Stoppress - instructions for use, dose, side effects, contraindications

mannitol - 70,97 mg; crospovidone - 9,00 mg; butyl methacrylate, dimethylaminoethyl methacrylate and methyl methacrylate copolymer (1: 2: 1) - 4.50 mg; silicon dioxide colloidal - 0.18 mg; magnesium stearate - 1.35 mg.

Tablets 8 mg:

mannitol - 141,94 mg; crospovidone - 18,00 mg; butyl methacrylate, dimethylaminoethyl methacrylate and methyl methacrylate copolymer (1: 2: 1) - 9.00 mg; silicon dioxide colloid - 0.36 mg; magnesium stearate - 2.70 mg.

Description:

For a dosage of 4 mg:

Tablets of white color, oblong, biconcave, with delicate risk on both sides.

For a dosage of 8 mg:

Tablets are white, round, flat.

Pharmacotherapeutic group:Angiotensin-converting enzyme inhibitor

ATX: & nbsp

C.09.A.A.04 Perindopril

Pharmacodynamics:

Perindopril is an inhibitor of the angiotensin-converting enzyme (ACE), which acts through its active metabolite, perindoprilat. Suppression of ACE leads to a decrease in angiotensin II in blood plasma,as a result of which the secretion of aldosterone is reduced and the renin activity of the blood plasma is increased (due to the inhibition of negative feedback).

Since ACE inhibits the activity of bradykinin, suppression of ACE is accompanied by an increase in the activity of both the circulating and tissue kallikrein-kinin system, and the system of prostaglandins is also activated.

As a rule, on the background of taking perindopril, the renal blood flow increases, while the speed of glomerular filtration does not change.

Arterial hypertension

Against the background of the use of perindopril, both systolic and diastolic blood pressure (BP) decrease in the "lying" and "standing" positions.

Perindopril reduces the overall peripheral vascular resistance (OPSS), which leads to a decrease in elevated blood pressure without changing the heart rate (heart rate).

The maximum antihypertensive effect develops 4-6 hours after ingestion of one dose of the drug. In this case, the antihypertensive effect persists for 24 hours. A stable decrease in blood pressure is achieved quickly enough. In patients with a positive response to treatment with perindopril, the normalization of BP occurs within 1 month of therapy and persists for a long time.

The termination of treatment is not accompanied by the development of the "withdrawal" syndrome. Determined that perindopril has a vasodilating effect, helps restore the elasticity of large arteries and structural deformations of small arteries, and also reduces left ventricular hypertrophy.

The concomitant use of a thiazide diuretic has an additive synergistic effect.

Chronic heart failure

Perindopril reduces preload and postnagruzku. In patients with chronic heart failure (CHF) on the background of taking perindopril, there is a decrease in the filling pressure in the left and right ventricles of the heart, a decrease in the OPSS, an increase in cardiac output and an increase in the cardiac index, and an increase in muscular regional blood flow.

In patients with chronic heart failure I-II functional class by classification NYHA after the first administration of perindopril at a dose of 2 mg, there was no significant decrease in blood pressure.

Stable ischemic heart disease

With prolonged use perindopril in a dose of 8 mg 1 time per day is able to significantly reduce the relative risk of cardiovascular complications inpatients with stable ischemic heart disease (IHD).

Pharmacokinetics:

After oral administration perindopril quickly absorbed from the gastrointestinal tract. The maximum concentration (C_{| TSHH}) perindopril in blood plasma is determined after 1 hour. Bioavailability is 65-70%. About 20% of the ingested dose of perindopril is metabolized to perindoprilat. Time to reach C_max Perindoprilata in blood plasma is 3-4 hours. In addition to perindoprilata, 5 metabolites are formed in the metabolism process - all of them are pharmacologically inactive. Taking the drug along with the food is accompanied by a decrease in the conversion of perindopril to perindoprilat, but this effect has no significant clinical significance.

