Equapress, 10 mg+1.5 mg+20 mg 28 pcs.

Equapress is a fixed combination of the antihypertensive components amlodipine, indapamide and lisinopril, which have complementary mechanisms of action to control blood pressure (BP) and also have a synergistic cardioprotective effect.

The combination of amlodipine, indapamide, and lisinopril prevents possible side effects of the individual components of the drug. For example, by dilating the arterioles, slow calcium channel blockers (SCBs) can cause sodium and fluid retention in the body, resulting in activation of the renin-angiotensin-aldosterone system (RAAS). Angiotensin-converting enzyme (ACE) inhibitor blocks this process and normalizes the body’s response to salt load.

The ACE inhibitors significantly reduce hypokalemia caused by diuretics.

Amlodipine

The dihydropyridine derivative is a “slow” calcium channel blocker that has antihypertensive and antianginal effects. It blocks “slow” calcium channels, decreases transmembrane transition of calcium ions into cells (more in vascular smooth muscle cells than in cardiomyocytes). Antianginal action is due to the dilation of coronary and peripheral arteries and arterioles:

In angina, it reduces the severity of myocardial ischemia; by dilating the peripheral arterioles, it reduces total peripheral vascular resistance, reduces the afterload on the heart, and reduces myocardial oxygen demand;

– expanding coronary arteries and arterioles in unchanged and in ischemic areas of the myocardium, increases the flow of oxygen to the myocardium (especially in vasospastic angina); prevents spasm of coronary arteries (including those caused by smoking).Also caused by smoking.)

In patients with stable angina, a single daily dose increases exercise tolerance, delays the development of angina attacks and ST-segment depression by 1 mm, reduces the frequency of angina attacks and the consumption of nitroglycerin and other nitrates.

It has a long-term dose-dependent antihypertensive effect. The antihypertensive effect is due to a direct vasodilatory effect on the vascular smooth muscles. In arterial hypertension a single dose provides clinically significant reduction of BP during 24 hours (in “lying” and “standing” positions).

Orthostatic hypotension when using amlodipine is quite rare. Amlodipine does not cause a decrease in exercise tolerance, left ventricular ejection fraction. It reduces the degree of left ventricular myocardial hypertrophy. It does not affect myocardial contractility and conduction, does not cause reflex increase of heart rate, inhibits platelet aggregation, increases glomerular filtration rate, has weak natriuretic effect.

In diabetic nephropathy it does not increase microalbuminuria. It does not have any adverse effect on metabolism and blood plasma lipid concentration and can be used for therapy of patients with bronchial asthma, diabetes and gout. Significant decrease in BP is observed after 6-10 hours, the duration of effect – 24 hours.

In patients with diseases of the cardiovascular system (including coronary atherosclerosis with lesions of one vessel and up to stenosis of 3 or more arteries, atherosclerosis of the carotid arteries), who had myocardial infarction, percutaneous transluminal coronary angioplasty (PTCA), or in patients with angina pectoris, the use of amlodipine prevents the development of carotid intima-media thickening, reduces mortality from myocardial infarction, stroke, PTCA, aortocoronary bypass; leads to fewer hospitalizations for unstable angina and progression of chronic heart failure (CHF); reduces the frequency of interventions to restore coronary blood flow.

Does not increase risk of death or complications and lethal outcomes in patients with CHF (New York Heart Association (NYHA) Class III-IV functional class) during therapy with digoxin, diuretics and ACE inhibitors. In patients with CHF (functional class III-IV according to NYHA classification) of non-ischemic etiology, there is a possibility of pulmonary edema when using amlodipine.

Indapamide

Indapamide refers to sulfonamide derivatives with an indole ring and has pharmacological properties similar to thiazide diuretics, which inhibit sodium ion absorption in the cortical segment of the nephron loop. The renal excretion of sodium and chlorine ions and, to a lesser extent, potassium and magnesium ions increases, which is accompanied by increased diuresis and antihypertensive effect.

In clinical studies, a 24-hour antihypertensive effect has been demonstrated with indapamide in monotherapy in doses that have no pronounced diuretic effect.

The antihypertensive activity of indapamide is associated with improvement of elastic properties of large arteries, reduction of arteriolar and total peripheral vascular resistance.

Indapamide reduces left ventricular hypertrophy.

The thiazide and thiazide-like diuretics reach a plateau of therapeutic effect at a certain dose, whereas the incidence of side effects continues to increase with further increasing of the drug dose. Therefore, do not increase the dose of the drug if the therapeutic effect is not achieved at the recommended dose.

