Iruzid tab 10mg / 12.5mg 30 pc

Description

Composition
Active substance:
Tablets 10 + 12.5 mg: one tablet contains: lisinopril dihydrate (based on the anhydrous lisinopril) 10 mg, and hydrochlorothiazide 12.5 mg.
Tablets of 20 mg + 12,5: one tablet contains: lisinopril dihydrate (based on the anhydrous lisinopril) 20 mg, and hydrochlorothiazide 12.5 mg.
Tablets of 20 mg + 25: one tablet contains: lisinopril dihydrate (based on the anhydrous lisinopril) 20 mg of hydrochlorothiazide and 25 mg.
Excipients:
Mannitol, calcium phosphate dihydrate, corn starch, pregelatinized starch, red iron oxide colorant, magnesium stearate.
Description:
Tablets of 10 mg + 12,5: blue, biconcave, hexagonal tablets. Tablets 20 mg + 12.5: yellow, biconcave, hexagonal tablets. Tablets 20 mg + 25: light pink, biconcave, round tablets.
Product form:
Tablets of 10 mg + 12.5 20 mg + 12.5 20 + 25 mg
30 tablets in PVC / PVDC-Al blister.
One blister is placed together with instructions for use in a cardboard box.
Contraindications
Increased sensitivity to the drug, other ACE inhibitors and derivatives of sulphonamides, anuria, severe renal impairment (creatinine clearance less than 30 mL / min.), Angioneurotic edema (including a history of ACE inhibitors), hemodialysis using vysokoprotochnyh membranes hypercalcemia , hyponatremia, porphyria, precoma, hepatic coma, severe diabetes, age of 18 years (effectiveness and safety have been established).
Carefully
Aortic stenosis / hypertrophic cardiomyopathy, bilateral renal artery stenosis, stenosis of the artery only kidneys with progressive azotemia, condition after kidney transplantation, renal failure (creatinine clearance of 30 ml / min.), Primary hyperaldosteronism, hypotension, marrow hypoplasia, hyponatremia (increased the risk of hypotension in patients who are at malosolevoy or salt-free diet), hypovolemic states (including diarrhea, vomiting), diseases connected itelnoy tissue (systemic lupus erythematosus, scleroderma), diabetes, gout, depression of bone marrow hematopoiesis, hyperuricemia, hyperkalemia, coronary heart disease, cerebrovascular disease (including cerebrovascular insufficiency), severe chronic heart failure, liver failure, old age.
Dosage
12.5 mg + 10 mg
Indications
Hypertension (in patients who have shown combination therapy).
Interaction with other drugs
While the use of potassium-sparing diuretics (spironolactone, triamterene, amiloride), potassium preparations, salt substitutes containing potassium -Improves risk of hyperkalemia, especially in patients with impaired renal function. Therefore, they can jointly appoint only on the basis of individual judgment of the prescribing physician with regular monitoring of potassium serum levels and renal function.
While the use of vasodilators, barbiturates, phenothiazines, tricyclic antidepressants, ethanol – increased hypotensive effect.
While the use of nonsteroidal anti-inflammatory drugs (indomethacin, etc.), Estrogen – reduced antihypertensive effect of lisinopril. While the use of drugs lithium – lithium deceleration of excretion (gain cardiotoxic and neurotoxic effects of lithium).
While the use of antacids and kolestiraminom – reduced absorption in the gastrointestinal tract.
The preparation enhances the neurotoxicity salicylates, reduces the effect of oral hypoglycemic drugs, norepinephrine, epinephrine and protivopodagricakih preparations enhances the effects (including spin), cardiac glycosides, peripheral muscle relaxant effect, reduces the excretion of quinidine.
Reduces the effect of oral contraceptives. Ethanol enhances the hypotensive effect of the drug. At the same time taking methyldopa increased risk of hemolysis.
Overdose
Symptoms: Marked reduction in blood pressure, dry mouth, drowsiness, urinary retention, constipation, anxiety, irritability.
Treatment: symptomatic therapy, intravenous fluids, blood pressure monitoring, therapy aimed at correcting disorders and dehydration of water-salt balance. Control of urea, creatinine and electrolytes in the blood serum, and urine output.
pharmachologic effect
Pharmacological group:
Antihypertensive combination means (+ ACE inhibitor, a diuretic).