Half-life (T1 / 2) perindopril is 1 hour. The volume of distribution of free (Vd) perindoprilata is approximately 0,2 l / kg. The association of perindoprilat with plasma proteins is insignificant (the association with ACE is less than 30%). Perindoprilat is excreted from the body by the kidneys. T'L metabolite is 3-5 hours. Dissociation of perindoprilat, associated with ACE, is slowed down. As a consequence, the "effective" T^1/2 is 25 hours.When reapplying perindopril Do not cumulate. The equilibrium state (C_ss) is achieved after 4 days.

The excretion of perindoprilat is delayed in the elderly, as well as in patients with chronic cardiac and renal insufficiency. In case of renal insufficiency, correction of the dose of the drug is carried out taking into account the degree of renal impairment in the case of creatinine clearance (CC) less than 60 ml / min. The dialytic clearance of perindoprilat is 70 ml / min.

In patients with cirrhosis of the liver, the "hepatic" clearance of perindopril is reduced by half. Nevertheless, the amount of perindoprilat formed does not decrease and dose adjustment is not required.

Indications:

- Ahyperthermia;

- chronic heart failure;

- stable ischemic heart disease: reduced risk of developing cardiovascular complications in patients who had previous myocardial infarction and / or coronary revascularization.

Contraindications:

- Hypersensitivity to perindopril or other components of the drug, as well as to other ACE inhibitors;

- angioedema in the anamnesis (hereditary, idiopathic or angioedema due to the administration of ACE inhibitors);

- pregnancy;

- lactation period;

- age to 18 years (safety and efficacy not established).

Carefully:

Renovascular hypertension, bilateral renal artery stenosis, stenosis of the artery only kidneys - risk of severe hypotension and renal failure; CHF in the stage of decompensation, arterial hypotension; chronic renal failure (creatinine clearance (CK) less than 60 ml / min); hypovolaemia and hyponatremia (due to a salt-free diet and / or previous diuretic therapy, dialysis, vomiting, diarrhea), cerebrovascular diseases (including cerebral circulatory insufficiency, ischemic heart disease, coronary insufficiency) - the risk of excessive blood pressure lowering; stenosis of the aortic or mitral valve, hypertrophic obstructive cardiomyopathy, hemodialysis using vysokoprotochnyh polyacrylonitrile membranes - the risk of anaphylactoid reactions; condition after kidney transplantation - there is no clinical experience; before the procedure for the apheresis of low-density lipoprotein (LDL); simultaneous conduct of desensitizing therapy with allergens (for example,poison Hymenoptera) - the risk of anaphylactoid reactions; connective tissue diseases (including systemic lupus erythematosus (SLE), scleroderma), oppression of bone marrow hematopoiesis with immunosuppressant, allopurinol or procainamide - the risk of agranulocytosis and neutropenia; congenital deficiency of glucose-6-phosphate dehydrogenase - single cases of hemolytic anemia; in representatives of the Negroid race, the risk of developing anaphylactoid reactions; surgical intervention (general anesthesia) - the risk of developing excessive blood pressure lowering; diabetes mellitus (monitoring the concentration of glucose in the blood); hyperkalemia; elderly age.

Pregnancy and lactation:

In pregnancy, the use of the drug is contraindicated. Do not use in the first trimester of pregnancy, so when confirming pregnancy, Stoppress should be discontinued as soon as possible. The drug is contraindicated in the FH trimesters of pregnancy, because the use of trimester of pregnancy in the N-III may cause fetotoxic effects (decreased kidney function, low blood pressure, slowing ossification of the fetal bones) and neonatal toxic effects (renal failure, arterial hypotension, hyperkalemia).If nevertheless used the drug in the II-III trimesters of pregnancy, then it is necessary to perform ultrasound examination of the kidneys and bones of the fetal skull.

Application of the drug Stoppress during breastfeeding is not recommended, due to the lack of data on the possibility of its penetration into breast milk. If it is necessary to use the drug during lactation, breastfeeding should be discontinued.