In short-, medium-, and long-term studies involving patients with arterial hypertension, it has been shown that indapamide:

– has no effect on lipid metabolism, including triglyceride, cholesterol, low and high density lipoprotein concentrations;

– has no effect on carbohydrate metabolism, including in patients with diabetes.

Lisinopril

Lisinopril is an ACE inhibitor and inhibits the transformation of angiotensin I into angiotensin II. Reducing the concentration of angiotensin II leads to a direct reduction of aldosterone secretion. Lisinopril inhibits bradykinin degradation and increases prostaglandin synthesis. It reduces total peripheral vascular resistance, BP, preload and pulmonary capillary pressure. In patients with CHF it increases minute blood volume and increases myocardial resistance to stress.

Dilates arteries more than veins. Some effects are explained by its effect on the tissue renin-angiotensin system. Long-term use reduces myocardial hypertrophy and resistive arterial wall hypertrophy.

Lisinopril improves the blood supply to the ischemic myocardium.

In patients with CHF, ACE inhibitors increase life expectancy; in patients with a history of myocardial infarction in the absence of clinical manifestations of heart failure, lisinopril slows the progression of left ventricular dysfunction.

In patients with CHF, lisinopril starts working within 1 hour after oral administration. Maximum effect is achieved within 6-7 hours; the duration of effect is 24 hours. In patients with arterial hypertension the effect is seen during the first days after treatment start; stabilization of the effect occurs within 1-2 months of treatment. Cases of marked increase in BP after abrupt withdrawal of the drug have not been registered.

Lisinopril provides both BP reduction and albuminuria reduction. In patients with hyperglycemia the drug promotes restoration of function of damaged glomerular endothelium. In patients with diabetes, lisinopril has no effect on plasma glucose concentration; the drug does not lead to increased incidence of hypoglycemia.

Indications

Active ingredient

Composition

Active ingredients:

Amlodipine besylate – 13.868 mg (equivalent to amlodipine 10 mg),

indapamide – 1.5 mg,

lisinopril dihydrate – 21.776 mg (equivalent to lisinopril 20 mg).

Auxiliary substances: lactose monohydrate, hypromellose, calcium hydrophosphate dihydrate, mannitol, corn starch, microcrystalline cellulose, croscarmellose sodium, talc, magnesium stearate, colloidal silicon dioxide, Opadray II white (contains: polyvinyl alcohol, titanium dioxide, macrogol-3350, talc), hard gelatin capsule (contains: iron oxide yellow dye, titanium dioxide, water, gelatin)

How to take, the dosage

Instructions for Use

The drug Equapress is taken orally, regardless of meals.

Dosages

The recommended dose is 1 capsule daily, preferably in the morning, at the same time each day. The maximum daily dose is 1 capsule.

If symptomatic arterial hypotension develops at the beginning of treatment with Equapress, the patient should lie on his back, suspend the drug and consult a physician. Transient arterial hypotension usually does not require withdrawal of the drug, but the need for dose reduction should be assessed.

Missing a dose

If you forget to take a capsule of Equapress, take the next dose at the usual time. Do not take two capsules at the same time to make up for a missed dose.

Patient special groups

Patients with renal impairment

With Equapress therapy, renal function and serum potassium and sodium should be monitored. If renal function is impaired, Equapress should be discontinued and replaced with an individually tailored single component therapy.

Patients with hepatic impairment

In patients with impaired hepatic function, amlodipine excretion may be delayed. There are no precise recommendations for these cases, so Equapress should be used with caution in these patients.

Children and adolescents (< 18 years)

The safety and effectiveness of Equapress in children and adolescents has not been established.

Elderly patients (>65 years)

This drug should be used with caution in elderly patients.

Plasma creatinine concentrations should be monitored according to age, body weight, and sex.

There have been no age-related changes in the efficacy and safety profile of amlodipine or lisinopril in clinical studies.

Interaction

Amlodipine

Contraindicated drug combinations

Dantrolene (intravenous administration)

Unrecommended drug combinations

Grapefruit juice

Taking amlodipine with grapefruit or grapefruit juice is not recommended because in some patients the bioavailability of amlodipine may increase, resulting in increased BP-lowering effects.

