Composition, form of production and packaging
The tablets covered with a film cover of yellow color, round, biconcave, with a risk; the core is white or almost white in cross section.
1 tab.
quinapril hydrochloride 5.416 mg,
which corresponds to the content of quinapril 5 mg
Auxiliary substances: lactose monohydrate (sugar milk) - 28.784 mg, magnesium hydroxycarbonate pentahydrate (magnesium carbonate basic water) - 75 mg, croscarmellose sodium (impellose) - 3 mg, povidone (polyvinylpyrrolidone medium molecular weight) - 6 mg, silicon dioxide colloid (aerosil) - 0.6 mg, magnesium stearate - 1.2 mg.
The composition of the shell: Opadrai II (polyvinyl alcohol, partially hydrolyzed - 1.6 mg, talc - 0.592 mg, titanium dioxide (E171) - 0.8748 mg, macrogol (polyethylene glycol 3350) - 0.808 mg, aluminum lacquer based on dye quinoline yellow - 0.1204 mg, aluminum varnish based on the dye sunset yellow - 0.0028 mg, iron oxide dye (II) yellow - 0.0012 mg, aluminum lacquer based on indigo carmine dye - 0.0008 mg).
10 pieces. - packings cellular planimetric (3) - packs cardboard.
10 pieces. - packings cellular planimetric (6) - packs cardboard.
30 pcs. - packings of cellular contour (1) - packs cardboard.
30 pcs. - packings cellular planimetric (2) - packs cardboard.
30 pcs. - polymer cans (1) - packs of cardboard.
30 pcs. - vials polymeric (1) - packs cardboard.
The tablets covered with a film cover of yellow color, round, biconcave; the core is white or almost white in cross section.
1 tab.
quinapril hydrochloride 10.832 mg,
which corresponds to the content of quinapril 10 mg
Auxiliary substances: lactose monohydrate (sugar milk) - 46.168 mg, magnesium hydroxycarbonate pentahydrate (magnesium carbonate basic water) - 125 mg, croscarmellose sodium (impellose) - 5 mg, povidone (polyvinylpyrrolidone medium molecular weight) - 10 mg, silicon dioxide colloid (aerosil) - 1 mg, magnesium stearate - 2 mg.
The composition of the shell: Opadrai II (alcohol polyvinyl, partially hydrolysed - 2.4 mg, talc 0.888 mg, titanium dioxide (E171) 1.3122 mg, macrogol (polyethylene glycol 3350) 1.212 mg, aluminum varnish based on dye quinoline yellow 0.1806 mg, aluminum varnish based on the dye sunset yellow - 0.0042 mg, iron oxide oxide yellow - 0.0018 mg, aluminum lacquer based on indigo carmine dye - 0.0012 mg).
10 pieces. - packings cellular planimetric (3) - packs cardboard.
10 pieces. - packings cellular planimetric (6) - packs cardboard.
30 pcs. - packings of cellular contour (1) - packs cardboard.
30 pcs. - packings cellular planimetric (2) - packs cardboard.
30 pcs. - polymer cans (1) - packs of cardboard.
30 pcs. - vials polymeric (1) - packs cardboard.
The tablets covered with a film cover of yellow color, round, biconcave; the core is white or almost white in cross section.
1 tab.
quinapril hydrochloride 21.664 mg,
which corresponds to the content of quinapril 20 mg
Auxiliary substances: lactose monohydrate (sugar milk) - 48.736 mg, magnesium hydroxycarbonate pentahydrate (magnesium carbonate basic water) - 157 mg, croscarmellose sodium (impellose) - 6.3 mg, povidone (polyvinylpyrrolidone medium molecular weight) - 12.5 mg, silicon colloidal dioxide (aerosil) - 1.3 mg, magnesium stearate - 2.5 mg.
The composition of the shell: Opadrai II (alcohol polyvinyl, partially hydrolysed - 3.2 mg, talc - 1.184 mg, titanium dioxide (E171) - 1.7496 mg, macrogol (polyethylene glycol 3350) - 1.616 mg, aluminum varnish based on dye quinoline yellow - 0.2408 mg, aluminum varnish based on the dye sunset yellow - 0.0056 mg, iron oxide dye (II) yellow - 0.0024 mg, aluminum dye based on indigo carmine dye - 0.0016 mg).