Pharmacodynamics:
Hypotensive combined tool. It possesses antihypertensive and diuretic action.
lisinopril
ACE inhibitor reduces the formation of angiotensin II from angiotensin I. Reduction of angiotensin II leads to a direct decrease in aldosterone release. Reduce bradykinin degradation and increases the synthesis of prostaglandins. , Decreases total peripheral vascular resistance, blood pressure (BP), preload, the pressure in the pulmonary capillaries, causes an increase in cardiac output and increased tolerance to stress in patients with chronic heart failure. It expands the artery to a greater extent than the vein. Some effects are explained by the influence on the tissue renin-angiotensin system. With prolonged use decreases the severity of myocardial hypertrophy of the arteries and resistive type. It improves blood flow to the ischemic myocardium. ACE inhibitors prolong the life expectancy of patients with chronic heart failure, slow the progression of left ventricular dysfunction in patients with myocardial infarction without clinical manifestations of heart failure. The antihypertensive effect starts after approximately 6 hours and stored for 24 hours. Duration of the effect is also dependent on the dose. The onset of action – within 1 hour. The maximum effect is determined after 6-7 hours. When hypertension effect noted in the first days after initiating treatment, stable action develops in 1-2 months.
With a sharp lifting of the drug has not been pronounced rise in blood pressure.
In addition to lowering blood pressure lisinopril reduces albuminuria. Patients with hyperglycemia contributes to the normalization of the function of the damaged glomerular endothelium.
Lisinopril does not affect the concentration of blood glucose in patients with diabetes mellitus and does not lead to increased incidence of hypoglycemia.
hydrochlorothiazide
A thiazide diuretic, diuretic effect which is associated with impaired reabsorption of sodium, chlorine, potassium, magnesium, water in the distal nephron; delaying removal of calcium ions, uric acid. It possesses antihypertensive properties; hypotensive action develops due to the expansion of arterioles. Almost no effect on normal blood pressure. The diuretic effect occurs within 1-2 hours, reaches a maximum after 4 hours and lasts 6-12 hours. The antihypertensive effect occurs within 3-4 days, but may need 3-4 weeks to achieve the optimal therapeutic effect.
Lisinopril and hydrochlorothiazide when used at the same time, have an additive antihypertensive effect.
Pregnancy and breast-feeding
The use of lisinopril during pregnancy is contraindicated. In establishing pregnancy the drug should be stopped as soon as possible. Receiving inhibitors of II and III trimester of pregnancy has adverse effects on the fetus (subject to marked reduction of blood pressure, renal failure, hyperkalemia, skull hypoplasia, intrauterine death). Information about the negative effects of the drug on the fetus when used during the I trimester there. For newborns and infants who have been exposed in utero ACE inhibitors, should be monitored for early detection of significant decrease in blood pressure, oliguria, hyperkalemia.
For the period of treatment with the drug should be abolished breastfeeding.
Conditions of supply of pharmacies
On prescription.
side effects
The most frequent side effects: dizziness, headache.
Other side effects:
Cardio-vascular system: marked reduction of blood pressure, chest pain, rarely – orthostatic hypotension, tachycardia, bradycardia, the emergence of symptoms of heart failure, impaired atrioventricular conduction, myocardial infarction.
On the part of the digestive tract: nausea, vomiting, abdominal pain, dry mouth, diarrhea, dyspepsia, anorexia, taste changes, pancreatitis, hepatitis (hepatocellular and cholestatic), jaundice.
For the skin: rash, increased sweating, photosensitivity, pruritus, hair loss.
Nervous system: mood lability, impaired concentration, paresthesia, fatigue, somnolence, jerking of the limbs and lips, rare – asthenic syndrome, confusion.
The respiratory system: dyspnea, bronchospasm, apnea.
From hemopoiesis system: a leukopenia, thrombocytopenia, neutropenia, agranulocytosis, anemia (decreased hemoglobin, hematocrit, erythropenia).
Allergic reactions: angioneurotic edema of face and extremities, lips, tongue, epiglottis, and / or larynx (see special instructions.), Skin rashes, itching, fever, vasculitis, positive antinuclear antibody reaction, increased ESR, eosinophilia.
With the genitourinary system: uremia, oliguria / anuria, renal dysfunction, acute renal failure, reduced potency.
Laboratory findings: hyperkalemia and / or hypokalemia, hyponatremia, hypomagnesemia, chloropenia, hypercalcemia, hyperuricemia, hyperglycemia, increased levels of urea and creatinine in the blood plasma, hyperbilirubinemia, hypercholesterolemia, hypertriglyceridemia, impaired glucose tolerance, increased activity of “liver” transaminases, especially during a history of renal diseases, diabetes and renovascular hypertension.
Other: dry cough, arthralgia, arthritis, myalgia, fever, impaired fetal development, exacerbation of gout.
special instructions
symptomatic hypotension
In most pronounced decrease in blood pressure occurs with a decrease in fluid volume caused by the diuretic therapy, reducing the amount of salt in the diet, dialysis, vomiting or diarrhea (see. The interaction with other drugs and side effects). In patients with chronic heart failure with concurrent renal failure or without her, perhaps pronounced reduction in blood pressure. She often diagnosed in patients with severe heart failure as a result of application of high doses of diuretics, hyponatremia or impaired renal function. In these patients, treatment should start under close medical supervision. Such rules must be followed in the appointment of patients with ischemic heart disease, cerebrovascular insufficiency, in which a sharp decrease in blood pressure can lead to heart attack or stroke.