Combinations of drugs requiring particular caution when using

CYP3A4 isoenzyme inducers

There are no data on the effect of CYP3A4 isoenzyme inducers on amlodipine pharmacokinetics. Concomitant use of CYP3A4 isoenzyme inducers (e.g., rifampicin, St. John’s Wort preparations) and amlodipine may lead to decreased plasma concentration of amlodipine. Caution should be exercised when using Equipress concomitantly with CYP3A4 isoenzyme inducers.

CYP3A4 isoenzyme inhibitors

. Simultaneous use of amlodipine and strong or moderate CYP3A4 inhibitors (protease inhibitors such as ritonavir, azole antifungals, macrolides such as erythromycin or clarithromycin, verapamil or diltiazem) may lead to a significant increase in amlodipine concentration. Clinical manifestations of these pharmacokinetic abnormalities may be more pronounced in elderly patients. In this regard, it may be necessary to monitor the clinical condition and adjust the dose of the drug Equipress.

Drug combinations requiring caution when using

Simvastatin

Calcium preparations

May decrease the effect of DMARDs.

Lithium preparations

The co-administration of BMCC with lithium preparations (no data for amlodipine) may increase their neurotoxicity (nausea, vomiting, diarrhea, ataxia, tremor or tinnitus).

Baclofen

Augmentation of the antihypertensive effect. BP and renal function should be monitored; if necessary, the dose of amlodipine should be adjusted.

Amifostine

Amifostine may increase the antihypertensive effect of amlodipine.

Glucocorticosteroids

Decreased antihypertensive effect (fluid and sodium ion retention as a result of corticosteroid action).

Tricyclic antidepressants neuroleptics, isoflurane

There is an increased risk of orthostatic hypotension and increased antihypertensive effect (additive effect).

Tacrolimus

In concomitant use with amlodipine there is a risk of increased plasma concentrations of tacrolimus. To avoid tacrolimus toxicity when used concomitantly with amlodipine, tacrolimus plasma concentrations in patients should be monitored and the tacrolimus dose should be adjusted if necessary.

Tasonermin

Other interactions with amlodipine

The antianginal and antihypertensive effects of DMARDs are likely to be enhanced with thiazide and loop diuretics, ACE inhibitors, beta-adrenoblockers and nitrates and their antihypertensive effects are likely to be enhanced when prescribed with alpha 1-adrenoblockers and neuroleptics.

When concomitant use of amlodipine and digoxin, renal clearance and serum concentrations of digoxin are not changed.

Concomitant use of warfarin with amlodipine does not change prothrombin time.

The pharmacokinetics of amlodipine is not changed when concomitant use with cimetidine.

Amlodipine does not affect the degree of binding of digoxin, phenytoin, warfarin and indomethacin to plasma proteins in vitro.

Aluminum and magnesium-containing antacids: single administration of these antacids together with amlodipine has no significant effect on the pharmacokinetics of amlodipine.

Indapamide

Controlled combinations of drugs

Lithium preparations

Concomitant use of indapamide and lithium preparations, as well as adherence to a salt-free diet, may result in increased plasma lithium concentrations due to reduced excretion, accompanied by signs of overdose. If necessary, diuretics may be used in combination with lithium preparations, and plasma lithium content should be carefully monitored and the dose of the drug should be adjusted accordingly.

Combinations of drugs requiring special caution during use

Drugs that can cause pirouette-type polymorphic ventricular tachycardia

Increased risk of ventricular arrhythmias, especially pirouette-type polymorphic ventricular tachycardia (hypokalemia is a risk factor).

Special Instructions

If you are hospitalized, tell your physician that you are taking Equapress.

When using Equapress, please note the special instructions regarding the individual components of the drug.

Amlodipine-related

Tooth hygiene must be maintained and monitored by a dentist (to prevent soreness, bleeding, and gum hyperplasia).

In elderly patients, the T1/2 may increase and the clearance of amlodipine may decrease. No change in doses is required, but closer monitoring of patients in this category is necessary.

The efficacy and safety of amlodipine in hypertensive crisis have not been established.

In in vitro studies it has been shown that amlodipine does not affect the degree of binding of digoxin, phenytoin, warfarin or indomethacin to human plasma proteins.

While there is no withdrawal syndrome in BMCC, it is advisable to discontinue amlodipine treatment by gradually reducing the dose of the drug.

An increased incidence of pulmonary edema has been noted with amlodipine in patients with CHF class III and IV according to NYHA nonischemic genesis, despite the absence of signs of worsening heart failure.

