BCC), caused by diuretic therapy, a decrease in the amount of salt in the diet, dialysis, diarrhea, or vomiting. In patients with chronic heart failure with or without renal insufficiency, a marked decrease in blood pressure is possible.
Under the strict supervision of a doctor, Liziprex® should be used for patients with coronary heart disease, cerebrovascular insufficiency, in whom a sharp decrease in blood pressure can lead to myocardial infarction or to a stroke.
Transient arterial hypotension ns is a contraindication for taking the next dose of the drug. In the case of development of arterial hypotension the patient should be transferred to the "lying" position with raised legs. If necessary, BCC should be filled with intravenous 0.9% sodium chloride solution. Transient arterial hypotension ns is an obstacle for further administration of the drug. After the recovery of bcc and blood pressure, treatment can be continued.
When using the drug Liziprex ®, 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.
Prior to drug treatment, if possible, should be to normalize the sodium content and / or make up the bcc carefully control action Lizipreks® starting dose of the drug to the patient.
In the case of renal artery stenosis (especially when bilateral stenosis or in the presence of artery stenosis single kidney) and circulatory failure due to lack of sodium and / or liquid, use Lizipreks® drug can lead to renal failure, acute renal failure, which is usually irreversible even after the drug is discontinued.
Hyperkalemia
Hyperkalemia can develop during treatment with ACE inhibitors, including Liziprex®. Risk factors for hyperkalemia include renal failure, decreased renal function, age over 70 years, diabetes mellitus, certain concomitant conditions (dehydration, acute heart failure, metabolic acidosis), simultaneous intake of potassium-sparing diuretics (such as spironolactone and its derivative, epsilon, triamtrins, amiloride), food additives / potassium preparations or potassium-containing substitutes for edible salt, as well as the use of other drugs that increase the potassium content in the blood (for example, heparin). The use of dietary supplements / potassium preparations, potassium-sparing diuretics, potassium-containing substitutes for edible salt can lead to a significant increase in potassium in the blood, especially in patients with reduced renal function. Hyperkalemia can lead to serious, sometimes fatal heart rhythm disturbances. If simultaneous use of the drug Liziprex® and the above drugs is necessary, treatment should be carried out with caution in the context of regular monitoring of potassium in the blood serum (see section "Interaction with other drugs").
Mitral stenosis / aortic stenosis / hypertrophic obstructive cardiomyopathy
Liziprex®, like other ACE inhibitors, should be administered with caution to patients with obstruction of the left ventricular outflow tract (aortic stenosis, hypertrophic obstructive cardiomyopathy), as well as to patients with mitral stenosis.
With acute myocardial infarction
The use of standard therapy (thrombolytics, acetylsalicylic acid as an antiaggregant agent, beta-blockers). Liziprks® can be used together with intravenous administration or with the use of therapeutic transdermal systems of nitroglycerin.
Surgery / general anesthesia
With extensive surgical interventions, as well as with the use of other drugs that cause a decrease in blood pressure, lisipopril, blocking the formation of angiotensin II, can cause a pronounced unpredictable decrease in blood pressure.
With the development of arterial hypotension, blood pressure should be maintained by replenishing the BCC. It is necessary to alert the surgeon / anesthesiologist that the patient is taking ACE inhibitors.
In elderly patients the same dose leads to a higher concentration of lisinopril in the blood, therefore special caution is required when determining the dose.
Hemodialysis
In patients under hemodialysis using high-permeability membranes (for example, AN69®), cases of anaphylactic reactions against ACE inhibitor therapy were observed.The use of ACE inhibitors should be avoided when using this type of membrane.
Neutropy / agranulocytosis / thrombocytopaedy / anemia
Against the background of taking ACE inhibitors, neutropenia / agranulocytosis, thrombocytopenia and anemia can occur. In patients with normal renal function and in the absence of other aggravating factors, neutropenia develops rarely. With particular caution, Liziprex® should be used in patients with systemic connective tissue diseases, when immunosuppressants, allopurinol or procainamide are used, especially in patients with impaired renal function. Some patients had severe infections, in some cases, resistant to intensive antibiotic therapy. When prescribing Liziprex®, it is recommended that such patients periodically check the white blood cell count. Patients should inform the doctor of any signs of infectious diseases (eg, sore throat, fever).
Anaphylactoid 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 anaphylactoid reaction, therapy with an ACE inhibitor 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
When taking ACE inhibitors, including the drug Liziprex®, in rare cases and in any period of therapy, development of angioedema of the face, upper and lower extremities, lips, mucous membranes, tongue, vocal cords and / or larynx can be observed (see section "Side effect").When symptoms appear, taking the drug should be stopped immediately, and the patient should be observed until the signs of edema disappear completely. If the swelling affects only the face and lips, then its manifestations usually pass on their own, although antihistamines can be used to treat the symptoms.
Angioedema, accompanied by swelling of the larynx, can lead to death. Swelling of the tongue, vocal cords, or larynx can lead to airway obstruction. When these symptoms appear, urgent therapy is required, including subcutaneous injection of epinephrine (adrenaline) and / or providing airway patency. The patient should be under medical supervision until the symptoms disappear completely and persistently.
Patients with a history of Quinck's edema who are not associated with taking ACE inhibitors may be at increased risk of developing this drug when taking this drug (see "Contraindications").
In rare cases, angiotoneurotic edema of the intestine develops in the foyer of therapy with ACE inhibitors. In this case, patients have abdominal pain as an isolated symptom or in combination with nausea and vomiting,in some cases without a prior angioedema and at a normal level of C1-esterase. The diagnosis was established using computed tomography of the abdominal region, ultrasound examination or surgical intervention. Symptoms disappeared after discontinuation of ACE inhibitors. Therefore, patients with abdominal pain receiving ACE inhibitors should take into account the possibility of angioedema edema development during differential diagnosis (see section "Side effect").
Kidney Transplantation
Data on the use of Liziprex® in patients after kidney transplantation are not available.
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, Liziprex® 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.
Impaired liver function
In rare cases, when taking ACE inhibitors, there was a syndrome of cholestatic jaundice with transition tofulminant liver necrosis, sometimes fatal. The mechanism of development of this syndrome is unclear. If there is jaundice or a significant increase in the activity of "liver" enzymes on the foyer of ACE inhibitors, the drug should be stopped (see the "Side effect" section), the patient should be under appropriate medical supervision.
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.
The combination with aliskiren is contraindicated in patients with diabetes mellitus or renal dysfunction (GFR <60 ml / min / 1.73 m2 "Contraindications" and "Interaction with other medicinal products").
Patients with diabetes mellitus
When the drug is prescribed for patients with diabetes mellitus, who receive 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 (see section "Interaction with other medicinal products").