Dosing and Administration:Stopress should be taken orally, before meals, once a day, preferably in the morning.

The dose of the drug is selected individually for each patient, depending on the severity of the disease and individual response to treatment.

In case of missed intake, the subsequent dose is not doubled.

Arterial hypertension

The drug Stoppress can be used in monotherapy and in combination with other antihypertensive drugs.

The recommended initial dose is 4 mg once a day, in the morning.

For patients with pronounced activation of the renin-angiotensin-aldosterone system (eg, with renal vascular hypertension, hypovolemia and / or hyponatremia, CHF in decompensation or severe hypertension), the recommended initial dose is 2 mg (1/2 tablet, 4 mg) per day in a single dose.If the therapy is ineffective for a month, the dose can be increased to 8 mg once a day and with good tolerability of the previous dose.

Addition of ACE inhibitors patients taking diuretics, can cause the development of arterial hypotension. In this regard, it is recommended to carry out therapy with caution, to cancel diuretics 2-3 days before the beginning of treatment with Stoppress or to start treatment with Stoppress from the initial dose of 2 mg (1/2 tablets of 4 mg) per day, in a single dose. It is necessary to control blood pressure, kidney function and potassium in the blood serum. In the future, the dose of the drug can be increased, depending on the dynamics of blood pressure. If necessary, diuretic therapy can be resumed.

Have elderly patients the recommended initial daily dose is 2 mg (1/2 tablet at 4 mg), in one session. In the future, the dose can be gradually increased to 4 mg and, if necessary, to a maximum of 8 mg once a day, provided that the dose is well tolerated.

Chronic heart failure

The recommended initial dose of Stoppress is 2 mg (1/2 tablet of 4 mg) in the morning, under medical supervision. After 2 weeks, the dose can be increased to 4 mg per day in one session, under the control of blood pressure.Treatment of CHF with clinical manifestations is usually combined with potassium-sparing diuretics, beta-adrenoblockers and / or digoxin.

Have patients with CHF, with renal failure and with a tendency to electrolyte disorders (hyponatremia), as well as in patients taking both diuretics and / or vasodilators, treatment with the drug is started under strict medical supervision.

Have patients with a high risk of developing clinically significant arterial hypotension (eg, taking high doses of diuretics), if possible, before the start of taking the drug, Stopress should eliminate hypovolemia and electrolyte disorders. It is recommended to carefully monitor blood pressure, the state of kidney function and the content of potassium in the blood serum before and during therapy.

Stable ischemic heart disease

In patients with stable ischemic heart disease, the recommended initial dose of Stoppress is 4 mg per day. After 2 weeks, the dose is increased to 8 mg per day, provided that the dose is well tolerated at 4 mg per day and that the kidney function is monitored.

Elderly patients

Treatment of elderly patients should begin with a dose of 2 mg (1/2 tablet of 4 mg), which after a week can be increased to 4 mg per day.In the future, if necessary, after a week, you can increase the dose to 8 mg per day with mandatory pre-control of kidney function. In elderly patients, the dose of the drug can be increased only if the previous, lower dose is well tolerated.

Renal insufficiency

In patients with kidney disease, the dose of Stoppress is determined depending on the degree of renal dysfunction. Patient monitoring usually involves regular determination of serum potassium and serum creatinine. W Recommended doses:

Creatinine clearance	Recommended dose
from 60 ml / min and above	4 mg per day
from 30 to 60 ml / min	2 mg (1/2 tablets of 4 mg) per day
from 15 to 30 ml / min	2 mg (1/2 tablets of 4 mg) every other day
Patients on hemodialysis * (SC less than 15 mL / min)	2 mg (1/2 tablet of 4 mg each) per day of dialysis

* - Dialyz clearance of perindoprilata is 70 ml / min. The drug Stopress should be taken after a dialysis session.

Liver failure

With liver diseases, dose adjustments are not required.