10 pieces. - packings cellular planimetric (3) - packs cardboard.
10 pieces. - packings cellular planimetric (6) - packs cardboard.
30 pcs. - packings of cellular contour (1) - packs cardboard.
30 pcs. - packings cellular planimetric (2) - packs cardboard.
30 pcs. - polymer cans (1) - packs of cardboard.
30 pcs. - vials polymeric (1) - packs cardboard.
The tablets covered with a film cover of yellow color, round, biconcave; the core is white or almost white in cross section.
1 tab.
quinapril hydrochloride 43.328 mg,
which corresponds to the content of quinapril 40 mg
Auxiliary substances: lactose monohydrate (milk sugar) - 70.672 mg, magnesium hydroxycarbonate pentahydrate (magnesium carbonate basic water) - 250 mg, croscarmellose sodium (impellose) - 10 mg, povidone (polyvinylpyrrolidone medium molecular weight) - 20 mg, silicon dioxide colloid (aerosil) - 2 mg, magnesium stearate - 4 mg.
The composition of the shell: Opadrai II (polyvinyl alcohol, partially hydrolyzed - 4.8 mg, talc - 1.776 mg, titanium dioxide (E171) - 2.6244 mg, macrogol (polyethylene glycol 3350) - 2.424 mg, aluminum varnish based on dye quinoline yellow - 0.3612 mg, aluminum lacquer based on the dye sunset yellow - 0.0084 mg, iron oxide dye (II) yellow - 0.0036 mg, aluminum lacquer based on indigo carmine dye - 0.0024 mg).
10 pieces. - packings cellular planimetric (3) - packs cardboard.
10 pieces. - packings cellular planimetric (6) - packs cardboard.
30 pcs. - packings of cellular contour (1) - packs cardboard.
30 pcs. - packings cellular planimetric (2) - packs cardboard.
30 pcs. - polymer cans (1) - packs of cardboard.
30 pcs. - vials polymeric (1) - packs cardboard.
INSTRUCTION FOR THE SPECIALIST.
Description of the drug approved by the manufacturer for the printed edition of 2016.
PHARMACHOLOGIC EFFECT
ACE is an enzyme that catalyzes the conversion of angiotensin I into angiotensin II, which has a vasoconstrictive effect and increases the tone of the vessels, incl. by stimulating the secretion of aldosterone with the adrenal cortex. Hinapril competitively inhibits ACE and causes a decrease in vasopressor activity and aldosterone secretion.
Elimination of the negative effect of angiotensin II on renin secretion by the feedback mechanism leads to an increase in renin plasma activity. In this case, a decrease in blood pressure is accompanied by a decrease in OPSS and resistance of renal vessels, while changes in heart rate, cardiac output, renal blood flow, glomerular filtration rate and filtration fraction are insignificant or absent.
Hinapril increases exercise tolerance. With prolonged use contributes to the reverse development of myocardial hypertrophy in patients with arterial hypertension;improves the blood supply of the ischemic myocardium. Strengthens coronary and renal blood flow. Reduces the aggregation of platelets.
The onset of action after taking a single dose - after 1 hour, maximum - after 2-4 hours, the duration of action depends on the amount of the dose taken (up to 24 hours).
Clinically pronounced effect develops a few weeks after the initiation of therapy.
PHARMACOKINETICS
Suction
The concentration of quinapril in the blood plasma after ingestion reaches a maximum for 1 hour, quinaprilat - 2 hours. Food intake does not affect the degree of absorption, but can increase the time to reach the maximum concentration (T max ) (fatty foods can reduce the speed and degree of absorption of quinapril) . Given the excretion of quinapril and its metabolites by the kidneys, the degree of absorption is approximately 60%.
Distribution
Approximately 97% of quinapril and quinaprilate circulate in blood plasma in protein-related form. Hinapril and its metabolites do not penetrate the BBB.
Metabolism
Under the influence of hepatic enzymes, quinapril is rapidly metabolized to quinaprilate by cleavage of the ester group (the main metabolite is dibasic acid of quinapril), which is an ACE inhibitor. About 38% of the ingested dose of quinapril circulates in the blood plasma in the form of quinaprilate.
