COMPOSITION AND PACKAGING:
Table. Contour. cell. y., № 20
- Hydrochlorothiazide 25 mg
- Other ingredients: Povidone low molecular medicine, lactose or lactose monohydrate, aerosil, potato starch, the magnesium stearate.
Pharmacodynamics. Kaptopres-Darnitsya - combined antihypertensive preparation comprising a combination of captopril and the dosage of hydrochlorothiazide.
Captopril - an ACE inhibitor. Inhibits the formation of angiotensin II, preventing its vasoconstrictor action and stimulating effect on the secretion of aldosterone in the adrenals. It reduces peripheral vascular resistance, blood pressure, reduces preload on the myocardium, reduces the pressure in the right atrium and the pulmonary circulation.
Hydrochlorothiazide causes moderately pronounced diuretic effect, increasing the excretion of sodium, chlorine, potassium and water. Reduces the content of sodium ions in the vessel wall, reducing its sensitivity to the effects of vasoconstrictor and thereby enhancing the antihypertensive effect of captopril.
Captopril. After oral administration of at least 75% of the drug is rapidly absorbed from the gastrointestinal tract. Cmax plasma levels achieved after 1 h after treatment.
Linking blood protein is 25-30%. It is metabolized in the liver. The major metabolites are captopril-cysteine, captopril disulfitny dimer. . T? ≈2-3 hours Over 95% captopril excreted by the kidneys, 50% - unchanged, the rest - in the form of metabolites.
Hydrochlorothiazide. If ingestion is absorbed in the gastrointestinal tract at 68-78%. T? ≈3-4 hours. Hydrochlorothiazide rapidly excreted by the kidneys in unchanged form (20-75%). In patients with renal insufficiency the excretion of the drug slows down.
Kaptopres-Darnitsya must be taken 1 hour before a meal, because when using the drug at meal times its absorption decreases.
Doses should be individualized according to the clinical picture of the disease.
The initial dose may leave ½ tablet (25 mg captopril and 12.5 mg hydrochlorothiazide) 1 time per day. Subsequently, if necessary maintenance dose can be increased to 1 tablet (50 mg captopril and 25 mg of hydrochlorothiazide) 1 time per day. The maximum therapeutic effect was observed in the 6-8 weeks of starting treatment. Korrigirovanie dose should be carried out with 6-week intervals if clinical manifestations do not require rapid changes in dosing. With insufficient decrease in blood pressure in the treatment regimen can further include captopril and hydrochlorothiazide as monotherapies. Thus, the daily dose of captopril should not exceed 150 mg, of hydrochlorothiazide - 50 mg.
Patients with impaired renal function
Since captopril and hydrochlorothiazide are excreted mainly by the kidneys, with impaired renal function, blood plasma preparations can be increased, so it is recommended dose reduction: the creatinine clearance of 30 to 80 ml / min, the initial dose is ½ tablet (25 mg captopril and 12.5 mg hydrochlorothiazide) 1 times a day (morning).
- Hypersensitivity to captopril, other ACE inhibitors, hydrochlorothiazide, other drugs, sulfonamide derivatives, or other components of the formulation;
- a history of angioedema during treatment with ACE inhibitors other;
- congenital angioneurotic edema;
- pronounced renal dysfunction (creatinine plasma concentration> 1.8 mg / 100 ml or creatinine clearance <30 mL / min);
- bilateral renal artery stenosis or stenosis of the artery only kidneys with progressive azotemia;
- condition after kidney transplantation;
- aortic stenosis and other obstructive disorders that hinder the outflow of blood from the left ventricle;
- primary hyperaldosteronism, hypokalemia, hyponatremia hypovolemia, hypercalcemia, gout;
- severe liver function abnormalities (prekomatosnoe condition, hepatic coma);
at temperatures up to 25 ° C.