Composition, form of production and packaging
The tablets covered with a film cover of pink color, oval, biconcave, with a risk on both sides and marking "PD 222" on one side.
1 tab.
quinapril hydrochloride 10.832 mg,
which corresponds to the content of quinapril 10 mg
hydrochlorothiazide 12.5 mg
Excipients: lactose monohydrate - 32.348 mg, magnesium carbonate - 35.32 mg, povidone K25 - 4 mg, crospovidone - 4 mg, magnesium stearate - 1 mg.
Composition of the film shell: opadrai pink OY-S-6937 (hypromellose, giprolose, titanium dioxide, macrogol 400, iron dye oxide yellow, iron oxide dye red) - 3 mg, herb wax - 0.05 mg.
10 pieces. - blisters (3) - packs of cardboard.
The tablets covered with a film cover of pink color, triangular, biconcave, with a risk and marking "PD 220" on one side.
1 tab.
quinapril hydrochloride 21.664 mg,
which corresponds to the content of quinapril 20 mg
hydrochlorothiazide 12.5 mg
Excipients: lactose monohydrate - 77.196 mg, magnesium carbonate - 70.64 mg, povidone K25 - 8 mg, crospovidone - 8 mg, magnesium stearate - 2 mg.
The composition of the film shell: opadrai pink OY-S-6937 (hypromellose, giprolose, titanium dioxide, macrogol 400, iron oxide oxide yellow, iron oxide dye red) - 6 mg, wax herbal - 0.1 mg.
10 pieces. - blisters (3) - packs of cardboard.
The tablets covered with a film cover of pink color, round, biconcave, with marking "PD 223" on one side.
1 tab.
quinapril hydrochloride 21.664 mg,
which corresponds to the content of quinapril 20 mg
hydrochlorothiazide 25 mg
Excipients: lactose monohydrate - 64.696 mg, magnesium carbonate - 70.64 mg, povidone K25 - 8 mg, crospovidone - 8 mg, magnesium stearate - 2 mg.
The composition of the film shell: opadrai pink OY-S-6937 (hypromellose, giprolose, titanium dioxide, macrogol 400, iron oxide oxide yellow, iron oxide dye red) - 6 mg, wax herbal - 0.1 mg.
10 pieces. - blisters (3) - packs of cardboard.
INSTRUCTION FOR THE SPECIALIST.
Description of the drug approved by the manufacturer for the printed edition of 2015.
PHARMACHOLOGIC EFFECT
Combined antihypertensive drug, which includes an inhibitor of ACE quinapril and a thiazide diuretic hydrochlorothiazide.
ACE catalyzes the conversion of angiotensin I into angiotensin II, which has a vasoconstrictive effect and controls the tone of the vessels, including by stimulating the secretion of aldosterone with the adrenal cortex. Hinapril competitively inhibits circulating in blood plasma and tissue 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.
In addition, quinapril somewhat reduces the loss of potassium caused by hydrochlorothiazide, which, due to its diuretic action, also increases the activity of renin of blood plasma, the secretion of aldosterone, reduces the potassium content in the serum and increases its excretion in the urine.
Hydrochlorothiazide is a diuretic with a direct effect on the kidneys, increasing the excretion of sodium ions, chlorides, water, as well as potassium and bicarbonate ions, and reducing the excretion of calcium ions. With prolonged use there is a decrease in OPSS. Thus, the use of a combination of quinapril and hydrochlorothiazide leads to a more pronounced decrease in blood pressure than therapy with each drug alone.
Antihypertensive effect of quinapril develops within 1 hour after ingestion, reaches a maximum in 2-4 hours and lasts for 24 hours with long-term treatment. In some cases, at least 2 weeks are required to achieve the maximum antihypertensive effect of therapy.
The diuretic effect of hydrochlorothiazide develops within 2 hours, reaches a maximum in about 4 hours and lasts about 6-12 hours.
PHARMACOKINETICS
Hinapril and hydrochlorothiazide do not affect the pharmacokinetics of each other.
Hinapril
Suction and distribution
After ingestion of C max, quinapril is achieved within 1 h. Hinapril is rapidly metabolized to quinaprilate, which is a potent inhibitor of ACE. The degree of absorption of quinapril is approximately 60%. C max quinaprilat in blood plasma is reached approximately 2 hours after ingestion of quinapril.
About 38% of the dose of quinapril is circulated in the form of quinaprilate. Approximately 97% of quinapril and quinaprilate circulate in blood plasma in protein-related form. Hinapril and its metabolites do not penetrate the BBB.