Excretion
T 1/2 of quinapril from the blood plasma is about 1-2 hours, quinaprilat - 3 hours. It is excreted by the kidneys - 61% (56% in the form of quinapril and quinaprylate) and through the intestine - 37%.
Pharmacokinetics in specific patient groups
In patients with renal insufficiency, T 1/2 of quinaprilate increases with decreasing CC.
The excretion of quinaprilat is also reduced in elderly patients (over 65 years) and closely correlates with impaired renal function, however, in general, there is no difference in the efficacy and safety of treatment in elderly and younger patients.
In patients with alcoholic cirrhosis of the liver, the concentration of quinaprilat decreases due to a violation of the de-esterification of quinapril.
INDICATIONS
- arterial hypertension (as a monotherapy or in combination with thiazide diuretics and beta-blockers);
- chronic heart failure (as part of combination therapy).
DOSING MODE
Take inside, without chewing, regardless of the time of eating, squeezed with water.
Arterial hypertension
With monotherapy, the recommended initial dose of the drug Hinapril-SZ in patients not receiving diuretics is 10 mg 1 time / day. Depending on the clinical effect, the dose can be increased (doubling) to a maintenance dose of 20 or 40 mg / day, which is usually prescribed in 1 or 2 doses. As a rule, the dose should be changed at intervals of 4 weeks. In most patients, the use of the drug Hinapril-SZ 1 time / day can achieve a persistent therapeutic response. The maximum daily dose is 80 mg / day.
With simultaneous use with diuretics, the recommended initial dose of the drug Hinapril-SZ in patients who continue taking diuretics is 5 mg 1 time / day; in the subsequent it is increased (as indicated above) until the optimal therapeutic effect is achieved.
Chronic heart failure
The recommended initial dose of Hinapril-SZ is 5 mg 1-2 times / day.
After taking the drug, the patient must be under medical supervision to detect symptomatic arterial hypotension. In case of good tolerability of the initial dose of the drug Hinapril-SZ, it can be increased to 10-40 mg / day by dividing into 2 doses.
Given the clinical and pharmacokinetic data in patients with impaired renal function, the initial dose should be selected as follows:
KK (ml / min) Recommended initial dose (mg)
more than 60 10
30-60 5
10-30 2.5 mg (1/2 tablets 5 mg)
If tolerability of the initial dose is good, then the drug Hinapril-SZ can be applied 2 times / day. The dose of the drug Hinapril-SZ can be gradually, not more often than once a week, increase, taking into account clinical, hemodynamic effects, as well as kidney function.
The recommended initial dose of the drug is Hinapril-SZ in elderly patients is 10 mg 1 time / day; in the subsequent it is increased until the optimal therapeutic effect is achieved.
SIDE EFFECT
Undesirable phenomena with the use of quinapril are usually mild and transitory. The most common symptoms are headache (7.2%), dizziness (5.5%), cough (3.9%), fatigue (3.5%), rhinitis (3.2%), nausea and / or vomiting (2.8%) and myalgia (2.2%) . It should be noted that in a typical case, cough is unproductive, persistent and occurs after discontinuation of treatment.
The incidence of withdrawal of quinapril as a result of side effects was observed in 5.3% of cases.
Below is a list of unwanted reactions, distributed according to organ systems and frequency of occurrence (classification of the World Health Organization): very often (more than 1/10); often (from more than 1/100 to less than 1/10); infrequently (from more than 1/1000 to less than 1/100); rarely (from more than 1/10 000 to less than 1/1000); very rarely (from less than 1/10 000, including individual messages).
From the nervous system: often - headache, dizziness, insomnia, paresthesia, increased fatigue; infrequently - depression, increased excitability, drowsiness, vertigo.
From the side of the organ of vision: infrequently - impaired vision.
From the side of the digestive tract: often - nausea and / or vomiting, diarrhea, dyspepsia, abdominal pain; infrequent - dryness of the mucous membrane of the mouth or throat, flatulence, pancreatitis *, angioedema, intestinal edema, gastrointestinal bleeding; rarely - hepatitis.
From the hemopoietic system: infrequently - hemolytic anemia *, thrombocytopenia *.
From the cardiovascular system: often - a pronounced decrease in blood pressure; infrequently - angina, palpitations, tachycardia, heart failure, myocardial infarction, stroke, increased blood pressure, cardiogenic shock, postural hypotension *, fainting *, symptoms of vasodilation.
