Kapoten - a drug with hypotensive action, related to ACE inhibitors.
Release form and composition
Kapoten produced in the form of tablets (biconvex, square with rounded edges, with a characteristic odor, from white to white with a cream shade of color), 10, 14 or 15 pcs. in blister packs packed in cartons of 1, 2, 3 or 4 blisters in a pack) or 40 pcs. in polyethylene bottles.
The composition of 1 tablet contains 25 or 50 mg of the active substance - captopril.
Auxiliary components that make up the drug: stearic acid, microcrystalline cellulose, corn starch, lactose.
Indications for use
- Arterial hypertension, including renovascular;
- Impaired left ventricular function in a clinically stable state after myocardial infarction;
- Chronic heart failure (simultaneously with other drugs);
- Diabetic nephropathy with type 1 diabetes mellitus (albuminuria> 30 mg per day).
Contraindications to the use of Capoten are:
- Pronounced disorders of the kidneys and liver;
- Condition after kidney transplantation;
- Angioedema (associated with hereditary factors or with the use of ACE inhibitors in history);
- Stenosis of the artery of the only kidney with progressive azotemia or bilateral renal artery stenosis;
- Aortic stenosis and similar obstructive changes that impede the flow of blood from the left ventricle;
- Age up to 18 years (safety and efficacy of the drug for this age group have not been established);
- Pregnancy and breastfeeding period;
- Hypersensitivity to the components of the drug and other ACE inhibitors.
The drug is prescribed with caution in the following conditions / diseases:
- Inhibition of bone marrow hematopoiesis (due to the risk of agranulocytosis and neutropenia);
- Coronary heart disease;
- Severe autoimmune diseases of the connective tissue (including systemic lupus erythematosus, scleroderma);
- Cerebral ischemia;
- Primary hyperaldosteronism;
- Diabetes mellitus (due to an increased risk of developing hyperkalemia);
- Conditions involving a decrease in circulating blood volume (including vomiting, diarrhea).
Kapoten should be taken with caution in elderly patients (dose adjustment is necessary), as well as in patients on hemodialysis and following a sodium-restricted diet.
Dosing and Administration
Capoten should be ingested 1 hour before meals. The doctor sets the dosing regimen individually.
The initial single dose in the treatment of hypertension is 12.5 mg, the drug is taken 2 times a day. If necessary, the dose is gradually (with an interval of 2-4 weeks) increased to achieve the desired effect. In moderate and mild hypertension, the therapeutic dose is usually 25 mg 2 times a day, maximum 50 mg 2 times a day. In severe cases of Capoten's disease, take 12.5 mg 2 times a day. Gradually, the dose is increased to a maximum of 150 mg per day (50 mg 3 times a day).
The use of Capoten in chronic heart failure is indicated in cases where diuretics do not provide an adequate effect. The initial dose - 3 times a day at 6.25 mg. If necessary, the dose can be increased every 14 days. Maintenance dose - 2-3 times a day, 25 mg, maximum - 150 mg per day.
In cases of dysfunction of the left ventricle after myocardial infarction in patients in a clinically stable condition, Capoten can be started 3 days after myocardial infarction. The initial daily dose is 6.25 mg, after which, depending on the tolerance of the drug, it can be increased to 37.5-75 mg taken in 2-3 doses. The maximum daily dose is 150 mg.
The daily dose for diabetic nephropathy is 75-100 mg, divided into 2-3 doses. When insulin-dependent diabetes mellitus with microalbuminuria (albumin clearance 30-300 mg per day) Capoten take 50 mg 2 times a day, with total protein clearance more than 500 mg per day - 25 mg 3 times a day.
Patients with impaired renal function moderate or mild (CK ≥ 30 ml / min / 1.73 m2) are prescribed the drug in a daily dose of 75-100 mg, with severe impairments (CK <30 ml / min / 1.73 m2) - not more than 12.5 mg 2 times a day. If necessary in the future, with sufficiently large intervals, the dose is gradually increased, but not more than the usual daily dose.
Elderly patients are treated individually. Therapy is recommended to start with a minimum therapeutic dose of 6.25 mg 2 times a day. Its further increase is not recommended.