Metabolism and excretion
Hinapril is metabolized to quinaprilate by cleavage of the ester group (the main metabolite is dibasic acid of quinapril).
T 1/2 of quinapril from the blood plasma is about 1 hour. Hinaprilat is excreted mainly by renal excretion, and its T 1/2 is about 3 hours.
Pharmacokinetics in special clinical cases
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 of age) and closely correlates with renal function, however, in general, there is no difference in the efficacy and safety of treatment in elderly and younger patients.
Hydrochlorothiazide
Suction and distribution
Hydrochlorothiazide is absorbed somewhat more slowly, C max is reached after 1-2.5 hours. The degree of absorption is 50-80%.
Hydrochlorothiazide penetrates the placental barrier and is excreted in breast milk, but does not penetrate the GEB.
Metabolism and excretion
Hydrochlorothiazide is not metabolized in the liver and is excreted unchanged in urine. T 1/2 is between 4 and 15 hours. About 61% of the ingested dose is excreted unchanged for 24 hours.
INDICATIONS
- Arterial hypertension (in patients who are shown combined therapy with quinapril and hydrochlorothiazide).
DOSING MODE
The drug is taken orally 1 time / day, regardless of food intake.
For patients who do not receive a diuretic (whether monotherapy with quinapril or not), the recommended initial dose of Acquid is 10 mg + 12.5 mg 1 time / day. In the future, if necessary, the dose can be increased to a maximum dose of 20 mg + 25 mg 1 time / day. Effective control of blood pressure is usually achieved with the use of the drug Akkudid В® in the dose range from 10 mg + 12.5 mg / day to 20 mg + 12.5 mg / day.
In patients with impaired renal function of mild severity (CK> 60 ml / min), the initial dose of the drug Akkudid В® is 10 mg + 12.5 mg.
The drug Akkudid В® should not be prescribed as an initial therapy in patients with impaired renal function with KK <60 ml / min . In patients with impaired renal function of moderate severity (CK 60-30 ml / min) , quinapril should be used in an initial dose of 5 mg with further titration.
In elderly patients, no dosage adjustment of the drug Akkudio В® is required. The initial dose of the drug is 10 mg + 12.5 mg.
SIDE EFFECT
Adverse reactions that occurred in patients receiving quinapril in combination with hydrochlorothiazide
More than 1% of patients: headache, dizziness, cough, unproductive persistent cough (passed after discontinuation of therapy), fatigue, myalgia, viral infections, rhinitis, nausea, vomiting, upper respiratory tract infections, insomnia, bronchitis, dyspepsia, asthenia, pharyngitis , symptoms of vasodilation, vertigo, chest pain, abdominal pain, back pain.
In general, adverse reactions were mild and transient, independent of age, sex, race, and duration of therapy.
Laboratory indicators: an increase (more than 1.25 times in comparison with IGN) of creatinine and urea nitrogen in the blood, respectively, in 3% and 4% of patients receiving quinapril and hydrochlorothiazide.
Adverse reactions occurred in 0.5-1% of patients receiving quinapril in combination with hydrochlorothiazide
From the hemopoietic system: hemolytic anemia, thrombocytopenia, leukopenia, agranulocytosis.
From the nervous system: increased excitability, paresthesia, depression, drowsiness.
Cardiovascular system: palpitation, tachycardia, marked decrease in blood pressure, orthostatic hypotension, fainting, heart rhythm disturbances, myocardial infarction, ischemic stroke, peripheral edema (including generalized edema), hypertensive crisis, angina pectoris, heart failure.
From the respiratory system: shortness of breath, sinusitis.
On the part of the digestive system: dryness of the mucous membrane of the mouth and throat, constipation or diarrhea, flatulence, pancreatitis, hepatitis, gastrointestinal bleeding, impaired functional hepatic tests.
Allergic reactions: skin rash, itching, hives, angioedema, angioedema, photosensitivity, exudative erythema multiforme, exfoliative dermatitis, pemphigus, Stevens-Johnson syndrome, anaphylactic reactions.
From the musculoskeletal and connective tissue: pain in the joints.
From the urinary system: urinary tract infections, renal dysfunction, acute renal failure.
On the part of the reproductive system: a decrease in potency.
From the side of the organ of vision: visual impairment.
Other: alopecia, hyperkalemia, increased sweating.
