Description of the drug
The drug "Captopres" refers to complex drugs that contain two active substances: captopril - an angiotensin-converting enzyme inhibitor and the diuretic hydrochlorothiazide. The drug exhibits a pronounced hypotensive and diuretic effect. It is produced in the form of tablets for oral administration by the Ukrainian pharmaceutical company.
There are two dosages of the drug, differing in the amount of the diuretic component. Captopres blood pressure tablets contain 50 mg of captopril and hydrochlorothiazide 25 or 12.5 mg. Additional components are povidone, milk sugar, aerosil, potato starch and magnesium stearate.
How the drug works
The active components determine the mechanism of action of the drug "Captopres", on which its therapeutic effect on the human body depends.
Due to the inhibition of the angiotensin-converting enzyme by captopril, the synthesis of angiotensin type 2 is suppressed. Under the influence of this oligopeptide hormone, blood vessels constrict, stimulating the production of aldosterone by the adrenal cortex.
A decrease in type 2 angiotensin reduces pressure in the arteries, in the right atrium, vessels forming the pulmonary circulation, indicators of general peripheral vascular resistance, and the load on the heart muscle. Knowing the characteristics of captopril, you can determine the effect of the drug “Captopres” and at what pressure to take this medication.
Thanks to hydrochlorothiazide, it has a moderate diuretic effect on the urinary system due to the removal of water molecules, chloride, potassium and sodium ions from the body. The substance is able to reduce the level of sodium in the vascular wall, making it less sensitive to vasoconstrictor effects, and enhance the antihypertensive effect of captopril.
Main indications
For the medicine to help, you should drink it only after measuring your blood pressure.
It is important to know when you can take Captopres tablets. Indications for use of the drug include:
- essential hypertension, which develops as a result of various factors not related to the disease;
- symptomatic hypertension, which is a symptom of various diseases;
- malignant hypertension with attacks of angina or cardiac failure;
- renovascular hypertension associated with kidney vascular problems;
- renoparenchymal hypertension in combination with chronic or acute forms of glomerulonephritis of primary and secondary etiology;
- hypertension with bronchial asthma;
- diabetic nephropathy;
- congestive heart failure, when cardiac glycosides have little effect;
- Conn's disease with the primary form of hyperaldosteronism.
The drug is used for emergency emergency treatment of hypertensive crisis.
How to take it correctly
You need to be extremely careful with Captopres tablets. At what pressure should you take the medication so as not to harm your health? This is a question many patients with hypertension ask their doctor.
Typically, normal blood pressure levels are considered to be 120/80 mmHg. Art. At higher values, it is necessary to take measures aimed at reducing blood pressure. If patients are prescribed the drug "Captopres" for blood pressure, it should be taken 60 minutes before meals so as not to interfere with the absorption of the active components. The dosage is selected depending on the form of hypertension and severity for each patient individually.
Treatment should be started with half a tablet containing captopril 25 mg and hydrochlorothiazide 12.5 mg. It is drunk once a day. For further maintenance therapy, take a whole tablet per day containing 50 mg of captopril and 25 mg of hydrochlorothiazide. The maximum therapeutic effect is observed after 1.5-2 months from the first use. Dosage adjustments are made using a 6-week interval, taking into account that there is no need for rapid changes.
Insufficient reduction in blood pressure may be a reason to include in therapy additional amounts of captopril and hydrochlorothiazide, which are taken as part of single-component drugs. The daily dose of captopril should not exceed 150 mg, and the content of hydrochlorothiazide should not exceed 50 mg.
To relieve a hypertensive crisis, I use one tablet, which is chewed and kept under the tongue.
How does the drug affect blood pressure?
The effectiveness of lowering blood pressure when taking Captopress is due to the presence of two active ingredients simultaneously in its composition. The main active ingredient is captopril. It belongs to a group of medications called ACE inhibitors.
This enzyme, like other enzymes from the above group, helps the body produce substances such as angiotensin II. Under its influence, the muscle tissue of blood vessels contracts, which reduces blood pressure.
In addition, captopress affects the formation of substances that destroy bradykinin. This mediator affects the level of vasodilation. Captopres reduces the amount of norepinephrine and endothelin in the blood, thereby lowering blood pressure.
Disorders in the urinary system
Captopril and hydrochlorothiazide are excreted via the kidneys. Disturbances in the functioning of this organ (with creatinine clearance of 30-80 ml in 1 minute) lead to an increase in the level of active components of the tablet in the blood serum.