From the respiratory system: often - cough, dyspnoea, pharyngitis, chest pain.
From the skin and subcutaneous tissues: infrequently - alopecia *, exfoliative dermatitis *, increased sweating, pemphigus *, photosensitivity reactions *, skin itch, rash.
From the musculoskeletal system: often - pain in the back; infrequently - arthralgia.
From the urinary system: infrequently - urinary tract infections, acute renal failure.
From the genitals and the breast: infrequently - a decrease in potency.
From the immune system: infrequently - anaphylactic reactions *, rarely - angioedema.
General disorders and disorders at the injection site: infrequently - edema (peripheral or generalized), malaise, viral infections.
Other: rarely - eosinophilic pneumonitis.
Laboratory indicators: very rarely noted agranulocytosis and neutropenia, although the cause-and-effect relationship with the use of hinapril has not yet been established.
Hyperkalemia: (see "Special instructions").
Creatinine and blood urea nitrogen: an increase (more than 1.25 times in comparison with IGN) of serum creatinine and blood urea nitrogen was observed in 2% and 2% of patients receiving quinapril monotherapy, respectively. The likelihood of an increase in these parameters in patients receiving diuretics simultaneously is higher than when one quinapril is used. With further therapy, the indicators often return to normal.
* - less frequent adverse events or those noted during post-marketing research.
With the simultaneous use of ACE inhibitors and gold preparations (sodium aurotomyulat, iv), a symptom complex is described, including facial flushing, nausea, vomiting and a decrease in blood pressure.
CONTRAINDICATIONS
- angioedema in history as a result of previous therapy with ACE inhibitors;
- hereditary and / or idiopathic angioedema;
- Pregnancy;
- the period of breastfeeding;
- age up to 18 years;
- Lactase deficiency, lactose intolerance and glucose-galactose malabsorption syndrome;
- simultaneous use with aliskiren and aliskirenoderzhaschimi means or with antagonists of the receptors of angiotensin II (ARA II) or with other preparations that inhibit RAAS (double blockade of RAAS):
- in patients with diabetes mellitus or in patients with diabetes mellitus with damage to target organs (diabetic nephropathy);
- in patients with impaired renal function (GFR less than 60 ml / min / 1.73 m 2 );
- in patients with hyperkalemia (more than 5 mmol / l);
- in patients with chronic heart failure and arterial hypotension;
- Hypersensitivity to any component of the drug.
Carefully:
- symptomatic arterial hypotension in patients who had previously taken diuretics and followed a diet with restricted intake of table salt;
- severe heart failure in patients with a high risk of hypotension;
- severe chronic heart failure;
- conditions accompanied by a decrease in BCC (including vomiting and diarrhea);
- Hyperkalemia;
- oppression of bone marrow hematopoiesis;
- aortic stenosis, hypertrophic obstructive cardiomyopathy, mitral stenosis;
- Insufficiency of cerebral circulation, IHD, coronary insufficiency - a sharp decrease in blood pressure on the background of therapy with ACE inhibitors, can worsen the course of these diseases;
- bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney, condition after kidney transplantation;
- impaired renal function;
- in patients on hemodialysis (CC less than 10 ml / min) (data on the use of quinapril in such patients is not enough);
- autoimmune systemic diseases of connective tissue (including systemic lupus erythematosus, scleroderma);
- violations of the liver (especially with simultaneous use with diuretics);
- with simultaneous application with potassium-sparing diuretics;
- diabetes;
- extensive surgical interventions and general anesthesia;
- simultaneous administration of other antihypertensive agents, as well as inhibitors of mTOR and DPP-4 enzymes.
PREGNANCY AND LACTATION
The use of the drug Hinapril-SZ is contraindicated in pregnancy, in women planning pregnancy, as well as in women of reproductive age who do not use reliable methods of contraception.
Women of reproductive age who take Hinapril-SZ should use reliable methods of contraception.
When diagnosing pregnancy, Hinapril-SZ should be discontinued as early as possible.