With simultaneous use of ACE inhibitors and preparations of gold (sodium aurotomy malate for intravenous administration), a symptom complex including facial flushing, nausea, vomiting, lowering of blood pressure and influenza-like syndrome is described.
Adverse reactions observed with the use of hydrochlorothiazide
From the metabolism: hypokalemia, hypomagnesemia, hypercalcemia and hypochloraemic alkalosis, hyponatremia (confusion, convulsions, lethargy, slowing down of the thinking process, increased fatigue, excitability, muscle cramps), hyperglycemia, glucosuria, hyperuricemia with the development of gout attack.
Hypochloremic alkalosis (dryness of the oral mucosa, thirst, heart rhythm disturbance, changes in mood or psyche, seizures and muscle pain, nausea, vomiting, fatigue or weakness) can cause hepatic encephalopathy or hepatic coma.
Treatment with thiazides can reduce glucose tolerance, and latent diabetes mellitus can manifest. When using high doses, lipid concentrations in the blood plasma can increase.
From the digestive system: cholecystitis, sialadenitis, anorexia.
From the cardiovascular system: arrhythmias, orthostatic hypotension, vasculitis.
On the part of the organs of hematopoiesis: aplastic anemia.
Allergic reactions: purpura, necrotizing vasculitis, respiratory distress syndrome (including pneumonitis and noncardiogenic pulmonary edema), photosensitivity, anaphylactic reactions up to shock.
From the side of the organ of vision: transient blurred vision, transient acute myopia and acute open-angle glaucoma.
From the side of the urinary system: violation of renal function, interstitial nephritis.
On the part of the reproductive system: a decrease in potency.
Postmarketing research
From the cardiovascular system: bradycardia, pulmonary heart, vasculitis, deep vein thrombosis.
From the digestive system: tumors of the digestive tract, cholestatic jaundice, hepatitis, esophagitis, vomiting, diarrhea.
From the hematopoiesis system: anemia.
From the side of metabolism: weight loss.
From the musculoskeletal system: myopathy, myositis, arthritis.
From the side of the nervous system: paralysis, hemiplegia, speech disorders, gait disturbance, phenomena of meningism, amnesia.
On the part of the respiratory system: pneumonia, bronchial asthma.
On the part of the skin: urticaria, maculopapular rash, petechiae.
From the urinary system: albuminuria, pyuria, hematuria, nephrosis.
Other: shock, accidental injuries, inflammation of subcutaneous fat, generalized edema, hernia.
CONTRAINDICATIONS
- angioedema in a history as a result of previous therapy with ACE inhibitors, idiopathic and hereditary angioedema;
- severe renal failure (CK <30 ml / min);
anuria;
severe hepatic impairment;
- Addison's disease;
- refractory hypokalemia, hypercalcemia and hyponatremia;
- Obstruction of the outflow tract of the left ventricle of the heart;
- diabetes mellitus with the presence of chronic kidney disease with renal insufficiency of moderate severity (GFR <60 ml / min);
- children and adolescents under 18 years of age (efficacy and safety of the drug are not established);
- lactose intolerance, lactase deficiency, glucose-galactose malabsorption;
- hypersensitivity to active substances, auxiliary components of the drug;
- hypersensitivity to sulfonamide derivatives.
- simultaneous use with aliskiren in patients with diabetes mellitus, in patients with impaired renal function (GFR <60 ml / min / 1.73 m 2 ), in patients with hyperkalemia (> 5 mmol / l), in patients with chronic heart failure with a decreased HELL;
- simultaneous use with angiotensin II receptor antagonists or other ACE inhibitors in patients with diabetes mellitus and end-stage target organ damage, in patients with impaired renal function from moderate to severe degree (GFR <60 ml / min / 1.73 m 2 ), in patients with hyperkalemia (> 5 mmol / l), in patients with chronic heart failure with low blood pressure.
Caution should be given to the drug in patients who had previously taken diuretics and followed a diet with limited intake of salt or are on hemodialysis; in severe chronic heart failure in patients with or without concomitant renal failure; at conditions accompanied by a decrease in BCC (including vomiting and diarrhea);oppression of bone marrow hematopoiesis; aortic stenosis, cerebrovascular diseases (a sharp decrease in blood pressure on the background of therapy with ACE inhibitors can worsen the course of these diseases); conditions after kidney transplantation, bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney; severe autoimmune systemic diseases of connective tissue (including SLE, scleroderma); impaired function or progressive liver disease; diabetes mellitus;extensive surgical interventions and general anesthesia; with simultaneous use of other antihypertensive agents, as well as inhibitors of mTOR and DPP-4 enzymes;with the simultaneous use of cardiac glycosides and other drugs that can lead to the development of ventricular tachycardia as pirouette; when the water-electrolyte balance is disturbed (hyperkalaemia, hypokalemia, hyponatremia, hypercalcemia); with gout; symptomatic hyperuricemia; at a closed angle glaucoma; in old age.