To adjust the dose of active substances to therapeutic levels, take half a tablet per day, which corresponds to the amount of captopril 25 mg and hydrochlorothiazide 12.5 mg. Usually take the medicine in the morning 1 hour before breakfast.
Efficacy of the drug
Captopres tablets are used to treat hypertension and heart failure, and their main component captopril was first used in the 70s of the last century. Many patients talk about the benefits of the drug, that with its help blood pressure quickly decreases during a hypertensive crisis. It is important to take the pills correctly and regularly to get effective results.
Numerous clinical studies of captopril-based drugs have shown that they lower blood pressure and reduce the number of deaths from cardiovascular diseases.
Who is contraindicated for treatment?
The instructions for use for the drug "Captopres" include a number of contraindications, which include increased individual sensitivity to the active substances of the tablets, angiotensin-converting enzyme inhibitors and sulfamide derivatives.
You cannot take the drug if there is stenosis of the artery leading to a single kidney or to two kidneys, after a transplant of this organ, in case of severe disturbances in its functioning, when the rate of blood purification from creatinine is 30 ml per 1 minute, and its concentration in plasma does not exceed 1, 8 mg per 100 ml.
The medicine is not used by patients who have signs of primary hyperaldosteronism, reduced levels of potassium and sodium ions in the blood, hypovolemia, gout and hypercalcemia, obstructive changes with stenosis of the aortic mouth and impaired outflow of blood in the left ventricle. It is prohibited to take the drug during severe liver diseases, pregnant and breastfeeding women. Contraindication is children under 18 years of age.
Diuretics should be stopped 3 days before the first use of a drug based on captopril and a diuretic.
Elderly people, vehicle drivers, patients with weakened immune systems, whose creatinine clearance is 30-60 ml per 1 minute, have an increased protein content in the urine and its levels exceed 1000 mg per day, require special caution.
You need to be extremely careful when taking procainamide, heart failure, kidney disorders, diabetes mellitus, high pressure in the renal arteries. To monitor the patient's health, periodic blood pressure measurements, kidney function tests, and blood electrolyte ion levels are usually prescribed.
Captopril Velpharm
Before starting, as well as regularly during treatment with Captopril Welfarm, blood pressure and kidney function should be regularly monitored.
In patients with chronic heart failure, the drug is used under close medical supervision.
Arterial hypotension
In patients with arterial hypertension, when using the drug Captopril Velpharm, severe arterial hypotension is observed only in rare cases; the likelihood of developing this condition increases with a decrease in circulating blood volume and an imbalance of water and electrolyte balance (for example, after intensive treatment with diuretics), in patients with chronic heart failure or on hemodialysis.
The possibility of a sharp decrease in blood pressure can be minimized by first withdrawing (4-7 days before) the diuretic or replenishing the volume of circulating blood (about a week before starting treatment), or by using the drug Captopril Velpharm in small doses at the beginning of treatment (6, 25-12.5 mg/day).
A marked decrease in blood pressure when using antihypertensive drugs in patients with cerebrovascular accidents and cardiovascular diseases may increase the risk of myocardial infarction or stroke.
If arterial hypotension develops, the patient should take a horizontal position with legs elevated. Sometimes it may be necessary to replenish the volume of circulating blood.
Renovascular hypertension
There is an increased risk of developing hypertension and renal failure in patients with bilateral renal artery stenosis of a solitary kidney when using ACE inhibitors.
Impaired renal function can occur with moderate changes in serum creatinine concentrations. In such patients, therapy should be initiated under close medical supervision with low doses, carefully titrated and with monitoring of renal function.
The simultaneous use of ACE inhibitors (including the drug Captopril Velpharm) with drugs containing aliskiren is contraindicated in patients with diabetes mellitus and/or with moderate or severe renal failure (GFR less than 60 ml/min 1.73 m2 body surface area) and not recommended in other patients.
Concomitant use of ACE inhibitors with angiotensin II receptor antagonists is contraindicated in patients with diabetic nephropathy and is not recommended in other patients.
Renal dysfunction
In patients with renal failure or when taking high doses of ACE inhibitors (including Captopril Welfarm), proteinuria may occur. In most cases, proteinuria decreased or disappeared within 6 weeks, regardless of whether treatment with Captopril Welfarm was continued or not.
