Capoten tablets: how long does it take for the maximum therapeutic effect to occur and how long does the drug last? Kapoten: at what pressure can I take

From this medical article, you can read medicine Kapoten. The instructions for use will explain in what cases the tablets can be taken, what the medicine helps with, what are the indications for use, contraindications and side effects. The annotation presents the forms of release of the drug and its composition.

In the article, doctors and consumers can only leave real reviews about Kapoten, from which you can find out if the medicine helped in therapy arterial hypertension and reducing elevated blood pressure in adults and children. The instructions list analogues of Capoten, prices of the drug in pharmacies, as well as its use during pregnancy.

The drug with antihypertensive action is Kapoten. Instructions for use recommend taking 25 mg and 50 mg tablets for arterial hypertension, heart failure chronic course, diabetic nephropathy caused by type I diabetes.

Release form and composition

Capoten is available in the form of tablets in blisters of 10 pieces (4 blisters in a pack) and 14 pieces (2 or 4 blisters in a pack). 1 tablet contains: active substance: captopril - 25 or 50 mg and auxiliary components.

pharmachologic effect

Capoten is an ACE inhibitor. It suppresses the formation of angiotensin II and eliminates its vasoconstrictive effect on arterial and venous vessels.

The drug reduces peripheral vascular resistance, afterload, lowers blood pressure, and also reduces preload, reduces pressure in the right atrium and pulmonary circulation.

Capoten, the instructions for use confirm this, reduces the production of aldosterone in the adrenal glands.

The peak of effectiveness is noted 60-90 minutes after ingestion. The degree of decrease in blood pressure is the same in the position of the patient standing and lying down.

When taken with food, absorption of the drug slows down by 30-40%. The half-life is 2-3 hours. The drug is excreted in the urine up to 50% - unchanged, the rest - in the form of metabolites.

What does Kapoten help with?

Indications for use of the drug include:

• left ventricular dysfunction after suffered a heart attack myocardium in a clinically stable condition;
• chronic heart failure (as part of combination therapy);
• diabetic nephropathy due to type 1 diabetes mellitus (with albuminuria >30 mg per day);
• arterial hypertension, incl. renovascular.

Instructions for use

Capoten is taken orally. The dosage regimen is determined by the indications.

For arterial hypertension, the doctor selects the dose of Capoten individually. The drug must be taken in the minimum effective dose.

Initial dose for mild and moderate degree hypertension is 12.5 mg 2 times a day, maintenance – 25 mg 2 times a day. If necessary, the dose can be increased every 2-4 weeks. The usual effective therapeutic dose is 50 mg 2 times a day.

The initial dose for severe hypertension is 12.5 mg 2 times a day. Gradually, the daily dose is increased to a maximum of 150 mg (3 times a day, 50 mg). When using Capoten simultaneously with other antihypertensive drugs, it is recommended to select the dose individually.

Treatment of heart failure should begin under the supervision of a doctor. As a rule, an initial dose of 6.25 mg 3 times a day maximizes the effect of transient hypotension. The maintenance dose is usually 25 mg 2-3 times a day. If necessary, the dose is increased every 2 weeks (maximum 150 mg).

After a myocardial infarction, the use of Capoten can be started after 3 days. The drug is prescribed at an initial dose of 6.25 mg 3 times a day with a gradual (over several weeks) increase in a single dose to 25 mg. If necessary, the dose can be gradually increased to a maximum of 50 mg 3 times a day.

If symptomatic hypotension develops, a dose reduction may be required.

According to indications, Capoten can be used simultaneously with other drugs, for example, thrombolytics, beta-blockers and acetylsalicylic acid.

The recommended daily dose for diabetic nephropathy is 75-100 mg 2-3 times a day. For patients with insulin-dependent diabetes with microalbuminuria (with albumin excretion of 30-300 mg per day), tablets are prescribed 50 mg 2 times a day. If the total protein clearance is more than 500 mg per day, the drug should be taken 25 mg 3 times a day.

If necessary, simultaneous use with other antihypertensive drugs is possible: beta-blockers, diuretics, vasodilators or drugs central action.

The daily dose of Capoten for moderate or mild degree impaired renal function (with creatinine clearance of at least 30 ml/min/1.73 m²) is 75-100 mg 2-3 times a day. The initial daily dose for severe renal impairment (with creatinine clearance less than 30 ml/min/1.73 m²) is no more than 25 mg (12.5 mg 2 times a day).

