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Capoten is an inhibitor of angiotensin-converting enzyme (ACE) inhibitors. It suppresses the formation of angiotensin II and eliminates its vasoconstrictor effects on the arterial and venous vessels. Decreases total peripheral vascular resistance, reduces afterload, reduces blood pressure. Reduced preload reduces the pressure in the right atrium and the pulmonary circulation. It reduces what is tren  the release of aldosterone in the adrenal glands.When administered captopril bioavailability is 60-70% Co-administration of food slows the absorption of the drug by 30-40%. Communication with the plasma proteins is 25-30%. The half-life of 2-3 hours of the drug is excreted from the body mainly by the kidneys, 50% unchanged.

Indications
– Arterial hypertension, including renovascular;
– chronic heart failure (in combination therapy);
– breach of left ventricular function after myocardial infarction in clinically stable condition;
– diabetic nephropathy and diabetes mellitus type 1 (albuminuria more than 30 mg / day).

Contraindications

Hypersensitivity to captopril or other ACE inhibitors; angioedema (in history against the background of ACE inhibitor therapy or hereditary); expressed human liver and / or kidney problems; hyperkalemia;bilateral renal artery stenosis, stenosis of the artery only kidneys with progressive azotemia, condition after kidney transplantation, aortic stenosis, and similar changes that impede the outflow of blood from the left ventricle, pregnancy, lactation, age 18 years (effectiveness and safety have been established).

Precautions: severe autoimmune connective tissue disease (including systemic lupus erythematosus, scleroderma), inhibition of bone marrow hematopoiesis (the risk of neutropenia and agranulocytosis), cerebral ischemia, diabetes (increased risk of hyperkalemia) patients on hemodialysis , diet sodium restriction, primary aldosteronism, coronary heart disease, conditions associated with decreased blood volume (including vomiting, diarrhea), advanced age (dose adjustments).

Dosing and Administration

Capoten is prescribed orally one hour before meals. Dosage is determined individually.

When hypertension drug is administered in an initial dose of 12.5 mg 2 times a day. If necessary, the dose is gradually (2-4 week intervals) is increased until the optimum effect. When mild to moderate hypertension usual maintenance dose is 25 mg 2 times a day; the maximum dose – 50 mg 2 times a day. In severe hypertension the initial dose is 12.5 mg 2 times a day. Dose gradually increased to the maximum daily dose of 150 mg (50 mg 3 times a day).

For the treatment of chronic heart failure Capoten prescribed in those cases where the application does not provide adequate diuretic effect. The initial daily dose is 6.25 mg three times a day. Further, if necessary, the dose is gradually (at intervals of not less than 2 weeks) increase. The average maintenance dose is 25 mg 2-3 times a day, and the maximum -150 mg.

When violations of left ventricular function after myocardial infarction in patients who are clinically stable condition, the use of the hood can start 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 2-3 mg 37,5-75 receive (depending on the tolerability) up to the maximum – 150 mg per day.

In diabetic nephropathy Capoten is administered in a dose of 75-100 mg, divided into 2-3 doses. In insulin-dependent diabetes with microalbuminuria (albumin excretion of 30-300 mg per day) dose of 50 mg 2 times a day. In general, protein clearance is more than 500 mg per day the drug is effective at a dose of 25 mg three times a day.

Patients with impaired function of the kidneys with moderate renal impairment (creatinine clearance (CC) is not less than 30 ml / min / 1.73 m²) hood can be administered at a dose of 75-100 mg / day. A more pronounced degree of renal dysfunction (creatinine clearance less than 30 mL / min / 1.73 m²), the initial dose should not exceed 12.5 mg / day; in the future, if necessary, with sufficiently long intervals Capote dose is gradually increased, but use a smaller than usual, the daily dose of the drug.

In old age is, the dose is adjusted individually, it is recommended to start treatment with a dose of 6.25 mg 2 times a day and as much as possible to keep it at this level.

If necessary, additional prescribed loop diuretics, thiazide diuretics but not number.