The effect on fertility

In some patients receiving calcium channel blockers, reversible biochemical changes in the sperm head have been found, which may be clinically significant in in vitro fertilization (IVF).

There are, however, currently insufficient clinical data regarding the potential effect of amlodipine on fertility. In a preclinical study, adverse effects on fertility were found in males.

Indapamide-related

Hepatic impairment

Patients with hepatic impairment may develop hepatic encephalopathy when prescribing thiazide and thiazide-like diuretics, especially in the presence of electrolyte imbalance. In this case it is necessary to stop using diuretics.

Photosensitization

Photosensitization cases have been reported with thiazide and thiazide-like diuretics. If photosensitization occurs, withdrawal of these drugs is indicated. If it is necessary to continue treatment, protection of the skin from sunlight or artificial UV radiation is recommended.

Phyto-electrolyte balance

Phyto-electrolyte balance

The plasma sodium content should be determined before starting treatment and regularly monitored. All diuretics can cause hyponatremia, which can have very serious consequences. Continuous monitoring of plasma sodium content is necessary, because at the beginning its reduction may not have clinical manifestations. Monitoring of sodium should be especially careful in patients with cirrhosis and the elderly.

All diuretics can cause hyponatremia, sometimes leading to extremely serious consequences. Hyponatremia and hypovolemia can lead to dehydration and orthostatic hypotension. Concomitant reduction of chlorine ions may lead to secondary compensatory metabolic alkalosis: the frequency and severity of this effect are insignificant.

Potassium content in plasma

With thiazide and thiazide-like diuretics therapy a sharp decrease of potassium content in plasma may occur, and also development of hypokalemia. It is necessary to prevent the risk of hypokalemia (< 3.4 mmol/l) in the following groups of patients: elderly, weakened patients and/or receiving concomitant drug therapy, patients with cirrhosis, peripheral edema and ascites, coronary heart disease, heart failure.

In these patients, hypokalemia increases the toxic effects of cardiac glycosides and increases the risk of arrhythmias. In addition, patients with a prolonged QT interval are at high risk, regardless of whether this prolongation is caused by congenital causes or by medications.

Hypokalemia, like bradycardia, contributes to severe arrhythmias, especially cardiac arrhythmias that can be fatal. The first measurement of plasma potassium should be made within the first week of starting treatment. If hypokalemia is detected, appropriate therapy is indicated.

Contraindications

– Hypersensitivity to amlodipine or other dihydropyridine derivatives.

– Hypersensitivity to lisinopril or other ACE inhibitors.

– Hypersensitivity to indapamide or other sulfonamide derivatives.

– Hypersensitivity to excipients of the drug.

– Severe arterial hypotension (systolic BP below 90 mm Hg).

– Past angioedema, including that associated with the use of ACE inhibitors.

– Hereditary or idiopathic angioedema.

– Severe renal insufficiency (creatinine clearance < 30 ml/min).

– Hepatic encephalopathy or severe hepatic dysfunction.

– Hypokalemia.

– Hemodynamically significant left ventricular outflow tract obstruction (e.g., severe aortic stenosis, hypertrophic obstructive cardiomyopathy), hemodynamically significant mitral stenosis.

– Hemodynamically unstable heart failure after myocardial infarction.

– Shock (including cardiogenic).

– Unstable angina (except for Prinzmetal angina).

– Concomitant use of Equapress and drugs containing aliskiren in patients with diabetes mellitus and/or moderate to severe renal impairment (glomerular filtration rate (GFR) less than 60 ml/min/1.73 m2 body surface area).

– Concomitant use with angiotensin II receptor antagonists (ARA II) in patients with diabetic nephropathy.

– Pregnancy and breastfeeding.

– Age less than 18 years (efficacy and safety not established).

– Hereditary lactose intolerance, galactosemia, glucose-galactose malabsorption syndrome.

Side effects

The most common adverse reactions reported with treatment with amlodipine, indapamide, and lisinopril as monotherapy were: Dizziness, headache, somnolence, visual disturbances, tinnitus, palpitations, blood “rushes” to the facial skin, decreased BP (and effects associated with hypotension), cough, shortness of breath Gastrointestinal disorders (abdominal pain, constipation, diarrhea, nausea, dyspepsia, vomiting), maculopapular rash, muscle cramps, swollen ankles, asthenia, edema and fatigue.

The following adverse drug reactions (ADRs) have been reported during the separate use of amlodipine 1, indapamide 2 and lisinopril 3.

