Symptomatic hypotension
Most often, a marked decrease in blood pressure occurs when the volume of fluid caused by diuretic therapy decreases, the amount of salt in the diet decreases, dialysis, diarrhea, or vomiting (see INTERACTION WITH OTHER MEDICINES and ADVERSE EFFECTS). In patients with chronic heart failure with simultaneous renal failure or without it, a marked decrease in blood pressure is possible. It is more often detected in patients with a severe degree of heart failure, as a result 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 appointing patients with ischemic heart disease, cerebrovascular insufficiency,in whom a sharp drop 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.
Before the start of treatment, if possible, normalize the sodium concentration and / or replenish the lost volume of fluid, carefully monitor the effect of the first dose of the drug on the patient.
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 renal artery stenosis or stenosis of the single-kidney artery 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.
Increased sensitivity / angioedema
Angioedema of the face, extremities, lips, tongue, epiglottis and / or larynx was rarely seen in patients treated with an ACE inhibitor, 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 usually 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 are covered, airway obstruction can occur, therefore, appropriate therapy should be performed immediately (0.3-0.5 ml epinephrine (adrenaline) 1: 1000 sc) and / or measures to ensure airway patency.
Patients who have had a history of angioedema, not associated with previous treatment with ACE inhibitors, may have an increased risk of developing it during treatment with an ACE inhibitor.
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 must also consider a cough caused by the use of an ACE inhibitor.
Patients on hemodialysis
Anaphylactic reaction was noted in patients undergoing hemodialysis using dialysis membranes with high permeability, which simultaneously take ACE inhibitors. In such cases it is necessary to consider the possibility of using another type of membrane for dialysis or another antihypertensive drug.
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 arterial 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 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 it is necessary to adjust the dosage of hypoglycemic drugs.
Thiazide diuretics can reduce the secretion of calcium in the urine and cause hypercalcemia. Expressed hypercalcemia may be a symptom of latent hyperparathyroidism. It is recommended to stop treatment with thiazide diuretics before the parathyroid gland function test.
During the treatment with the drug, regular monitoring of the blood plasma of potassium, glucose, urea, lipids and creatinine is required.
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 performing physical exercises,hot weather (the risk of dehydration and excessive decrease in blood pressure due to a decrease in the volume of circulating blood).