Side effect On the part of the cardiovascular system: orthostatic hypotension, tachycardia, peripheral edema, decreased blood pressure. The respiratory system: dry cough, usually passes after discontinuation of the drug, bronchospasm, pulmonary edema. Allergic reactions: angioedema extremity edema, face, lips, , mucous membranes, tongue, pharynx and larynx. On the part of the central nervous system: headache, dizziness, ataxia, paresthesia, drowsiness, visual disturbances. From the water-electrolyte metabolism: hyperkalemia, hyponatremia, proteinuria, elevated blood urea nitrogen and creatinine blood acidosis. From the side of hematopoiesis: neutropenia, agranulocytosis, thrombocytopenia, anemia, a positive test for antibodies to the nuclear antigen (rare). From the digestive system:taste disturbance, dry mouth, stomatitis, gingival hyperplasia, increased liver enzymes, abdominal pain, diarrhea, hepatitis, hyperbilirubinemia.

Overdose Symptoms: a sharp decrease in blood pressure. Treatment: isotonic sodium chloride solution or other plasma solutions, hemodialysis.

Interaction with other drugs

Diuretics and vasodilators (eg minoxidil) potentiate the hypotensive effect of the hood.

In a joint application with the hood indomethacin (and possibly with other nonsteroidal anti-inflammatory drugs) can be marked decrease in the hypotensive action.

Concomitant use of potassium-sparing diuretics (eg, triamterene, spironolactone, amiloride), potassium supplements, potassium supplements, salt substitutes (contain significant amounts of potassium), increases the risk of hyperkalemia.

With simultaneous use of lithium salts may increase the concentration of lithium in blood serum.

The use of the hood of the patients taking allopurinol or procainamide, increases the risk of neutropenia and / or Stevens-Johnson syndrome.

The use of the hood in patients taking immunosuppressants (eg, azathioprine or tsiklofosfatsin), increases the risk of haematological disorders.

special instructions

Before and during the treatment regularly Kapotenom should monitor renal function. In patients with chronic heart failure is used under close medical supervision.

Against the background of the prolonged use of the hood approximately 20% of patients experience an increase in urea and serum creatinine of more than 20%, compared with the normal or baseline what is tren value.Less than 5% of patients, especially in severe nephropathy, requires discontinuation of treatment due to the increase in creatinine concentration.

In patients with hypertension when using the hood marked hypotension observed only in rare cases; the likelihood of developing this condition increases with increased loss of fluid and salts (for example, after intensive treatment with diuretics), in patients with heart failure or on dialysis.

Possibility of a sharp decline in blood pressure can be reduced to a minimum when pre-cancellation (for 4-7 days) diuretic or increasing the sodium chloride intake (approximately one week prior to admission), or by assigning the hood at the beginning of treatment in small doses (6,25- 12.5 mg / day).

In the first 3 months of therapy monthly control the number of white blood cells, then – 1 every 3 months; patients with autoimmune diseases in the first 3 months – every 2 weeks, and then – once every two months. If the white blood cell count below 4000 cells / mm is shown holding a general analysis of blood, less than 1000 / mm – the drug is stopped.

In some cases, treatment with ACE inhibitors, including The hood, there is an increase of potassium concentration in the serum. The risk of hyperkalemia with ACE inhibitors increased in patients with renal insufficiency and diabetes, as well as taking potassium-sparing diuretics, potassium supplements or other. Drugs that cause an increase in the concentration of potassium in the blood (eg heparin). Avoid the simultaneous use of potassium-sparing diuretics and potassium preparations.

In hemodialysis patients receiving Capoten avoid using dialysis membranes with high permeability (e.g., AN69), because in such cases an increased risk of anaphylactoid reactions.

In the case of angioedema drug overturned and conduct a thorough medical supervision. If localized swelling of the face, usually no special treatment is required (antihistamines may be employed to reduce the severity of symptoms); in that case the swelling spreads tongue, pharynx and larynx, or there is a threat of airway obstruction, should immediately enter epinephrine (adrenaline) subcutaneously (0.5 ml of a 1: 1000 dilution).

Upon receipt of the hood may be a false positive reaction in the analysis of urine for acetone.

During the period of treatment should refrain from driving motor vehicles and activities potentially hazardous activities that require high concentration and speed of psychomotor reactions, because dizziness, especially after receiving the initial dose.

Be wary appoint patients who are on malosolevoy or salt-free diet (increased risk of hypotension) and hyperkalemia.

In the event of the hood after receiving symptomatic hypotension the patient should take a horizontal what is tren position with raised legs.

Product Form
The tablets of 25 or 50 mg.
In 10 or 14 tablets in blisters. 1, 2, 3 or 4 blisters with instruction on use are placed in a pile of cardboard.

Storage conditions
List B.
In dry, the reach of children, at a temperature no higher than 25 ° C.

Shelf life
5 years.
Do not use after the date printed on the packaging.