Side effects:

Depending on the frequency of occurrence, the following groups of side effects are distinguished: very often:> 1/10; often:> 1/100, <1/10; infrequently:> 1/1000, <1/100; rarely:> 1/10000,<1/1000; very rarely: <1/10000, including individual messages.

From the central and peripheral nervous system: often - headache, dizziness, paresthesia; infrequently - sleep or mood disturbances; very rarely confusion.

From the side of the organ of vision: often - visual impairment.

From the organ of hearing: often - noise in the ears.

From the cardiovascular system: often marked decrease in blood pressure; very rarely - arrhythmias, angina pectoris, myocardial infarction or stroke, possibly secondary, due to severe arterial hypotension in high-risk patients; vasculitis (frequency unknown).

On the part of the respiratory system: often - cough, shortness of breath; sometimes bronchospasm; very rarely - eosinophilic pneumonia, rhinitis.

From the digestive tract: often - nausea, vomiting, abdominal pain, dysgeusia, dyspepsia, diarrhea, constipation; infrequent - dryness of the oral mucosa; rarely - pancreatitis; very rarely - cytolytic or cholestatic hepatitis (see section "Special instructions"), angioedema of the intestine.

From the skin: often - skin rash, itching; infrequently - angioedema, swelling of the face, extremities, urticaria; very rarely - erythema multiforme.

From the musculoskeletal system: often - muscle cramps.

From the genitourinary system: infrequently - renal failure, impotence; very rarely acute renal failure.

Common violations: often - asthenia; infrequently - increased sweating.

From the organs of hematopoiesis and lymphatic system: very rarely - with prolonged use in high doses, it is possible to reduce hemoglobin and hematocrit, thrombocytopenia, leukopenia / neutropenia, agranulocytosis, pancytopenia; very rarely - hemolytic anemia (in patients with congenital deficiency of glucose-6-phosphate dehydrogenase).

Laboratory indicators: increased urea concentration in blood serum and plasma creatinine, and hyperkalemia reversible after discontinuation of the drug (especially in patients with renal insufficiency, severe CHF and renovascular hypertension); rarely - increased activity of "hepatic" enzymes and bilirubin in the blood serum; hypoglycemia.

Overdose:

Symptoms: marked decrease in blood pressure, shock, disturbance of water-electrolyte balance (hyperkalemia, hyponatremia), renal failure, hyperventilation, tachycardia, palpitations, bradycardia, dizziness, anxiety, cough.

Treatment: with a pronounced decrease in blood pressure - give the patient a horizontal position with raised legs and take measures to replenish the volume of circulating blood (BCC), if possible, intravenous injection of angiotensin II and / or an intravenous solution of catecholamines. With the development of severe bradycardia, which is not amenable to drug therapy (including atropine), an artificial pacemaker is shown. It is necessary to monitor the vital functions and concentrations of creatinine and electrolytes in the blood serum. Perindopril can be removed from the systemic blood flow by hemodialysis. It is necessary to avoid the use of high-flow polyacrylonitrile membranes (for example, AN 69).

Interaction:Diuretics

In patients taking diuretics, especially with excessive excretion of fluid and / or sodium, at the beginning of therapy with ACE inhibitors, excessive arterial hypotension may develop. The risk of developing excessive arterial hypotension can be reduced by abolishing the diuretic, intravenously administering a 0.9% solution of sodium chloride, and by prescribing an ACE inhibitor at lower doses.Further increase in the dose of Stoppress should be carried out with caution.

Potassium-sparing diuretics, potassium preparations, potassium-containing foods and nutritional supplements

Usually, with the ACE inhibitor therapy, the serum potassium content remains within normal limits, but some patients may develop hyperkalemia. The combined use of ACE inhibitors and potassium-sparing diuretics (eg, spironolactone, triamterene, amiloride), potassium or potassium-containing products and food additives can cause hyperkalemia. Therefore, it is not recommended to combine Stoppress with these drugs. Apply these combinations only in the case of hypokalemia, observing the precautionary measures and regularly monitoring the potassium content in the blood serum.

