Symptomatic hypotension
Most often, pronounced BP occurs when the volume of circulating blood decreases, caused by diuretic therapy, a decrease in the amount of salt in the food, dialysis, diarrhea, or vomiting (see "Interaction with other drugs "and" Side effect. ") In patients with chronic cardiac insufficiency with simultaneous renal insufficiency or without it may develop symptomatic hypotension. It is more often detected in patients with severe cardiac insufficiency, as a consequence of the use of large doses of diuretics, hyponatremia or impaired renal function. In such patients, treatment should begin under the strict supervision of a physician. Similar rules should be adhered to when assigning patients with coronary heart disease, 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.
Impaired renal function
In patients with chronic heart failure, a marked decrease in blood pressure after initiation of treatment with ACE inhibitors may lead to further deterioration of renal function. Cases of acute renal failure are noted.
In patients with bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney receiving 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.
Hypersensitivity / Angioedema
Angioedema of the face, extremities, lips, tongue, epiglottis and / or larynx was rarely seen in patients treated with ACE inhibitors, including lisinopril, which can occur in any period of treatment. In this case, treatment with lisinopril should be stopped as soon as possible and for the patient to establish an observation until the symptoms regress completely. In cases where the edema appeared only on the face and lips, the condition often passes without treatment, however,it is possible to prescribe antihistamines.
Angioedema with edema of the larynx can be fatal. When the tongue, epiglottis or larynx is covered, airway obstruction can occur, therefore, appropriate therapy should be performed immediately (0.3-0.5 ml epinephrine (adrenaline) 1: 1000 sc, hypodermic) and / or measures to ensure airway patency. Patients who have had an angioedema in their history who are not associated with previous treatments with ACE inhibitors may be at increased risk of developing it during treatment with an ACE inhibitor. "Contraindications").
Cough
When an ACE inhibitor was used, a cough was noted. 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.
Patients on dialysis
Anaphylactic reaction was noted in patients undergoing hemodialysis using dialysis membranes with high permeability, 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.
Surgery / General Anesthesia
When using drugs 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.
Potassium in the serum
In some cases, hyperkalemia was noted.
Risk factors for the development of hyperkalemia include renal failure, diabetes mellitus, the use of potassium drugs or drugs that cause an increase in the potassium concentration in the blood (eg, heparin), especially in patients with impaired renal function.
In patients who have a risk of symptomatic hypotension (on a low-salt or salt-free diet) with or without hyponatremia, as well as in patients who received high doses of diuretics, the above-mentioned conditions must be compensated before the start of treatment (loss of fluid and salts).
Metabolic and endocrine effects
Thiazide diuretics can influence glucose tolerance, so dosage of antidiabetic drugs should be adjusted.
Thiazide diuretics can reduce the release of calcium in the urine and cause hypercalcemia.
Expressive hypercalcemia may be a symptom of latent hyperparathyroidism, it is recommended that treatment with thiazide diuretics should be discontinued before the parathyroid function test is performed. During the period of treatment with the drug Lizoretik®, regular monitoring in the blood plasma of potassium, glucose, urea, fat and creatinine is necessary.
During the period of treatment it is not recommended to drink alcoholic beverages, since alcohol enhances the hypotensive 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).