Parameters of renal function, such as residual blood nitrogen and creatinine, rarely changed in patients with proteinuria.
In patients with kidney disease, the protein content in the urine should be determined before starting therapy and periodically throughout the course of therapy.
Hyperkalemia
In some cases, when using the drug Captopril Velpharm, an increase in potassium levels in the blood serum is observed. The risk of developing hyperkalemia when using ACE inhibitors is increased in patients with renal failure and diabetes mellitus, as well as those taking potassium-sparing diuretics, potassium supplements and other drugs that cause an increase in potassium levels in the blood (for example, heparin).
The simultaneous use of potassium-sparing diuretics and potassium supplements should be avoided.
Use with caution in patients on a low-salt or salt-free diet (increased risk of hypotension and hyperkalemia).
Neutropenia/agranulocytosis
In the first 3 months of therapy, the number of leukocytes in the blood is monitored monthly, then once every 3 months.
Neutropenia, agranulocytosis, anemia and thrombocytopenia have been reported in patients taking ACE inhibitors, including Captopril Welfarm.
In patients with normal renal function and no other complicating factors, neutropenia rarely occurs.
Captopril should be used with great caution in patients with connective tissue diseases who are simultaneously receiving immunosuppressive therapy (allopurinol or procainamide), especially with existing renal impairment. In such patients, a clinical blood test is monitored every 2 weeks in the first 3 months, then every 2 months. If the leukocyte count is below 4.0 x 109/l, a general blood test is indicated; below 1.0 x 109/l, the drug is stopped. These patients may develop severe infections that do not respond to intensive antibiotic therapy.
During treatment, all patients should be instructed that if signs of infection occur (eg, sore throat, fever), they should notify the physician and have a complete blood count performed. In most patients, the white blood cell count quickly returns to normal when treatment with Captopril is stopped.
Anaphylactoid reactions
In patients taking Captopril Welfarm during desensitizing therapy with hymenoptera venom, etc. increased risk of developing anaphylactoid reactions. This can be avoided if you first temporarily stop taking the drug.
When carrying out hemodialysis in patients treated with Captopril Welfarm, the use of high permeability dialysis membranes (for example, AN69®) should be avoided, since in such cases the risk of developing anaphylactoid reactions increases.
In rare cases, life-threatening anaphylactoid reactions may occur in patients receiving ACE inhibitors during low-density lipoprotein (LDL) apheresis using dextran sulfate. To prevent anaphylactoid reactions, ACE inhibitor therapy should be discontinued before each LDL apheresis procedure using high-flux membranes.
Angioedema
In patients taking Captopril Velpharm, the appearance of abdominal pain must be differentiated from intestinal angioedema.
If angioedema develops, the drug is discontinued and careful medical observation and symptomatic therapy are provided. If the swelling is localized on the face, special treatment is usually not required (antihistamines can be used to reduce the severity of symptoms); in the event that the swelling spreads to the tongue, pharynx or larynx and there is a threat of developing airway obstruction and a threat to the patient’s life, epinephrine (adrenaline) should be immediately administered subcutaneously (0.5 ml in a dilution of 1:1000), and also make sure that airway patency.
It is recommended to stop taking ACE inhibitors, including Captopril Welfarm, 12 hours before surgery, warning the surgeon-anesthesiologist about the use of ACE inhibitors.
Cough
The development of a non-productive, prolonged cough when taking ACE inhibitors is reversible and resolves after discontinuation of treatment.
Diabetes
In patients with diabetes mellitus taking oral hypoglycemic agents or insulin, blood glucose concentrations should be regularly monitored during the first month of treatment with Captopril Welfarm.
Liver dysfunction
Several cases of liver dysfunction with cholestatic jaundice, fulminant liver necrosis, sometimes fatal, have been reported during therapy with ACE inhibitors.
If, during therapy with Captopril Velpharm, jaundice develops or the activity of “liver” transaminases increases, the drug should be discontinued immediately; the patient should be closely monitored and, if necessary, receive appropriate therapy.
Hypokalemia
The simultaneous use of an ACE inhibitor and a thiazide diuretic does not exclude the possibility of hypokalemia. It is recommended to regularly monitor potassium levels in the blood.
Surgery/anesthesia
Hypotension may occur in patients undergoing major surgery or during the use of anesthetics known to lower blood pressure. If arterial hypotension occurs, it is recommended to replenish the volume of circulating blood.
