Captopril: when prescribed, special instructions

"Captopril": main characteristics

The drug is a light-colored tablet with a characteristic odor. It is also available in the form of capsules of a similar composition. The active ingredient is captopril (1 tablet contains 25 mg). The therapeutic effect is based on inhibition of the action of the ACE enzyme.

Available in cardboard packaging of 10 tablets. Store at room temperature (no more than 25 degrees) and moderate humidity. The shelf life is 4 years from the date of issue. Dispensed from pharmacies only with a prescription.

What does Capril help with: indications for use

The drug is indicated for use in the presence of chronic and acute diseases of the cardiovascular system:

mild to moderate high blood pressure;
insufficient heart function (impaired functioning of the left ventricle);
myocardial infarction (taken during the first 24 hours, as well as as long-term prophylaxis);
diabetic nephropathy type 1.

The effect of "Capril" is due to the fact that the active substance reduces the synthesis of angiotensin II, which leads to severe vasoconstriction. Due to this, the potassium content in the blood plasma increases. In this case, the drug reduces blood pressure without affecting the pulse.

Captopril-Akos tablets 25 mg 40 pcs. in St. Petersburg

Orally 1 hour before meals. The dosage regimen is set individually.

For arterial hypertension

treatment begins with the lowest effective dose of 12.5 mg 2 times a day (for this dosage regimen it is necessary to use captopril in 25 mg tablets with the risk of other manufacturers). Attention should be paid to the tolerability of the first dose within the first hour. If arterial hypotension develops, the patient should be transferred to the “lying” position with legs elevated (such a reaction to the first dose should not serve as an obstacle to further therapy). If necessary, the dose is gradually increased (with an interval of 2-4 weeks) until the optimal effect is achieved. For mild to moderate arterial hypertension, the usual maintenance dose is 25 mg (1/2 tablet of 50 mg) 2 times a day; the maximum dose is 50 mg 2 times a day. For severe arterial hypertension, the maximum daily dose of Captopril-AKOS is 150 mg (50 mg 3 times a day).

For chronic heart failure

prescribed together with diuretics and/or in combination with cardiac glycosides (to avoid an initial excessive decrease in blood pressure, stop taking the diuretic or reduce the dose before prescribing the drug). The initial daily dose is 6.25 mg (for this dosing regimen, it is necessary to use captopril in tablets of 12.5 mg with a score or in tablets of 25 mg with a cross-shaped score from other manufacturers) 3 times a day, then, if necessary, the dose is increased gradually (at intervals of at least 2 weeks). The average maintenance dose is 25 mg (1/2 tablet of 50 mg) 2-3 times a day, and the maximum dose is 150 mg per day. In case of symptomatic arterial hypotension in heart failure, the doses of diuretics and/or other concomitantly prescribed vasodilators can be reduced to achieve a stable effect of the drug Captopril-AKOS.

For left ventricular dysfunction

after myocardial infarction in patients who are in a clinically stable condition, the use of the drug Captopril-AKOS can be started within 3 days after myocardial infarction. The initial dose is 6.25 mg per day (for this dosing regimen, it is necessary to use captopril in 12.5 mg scored tablets or 25 mg cross-scored tablets from other manufacturers). If necessary, the dose is gradually, over several weeks, increased to 75 mg per day in 2-3 doses (depending on tolerability of the drug) up to a maximum daily dose of 150 mg (50 mg 3 times a day). If arterial hypotension develops, a dose reduction may be required. Subsequent attempts at the maximum daily dose of 150 mg should be based on patient tolerance to the drug.

For diabetic nephropathy, the drug

Captopril-AKOS is prescribed at a dose of 75-100 mg per day in 2-3 doses. For insulin-dependent diabetes (type 1) with microalbuminuria (albumin secretion 30-300 mg per day), the dose of the drug is 50 mg 2 times a day. With a total protein clearance of more than 500 mg per day, the drug is effective at a dose of 25 mg (1/2 tablet of 50 mg) 3 times a day. With a moderate degree of renal dysfunction (GFR - at least 30 ml/min/1.73 m2), Captopril-AKOS can be prescribed at a dose of 75-100 mg per day. With a more severe degree of renal dysfunction (GFR - less than 30 ml/min/1.73 m2), the initial dose should be no more than 12.5 mg per day (for this dosing regimen, it is necessary to use captopril in tablets of 25 mg with the risk of other manufacturers); in the future, if necessary, the dose is gradually increased at sufficiently long intervals, but a lower daily dose of the drug is used than in the case of treating arterial hypertension. If necessary, loop diuretics are additionally prescribed rather than thiazide diuretics.

Contraindications for use

In some cases, taking the drug is excluded:

pregnancy period (2nd and 3rd trimester);
GW period (entirely);
angioedema;
hypersensitivity, individual intolerance to captopril or excipients;
simultaneous use with the drug "Aliskiren" (should be excluded by people suffering from diabetes or having renal failure).

CAPTOPRIL-ACOS

special instructions

Before starting, as well as regularly during treatment with Captopril-AKOS, 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-AKOS, 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 disease insufficiency or on hemodialysis. The possibility of a sharp decrease in blood pressure can be minimized by prior withdrawal (4-7 days) of the diuretic or replenishment of circulating blood volume (about a week before the start of treatment), or by using the drug Captopril-AKOS 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 use of ACE inhibitors (including Captopril-AKOS) with aliskiren should be avoided in patients with severe renal failure (GFR less than 60 ml/min/1.73 m2 body surface area).