If necessary, additional appointment of loopback diuretics is possible, and not of the thiazide diuretics.
When using Capoten possible development of violations:
- Respiratory system: bronchospasm, dry cough (usually disappears after drug withdrawal), pulmonary edema;
- Central and peripheral nervous system: ataxia, dizziness, headache, drowsiness, paresthesia, visual disturbances;
- Cardiovascular system: tachycardia, orthostatic hypotension, lowering blood pressure, peripheral edema;
- Digestive system: dry mouth, a violation of taste, gingival hyperplasia, stomatitis, hyperbilirubinemia, abdominal pain, hepatitis, diarrhea, increased levels of hepatic transaminases in the blood plasma;
- Hematopoietic system: agranulocytosis, neutropenia, anemia, thrombocytopenia; rarely, a positive antibody test for a nuclear antigen;
- Urinary system: an increase in the content of creatinine and urea nitrogen in the blood plasma, acidosis, proteinuria;
- Water and electrolyte balance: hyponatremia, hyperkalemia;
- Allergic reactions: angioedema of the extremities, face, lips, mucous membranes, tongue, pharynx or larynx.
Before starting treatment, and regularly in its process, it is necessary to monitor renal function. In patients with chronic heart failure, the drug can be taken only under close medical supervision.
With prolonged use of Capoten quite often there is a significant increase in serum creatinine and urea. In some patients, especially with severe nephropathy, this is the reason for discontinuing therapy.
The probability of the development of severe arterial hypotension increases with increased loss of salts and fluids in patients on dialysis and in patients with heart failure.
The possibility of a sharp decrease in blood pressure can be significantly reduced when the drug is used at the beginning of treatment in small doses (6.25-12.5 mg per day), the diuretic is withdrawn 4-7 days, or an increase in about a week before the start of Capoten sodium intake .
The number of blood leukocytes in the first 3 months of therapy should be monitored monthly, in the future - 1 time in 3 months. In autoimmune diseases, the number of leukocytes in the first 3 months of taking Capoten should be monitored every 14 days, then 1 time in 2 months. If the number of leukocytes is less than 1000 / μl, treatment is stopped.
A false-positive reaction may be observed during urine-to-acetone therapy.
Sometimes when using Capoten and other ACE inhibitors, an increase in serum potassium is observed. Patients with diabetes mellitus and renal insufficiency, as well as patients taking potassium preparations, potassium-saving diuretics, and other drugs causing an increase in the concentration of potassium in the blood are most at risk of developing hyperkalemia. In this regard, such combinations are recommended to be avoided.
In the event of angioedema, Kapoten is canceled and thorough medical observation is carried out. When localization of edema on the face special treatment is usually not required (to reduce the severity of symptoms may use antihistamines). If the edema spreads to the pharynx, tongue or larynx, and there is a threat of development of airway obstruction, you must immediately enter a 0.1% solution of epinephrine (adrenaline) in a volume of 0.5 ml.
If, after taking Capoten, symptomatic hypotension occurs, the patient needs to take a horizontal position with the legs elevated.
During the period of therapy, it is recommended to refrain from driving vehicles and performing potentially hazardous types of work that require psychomotor speed and increased concentration of attention, which is associated with the likelihood of dizziness, especially after taking the initial dose.
The antihypertensive effect of Capoten potentiate vasodilators (minoxidil) and diuretics.
Simultaneous use with lithium salts can lead to an increase in the serum concentration of lithium.
With the simultaneous use of Capoten with procainamide and allopurinol may develop Stevens-Johnson syndrome and / or neutropenia, with immunosuppressants - the risk of hematological disorders increases.
The antihypertensive effect of the drug reduces indomethacin and other nonsteroidal anti-inflammatory drugs.
The simultaneous use of potassium-sparing diuretics, potassium supplements, potassium supplements and salt substitutes with Capoten may increase the risk of hyperkalemia.
Terms and conditions of storage
Store in a dry place out of reach of children at a temperature up to 25 ° C.
The shelf life of the drug is 5 years.