PREGNANCY AND LACTATION
The use of the drug Acquid is contraindicated in pregnancy, women planning pregnancy, as well as women of reproductive age who do not use reliable methods of contraception.
Women of reproductive age who take Acquid В® should take reliable methods of contraception.
At the onset of pregnancy during treatment with Accoucid, the drug should be discontinued as soon as possible.
The appointment of ACE inhibitors in pregnancy is accompanied by an increased risk of cardiovascular and nervous system anomalies. In addition, against the background of the use of ACE inhibitors in pregnancy, cases of low blood pressure, premature birth, the birth of children with arterial hypotension, impaired renal function, including acute renal failure, hypoplasia of the skull bones, limb contractures, craniofacial anomalies, lung hypoplasia, intrauterine growth retardation , an open arterial duct, as well as cases of intrauterine fetal death and death of newborns. Often, anhydration is diagnosed after the fetus has been irreversibly damaged.
Newborns who have undergone intrauterine exposure to ACE inhibitors should be monitored for the purpose of identifying arterial hypotension, oliguria, and hyperkalemia. When oliguria occurs, blood pressure and renal perfusion should be maintained.
Thiazides penetrate the placental barrier and are found in the blood of the umbilical cord. Non-teratogenic effects of thiazides include jaundice and thrombocytopenia of the fetus and / or newborn, and other undesirable phenomena observed in adults are also susceptible.
ACE inhibitors, including quinapril, penetrate to a limited extent in breast milk. Thiazide diuretics are excreted in breast milk. Considering the possibility of developing serious unwanted reactions in newborns, do not use AccoucadВ® during lactation, and if necessary, stop breastfeeding.
APPLICATION FOR FUNCTIONS OF THE LIVER
The use of the drug is contraindicated in patients with severe renal insufficiency (CC less than 30 ml / min ).
In patients with impaired renal function of mild severity (CK> 60 ml / min), the initial dose of the drug Akkudid В® is 10 mg + 12.5 mg.
Preparation Akkuzid В® should not be given as initial therapy in patients with impaired renal function with creatinine clearance <60 mL / min . In patients with impaired moderate renal function (creatinine clearance 60-30 ml / min) to be applied quinapril at an initial dose of 5 mg to further titration.
Precautions prescribers for conditions following transplantation of kidney, bilateral renal artery stenosis or artery stenosis only kidneys.
APPLICATION FOR VIOLATIONS OF THE FUNCTION OF KIDNEYS
Contraindicated for use during liver failure and severe.
Precautions should be prescribed in violation of function or progressive liver disease.
APPLICATION FOR CHILDREN
Do not use this medication in children and adolescents under 18 years of age (efficacy and safety have not been established).
APPLICATION IN ELDERLY PATIENTS
In elderly patients do not require dose adjustment of the drug Akkuzid В® . The initial dose is 10 mg + 12.5 mg.
SPECIAL INSTRUCTIONS
Angioedema
When treating cases are described ACE inhibitors angioneurotic edema of the face and neck, including in 0.1% of patients receiving quinapril. When the whistle or laryngeal angioedema face, tongue or glottis, difficulty swallowing food or breathing Akkuzid В® should be lifted immediately. The patient must assign adequate treatment and watch it until disappearance of edema. antihistamines may be used to reduce symptoms. Angioedema with laryngeal lesion can lead to death. If the swelling of the tongue, glottis or larynx 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 and vomiting); in some cases, no prior facial angioedema and normal activity of C1-esterase. The diagnosis using computed tomography abdominal region,Ultrasound or during surgery. Symptoms disappeared after discontinuation of ACE inhibitors.
Patients who have had angioedema unrelated to ACE inhibitors, the risk of its development can be promoted in the treatment of this group of drugs.
Patients receiving both therapies mTOR enzyme inhibitors (e.g., temsirolimus) and the DPP-4 (e.g. vildagliptin) may be at greater risk of angioedema.
ACE inhibitors are more likely to cause angioedema in blacks patients than in Caucasians. As well as the application of other ACE inhibitors, quinapril may be less effective in reducing blood pressure in patients blacks.