Lithium

With simultaneous use of lithium drugs and ACE inhibitors, it is possible to develop a reversible increase in lithium serum and lithium toxicity. The simultaneous use of ACE inhibitors with thiazide diuretics can further increase the serum lithium content and increase the risk of developing ittoxic effects. The simultaneous use of the drug Stopress and lithium preparations is not recommended.

If necessary, this combination therapy is carried out under regular control of the lithium content in the blood serum.

Non-steroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid in doses from 3 grams day and above

Therapy of NSAIDs may reduce the antihypertensive effect of ACE inhibitors. In addition, NSAIDs and ACE inhibitors have an additive effect on the increase in potassium in the blood serum, which can lead to impaired renal function. This effect is usually reversible. In rare cases, acute renal failure may develop, especially in patients with existing renal dysfunction, for example in elderly patients or with dehydration.

Other antihypertensives and vasodilators

Simultaneous use of the drug Stoppress with other antihypertensive drugs can enhance the antihypertensive effect of perindopril. Simultaneous use of nitroglycerin, other nitrates or vasodilators can lead to an additional hypotensive effect.

Hypoglycemic agents

Simultaneous use of ACE inhibitors and hypoglycemic agents (insulin or hypoglycemic agents for oral administration) can increase the hypoglycemic effect, up to the development of hypoglycemia. As a rule, this phenomenon occurs in the first weeks of combined therapy in patients with renal insufficiency.

Acetylsalicylic acid, thrombolytic agents, beta-blockers and nitrates

Stoppress can be combined with acetylsalicylic acid (as an antiplatelet agent), thrombolytic agents and beta-blockers and / or nitrates. Tricyclic antidepressants / antipsychotics (antipsychotics) / general anesthetic agents (general anesthetics)

Co-administration with ACE inhibitors can lead to an increased hypotensive effect.

Sympathomimetics

Sympathomimetics can reduce the antihypertensive effect of ACE inhibitors. When this combination is prescribed, the effectiveness of ACE inhibitors should be evaluated regularly.

Special instructions:Stable ischemic heart disease

When the episode of unstable angina develops (significant or not) during the first month of therapyThe Stoppress drug should evaluate the benefit / risk ratio for therapy with this drug.

Arterial hypotension

ACE inhibitors can cause a sharp decrease in blood pressure. In patients with uncomplicated arterial hypertension, symptomatic arterial hypotension rarely occurs after taking the first dose of Stoppress. The risk of excessive reduction in blood pressure is increased in patients with reduced BCC in the presence of diuretic therapy, with a strict salt-free diet, hemodialysis, as well as with diarrhea or vomiting, or with severe renin-dependent hypertension. The expressed arterial hypotension is observed in patients with severe CHF, both in the presence of concomitant renal failure, and in its absence. The most common arterial hypotension can develop in patients with more severe CHF, taking "loop" diuretics in high doses, as well as against hyponatremia or kidney failure. These patients are recommended careful medical supervision at the beginning of therapy and when titrating doses of the drug. The same applies to patients with IHD or cerebrovascular disease, in whom excessive reduction of blood pressure can lead to myocardial infarction or cerebrovascular complications.

In case of development of arterial hypotension, it is necessary to give the patient a horizontal position with raised legs, and if necessary, administer sodium chloride solution (0.9%) to increase the BCC. Transient arterial hypotension is not a contraindication for further therapy. After the recovery of bcc and blood pressure, treatment can be continued provided that the dose of Stoppress is carefully selected.

In some patients with CHF and normal or low blood pressure during therapy with CGAPPress, an additional decrease in blood pressure may occur. This effect is expected and usually is not a basis for drug discontinuation. If arterial hypotension is accompanied by clinical manifestations, a dose reduction or stopping of the Stoppress drug may be required.