The use of ACE inhibitors in pregnancy is accompanied by an increased risk of anomalies from the cardiovascular and nervous systems of the fetus. In addition, against the background of taking ACE inhibitors in pregnancy, cases of low blood pressure, premature birth, birth of children with arterial hypotension, renal pathology (including acute kidney failure), hypoplasia of the skull bones, limb contractures, craniofacial deformities, lung hypoplasia, intrauterine retention development, an open arterial duct, as well as cases of intrauterine fetal death and death of a newborn. Often, anhydration is diagnosed after the fetus has been irreversibly damaged.
Newborns who have been exposed to ACE inhibitors in utero should be monitored for the purpose of identifying arterial hypotension, oliguria, and hyperkalemia.When oliguria occurs, blood pressure and renal perfusion should be maintained.
The drug Hinapril-SZ should not be given during breast-feeding, because ACE inhibitors, including quinapril, are limited to breast milk. Given the possibility of developing serious adverse events in a newborn, Hinapril-SZ should be canceled during lactation or to stop breastfeeding.
APPLICATION FOR FUNCTIONS OF THE LIVER
Given the clinical and pharmacokinetic data in patients with impaired renal function, the initial dose should be selected according to the formula (see section "Dosing regimen").
With caution should prescribe the drug for violations of kidney function and in patients on hemodialysis (QC less than 10 ml / min) (data on the use of quinapril in these patients is not enough).
APPLICATION FOR VIOLATIONS OF THE FUNCTION OF KIDNEYS
Take with caution in case of impaired liver function.
APPLICATION FOR CHILDREN
Contraindicated in children and adolescents under 18 years.
APPLICATION IN ELDERLY PATIENTS
The recommended initial dose of the drug Hinapril-SZ in elderly patients is 10 mg 1 time / day; in the subsequent it is increased until the optimal therapeutic effect is achieved.
SPECIAL INSTRUCTIONS
In the treatment of ACE inhibitors, cases of angioedema in the head and neck, including 0.1% of patients receiving quinapril, have been described. When a laryngeal whistle or angioedema, face, tongue, or vocal cords, quinapril should be immediately withdrawn. The patient should be given adequate treatment and observed before the regression of the symptoms of edema. To reduce the symptoms can be used antihistamines. Angioedema with involvement of the larynx can lead to death. If the swelling of the tongue, laryngeal or vocal cord threatening development of airway obstruction, an urgent need adequate therapy, comprising n / k administering epinephrine solution (epinephrine) 1: 1000 (0.3-0.5 ml).
In the treatment of bowel angioneurotic edema cases also describes ACE inhibitors. Patients report pain in the abdomen (with / without nausea or vomiting); in some cases, no prior facial angioedema and normal activity of C1-esterase. The diagnosis was made by CT abdomen, ultrasound, or at the time of surgery. Symptoms disappeared after discontinuation of ACE inhibitors. Therefore, in patients with pain in the abdomen, taking ACE inhibitors in the differential diagnosis should consider the possibility of angioneurotic edema of the intestine.
Patients who have a history of observed angioedema unrelated to ACE inhibitors, the risk of its development can be promoted in the treatment of this group of drugs.
Patients receiving ACE inhibitors during desensitizing treatment of Hymenoptera venom may develop anaphylactoid reactions, life-threatening. By suspending the use of ACE inhibitors of these reactions were avoided, but they appeared again at random reception of these drugs.
Anaphylactoid reactions may also occur with use of ACE inhibitors in patients undergoing apheresis LDL absorption by using dextran sulfate or patients on hemodialysis vysokoprotochnyh using membranes, such as polyacrylonitrile (e.g., AN69). Therefore, such combinations should be avoided by applying any other antihypertensive drugs, or alternative membranes for hemodialysis.
Symptomatic hypotension is rarely found in the treatment of quinapril in patients with uncomplicated hypertension, but may develop as a result of ACE inhibitor therapy in patients with reduced BCC, for example, a diet with a limited consumption of salt, hemodialysis. In the case of symptomatic hypotension, symptomatic therapy is necessary to (patient should take a horizontal position and hold it in / in infusion with 0.9% sodium chloride solution if needed). Transient hypotension is not a contraindication to further use of the drug, but in such cases it is necessary to reduce the dose or to assess the feasibility of concurrent therapy with diuretics.
Other causes of reduction of BCC, such as vomiting or diarrhea may also lead to a marked decrease in blood pressure. In such cases, patients should consult a doctor.