Patients receiving ACE inhibitors during desensitizing Hymenoptera venom therapy (wasps, bees), may develop persistent anaphylactoid reactions, life-threatening. Suspension of an ACE inhibitor promotes regression of the symptoms, but they can occur again when resuming therapy of ACE inhibitors.
Anaphylactoid reactions may also occur when assigning ACE inhibitors to patients undergoing apheresis LDL with dextran sulfate or patients on hemodialysis vysokoprotochnyh using membranes, such as polyacrylonitrile. You must use an alternative lipid-lowering therapy or use other membranes for hemodialysis.
Hypotension
Akkuzid В® It can cause transient hypotension, but no more frequently than with monotherapy both components of the preparation. 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, such as after treatment with diuretics, with a diet with a restricted sodium or consumption during hemodialysis. In the case of symptomatic hypotension, the patient should be given 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 advisable to reduce the dose.
Chronic heart failure
in patients with chronic heart failure with or without renal failure, ACE inhibitor therapy for hypertension may cause an excessive decrease in blood pressure, which may be accompanied by oliguria, azotemia, and in rare cases acute renal failure and even death. Treatment of such patients with drug Akkuzid В® should be initiated under close medical supervision and control within the first 2 weeks and with increasing dose.
agranulocytosis
In rare cases, treatment with ACE inhibitors may be associated with the development of agranulocytosis and suppression of bone marrow hematopoiesis in patients with uncomplicated hypertension, but more frequently in patients with impaired renal function, especially with connective tissue diseases. In these cases, you should monitor the number of leukocytes in the blood.
When you see any symptoms of infection (eg, sore throat, fever), patients should consult a doctor immediately, because these symptoms may be a manifestation of neutropenia.
Systemic lupus erythematosus
Thiazide diuretics may occasionally cause exacerbation of SLE.
Renal dysfunction
Akkuzid В® should not be used in patients with severe renal impairment (creatinine clearance less than 30 mL / min), as thiazide diuretics contribute to the progression of azotemia and have a cumulative effect with prolonged use in such patients. The drugs of choice in this group of patients receiving quinapril, are "loop" diuretics. For this reason, do not use a fixed combination hydrochlorothiazide / quinapril in patients with severe renal insufficiency.
T 1/2 hinaprilata increases with a decrease in SK. Patients with a CC less than 60 ml / min and 30 ml / min quinapril be administered at a lower initial dose. In such patients, the dose of the drug Akkuzid В®should be increased in view of the patient's clinical status at regular monitoring of renal function, although clinical trials have not observed any further deterioration of renal function in the treatment of drug Akkuzid В® .
In hypertensive patients without overt signs of renal dysfunction starting the application quinapril, especially in combination with a diuretic, was an increase in concentration of blood urea nitrogen and creatinine in blood serum, which is typically expressed poorly and is usually transient. These changes are most likely to occur in patients with impaired renal function source. In such cases it may require dose reduction Akkuzid preparation В®. All hypertensive patients should monitor kidney function. Do not use the drug Akkuzid В® as a starting therapy for patients with CC less than 60 ml / min.
The impact of RAAS
In some patients, suppression of RAAS activity may lead to impaired renal function. Patients with severe heart failure, renal function may depend on the activity of the RAAS, so treatment with ACE inhibitors including quinapril, can lead to oliguria and / or progressive azotemia, and in rare cases - to acute renal failure and / or death.
Dual blockade of the RAAS
Use of angiotensin II receptor antagonists, 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 taking the drug Akkuzid В® and other drugs that affect the RAAS. Avoid the simultaneous application RAAS-active agents and quinapril. The use of the combination should be narrowed to individual cases, with careful monitoring of renal function and potassium in the blood plasma.
Renal artery stenosis
In clinical studies in hypertensive patients with bilateral renal artery stenosis or stenosis of the artery only kidneys in the treatment of ACE inhibitors in some cases, we observed an increase in blood urea nitrogen level 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 Akkuzid В® should monitor renal function.
Impaired liver function
Akkuzid В® 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.
Water-electrolyte balance
With a view to identifying possible violations of electrolyte balance should be regularly monitored serum levels of electrolytes. In patients receiving quinapril monotherapy, like other ACE inhibitors, may increase serum potassium levels.