If the drug is insufficiently effective, the dose is slowly increased every 7-14 days until the therapeutic effect occurs, but it should be lower than the maximum daily dose(by reducing the single dose or increasing the interval between doses of the drug). If necessary, additional loop diuretics (not thiazide-type diuretics) should be used.

For elderly patients, the dose is selected individually. It is recommended to start therapy with minimal therapeutic dose, which should not be increased in the future.

Contraindications

Side effects

• tachycardia;
• dry mouth;
• dry cough (usually disappears after discontinuation of the drug);
• stomatitis;
• drowsiness;
• peripheral edema;
• paresthesia;
• pulmonary edema;
• orthostatic hypotension;
• neutropenia, agranulocytosis, thrombocytopenia, anemia;
• visual impairment;
• taste disturbance;
• diarrhea;
• headache, dizziness;
• hyperkalemia, hyponatremia;
• bronchospasm;
• stomach ache;
• angioedema limbs, face, lips, mucous membranes, tongue, pharynx or larynx.

Children, pregnancy and breastfeeding

Contraindicated during pregnancy and lactation. Contraindicated for children under 18 years of age.

special instructions

In patients with arterial hypertension, when using the drug, pronounced arterial hypotension observed only in isolated cases; the likelihood of developing this condition increases with excessive loss of salts and fluids (for example, after intensive care diuretics), in patients on dialysis or in patients with heart failure.

The possibility of a sharp decrease in blood pressure can be minimized if diuretics are discontinued 4-7 days in advance or the sodium chloride intake is increased in advance (7 days in advance). This can also be achieved by prescribing small doses of Capoten (6.25-12.5 mg per day) at the beginning of treatment.

Drug interactions

Capoten may potentiate the hypotensive effect of diuretics. An excessive decrease in blood pressure is possible when strictly limited reception table salt, hemodialysis and usually occurs within the first hour after taking the first prescribed dose of the drug.

During therapy, vasodilators should be used at the lowest possible effective doses due to the risk of excessive reduction in blood pressure. When combining Capoten and drugs that affect the sympathetic nervous system, caution should be exercised.

Analogues of the drug Kapoten

Analogues are determined by structure:

1. Katopil.
2. Angiopril-25.
3. Blockordil.
4. Vero-Captopril.
5. Epsitron.
6. Alkadil.

Vacation conditions and price

The average price of Capoten (25 mg tablets No. 56) in Moscow is 309 rubles. In Kyiv you can buy medicine for 340 hryvnia, in Kazakhstan - for 1975 tenge. It is difficult to find the drug in Minsk. Dispensed from pharmacies with a prescription.

Or angiotensin-converting enzyme. Its main effect is to lower blood pressure. The drug is also often used along with other drugs in the treatment of heart failure in chronic form. We will consider reviews of “Kapoten” in this article.

Compound

The only form in which the drug is available is oral tablets. The active substance is captopril. The drug is available in two dosages, 25 and 50 mg. active substance in one tablet. Excipients of "Capoten" are:

1. Lactose.
2. Corn starch.
3. Stearic acid.
4. Cellulose in the form of microcrystals.

Indications

The drug is prescribed to patients with the following pathologies:

1. Arterial hypertension various genesis, including renal.
2. Heart failure in a chronic form.
3. A heart attack resulting in disruption of the functioning of the left ventricle of the heart muscle.
4. Nephropathy that developed against the background of type 1 diabetes mellitus.

Application

The medication is taken orally. The tablet can be divided into parts depending on the required dose. Do not chew, bite or crush the tablet. Required dosage calculated in individually. Reception begins with the smallest dose - 6.25 mg with a gradual increase to the amount that has the maximum effect. therapeutic effect. The largest permissible daily dosage- 600 mg. The optimal dosage for most patients is 300 mg. Reviews about “Kapoten” abound.