Stenosis of the aortic or mitral valve / hypertrophic obstructive cardiomyopathy

ACE inhibitors, incl. and Stoppress, should be used with caution in patients with mitral valve stenosis and left ventricular outflow tract obstruction (aortic valve stenosis and hypertrophic obstructive cardiomyopathy).

Impaired renal function

In patients with renal insufficiency (CC less than 60 ml / min), the initial dose of the Stopress drug should be selected according to the QC (see the "Method of administration and dose" section) and then, depending on the therapeutic response to the therapy. For such patients, regular monitoring of serum potassium and serum creatinine is necessary.

In patients with symptomatic heart failure, arterial hypotension, which develops during the initial period of therapy with ACE inhibitors, can lead to impaired renal function. In these patients, sometimes there were cases of acute renal failure, usually reversible.

In some patients with bilateral renal artery stenosis or stenosis of the renal artery to a solitary kidney (especially in the presence of renal failure) during therapy with ACE inhibitors was an increase in serum concentrations of urea and creatinine, reversible after discontinuation of therapy. Patients with renovascular hypertension during therapy with ACE inhibitors are at increased risk of severe hypotension and renal insufficiency.Treatment of such patients should start under close medical supervision with low doses and with further adequate dose selection. During the first weeks of therapy with Stoppress, it is necessary to cancel diuretics and regularly monitor the kidney function.

In some patients with arterial hypertension, in the presence of previously unidentified renal failure, especially with concomitant diuretic therapy, there was a slight and temporary increase in the concentration of urea and creatinine in the serum. In this case, it is recommended to reduce the dose of Stoppress and / or to cancel the diuretic.

Patients on hemodialysis

In patients on dialysis using high-flow membranes (for example, AN 69), and concurrently taking ACE inhibitors, several cases of persistent, life-threatening anaphylactic reactions were noted. If you need hemodialysis, you need to use a different type of membrane. Kidney transplantation

The experience of using the drug Stoppress in patients with recently transferred kidney transplantation is absent.

Increased sensitivity / angioedema

Rarely, in patients taking ACE inhibitors, incl. perindopril, developed angioedema, swelling of the face, limbs, lips, tongue, glottis and / or larynx. This condition can develop at any time of treatment. With the development of angioedema, treatment should immediately be discontinued, the patient should be under medical supervision until the symptoms disappear completely. Angioedema of the lips and face usually does not require treatment; To reduce the severity of symptoms, you can use antihistamines.

Angioedema, swelling of the tongue, glottis or larynx can lead to death. With the development of angioedema, immediately subcutaneously epinephrine (epinephrine) and ensure airway patency.

ACE inhibitors often cause angioedema in patients of the Negroid race. Patients with a history of anginaevrotic edema not associated with the use of ACE inhibitors may be at high risk of developing angioedema when taking an ACE inhibitor.

Anaphylactoid reactions during the procedure of apheresis of low-density lipoproteins (LDL-apheresis)

In patients with the appointment of ACE inhibitors on the background of the procedure LDL-apheresis through dextran sulfate, in rare cases, the development of an anaphylactic reaction is possible. It is recommended that the ACE inhibitor be temporarily withdrawn before each procedure for LDL apheresis.

Anaphylactic reactions during desensitization

In patients receiving ACE inhibitors during the course of desensitization (for example, the venom of Hymenoptera), in very rare cases development of life threatening anaphylactic reactions is possible. It is recommended that the ACE inhibitor be temporarily withdrawn before each desensitization procedure begins.

Liver failure

During therapy with ACE inhibitors, it is sometimes possible to develop a syndrome that starts with cholestatic jaundice and then progresses to fulminant liver necrosis, sometimes with a fatal outcome. The mechanism of development of this syndrome is unclear. If there is jaundice during the use of an ACE inhibitor or an increase in the activity of "hepatic" enzymes, the ACE inhibitor should be immediately discontinued,and the patient must be carefully monitored. It is also necessary to conduct an appropriate examination.