In patients receiving diuretics, the use of quinapril may also lead to the development of symptomatic hypotension. Such patients it is advisable to temporarily stop taking the diuretic 2-3 days before starting treatment quinapril, except for patients with malignant and difficult to treat hypertension. If quinapril monotherapy does not give the desired therapeutic effect, diuretic treatment should be resumed. If you cancel the diuretic is not possible, quinapril is used in a low initial dose.
In patients with chronic heart failure who are at increased risk of severe arterial hypotension, quinapril treatment should be initiated at the recommended dose under close medical supervision; patients should be monitored during the first two weeks of treatment, as well as in all cases where the increased dose of quinapril.
When therapy with ACE inhibitors in patients with uncomplicated hypertension patients in rare cases develop agranulocytosis, which is more common in patients with impaired renal function and connective tissue diseases. In the treatment of quinapril developed agranulocytosis rarely. In the application of quinapril (as well as other ACE inhibitors) in patients with connective tissue diseases and / or kidney disease should control the number of leukocytes in blood.
In susceptible patients suppression of RAAS activity may lead to impaired renal function. In patients with severe chronic heart failure, in whom renal function may depend on the activity of the RAAS, treatment with ACE inhibitors, including quinapril, may be associated with oliguria and / or progressive azotemia, and rarely, acute renal failure and / or death. Application ARA II, ACE inhibitors or aliskiren can lead to dual blockade of the RAAS activity. This effect may manifest a decrease in blood pressure, hyperkalemia, and changes in renal function (including acute renal failure) as compared with monotherapy. Should be carefully monitored blood pressure, renal function and electrolytes in the blood plasma of patients receiving quinapril and other medicines that affect the RAAS.Avoid the simultaneous application RAAS-active agents and quinapril. If necessary, this combination should in each individual case to assess the expected benefit ratio for the possible risk of using a combination of regularly monitor renal function and potassium content.
Patients with chronic heart failure or hypertension with unilateral or bilateral renal artery stenosis, the treatment with ACE inhibitors in some cases, the observed increase in the concentration of blood urea nitrogen and serum creatinine. These changes were almost always reversible and disappeared after discontinuation of ACE inhibitor and / or a diuretic. In such cases, during the first few weeks of treatment should monitor renal function.
T 1/2hinaprilata increases with a decrease in SK. In patients with CC less than 60 ml / min quinapril should be applied at a lower initial dose. In such patients, the dose should be increased in view of the therapeutic effect with regular monitoring of renal function, although clinical trials was not observed any further deterioration of renal function in the treatment of drug.
Quinapril in combination with diuretics should be used with caution in patients with impaired function or progressive liver disease, since small changes in fluid and electrolyte balance may induce hepatic coma.
ACE inhibitors, including quinapril, may increase the potassium level in the blood serum.
Quinapril may reduce hypokalemia caused thiazide diuretics while the application. The use of quinapril in a combination therapy with potassium-sparing diuretics has not been studied. Given the risk of a further increase in the content of potassium in the blood serum, combination therapy with potassium-sparing diuretics should be performed with caution, under the control of the content of potassium in the blood serum.
Patients with diabetes may require more careful monitoring and dose adjustment hypoglycemic agents for oral administration of both insulin and glucose control, especially during the first month of treatment with an ACE inhibitor, including quinapril.
In the treatment with ACE inhibitors, including quinapril, noted the development of cough. In a typical case, it is non-productive, persistent and extends after cessation of therapy. In the differential diagnosis of cough should be considered its possible relationship with ACE inhibitors.
Prior to surgery (including dental), you must notify the surgeon / anesthetist on the use of ACE inhibitors.
When any signs of infection (eg, acute tonsillitis, fever), the patient should consult a doctor immediately, because they can be a manifestation of neutropenia.
Impact on the ability to drive vehicles and manage mechanisms
In applying the drug-NW Quinapril caution when driving or performing other work requiring special attention, especially in the beginning of treatment, due to the risk of hypotension and dizziness.
OVERDOSE
Symptoms: marked reduction of blood pressure, dizziness, weakness, blurred vision.