The frequency was determined as follows:

Very frequently, 1/10 of prescriptions (≥10%).

Frequent – 1/100 appointments (≥1% and < 10%).

Infrequent – 1/1000 appointments (≥0.1% and < 1%).

Rarely, 1/10000 appointments (≥0.01% and < 0.1%).

Very rarely, less than 1/10000 appointments (< 0.01%).

The frequency is unknown (frequency cannot be estimated from available data).

Within each frequency group, adverse reactions are presented in decreasing order of importance.

Disorders of the blood and lymphatic system

decrease in hemoglobin3(rare), decrease in hematocrit3(rare), suppression of medullary hematopoiesis3(very rare), leukopenia1,2,3(very rare), thrombocytopenia1,2,3(very rare), Agranulocytosis2,3(very rare), aplastic anemia2(very rare), hemolytic anemia2,3(very rare), neutropenia3(very rare), anemia3(very rare), lymphadenopathy3(very rare).

Immune system disorders

Allergic reactions1(very rare), autoimmune disorders3(very rare).

Endocrine system disorders

Inadequate secretion of antidiuretic hormone syndrome3(rare).

Metabolic and nutritional disorders

Hyperglycemia1(very rare), hypoglycemia3(very rare), hypercalcemia2(very rare), decrease in potassium and development of hypokalemia2(frequency unknown), especially significant in patients at risk; hyponatremia2(frequency unknown).

Mental disorders

Mood lability1,3(infrequent), sleep disturbances3(infrequent), hallucinations3(infrequent), insomnia1(infrequent), anxiety1(infrequent), depression1(infrequent),3(frequency unknown), confusion1,3(rare).

Nervous system disorders

Dizziness1,3(often),headache1,3(often),2(rarely),somnolence1(often),increased fatigability2(rarely),vertigo2(rarely),3(infrequently),paresthesia2(rarely),1,3(infrequently),dysgeusia1,3(infrequently),syncope1(infrequently),23(frequency unknown),tremor1(infrequent), hypoesthesia1(infrequent), parosmia (olfactory disturbance)3(rare), muscle hypertonicity1(very rare), peripheral neuropathy1(very rare), extrapyramidal disorders1(frequency unknown).

Visual disturbances

Visual disturbances (including diplopia) 1(often),2(frequency unknown), myopia2(frequency unknown), blurred vision2(frequency unknown).

Hearing and balance disorders

Tinnitus1(infrequent).

Cardiac disorders

palpitations1(often), 3(infrequent), myocardial infarction3(infrequent), 1(very rare), tachycardia3(infrequent), ventricular tachycardia 1(infrequent), arrhythmia1(infrequent), 2(very rare), polymorphic pirouette-type ventricular tachycardia (potentially fatal)2(frequency unknown), bradycardia1(infrequent), atrial fibrillation1(infrequent).

Vascular disorders

Orthostatic hypotension and related symptoms3(often), facial blood flushes1(often), acute cerebral circulation disorder3(infrequent) (due to marked BP reduction in high-risk patient groups), Raynaud’s syndrome3(infrequent), vasculitis1(very rare), hypotension1(infrequent), marked BP reduction2(very rare).

Respiratory system, chest and mediastinum disorders

dyspnea1 (frequent), cough1(infrequent), 3(frequent), rhinitis1,3(infrequent), bronchospasm3(very rare), allergic alveolitis3(very rare), eosinophilic pneumonia3(very rare), sinusitis3(very rare).

Gastrointestinal tract disorders

Abdominal pain1(often), 3(infrequent), nausea1(often),2(rare), 3( infrequent), dyspepsia1(often),3(infrequent), change in defecation rate1(often), diarrhea1,3(frequent), constipation1(often),2(rare), vomiting1,2(infrequent),3(frequent), dry mouth1(infrequent),2,3(rare), pancreatitis1,2,3(very rare), gastritis1(very rare), interstitial angioedema3(very rare), gum hyperplasia1(very rare).

Liver and biliary tract disorders

Hepatitis1(very rare),2(frequency unknown), hepatitis (including hepatic-cellular or cholestatic)3(very rare), jaundice1,3(very rare), liver failure3(very rare), possible development of hepatic encephalopathy in cases of liver failure2(frequency unknown), liver function disorder2(very rare), increased activity of “liver” enzymes*1(very rare).

