Captopril is an ACE inhibitor that has an antihypertensive effect.
Release form and composition
Captopril dosage form - tablets (10 each in a blister, 1, 2, 3, 4, 5 or 10 packages in a carton box; in plastic cans of 20, 30 or 40 pcs., 1 can in a carton box ).
The active ingredient of the drug is captopril, in 1 tablet it may contain 12.5, 25 or 50 mg.
Excipients: talc, corn starch, lactose and magnesium stearate.
Indications for use
- Arterial hypertension (including renovascular);
- Chronic heart failure (as part of combination therapy);
- Impaired left ventricular function after myocardial infarction, provided the patient is clinically stable;
- Diabetic nephropathy due to type 1 diabetes mellitus (with albuminuria more than 30 mg per day).
- Mitral stenosis, aortic stenosis and other pathologies that prevent the outflow of blood from the left ventricle of the heart;
- Angioedema (including hereditary) in history, including developed after the use of other ACE inhibitors;
- Severe abnormal liver function;
- Severe renal dysfunction, hyperkalemia, azotemia, bilateral renal artery stenosis or stenosis of a single kidney with progressive azotemia, primary hyper aldosteronism, condition after kidney transplantation;
- Cardiogenic shock;
- Age up to 18 years (due to lack of data on the safety and efficacy of use in this age group of patients);
- Hypersensitivity to captopril, any auxiliary component of the drug or other ACE inhibitors.
Elderly people who are on hemodialysis, people who are on a sodium-restricted diet, as well as patients diagnosed with severe autoimmune diseases (including systemic lupus erythematosus and scleroderma), cerebral ischemia, and ischemic disease should be under constant observation during the treatment period. heart, diabetes, inhibition of bone marrow circulation and conditions, accompanied by a decrease in the BCC (including diarrhea and / or vomiting).
Dosing and Administration
Captopril should be taken orally one hour before meals.
Treatment of arterial hypertension (AH) begins with a dose of 25 mg 2 times a day. If the therapeutic effect is not enough, it is gradually (at intervals of 2-4 weeks) increased. The maximum permissible daily dose for severe hypertension is 150 mg (50 mg 3 times a day).
In chronic heart failure, captopril is prescribed in cases where previous use of diuretics could not provide the desired effect. Treatment begins with a dose of 6.25 mg 2-3 times a day. In the future, it gradually (with minimal intervals of 2 weeks) is increased to 25 mg 2-3 times a day. If, in this case, the therapeutic effect is not enough, a further gradual increase to the maximum permissible daily dose of 150 mg (50 mg 3 times a day) is possible.
In patients with a moderate degree of renal dysfunction (with a CC of at least 30 ml / minute / 1.73 m 2 ), the drug can be used in a daily dose of 75-100 mg. With more pronounced impaired renal function, Captopril should be started with a dose of 12.5-25 mg / day. If necessary, further increase in dose is possible, but with rather long intervals. At the same time, the maximum dose should be less than the usual daily dose for patients without functional renal impairment.
The dose of Captopril for the elderly is selected individually. Treatment begins with 6.25 mg 2 times a day and, if possible, try to maintain it at this level.
- Cardiovascular system: marked reduction in blood pressure (BP), peripheral edema, orthostatic hypotension, tachycardia;
- The urinary system: proteinuria, renal function disorders (increased creatinine and urea in the blood);
- Central nervous system: paresthesia, ataxia, drowsiness, headache, blurred vision, asthenia dizziness, feeling tired;
- The digestive system: dry mouth, decreased appetite, stomatitis, a violation of taste, nausea; rarely - abdominal pain, diarrhea, hyperbilirubinemia, increased activity of hepatic transaminases, hepatitis;
- Respiratory system: dry cough (in most cases passes after cancellation of Captopril) bronchospasm, pulmonary edema;
- Blood system: rarely - anemia, agranulocytosis, neutropenia, thrombocytopenia;
- Dermatological reactions: increased photosensitivity, itching, rash (usually maculopapular, rarely bullous and vesicular);
- Allergic and immunopathological reactions: lymphadenopathy, serum sickness, angioedema of the extremities, face, tongue, mucous membranes, lips, pharynx and / or larynx; rarely, intestinal edema, the appearance of anti-nuclear antibodies in the blood;
- Laboratory indicators: hyponatremia, hyperkalemia, acidosis. There are isolated cases of hypoglycemia in diabetic patients who received oral hypoglycemic drugs and insulin;
- Other: paresthesias.