Treatment: symptomatic. Patients should take a horizontal position, it is advisable to conduct / infusion with 0.9% sodium chloride solution (to increase the bcc).Hemodialysis and peritoneal dialysis are ineffective.
DRUG INTERACTION
Tetracycline and other drugs that interact with magnesium
simultaneous use of tetracycline with the tetracycline quinapril reduces the absorption by approximately 28-37% due to the presence of magnesium carbonate as the support component of the drug. With simultaneous application should take into account the possibility of such an interaction.
Lithium
Patients treated simultaneously drugs lithium and ACE inhibitors, observed an increase in the content of lithium in blood serum and lithium intoxication symptoms by increasing sodium excretion. Apply these drugs simultaneously with caution; indicated in the treatment of regular determination of lithium in blood serum. Simultaneous treatment with diuretics may enhance the risk of lithium toxicity.
diuretics
With simultaneous use of quinapril with diuretics there is a growing anti-hypertensive action.
Drugs that increase the serum potassium
If a patient receiving quinapril, shown potassium sparing diuretics (e.g., spironolactone, triamterene or amiloride), potassium salt substitutes and preparations containing potassium then apply them to be carefully controlled concentration of potassium in blood serum.
Ethanol (beverages containing alcohol)
Ethanol enhances the antihypertensive effect of quinapril.
Hypoglycemic agents for oral and insulin
ACE inhibitor therapy is sometimes accompanied by the development of hypoglycemia in diabetic patients receiving insulin or hypoglycemic agents for oral administration. Quinapril enhances hypoglycemic effect means for intake and insulin.
Other formulations
evidence of clinically significant pharmacokinetic interactions with propranolol quinapril, hydrochlorothiazide, digoxin or cimetidine is not revealed. Application quinapril 2 times / day did not significantly affected the anticoagulant effect of warfarin when a single application (evaluated based on the prothrombin time).
Simultaneous use of multiple atorvastatin 10 mg of quinapril with a dose of 80 mg did not result in significant changes in the equilibrium pharmacokinetic parameters of atorvastatin.
Quinapril increases the risk of leukopenia while the use of allopurinol, cytostatic agents, immunosuppressants, procainamide.
Antihypertensive drugs, narcotic analgesics, drugs for general anesthesia increase the antihypertensive effect of quinapril.
Estrogens, NSAIDs (including selective COX-2 inhibitors) weaken the antihypertensive effect of quinapril result of fluid retention. Furthermore, elderly patients, patients with reduced BCC (including patients receiving diuretics) or patients with impaired renal function, the simultaneous use of NSAIDs (including selective COX-2), with ACE inhibitors, including quinapril, can lead to deterioration of renal function, including possible acute renal failure. Should regularly monitor renal function in patients receiving concomitant NSAIDs and quinapril.
Application ARA II, ACE inhibitors or aliskiren can lead to dual blockade of the RAAS activity. This effect may manifest a decrease in blood pressure, hyperkalemia, and changes in renal function (including acute renal failure) as compared with monotherapy.
Should not be simultaneously used with aliskiren quinapril and aliskirensoderzhaschimi means or ARA II or with other drugs that inhibit the RAAS (dual blockade of the RAAS):
- in patients with diabetes or in patients with diabetes with end-organ damage (diabetic nephropathy);
- in patients with impaired renal function (GFR of less than 60 ml / min / 1.73 m 2 );
- patients with hyperkalemia (5 mmol / l);
- in patients with chronic heart failure and hypertension.
Medicines that cause depression of bone marrow function, increase the risk of neutropenia and / or agranulocytosis.
With simultaneous use of ACE inhibitors and drugs gold (sodium aurothiomalate, w / w) described symptom, including facial flushing, nausea, vomiting and reduced blood pressure.
Patients receiving both therapies enzyme inhibitors mTOR (such as temsirolimus), or DPP-4 inhibitors (sitagliptin, vildagliptin, alogliptin, saxagliptin, linagliptin) estramustine or may be at greater risk of angioedema. Caution must be exercised while the use of these drugs with a drug-Quinapril SOC.
TERMS OF RELEASE FROM PHARMACY
The drug is released by prescription.
TERMS AND CONDITIONS OF STORAGE
The drug should be stored out of reach of children, dry, protected from light at a temperature of no higher than 25 В° C. Shelf life - 3 years.