Contraindications

"Kapoten" - quite potent drug and has a number absolute contraindications, which include:

Relative contraindications

It is relatively contraindicated to take the drug in the following conditions:

Side effects

"Kapoten" can cause adverse reactions from almost all organs and systems of the human body:

1. Nervous system: dizziness, drowsiness, fatigue, headaches, fainting, confusion, depression, lack of coordination, convulsions, numbness of the limbs, impaired sense of smell and vision.
2. Circulatory system: hypotension, myocardial infarction, angina pectoris, arrhythmia, palpitations, pallor skin, anemia, thromboembolism pulmonary artery, hot flashes, neutropenia, peripheral edema, eosinophilia, thrombocytopenia, agranulocytosis.
3. Respiratory system: bronchospasm, pneumonitis, bronchitis, shortness of breath, nonproductive cough, rhinitis.
4. Gastrointestinal tract: stomatitis, glossitis, xerostomia, anorexia, gingival hyperplasia, vomiting, nausea, oral ulcers, dyspepsia, diarrhea, constipation, cholestasis, pancreatitis, hepatocellular cirrhosis, cholestatic hepatitis. This confirms the "Kapoten" instructions for use and reviews.
5. Reproductive system: polyuria, proteinuria, oliguria, decreased erectile function, impotence, deterioration of kidney function.
6. Skin: rashes, redness, itching, herpes zoster, photodermatitis, erythroderma, toxic epidermal necrolysis, exfoliative dermatitis.
7. Allergies: Quincke's edema, urticaria, anaphylactic shock, Stevens-Johnson syndrome.
8. Blood composition: increased levels of potassium and sodium in the blood, as well as decreased glucose levels. The activity of liver enzymes, the concentration of urea, bilirubin and creatinine increases. There is a decrease in hematocrit and hemoglobin.
9. Joints and muscles: arthralgia, myalgia, chills.

All this is indicated in the instructions. We will consider reviews and the price of “Capoten” below.

Interaction with other drugs

The possibility of developing leukopenia increases when taking Capoten simultaneously with interferon alpha-2, cytostatics, immunosuppressants and procainamide.

Hyperkalemia can be caused by simultaneous administration drug with potassium-sparing, diuretic drugs. The same applies to heparin and potassium-containing salt substitutes.

When taken simultaneously with drugs such as Nimesil, Ibuprofen, etc., kidney function may be impaired. Cyclosporine can cause the development of kidney failure. "Kapoten" at joint reception with diuretics and anesthetic drugs can provoke hypotension, as they sharply reduce blood circulation. All this is described in detail in the instructions for use. The price of "Capoten", according to reviews, is slightly overpriced.

Azathioprine can cause leukopenia and anemia. The effectiveness of Capoten is significantly reduced when taken with hydroxides of magnesium, aluminum and magnesium carbonate. Erythropoietins and Orlistat have the same effect. The latter may cause hypertensive crisis and even cerebral hemorrhage.

Price

The drug costs approximately 140-150 rubles. It depends on the region and pharmacy chain. If desired, you can find similar drugs, but they will cost several times less.

Analogs

Below are analogues that are cheaper in price:

The drug "Capoten" - medicine, which is an angiotensin-digesting enzyme inhibitor, refers to synthetic medicines. It contains the active element captopril and the following Excipients, like lactose, corn starch. Basically, in case of cardiac dysfunction, the drug "Capoten" is prescribed. What exactly is it used for? Let's find out in the article.

Release form

The medicine is produced in the form of square biconvex tablets white. Each tablet contains 25 mg captopril. One blister contains 10 or 14 tablets. There are 2 or 4 blisters in a pack.

The drug "Capoten": what is it used for?

The medication is prescribed for conditions such as:

• diabetic nephropathy, which develops due to diabetes mellitus (type 1);
• post-infarction period with impaired functioning of the left ventricle;
• arterial hypertension (including renovascular).

The drug "Capoten" is one of the means of combination therapy.

pharmachologic effect

In relatively short time possible if you accept this medicine(Capoten is prescribed quite often for blood pressure). At the same time, the myocardial oxygen demand decreases, and the development of tachycardia does not occur. The maximum therapeutic effect is usually achieved after an hour. The optimal value can be achieved with long-term use of the medication after several weeks. In diabetic nephropathy, the use of the drug helps slow down the development of kidney pathology.

Contraindications to the use of the medication

We have found out why Capoten tablets are prescribed, now we will look into the contraindications for use this drug. The medicine is not prescribed if the patient has the following conditions:

The drug cannot be used in pediatrics and children under 18 years of age, since the necessary clinical trials have not been conducted.

The drug "Capoten" is used with caution in the following conditions:

• primary hyperaldosteronism;
• heavy autoimmune diseases connective tissue;
• oppression of bone marrow hematopoiesis (since the development of agranulocytosis and neutropenia is possible);
• coronary disease heart or cerebral ischemia;
• following a salt-free or low-salt diet;
• in old age.