Transient hypotensive response is not a contraindication to receive the next dose.
Prior to treatment should be possible to normalize the concentration of sodium and / or make up for the lost volume of liquid, the action of carefully controlled initial dose for the patient.
Renal function
Patients with chronic heart failure, expressed as decrease in blood pressure after the start of treatment with ACE inhibitors may lead to further deterioration of renal function. Cases of acute renal failure.
In patients with bilateral renal artery stenosis or stenosis of the artery to a solitary kidney, treated with ACE inhibitors, was an increase in urea and serum creatinine, usually reversible upon discontinuation of treatment. More frequent in patients with renal insufficiency.
Increased chuvstvitelnost / Angioedema
Angioneurotic edema of the face, extremities, lips, tongue, epiglottis and / or larynx rarely observed in patients treated with ACE inhibitors, including lisinopril, which may occur at any time during treatment. In this case, treatment with lisinopril is necessary as soon as possible and stop the patient be placed under observation until complete regression of symptoms. In cases where swelling appeared only on the face and lips, the condition often goes untreated, however, perhaps the appointment of antihistamines.
Angioneurotic edema, laryngeal edema can be fatal. When covered tongue, epiglottis larynx or airway obstruction may occur, so it is necessary to immediately carry out the appropriate therapy (0.3-0.5 ml solution of epinephrine (adrenaline) 1: 1000 s.c.) and / or measures to ensure airway patency.
In patients with a history of angioedema have been not related to previous treatment with ACE inhibitors may be at increased risk of its development during treatment with an ACE inhibitor.
Cough
With the use of ACE inhibitors coughing was observed. Cough dry, long, which disappear after cessation of treatment with an ACE inhibitor. The differential diagnosis of cough should be considered, and cough caused by ACE inhibitors.
Patients on hemodialysis
Anaphylactic reactions observed in patients undergoing hemodialysis using dialysis membranes with high permeability are simultaneously taking ACE inhibitors. In such cases it is necessary to consider the possibility of using a different type of dialysis membrane or other antihypertensive drugs.
Surgery / general anesthesia
In applying drugs that reduce blood pressure in patients with extensive surgery or during general anesthesia lisinopril can block the formation of angiotensin II.
Marked reduction in blood pressure, which is considered a consequence of this arrangement, it is possible to eliminate an increase in blood volume.
Prior to surgery (including dental), you must notify the surgeon / anesthetist on the use of ACE inhibitors.
Potassium in serum
In some cases, there is hyperkalemia.
Risk factors for the development of hyperkalemia include renal failure, diabetes, potassium receiving medications or drugs that increase the concentration of potassium in the blood (e.g., heparin), especially in patients with impaired renal function.
Patients who are at risk of symptomatic hypotension (located on malosolevoy or salt-free diet) with or without hyponatremia, and in patients who received higher doses of diuretics, the aforementioned state of pre-treatment is necessary to compensate for (loss of fluids and salts).
Metabolic and endocrine effects
Thiazide diuretics may affect glucose tolerance, so it is necessary to adjust the dose of antidiabetic drugs.
Thiazide diuretics may decrease urinary excretion of calcium and cause hypercalcemia. Marked hypercalcaemia may be a sign of hidden hyperparathyroidism. It is recommended to discontinue treatment with thiazide diuretics in before the test to assess the function of the parathyroid glands.
During the period of treatment requires regular monitoring of serum potassium, glucose, urea, fat and lipid.
During the period of treatment is not recommended to drink alcohol, because alcohol enhances the hypotensive effect of the drug.
Caution should be exercised during exercise, hot weather (risk of development of dehydration and excessive reduction in blood pressure due to a decrease in blood volume).
Effect on vehicle control and the ability to work with the technique
During the period of treatment should refrain from driving motor vehicles and activities potentially hazardous activities that require high concentration and psychomotor speed reactions as dizziness, especially early in the course of treatment.
Storage conditions
At temperatures above 25 ° C.
Keep out of the reach of children!.
Dosing and Administration
Inside.
1 tablet Iruzida® 10 mg + 12.5 mg or 20 mg + 12.5 mg 1 time per day. Sometimes, if necessary, the dose may be increased to Iruzida® 20 mg + 25 mg 1 time per day.
Dose in renal failure:
In patients with a creatinine clearance of 30 and less than 80 ml / min., A drug may only be used after the selection of doses of the individual components of the preparation. The recommended initial dose of lisinopril with uncomplicated renal failure is 5-10 mg.
Prior diuretic therapy:
Symptomatic hypotension may occur after receiving the initial dose. Such cases are more common in patients who have had a loss of fluids and electrolytes as a result of prior treatment with diuretics. Therefore, it is necessary to stop the diuretic 2-3 days before the start of drug treatment (see. Special instructions).
Information
Appearance may differ from that depicted in the picture. There are contraindications. You need to read the manual or consult with a specialist