Inside, regardless of food intake, once a day.
Arterial hypertension
For 1 tablet of Skopryl Plus 20 mg + 12.5 mg once a day. With insufficient antihypertensive effect, the dose can be increased to the maximum daily dose - 1 tablet of Skopryl Plus 20 mg + 25 mg once a day.
Doses in renal failure
In patients with KK more than 30 and less than 80 ml / min. the drug can be used only after selecting the dose of individual components of the drug. Use of the drug in patients with SC less than 30 ml / min. contraindicated (see section "Contraindications for use"). The recommended initial dose of lisinopril in uncomplicated renal failure is 5-10 mg.
Prior therapy with diuretics
After taking the initial dose of the drug, symptomatic arterial hypotension may occur. Such cases are more common in patients who have had a loss of fluid and electrolytes due to previous treatment with diuretics. Therefore, it is necessary to stop taking diuretics 2-3 days before the treatment with Skopryl Plus (see "Precautions for Use").
Precautions for use:
If you have any of these diseases, consult a doctor before taking the drug.
Aortic stenosis / hypertrophic obstructive cardiomyopathy, bilateral renal artery stenosis or arterial stenosis of a single kidney with progressive azotemia, condition after kidney transplantation, renal failure (QC more than 30 ml / min), primary hyperaldosteronism, hypotension, bone marrow hypoplasia, hyponatremia the development of arterial hypotension in patients on a low-salt or salt-free diet), conditions accompanied by a decrease in the volume of circulating blood (including diarrhea, vomiting), connective tissue diseases (including systemic lupus erythematosus, scleroderma), diabetes mellitus, gout, hyperuricemia, ischemic heart disease, cerebrovascular diseases (including cerebral circulatory insufficiency), severe chronic heart failure, hepatic insufficiency, advanced age.
Arterial hypotension and water-electrolyte disorders
Most often, a marked decrease in blood pressure occurs with a decrease in the volume of circulating blood(Bcc) caused by prior therapy with diuretics, decreasing the amount of salt in the diet, dialysis, vomiting or diarrhea (see. The sections "Side effect", "Interaction with other drugs"). In patients with chronic heart failure with simultaneous renal failure or without it, a marked decrease in blood pressure is possible. It is often diagnosed in patients with severe chronic heart failure - as a result of application of high doses of diuretics, hyponatremia or impaired renal function. In such patients, treatment with the drug should be started under strict medical supervision and periodically monitor the electrolyte content in the blood serum.
Such rules must be followed in the appointment of the drug to patients with ischemic heart disease, cerebrovascular insufficiency, in which a sharp decrease in blood pressure can lead to heart attack or stroke.
Transient arterial hypotension is not a contraindication for taking the next dose of the drug.
Prior to treatment, if possible, should be to normalize the concentration of sodium ions and / or fill bcc carefully controlled initial dose effect on the patient.
Aortic stenosis / hypertrophic cardiomyopathy
ACE inhibitors should be administered with caution to patients with left ventricular outflow obstruction.
Renal impairment
In patients with chronic heart failure, a marked decrease in blood pressure after initiation of treatment with ACE inhibitors may lead to a further deterioration in kidney function. Cases of acute renal failure are noted.
In patients with bilateral renal artery stenosis or stenosis of the artery of a single kidney receiving ACE inhibitors, there was an increase in the concentration of urea and serum creatinine, usually reversible after discontinuation of treatment. It was more common in patients with impaired renal function.
Patients on hemodialysis
Anaphylactic reactions have been observed in patients undergoing hemodialysis using dialysis membranes with high permeability (for example, AN69), 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 agent.
Anaphylactoid reactions
In patients receiving ACE inhibitors, life-threatening anaphylactoid reactions were noted during apheresis of low-density lipoprotein (LDL) using dextran sulfate.The appearance of these reactions is prevented with the temporary cessation of treatment with ACE inhibitors before each session of apheresis. In patients taking ACE inhibitors during desensitization with Hepaticoptera venom (eg, bee or aspen poison), life-threatening anaphylactoid reactions were rarely observed. These reactions can be avoided by temporarily stopping the use of an ACE inhibitor before each desensitization to the hymenoptera.
Diseases of the liver
Caution should be used with thiazides in patients with impaired hepatic function or progressive liver disease, since minor changes in the water-electrolyte balance may cause a sudden hepatic coma.
Surgery / general anesthesia
With extensive surgical interventions, as well as with the use of other drugs that cause a decrease in blood pressure, lisinopril, blocking the formation of angiotensin II, can cause a pronounced unpredictable decrease in blood pressure. The pronounced decrease in blood pressure, which is considered a consequence of this mechanism, can be eliminated by an increase in BCC.
Before surgery (including dentistry) it is necessary to warnan anesthesiologist on the use of an ACE inhibitor.
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 during any period of therapy. In this case, treatment with Skopryl Plus should be stopped as soon as possible and monitored until the symptoms regressed completely. In cases where edema is localized only on the face and lips, the general 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 are covered, airway obstruction may occur, therefore, an appropriate therapy (0.3-0.5 ml epinephrine (adrenaline) 1: 1000 subcutaneously) and / or measures to ensure airway patency should be taken immediately.
Patients who had a history of angioedema, unrelated to previous treatment with ACE inhibitors, may be at increased risk during development with ACE inhibitor therapy (see section "Contraindications for use").
Cough
Reported the appearance of cough with the use of ACE inhibitors. The characteristic cough is unproductive, persistent and stops after discontinuation of treatment. In the case of a cough, it is necessary to include cough induced by ACE inhibitors in differential diagnosis.
Potassium in the serum
In some cases, hyperkalemia was noted. Risk factors for the development of hyperkalemia include renal failure, diabetes mellitus, administration of potassium drugs or agents that cause an increase in potassium in the blood (eg, heparin), especially in patients with impaired renal function.
Patients who are at risk for symptomatic arterial 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 before the start of therapy with Skopryl Plus should be compensated (loss of fluid and salts) .
Metabolic and endocrine effects
Thiazide diuretics can affect glucose tolerance, so you need to adjust the dose of hypoglycemic agents.
Thiazide diuretics can reduce the release of calcium ions by the kidneys and cause hypercalcemia. Expressed hypercalcemia may be a symptom of latent hyperparathyroidism. It is recommended to stop therapy with thiazide diuretics before the parathyroid gland function test.
During the treatment with Skopryl Plus, regular monitoring of the potassium, glucose, urea, creatinine and lipid content is necessary.
During the treatment with Skopryl Plus, it is not recommended to drink alcoholic beverages, since alcohol increases the antihypertensive effect of the drug. Care should be taken when performing physical exercises, hot weather (the risk of dehydration and excessive blood pressure lowering due to a decrease in BCC).