Ethnic differences
ACE inhibitors, including Captopril Welfarm, have a less pronounced antihypertensive effect in patients of the Black race, which is apparently due to the frequent occurrence of low renin activity in this group of patients.
Laboratory data
Captopril may cause a false-positive urine acetone test.
Undesirable consequences
When taking the drug "Captopres", the instructions describe the occurrence in some patients of various adverse reactions that affect different systems of the body.
With a negative effect on the digestive tract and liver, appetite decreases, the oral mucosa becomes dry, nausea, vomiting, pain in the stomach, irregular bowel movements, the development of stomatitis, peptic ulcers, jaundice, hepatitis, and increased bilirubin in the blood can be observed.
The effect on the heart, blood vessels and hematopoietic organs can be manifested by tachycardia, angina pectoris, low blood pressure, Raynaud's syndrome, redness or pallor of the skin, cardiogenic shock, neutropenia, agranulocytosis, thrombocytopenia, pancytopenia, hemolytic or aplastic anemia.
The drug has an effect on the central nervous system that disrupts sleep patterns, vision and taste, cerebral circulation, causes headaches, attacks of dizziness, emotional lability, confusion, and numbness of the extremities.
The effect on the respiratory system is manifested by cough, respiratory dysfunction, bronchospasm, and allergic rhinitis.
Side effects on the urinary system include renal failure, polyuria, oliguria, and nephrotic syndrome.
Allergies may develop in the form of skin rash, itching, urticaria, Quincke's edema, Stevens-Johnson syndrome, photosensitivity, erythema.
SIDE EFFECTS:
Captopril
From the blood and lymphatic system: eosinophilia, pancytopenia (especially in patients with impaired renal function), thrombocytopenia, anemia (including aplastic and hemolytic), leukopenia, neutropenia, agranulocytosis.
Metabolic disorders: anorexia, hypoglycemia, hyperkalemia, hyponatremia.
Mental disorders: sleep disturbance, confusion, depression.
Neurological disorders: headache, drowsiness, taste disturbance, dizziness, paresthesia, cerebrovascular accident (including stroke and syncope).
On the part of the organ of vision: blurred vision.
From the cardiovascular system: tachycardia or tachyarrhythmia, angina pectoris, cardiogenic shock, asystole.
Vascular disorders: arterial hypotension, Raynaud's syndrome, hot flashes, pallor of the skin.
Respiratory, thoracic and mediastinal disorders: dry, irritating (non-productive) cough, shortness of breath, bronchospasm, rhinitis, laryngitis, allergic alveolitis/eosinophilic pneumonia, chest pain.
From the digestive system: dry mouth, nausea, vomiting, epigastric discomfort, abdominal pain, diarrhea, constipation, stomatitis/aphthous stomatitis, glossitis, gastric and duodenal ulcers, pancreatitis.
From the hepatobiliary system: impaired liver function and cholestasis (including jaundice), hepatitis (including necrosis), increased levels of liver enzymes, hyperbilirubinemia.
From the immune system, skin and subcutaneous tissue: itching with/without rash, rash, alopecia, angioedema of the face, eyelids, tongue, interstitial angioedema, peripheral edema, urticaria, Stevens-Johnson syndrome, erythema multiforme, photosensitivity, erythroderma, pemphigoid reactions, exfoliative dermatitis, autoimmune diseases, fever.
From the musculoskeletal system and connective tissue: myalgia, arthralgia.
From the urinary system: impaired renal function (including renal failure), proteinuria, polyuria, oliguria, increased frequency of urination, nephrotic syndrome.
From the reproductive system and mammary glands: impotence, gynecomastia.
General disorders: fatigue, lymphadenopathy.
Laboratory indicators: increased urea nitrogen in the blood, creatinine in the blood plasma, decreased hemoglobin levels, hematocrit, increased ESR, increased levels of antinuclear antibodies.
Hydrochlorothiazide
Infections and infestations: sialadenitis.
From the circulatory and lymphatic system: leukopenia, neutropenia/agranulocytosis, thrombocytopenia, aplastic anemia, hemolytic anemia, bone marrow dysfunction.
