Is not accompanied by a reflex tachycardia and leads to a decrease in myocardial oxygen demand. In heart failure in an adequate dose has no effect on the blood pressure value. The maximum reduction in blood pressure after oral administration is observed in 60-90 minutes. . The duration of the hypotensive effect dose-dependent and achieves optimum values ??for several weeks
Temporary cancellation of parabolan steroid captopril should not happen abruptly, as this may cause a significant increase in blood pressure. Pharmacokinetics Absorption – fast, is about 75% of the dose. Food intake reduces the bioavailability of 30-40%. Bound to plasma proteins – 25-30%, mainly to albumin. Less than 0.002% of the dose of captopril is secreted in human milk, it does not penetrate the blood-brain barrier. It is metabolized in the liver with the formation of a disulfide dimer of captopril and captopril-tsisteinsulfida. The metabolites are pharmacologically inactive. The half-life of captopril is about 2-3 hours. About 95% of output by the kidneys during the first day, of which 40-50% in unmodified form and the rest – in the form of metabolites. After 4 hours after receiving a single urine contains about 38% of unchanged captopril and 28% in the form of metabolites through 6 watches – only as metabolites; in daily urine – 38% of unchanged captopril and 62% -. metabolites as a result of accumulation of captopril and its metabolites in the kidneys may occur a violation of their function. The half-life in renal failure – 3.5 – 32 hours. It accumulates in chronic renal failure. Therefore, in patients with impaired renal function, the dose should be reduced and / or increase the interval between doses doses.
• Hypersensitivity to captopril, other ingredients or other ACE inhibitors (including history);
• hereditary angioedema or idiopathic edema; angioedema (against the background of previous therapy with other ACE inhibitors in history);
• severe renal dysfunction, azotemia, hyperkalemia, bilateral renal artery stenosis or stenosis of a solitary kidney with progressive azotemia, condition after kidney transplantation, primary aldosteronism;
• the period of breast feeding;
• lactose intolerance, lactase deficiency or glucose-galactose malabsorption;
• concurrent use of ACE inhibitors (including captopril) and angiotensin II receptor antagonists with aliskiren and aliskirensoderzhaschimi drugs in patients with type 2 diabetes mellitus or renal impairment parabolan steroid
• up to age 18 years (effectiveness and safety have been established).
Hypertrophic obstructive cardiomyopathy, a disease of the connective tissue (especially systemic lupus erythematosus or scleroderma), inhibition of bone marrow blood (the risk of neutropenia and agranulocytosis), cerebrovascular disease, ischemic heart disease, diabetes (increased risk of hyperkalemia), a diet with restriction of salt, state accompanied by a decrease in circulating blood volume (including diarrhea, vomiting, patients on hemodialysis), mitral stenosis, aortic stenosis, and similar changes that impede the outflow of blood from the left ventricle of the heart, angioedema in history, abnormal liver function, chronic renal failure, bilateral renal artery stenosis or stenosis of the artery to a solitary kidney, patients blacks, surgery / general anesthesia, hemodialysis using vysokoprotochnyh membranes (eg, AN69 ®), desensitizing therapy, apheresis low-density lipoprotein (LDL), receiving potassium-sparing diuretics , potassium preparations, potassium-containing salt substitutes and lithium, renovascular hypertension, old age.
Application of pregnancy and during breastfeeding
The use of the drug during pregnancy is contraindicated.
The use of ACE inhibitors in pregnancy can lead to illness and death of the fetus and / or newborn. Long-term use of captopril in the second and third trimesters is toxic to the fetus (decreased renal function, oligohydramnios, delayed ossification of the skull bones) and newborns (neonatal renal failure, hypotension, hyperkalemia).
In addition, use of ACE inhibitors in the first trimester of pregnancy is associated with potentially an increased risk of congenital defects in the fetus.
If the pregnancy during the drug captopril Sandoz ® , use of the drug should be discontinued as soon as possible and regularly monitor the development of the fetus.
Women who are planning a pregnancy should not use ACE inhibitors (including captopril). Women of childbearing age should be aware of the potential dangers of the use of ACE inhibitors (including captopril).
Approximately 1% of applied dose of captopril is found in breast milk. Due to the risk of serious adverse reactions in children, should stop breastfeeding or cancel therapy drug Captopril Sandoz ® in the mother on breastfeeding.
If the patient received the drug during the II and III trimester of pregnancy, it is recommended to carry out ultrasound to assess the condition of the skull bones and fetal renal function.
If the use of an ACE inhibitor is considered essential, patients planning pregnancy should be transferred to alternative antihypertensive therapy, having established safety profile for use in pregnancy.
Dosing and Administration
Inside for 1 hour before meals. The dosage regimen administered individually. When hypertension treatment is initiated with the lowest effective dose of 12.5 mg 2 times a day. It should be noted the portability of the first dose within 1 hour. If the developed hypotension, the patient should be transferred to a horizontal position (this reaction to the first dose should not be an obstacle to further therapy). If necessary, gradually increase the dose (every 2-4 weeks) to achieve an optimal effect. If soft or moderate hypertension usual maintenance dose is 25 mg 2 times a day; the maximum dose can be increased to receive 50 mg 3 times a day. The maximum daily dose – 150 mg. In parabolan steroid elderly patients the initial dose is 6.25 mg 2 times a day. In chronic heart failure administered together with other diuretics and / or in combination with digitalis preparations (in order to avoid excessive initial reduction in blood pressure, diuretic cancel or reduce the dose of the drug before administration ). The starting dose is 6.25 mg or 12.5 mg 3 times a day if necessary increase dose. The average maintenance dose is 25 mg 2-3 times a day, while the maximum – 150 mg per day. In the case of symptomatic hypotension with heart failure the dose of diuretics and / or other simultaneously appointed vasodilators may be reduced in order to achieve a sustainable effect dose of captopril. In violation of the functions the left ventricle after myocardial infarction in patients who are clinically stable condition, the use of captopril can begin as early as 3 days after myocardial infarction. The starting dose is 6.25 mg per day, then the daily dose can be increased up to 37,5-75 mg up to a maximum of 2-3 hours (depending on tolerability.) – 150 mg per day Captopril may be administered in combination with other drugs for the treatment of myocardial infarction, such as thrombolytic agents, beta-blockers, and acetylsalicylic acid. Patients with type I diabetes mellitus complicated by nephropathy, the recommended daily dose of captopril is 75-100 mg in 2-3 doses. If necessary, further reduction of blood pressure Captopril may be administered in combination with other drugs. In patients with impaired renal function should be to adjust the dose of captopril: should reduce the dose or increase the reception intervals. If necessary, further prescribed loop diuretics, thiazide diuretics but not number.