Lysoretic, 20 mg+12, 5 mg tablets 28 pcs

Lysoretic has an antihypertensive, diuretic effect.

Pharmacodynamics

Lysoretic is a combination of an angiotensin-converting enzyme inhibitor (lisinopril) and a diuretic (hydrochlorthiazide). It has antihypertensive and diuretic action.

Lisinopril. ACE inhibitor, reduces the formation of angiotensin II from angiotensin I. Reduction of angeotensin II leads to a direct reduction of aldosierone release. Reduces bradykinin degradation and increases prostaglandin synthesis. Reduces total peripheral vascular resistance, blood pressure (BP), preload, pulmonary capillary pressure, causes an increase in the minute blood volume and increases exercise tolerance in patients with heart failure.

Dilates arteries to a greater extent than veins. Some effects are explained by the effect on tissue retin-angiotensin systems. Long-term use reduces myocardial hypertrophy and resistive arterial wall hypertrophy. It improves the blood supply to the ischemic myocardium. ACE inhibitors prolong life expectancy in patients with chronic heart failure, slow the progression of left ventricular dysfunction in patients who have had myocardial infarction without clinical manifestations of heart failure. Onset of action in 1 hour, the maximum effect is determined after 6-7 hours, the duration – 24 hours. In case of arterial hypertension the effect is noted during the first days after the treatment start, the stable effect develops after 1-2 months.

Hydrochlorothiazide. Thiazide diuretic, diuretic effect of which is associated with disruption of reabsorption of sodium, chloride, potassium, magnesium and water ions in the distal nephron; it delays excretion of calcium and uric acid ions. It has antihypertensive properties; hypotensive effect develops due to dilation of arterioles. It has practically no effect on normal blood pressure. Diuretic effect occurs in 1-2 hours, reaches a maximum in 4 hours and lasts 6-12 hours.

The antihypertensive effect occurs within 3-4 days, but it may take 3-4 weeks to achieve optimal therapeutic effect. Lisinopril and hydrochlorthiazide, if used simultaneously, have an addetive antihypertensive effect.

Indications

Arterial hypertension (in patients who are indicated for combination therapy).

Composition

Active ingredients:

lisinopril 20 mg;

hydrochlorothiazide 12.5 mg;

Supplements:

calcium hydrophosphate,

mannitol.

Corn starch,

Pre-slated starch,

Red iron oxide dye,

iron oxide dye yellow,

magnesium stearate,

purified water

How to take, the dosage

Take orally, once daily.

Arterial hypertension
1 tablet Lysoretic 10 mg) 12.5 mg once daily. If necessary, the dose can be increased to Lysoretic 20 mg +12.5 mg daily.

Doses in renal failure
In patients with a creatinine clearance of more than 30 and less than 80 ml/min, the drug can be used only after titrating the dose of individual components of the drug. The recommended starting dose of lisinopril in uncomplicated renal failure is 5-10 mg.

Previous therapy with diuretics
Symptomatic hypotension may occur after the initial dose of the drug. These cases occur more frequently in patients who have had fluid and electrolyte loss due to prior diuretic treatment. Therefore, it is necessary to stop taking diuretics 2-3 days before starting treatment with Lysoretic.

Interaction

In concomitant use: with potassium-saving diuretics (spironolactone, triamterene, amiloride), potassium preparations, salt substitutes containing potassium – the risk of hyperkalemia increases, especially in patients with impaired renal function;
with vasodilators, barbiturates, phenothiazines, antidepressants, ethanol – the increase of hypotensive effect;
with non-steroidal anti-inflammatory drugs (indomethacin and others) – the increase of hypotensive effect.
with lithium preparations – slowing down the elimination of lithium from the body (intensification of cardiotoxic and neurotoxic effects of lithium);
with antacids and colestramine – reducing absorption in the gastrointestinal tract. It increases neurotoxicity of salicylates, weakens action of oral hypoglycemic agents, norepinephrine, epinephrine and antipodagric agents, increases effects (including side effects) of cardiac glycosides, effects of peripheral muscle relaxants, reduces excretion of quinidine.
It reduces effect of oral contraceptives.

Special Instructions

A pronounced decrease in BP most often occurs with a decrease in the RBC caused by diuretic therapy, reduction of salt in food, dialysis, diarrhea or vomiting. In patients with chronic heart failure with or without simultaneous renal failure, symptomatic hypotension may develop. It is more often found in patients with severe forms of heart failure, as a consequence of using high doses of diuretics, hyponatremia or impaired renal function. In such patients, treatment should be started under strict medical supervision. Similar rules should be followed when prescribing to patients with CHD, cerebrovascular insufficiency, in whom a sharp decrease in BP may lead to myocardial infarction or stroke.

The effect on the ability to drive and operate machinery:

During treatment, patients should refrain from driving and engaging in potentially hazardous activities that require increased concentration and rapid psychomotor reactions because dizziness may occur, especially at the beginning of treatment.

Contraindications

Side effects

Cardiovascular system: marked decrease of blood pressure, chest pain, rarely – orthostatic hypotension, tachycardia, bradycardia, the appearance of symptoms of heart failure, atrioventricular conduction failure, myocardial infarction.

Gastrointestinal tract: nausea, vomiting, abdominal pain, dry mouth, diarrhea, dyspepsia, anorexia, change in taste, pancreatitis, hepatitis (hepatocellular and cholestatic), jaundice.

Nervous system disorders: mood lability, concentration disorders, paresthesia, fatigue, somnolence, convulsive twitching of limbs and lips, rarely – asthenic syndrome, confusion.

Respiratory system – dyspnea, bronchospasm, apnea.

Skin disorders – hives, sweating, hair loss, photosensitization.

Allergic reactions: angioedema of the face, extremities, lips, tongue, epiglottis and/or larynx, skin rash, itching, fever, vasculitis, positive results for antinuclear antibodies, increased CRP, eosinophilia.

Hematopoietic disorders: leukopenia, thrombocytopenia, neutropenia, agranulocytosis, anemia (decrease of hemoglobin, hematocrit, erythrocytopenia). Urogenital system – uremia, oliguria/anuria, renal dysfunction, acute renal failure, decreased potency.

Laboratory indices: hyperkalemia and/or hypokalemia, hyponatremia, hypomagnesemia, hypochloremia, hyperuricemia, hyperglycemia, increased levels of urea and creatinine, rarely – increased activity of “hepatic” transaminases, hyperbilibinemia, hypercholesterolemia, hypertriglyceridemia, reduced glucose tolerance.

Others: dry cough, arthralgia/arthritis, myalgia, fetal renal impairment, gout exacerbation.

Overdose

Symptoms: pronounced BP decrease.

Treatment: induce vomiting and/or gastric lavage, symptomatic therapy aimed at correction of dehydration and impaired intra-saline balance. In case of arterial hypotension, administer isotonic solution. Monitoring of urea, creatinine and electrolytes in the serum, as well as diuresis.

Pregnancy use

The use of Lysoretic during pregnancy is contraindicated. If pregnancy is established, the drug should be discontinued as soon as possible.

The use of inhibitors in the II and III trimesters of pregnancy has adverse effects on the fetus (marked BP decrease, renal failure, hyperkalemia, skull hypoplasia, intrauterine death are possible). There are no data on the negative effects of Lysoretic on the fetus in case of use during the first trimester.

Newborns and infants who have been intrauterine exposed to ACE inhibitors are recommended to be monitored for timely detection of marked BP decrease, oliguria, hyperkalemia. Breastfeeding should be discontinued during treatment with the drug.