Instructions for use

The drug "Capoten", from whatever it was prescribed, is taken one hour before eating. The dose of the drug is determined individually and depends on the type and severity of the disease.

The initial dose for hypertension is 12.5 mg, take the medicine 2 times a day. Gradually increase the dose, the interval between increases can be several weeks. With moderate hypertension, take 2 tablets of the drug twice a day, a maximum of 4 tablets can be taken. In severe form, the initial dose is 12.5 mg twice a day, gradually increasing the amount to the maximum dose - three times a day, 2 tablets.

For CHF, medication is prescribed if there is no positive effect from taking diuretics. Initially, take 6.25 mg up to three times a day, after that - 25 mg three times a day, maximum dose for 24 hours - 6 tablets. It is recommended to increase the dose every 2 weeks.

In the post-infarction period, in a stable state, take 6.25 mg per day. You can gradually increase the dose to the maximum.

For diabetic nephropathy, take up to 3-4 tablets per day, divide the specified amount into 2-3 doses.

With impaired renal function in moderate or mild form take 75-100 mg per day, in severe forms - 2 tablets per day.

Those who have used the drug "Capoten" for blood pressure leave mostly positive reviews. However, this is only subject to compliance with all doctor’s instructions.

Side effects

The drug "Capoten" can have side effect, which appears:

• orthostatic hypotension, tachycardia;
• bronchospasm or pulmonary edema;
• angioedema of the mucous membranes, lips, tongue, face, larynx, pharynx, extremities;
• drowsiness, headache, ataxia, blurred vision, dizziness;
• agranulocytosis, neutropenia, thrombocytopenia, anemia.

Finally

After reading this article, you learned more about the drug "Capoten": what it is used for, how to use it correctly, possible side effects. Before using the medicine, be sure to consult a specialist.

Tradename

International nonproprietary name

Captopril.

Latin name

Pharmacological group

The product belongs to the group ACE inhibitors(angiotensin converting enzyme).

Release forms and composition

The active ingredient is captopril. 1 tablet - 25 mg active component. The product also contains excipients: cellulose, lactose, starch and stearic acid.

Mechanism of action of Capoten

Pharmacodynamics

The basis of the action of angiotensin-converting enzyme inhibitors, which include captopril, is the suppression of the renin-angiotensin-aldosterone system. Angiotensin is a substance that can bind to vascular receptors, exerting a narrowing effect on them.

Thanks to angiotensin, regulation occurs general level blood pressure. By suppressing the formation of this substance, the drug prevents hypertensive crises, regulates the secretion of aldosterone by the adrenal glands.

ACE affects the kalikrein-kinin system. The enzyme promotes the breakdown of bradykinin into inactive metabolites. Suppression of the activity of this substance contributes to the normalization of blood pressure. Under such conditions, the peripheral vessels expand, turning into a blood depot and reducing the load on the central vessels.

At orally The maximum effect is observed after 1-1.5 hours. The activity of captopril depends on the amount of the substance taken.

During long-term use, the effectiveness of the drug gradually increases. Best effect observed several weeks after continuous use. The inhibitor shows the maximum effectiveness in combination with thiazide diuretics.

Captopril helps reduce the load on the heart. Long-term use reduces hypertrophic phenomena in the left ventricle, prevents the development of heart failure.

Pharmacokinetics

The active component of the drug does not undergo metabolic transformations when it enters the body. Up to 75% of the drug is absorbed by the mucous membrane small intestine. Maximum concentration the drug in the bloodstream is observed after 1-1.5 hours.

When taking the drug with food, its absorption is reduced by 30%. In the blood, about 30% binds to transport peptides active substance.

The half-life of captopril is approximately 120 minutes. Almost completely excreted in urine 24 hours after administration. Half of the substance is excreted unchanged, half - in the form of inactive metabolites. Renal dysfunction leads to a gradual accumulation of captopril in the body.

During clinical trials penetration of the active component of the drug through the blood-brain barrier was not detected.

What does Kapoten help with?

The tool is prescribed in the following cases:

• essential arterial hypertension;
• chronic heart failure;
• myocardial hypertrophy;
• myocardial infarction;
• diabetic nephropathy;
• macroproteinuria.