Neutropenia / agranulocytosis / thrombocytopenia / anemia

In patients on the background of therapy with ACE inhibitors, cases of development of neutropenia / agranulocytosis, thrombocytopenia and anemia were noted. With normal kidney function, in the absence of other complications, neutropenia develops rarely. The drug Stoppress should be used with extreme caution in patients with systemic connective tissue diseases (eg, SLE, scleroderma), simultaneously receiving immunosuppressive therapy, allopurinol or procainamide, as well as when combining all of these factors, especially if there is an existing impairment of kidney function. Such patients may develop severe infections that do not respond to intensive antibiotic therapy. When carrying out therapy with Stoppress in patients with the above factors it is recommended to periodically monitor the amount of white blood cells in the blood and warn the patient about the need to inform the doctor about the appearance of any symptoms of infection.

Negroid race

The risk of angioedema development in patients of the Negroid race is higher. Like other ACE inhibitors, the Stoppress drug is less effective in reducing blood pressure in patients of the Negroid race, possibly because of the higher prevalence of low-grade conditions in the population of this group of patients with hypertension.

Cough

Against the background of therapy with ACE inhibitors, a persistent, unproductive cough may develop which stops after the drug is discontinued. This should be taken into account in the differential diagnosis of cough.

Surgery / general anesthesia

In patients whose condition requires extensive surgical intervention or general anesthesia with drugs that cause arterial hypotension, ACE inhibitors, including the Stoppress drug, can block the formation of angiotensin II with compensatory release of renin. The day before the surgery, therapy with ACE inhibitors should be canceled. If the ACE inhibitor can not be canceled, then the arterial hypotension, which develops according to the mechanism described, can be corrected by an increase in BCC.

Hyperkalemia

Against the background of therapy with ACE inhibitors, including perindopril, in some patients the potassium content in the blood can increase. The risk of hyperkalemia is elevated in patients with renal and / or heart failure, decompensated diabetes mellitus, and in patients using potassium-sparing diuretics, potassium preparations or other drugs that cause hyperkalemia (eg, heparin). If it is necessary to simultaneously prescribe these drugs, it is recommended to regularly monitor the potassium content in the blood serum.

Diabetes

In patients with diabetes who take hypoglycemic agents for ingestion or insulin, in the first few months of therapy with ACE inhibitors, the concentration of glucose in the blood should be carefully monitored.

Lithium

It is not recommended to take joint medications with lithium and Stoppress. Potassium-sparing diuretics, preparations containing potassium, potassium-containing foods and nutritional supplements

It is not recommended to use together with ACE inhibitors.

Effect on the ability to drive transp. cf. and fur:

It is necessary to consider the possibility of developing arterial hypotension or dizziness, which can affect the management of transport and work with technical means,requiring increased concentration of attention.

Form release / dosage:Tablets 4 mg, 8 mg.

Packaging:10 tablets per foil blister A1 / PVC / PCTFE.

3 blisters of 10 tablets together with instructions for use are placed in a cardboard box.

Storage conditions:

In the original packaging to protect from light, at a temperature not higher than 25 ° C. Keep out of the reach of children.

Shelf life:

3 years.

Do not use the drug after the expiration date.

Terms of leave from pharmacies:On prescription

Registration number:LP-001535

Date of registration:24.02.2012

Expiration Date:24.02.2017

Date of cancellation:2017-03-30

The owner of the registration certificate:Pharmaceutical factory "POLFARMA" JSCPharmaceutical factory "POLFARMA" JSC Poland

Manufacturer: & nbsp

Pharmaceutical Works POLPHARMA, S.A. Poland

Representation: & nbspAKRIKHIN OJSC AKRIKHIN OJSC Russia

Information update date: & nbsp17.04.2017

Illustrated instructions

Instructions

Stoppress (Stopress)