Renal dysfunction

In patients with renal failure or when taking high doses of ACE inhibitors (including Captopril-AKOS), proteinuria may occur. In most cases, proteinuria decreased or disappeared within 6 weeks, regardless of whether treatment with Captopril-AKOS 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-AKOS, 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-AKOS. In patients with normal renal function and no other complicating factors, neutropenia rarely occurs. Captopril-AKOS 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 - stop taking the drug. 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-AKOS is stopped.

Anaphylactoid reactions

In patients taking Captopril-AKOS during desensitizing therapy with hymenoptera venom, etc., the risk of developing anaphylactoid reactions is increased.

If, during therapy with Captopril-LKOS, 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-AKOS, 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-AKOS may cause a false-positive urine test for acetone.

"Captopril": instructions for use

The optimal dosage is determined by the doctor depending on the age, condition of the patient, and concomitant diseases. The maximum daily amount in terms of the weight of the active substance is 150 mg, which corresponds to 6 tablets per day. Also, the dosage depends on the disease:

High blood pressure – 25-50 mg per day. The dose can be gradually increased starting from the 3rd week of admission.
Heart failure - therapy begins with a dosage of 6.25 to 12.5 mg with a gradual increase to a maximum amount of 150 mg.
For myocardial infarction, first take 6.25 mg, then after 2 hours increase to 12.5 mg and after another 12 hours - 25 mg. Starting from the next day, take 100 mg for a month, after which the decision to continue therapy should be made in consultation with the doctor.
In case of long-term treatment in the presence of established myocardial infarction, up to 75 mg per day is prescribed. Moreover, the initial dose is 6.25 mg with a gradual increase to 12.5 mg and 25 mg, then from 75 to 150 mg.
In the presence of diabetic nephropathy type I, use from 75 to 100 mg.

Elderly people should start taking the medicine with a minimum dose of 6.25 mg. Then the amount is gradually increased. Teenagers under 18 years of age can also start with this amount, but only in consultation with their doctor. Also, "Captopril" can be prescribed to newborns and infants based on the ratio of 0.15 mg of the substance per kilogram of body (also in agreement with the doctor).

Attention!

In all cases, the tablet is placed under the tongue 30-60 minutes before meals. May be taken during or after meals.

Captopril-AKOS

Before starting, as well as regularly during treatment with the drug, blood pressure and kidney function should be regularly monitored. In patients with chronic heart failure, captopril is used under close medical supervision.

Arterial hypotension

In patients with arterial hypertension, when using captopril, 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 in water and electrolyte balance (for example, after intensive treatment with diuretics), in patients with chronic heart failure or in 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 captopril 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

Renal dysfunction

Proteinuria may occur in patients with renal failure or when taking high doses of ACE inhibitors (including captopril). In most cases, proteinuria decreased or disappeared within 6 weeks, regardless of whether treatment with the drug 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 captopril, 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. 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 number of leukocytes is below 4.0 × 109/l, a general blood test is indicated; below 1.0 × 109/l, the drug is stopped. Such 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 the drug is stopped.

Anaphylactoid reactions

Patients taking captopril during desensitizing therapy with hymenoptera venom, etc., have an increased risk of developing anaphylactoid reactions. This can be avoided if you first temporarily stop taking the drug.

When performing hemodialysis in patients receiving captopril, the use of dialysis memoranda with high permeability (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 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, 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.

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 the drug.

Liver dysfunction

During therapy with ACE inhibitors, several cases of liver dysfunction with cholestatic jaundice, fulminant liver necrosis, sometimes fatal, have been reported.

If jaundice develops during captopril therapy 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

It is recommended to stop taking ACE inhibitors, including captopril, 12 hours before surgery, warning the surgeon-anesthesiologist about the use of ACE inhibitors.

The simultaneous use of ACE inhibitors with drugs containing aliskiren is contraindicated in patients with diabetes mellitus and/or with moderate or severe renal impairment (GFR less than 60 ml/min/1.73 m2 body surface area) and is 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.

Ethnic differences

ACE inhibitors, including captopril, have a less pronounced antihypertensive effect in black patients, 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.

Side effects

When taking Catopril, side effects may occur from different organ systems - nervous, circulatory, digestive and others. Main manifestations:

sleep disorders;
drowsiness;
pancytopenia;
problems with taste (reversible);
nausea, vomiting;
pain, heaviness in the abdomen;
diarrhea;
dizziness;
dyspnea;
feeling of dry mouth;
ulcer of the stomach walls;
constipation.

The following manifestations are much less common:

anorexia;

confusion;
depressive states;
headache;
heartbeat disturbance;
exacerbation of autoimmune diseases;
rhinitis;
bronchospasm;
eosinophilic pneumonia;
pancreatitis;
angioedema;
nephrotic syndrome;
impotence;
febrile conditions.

Attention!

In case of overdose, shock, stupor, bradycardia, and symptoms of renal failure may occur. In this case, urgent gastric lavage and administration of activated charcoal are indicated (30 minutes after the Captopril tablet). In case of emergency, you should seek emergency help.

special instructions

Taking the drug during pregnancy is excluded during the 2nd and 3rd trimester and is undesirable at the initial stage. Therefore, on the eve of planning or immediately after pregnancy is detected, you should switch to other medications in consultation with your doctor. During breastfeeding, the use of the product is completely excluded.

During therapy with Captopril, the ability to drive a car, as well as certain types of activities, may decrease. The onset of such effects depends on the dosage and individual characteristics of the body.