Symptoms of a captopril overdose: marked reduction in blood pressure, up to collapse, acute cerebral circulation disorder, myocardial infarction, thromboembolic complications. In the event that the patient has taken too high a dose of the drug, it should be laid in a horizontal position and slightly raise the lower limbs. Symptomatic overdose treatment. Appointed events aimed at restoring blood pressure. If necessary, conduct hemodialysis. Peritoneal dialysis is ineffective.
Before the appointment of the drug, it is necessary to conduct a survey of renal function and then monitor its entire period of treatment.
With extreme caution, captopril is prescribed to patients receiving immunosuppressants, procainamide or allopurinol, especially if they have impaired renal function, as well as in patients with systemic vasculitis and diffuse connective tissue diseases. Before the start of treatment, every 2 weeks during the first 3 months and periodically the entire subsequent period of therapy, it is necessary to monitor the picture of peripheral blood.
If the effect of using one captopril is insufficient, loop diuretics can be additionally prescribed, but not only thiazide!
With caution, the drug should be used in patients with a history of which there are indications of kidney disease, since they have a high risk of developing proteinuria. They are the first 9 months of treatment every month, you need to control the concentration of protein in the urine. If the level exceeds 1 g / day, the doctor must decide whether further use of Captopril is advisable.
The likelihood of arterial hypotension may be reduced if diuretics are canceled or their dose is significantly reduced 4–7 days before the start of captopril.
After taking the drug may develop symptomatic hypotension. In this case, you should take a horizontal position with raised legs.
In the case of an increase in the level of creatinine or urea in the blood of patients with renal artery stenosis, reduce the dose of the drug, and in some cases cancel it altogether.
When administering hemodialysis to patients receiving Captopril, high-permeability dialysis membranes should not be used, since increases the risk of anaphylactoid reactions.
With the development of angioedema, captopril is canceled and a thorough medical examination is carried out. If swelling of the face is observed, special treatment is usually not required, antihistamines can be prescribed to reduce the symptoms. If the edema extends to the larynx, pharynx and tongue, or there is a threat of airway obstruction, an immediate subcutaneous administration of epinephrine is indicated.
Captopril can cause a false positive urine test for acetone.
During treatment with this drug, you must refrain from engaging in potentially hazardous activities, including driving a car.
Captopril is contraindicated during pregnancy. It should be borne in mind that when taken in the second and third trimesters, the drug can cause serious developmental disorders and even death of the fetus.
In the event that the pregnancy is confirmed during treatment, the drug should be immediately canceled.
The hypotensive effect of captopril is enhanced by vasodilators and diuretics, pergolid, minoxidil, nitroprusside, reduced - estrogens, erythropoietins, indomethacin and, presumably, other nonsteroidal anti-inflammatory drugs.
The antihypertensive effect of the drug may slow clonidine.
When applied simultaneously with lithium salts, Captopril may increase the concentration of lithium in the blood serum.
When combined with potassium preparations, potassium-sparing diuretics, salt substitutes and dietary supplements containing potassium, trimethoprim, there is a risk of hyperkalemia (especially in patients with impaired renal function); with insulin and oral hypoglycemic agents - hypoglycemia; with allopurinol and procainamide - Stevens-Johnson syndrome and / or neutropenia; with immunosuppressants and cytostatics - hematological disorders; with interleukin-3 - arterial hypotension; with anesthetic means - severe hypotension; with procainamide - leukopenia; with chlorpromazine - orthostatic hypotension; with azathioprine - anemia; with interferon alpha-2a or interferon beta - severe granulocytopenia.
When taking captopril, a false-positive reaction of the urine to acetone may be observed.
There are reports of the development of a symptom complex, including nausea, vomiting, facial flushing, and a decrease in blood pressure, in patients who were taking gold medications at the same time as Captopril (sodium aurothiomalate).
Renal clearance of captopril is reduced with the use of probenecid.
Orlistat can significantly reduce the effectiveness of the drug, which can lead to an increase in blood pressure and hypertensive crisis. A known case of hemorrhage in the brain.
Captopril can increase the concentration of digoxin in the blood plasma, especially high risk in patients with impaired renal function.
The bioavailability of captopril reduces magnesium carbonate, magnesium hydroxide and aluminum hydroxide.
Terms and conditions of storage
To store at a temperature up to 30 ºС in the place, dry, unavailable to children.
Shelf life - 3 years.