Hyperkalemia (> 5.8 mmol / L) noted in approximately 2% of patients treated with quinapril, but in most cases this deviation to the unit and passed in the course of treatment. Risk factors for hyperkalemia include renal dysfunction, diabetes mellitus and simultaneous reception of potassium-sparing diuretics, potassium preparations and / or salt substitute containing potassium. Simultaneous treatment with potassium-sparing diuretics Akkuzidom, which includes a thiazide diuretic, is not recommended. Treatment of thiazide diuretics, on the contrary, accompanied by hypokalemia, hyponatremia and alkalosis gipohloremichesky. These disorders are sometimes manifested by symptoms such as dry mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle weakness, muscle pain or cramps, decreased blood pressure, oliguria, tachycardia, nausea, confusion,cramps and vomiting.
Hypokalemia can also increase the toxic effect of cardiac glycosides. The risk of hypokalemia is particularly high in liver cirrhosis, diuresis, inadequate consumption preparations improving myocardial metabolism, concomitant therapy of corticosteroids or corticotropin, the simultaneous use of drugs that increase the risk of hypokalemia in patients receiving thiazide diuretics. Opposing effects Akkuzida components on the serum potassium level lead to the fact that its value does not change in many patients.
In some cases the effect of one drug component Akkuzid В® may predominate over the other. Before and during treatment should periodically determine serum levels of electrolytes to detect possible electrolyte metabolism disorders.
Chlorides deficiency associated with thiazide diuretic therapy, usually poorly defined, and only in exceptional cases requires special treatment (e.g., diseases of liver or kidneys).
In hot weather, in patients with peripheral edema may develop hyponatremia. In this case, ensure adequate replacement therapy.
Thiazide diuretics reduce calcium excretion.
In rare cases, patients receiving long-term therapy with thiazide, developed pathological changes of the parathyroid glands, accompanied by hypercalcemia and hypophosphatemia. More serious complications of hyperparathyroidism (nephrolithiasis, bone resorption and peptic ulcer) is not described. Prior to the investigation of the function of the parathyroid glands, thiazide diuretics should be discontinued.
Thiazide diuretics increase urine magnesium excretion and can cause hypomagnesemia.
Thiazide diuretics may increase serum levels of cholesterol, triglycerides and uric acid. These effects are usually mild, but in susceptible patients thiazide diuretics may provoke the development of gout or diabetes.
Diabetes
Hyperglycemia induced by high doses of thiazide diuretics (including hydrochlorothiazide in a dose> 100 mg / day), can disrupt the control of plasma glucose concentration. Reducing the content of potassium in the blood plasma leads to increased glucose tolerance. It should monitor the concentration of glucose in blood plasma, as appropriate, prescribe potassium to maintain the potassium in the plasma and adjust hypoglycemic therapy. Therapy with ACE inhibitors may be accompanied by the development of hypoglycemia in diabetics receiving insulin or hypoglycemic agents for oral administration. When treating diabetic patients may require closer monitoring and dose adjustment hypoglycemic agents. ACE inhibitor therapy may be associated with the development of hypoglycemia in patients with diabetes,receiving insulin or oral hypoglycemic agents. When treating diabetic patients may require closer monitoring.
Cough
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.
Surgery
In patients undergoing surgery or general anesthesia, ACE inhibitors should be used with caution, because they block the formation of angiotensin II, due to compensatory secretion of renin. This may lead to hypotension, which is eliminated by increasing the BCC. Before surgery the patient should notify anesthesiologist, that it takes an ACE inhibitor.
bCC
Patients should be warned about the fact that inadequate fluid intake, sweating can lead to excessive decrease of blood pressure by reducing the BCC. Other causes of dehydration, such as vomiting or diarrhea may also lead to a drop in blood pressure.
The acute angle-closure glaucoma and myopia
Hydrochlorothiazide (sulfonamide derivative) can lead to acute transient myopia and acute angle-closure glaucoma. Symptoms include sudden decrease in vision or eye pain and typically occur within the first hours, weeks after initiation of therapy. Without proper treatment closure glaucoma can lead to irreversible vision loss. The main method of treatment of this condition is the immediate removal of hydrochlorothiazide. You may need urgent medical or surgical treatment if the intraocular pressure remains uncontrolled. Risk factors for developing acute angle-closure glaucoma may include allergic reactions to sulfonamides and penicillin in history.
Impact on the ability to drive vehicles and manage mechanisms
Caution should be exercised when driving or performing other work requiring special attention, especially at the beginning of treatment.
OVERDOSE
Information about drug overdose Akkuzid В® and specific data about its treatment there.
Symptoms: expressed