Metabolic: anorexia, hyperglycemia, glycosuria, decreased glucose tolerance, which can provoke the manifestation of latent diabetes mellitus, hyperuricemia, which can cause gout attacks in patients with asymptomatic disease, electrolyte imbalance, in particular hypochloremic alkalosis, which can induce hepatic encephalopathy and coma, acidosis; hypokalemia, hyponatremia, hypomagnesemia; hypercalcemia, increased levels of cholesterol and triglycerides.
Psychiatric: anxiety, nervousness, depression, mood changes, sleep disturbance, disorientation, confusion.
From the side of the central nervous system: headache, drowsiness, convulsions, paresthesia, vertigo, dizziness.
From the organ of vision: xanthopsia, transient visual impairment.
From the cardiovascular system: postural hypertension, arrhythmia, necrotizing vasculitis.
From the respiratory system: respiratory disorders (including pneumonitis and pulmonary edema).
From the digestive system: loss of appetite, thirst, dry mouth, nausea, vomiting, stomach irritation, diarrhea, constipation, pancreatitis.
From the hepatobiliary system: cholestatic jaundice (intrahepatic cholestasis), cholecystitis.
From the immune system, skin and subcutaneous tissue: photosensitivity, rash, eczema, purpura, lupus-like syndrome, reactivation of cutaneous lupus erythematosus, urticaria, anaphylactic reactions, anaphylactic shock, toxic epidermal necrolysis, Stevens-Johnson syndrome.
From the musculoskeletal system: muscle spasm, myalgia.
From the urinary system: impaired renal function, renal failure, interstitial nephritis.
General disorders: fever, weakness.
Features of treatment
For many patients, it is important to know how the drug Captopres works and at what pressure to take it. Usually the medicine is taken when blood pressure rises, which is not correct. You need to take the medication systematically as recommended by your doctor.
During treatment, you should check the electrolyte concentration, especially potassium ions, the amount of creatinine and urea and monitor peripheral blood counts.
While taking the drug, you need to consume foods with minimal sodium content; alcohol is contraindicated.
Having a diuretic effect, the medicine can aggravate the state of impaired water-electrolyte balance associated with diuretic therapy, diarrhea, vomiting, a low-sodium diet, hemodialysis, resulting in arterial hypotension. Before antihypertensive therapy, electrolyte levels in the body should be adjusted.
Patients with impaired cardiac activity and the elderly are prescribed Captopres tablets with caution. At what pressure should I take the drug so that its readings do not become too low? Before taking the medication, you should check your blood pressure, it is also necessary to monitor your kidney function and the content of vital ions.
The Negroid race is considered resistant to the effects of drugs that inhibit angiotensin-converting enzyme, which is why captopril has less effect in such patients.
Contraindications and side effects
People suffering from the following symptoms and conditions should not take Captopress:
- Individual intolerance to the active ingredients of the drug;
- hypersensitivity to the substance captopril;
- increased sensitivity to diuretics;
- hypercalcemia;
- various diseases associated with impaired immunity;
- disturbance of water and electrolyte balance in the body;
- gout.
Treatment with captopress is comparable in the occurrence of many side effects. The most common ones are listed below:
- a sharp drop in blood pressure, accompanied by an irregular heartbeat;
- dry cough;
- runny nose;
- digestive disorders - nausea, changes in stool;
- dry mouth;
- Various allergic reactions to substances contained in the drug.
Advantages of Captopres tablets
- Captopril-based drugs reduce mortality rates in diseases of the cardiovascular system.
- Captopres tablets can reduce high blood pressure. They can be used in old and senile age.
- When treated with the drug, kidney damage, including diabetic nephropathy and cancer, is reduced.
- Does not reduce libido in males, can exhibit antioxidant activity.
- A course of treatment with Captopres tablets will cost less than taking other modern medications that lower blood pressure.
Interaction with other drugs
Kaptopress is prescribed for treatment in combination with other auxiliary agents, which will differently affect the effect of taking the drug. The use of Captopress is affected by:
- a group of diuretics and adrenergic blockers - increases the degree of hypotensive effect;
- non-steroidal anti-inflammatory drugs - reduce the effect of taking Captopress;
- drugs containing ethyl alcohol and narcotic substances lead to orthostatic hypotension;
- potassium-based drugs - simultaneous use leads to hyperkalemia.
Moreover, the effect of Captopress changes when taking other medications:
- Anesthetics - there is an increase in effect;
- drugs intended for the treatment of diabetes mellitus - reduces effectiveness;
- drugs from the group of cardiac glycosides - increase the degree of intoxication in the body.