(*-predominantly due to cholestasis)

Skin and subcutaneous tissue disorders

alopecia1(infrequent), 3(infrequent), hypersensitivity reactions2(frequent), maculopapular rash2(frequent), exanthema1(infrequent), purpura1,2(infrequent), skin depigmentation1(infrequent), hyperhidrosis1(infrequent),3(very rare) pruritus1,3(infrequent), rash1,3(infrequent), urticaria1(infrequent),2(very rare),3(rare), Psoriasis3(rare), erythema multiforme1,3(very rare), angioedema1,2(very rare),3(rare), exfoliative dermatitis1 (very rare), toxic epidermal necrolysis2,3(very rare), Stevens-Johnson syndrome1,2,3(very rare), Quincke’s edema1(very rare), photosensitivity1(very rare), 2(frequency unknown), vesicular vulgaris3(very rare), benign skin lymphadenosis*3(very rare), exacerbation of pre-existing acute systemic lupus erythematosus2(frequency unknown), hypersensitivity/angioneurotic edema of face, hands and feet, lips, tongue, vocal cleft and/or larynx3(rare).

(* – A symptom complex has been reported that may include one or more of the following symptoms: fever, vasculitis, myalgia, arthralgia/arthritis, positive antinuclear antibody (ANA) reaction, increased erythrocyte sedimentation rate (ESR), eosinophilia and leukocytosis, skin rash, photosensitization or other skin changes).

Muscular and connective tissue disorders

Muscular cramps1(often), swollen ankles1(often), arthralgia1(infrequent), myalgia1(infrequent), back pain1(infrequent).

Kidney and urinary tract disorders

Renal dysfunction3(often), urinary distress1(infrequent), nycturia1(infrequent), rapid urination1(infrequent), acute renal failure1(rare), renal failure2(very rare), uremia3(rare), oliguria3(very rare), anuria3(very rare).

Genital and mammary disorders

Gynecomastia1(infrequent), 3(rare), impotence1,3(infrequent).

General disorders and disorders at the site of administration

Edema1(very often), increased fatigue1(often),3(infrequent), asthenia1(often),3(infrequent), chest pain1(infrequent), pain1(infrequent), malaise1(infrequent).

Impact on laboratory and instrumental findings:

increased concentration of creatinine and urea3(infrequent), hyperkalemia3(infrequent), hyperbilirubinemia3(rare), increased activity of “liver” enzymes2(frequency unknown), 3(infrequent), hyponatremia3(rare), prolongation of QT interval on ECG2(frequency unknown), increase in uric acid concentration2(frequency unknown), increase in blood glucose concentration2(frequency unknown), decrease or increase in body weight1(infrequent).

If any of the side effects listed in the instructions worsen, or if you notice any other side effects not listed in the instructions, tell your doctor.

Overdose

Amlodipine overdose

Symptoms: significant BP decrease with possible development of reflex tachycardia and excessive peripheral vasodilation (there is a risk of significant and persistent hypotension, with development of shock and death).

Treatment: gastric lavage, administration of activated charcoal (especially during the first 2 hours after overdose), keeping the patient in horizontal position with elevated lower extremities, active support of cardiovascular system function, control of cardiac and pulmonary function parameters, control of circulating blood volume and diuresis.

In the absence of contraindications for restoration of vascular tone and BP it may be reasonable to prescribe vasoconstrictors. Intravenous injections of calcium gluconate may help to stop the effects of calcium channel blockade. Since amlodipine is largely bound to serum proteins, hemodialysis is ineffective in the treatment of amlodipine overdose.

Indapamide overdose

Toxic effects of indapamide in overdose have not been noted even in very high doses (up to 40 mg, i.e. 27 times the therapeutic dose).

The signs of acute poisoning with indapamide are primarily associated with disruption of water-electrolyte balance (hyponatremia, hypokalemia). Clinical symptoms of overdose may include nausea, vomiting, decreased blood pressure, seizures, dizziness, drowsiness, confusion, polyuria or oliguria leading to anuria (due to hypovolemia).

Emergency measures include flushing the drug out of the body, gastric lavage, and/or administration of activated charcoal with restoration of the water-electrolyte balance.

Lisinopril overdose

Symptoms: significant decrease in BP, dry mouth, drowsiness, delayed urination, constipation, anxiety, increased irritability.

Treatment: symptomatic therapy, intravenous administration of 0.9% sodium chloride solution and, if possible, vasopressors, BP control, control of water-electrolyte balance. Hemodialysis may be performed.