Contraindications

The drug is not prescribed in the following cases:

• angioedema;
• individual hypersensitivity to the components that make up the drug;
• porphyria;
• stenosis of the renal arteries, accompanied by impaired blood circulation in the organs;
• refractory hyperkalemia;
• aortic stenosis;
• after kidney transplant;
• galactose intolerance;
• lactase deficiency;
• a history of hypersensitivity to other ACE inhibitors.

It is used with caution when:

• autoimmune diseases;
• violation of the hematopoietic function of the bone marrow;
• cerebral ischemia;
• diabetes mellitus;
• elevated aldosterone levels;
• hypotension;
• surgical interventions.

How to take Capoten

Pills

The initial dose for essential arterial hypertension is half a tablet 2 times a day. Every 14-28 days, the dosage is increased until the optimal blood pressure level is achieved.

The maintenance dose of the drug for mild to moderate cases is 50 mg, divided into 2 doses. The maximum daily dose is 100 mg. For severe arterial hypertension - 150 mg.

In case of pathology of the left ventricle after myocardial infarction, the drug can be prescribed 3 days after the attack. The initial dose is 6.25 mg three times a day. Then the dosage is gradually increased to a maximum of 150 mg. In the same dosages, the drug is prescribed in the treatment of chronic heart failure.

In diabetic nephropathy, the dose of the drug is up to 100 mg, divided into 2-3 doses.

Under the tongue or washed down

The drug is taken orally (washed down with water).

Before or after meals

It is advisable to take the product one hour before meals.

How long does it take for the drug to work?

The duration of action of the drug is about 24 hours. The effect is observed 1-1.5 hours after administration.

How many times a day to take

The dosage regimen is selected depending on pathological process and the patient's condition.

Duration of treatment

Determined individually.

At what pressure can it be taken?

It is most effective to take captopril for mild and medium degree. When the blood pressure level is above 180/110 mm Hg. Art. it is recommended to combine drugs with thiazide diuretics or other drugs.

In hypertensive crisis

For more fast action you can crush the tablet to a powdery consistency. For 1 time take about 50 mg of captopril.

Side effects

During the course of therapy, the following adverse reactions may occur:

• cardiovascular system: rhythm disturbances, chest pain, edema, Raynaud's syndrome, pallor, orthostatic hypotension;
• respiratory system: cough, shortness of breath, bronchospasm, pulmonary edema;
• immune system: itching, erythema, Stevens-Johnson syndrome, dermatitis, photosensitivity;
• nervous system: insomnia, drowsiness, dizziness, loss of coordination, headache, paresthesia, depression, stroke, blurred vision;
• blood: neutropenia, thrombocytopenia, anemia, eosinophilia;
• gastrointestinal tract: nausea, vomiting, dyspeptic symptoms, epigastric pain, constipation, anorexia, stomatitis, glossitis, ulcers on the mucous membranes of the stomach and small intestine, hepatitis;
• urinary system: polyuria, oliguria, proteinuria, increased urea nitrogen;
• others: taste disturbance, muscle and joint pain, impotence, gynecomastia, increased fatigue.

Overdose

With an overdose of this drug, a sharp decrease in blood pressure is observed, shock and collapse may develop. Slows down heartbeat, disturbed water-electrolyte balance, urine outflow.

To stabilize the patient's condition, it is necessary to wash the stomach, give him sorbents. Perhaps hemodialysis. It is recommended to carry out detoxification therapy, to introduce a solution of 0.9% sodium chloride.

Application features

During pregnancy and lactation

The drug is not used to treat pregnant and lactating women.

The prohibition of use in pregnant women is associated with a disadvantage clinical trials. There is no reason to believe that the drug may have a teratogenic effect in the first trimester of pregnancy. This does not exclude some risk to the fetus. In this regard, antihypertensive therapy in this group of patients should be carried out with the help of other drugs.

In the second and third trimester, captopril disrupts the development of the fetus, slows down its growth, causes kidney failure, hyperkalemia. In case of accidental intake of the drug during this period, it is recommended to undergo an ultrasound scan to make sure there is no pathology.

Up to 1% of the active substance taken ends up in breast milk. Because of existing risk emergence side effects It is recommended to transfer the child to artificial feeding if necessary, treatment with this drug.

In childhood

The safety of captopril in the treatment of children has not been established. If treatment with this drug is necessary, therapy should be carried out under the constant supervision of a physician. The dosage for children is selected individually in each case. It is possible to increase the interval between doses.

In old age

The initial dose for elderly people is ¼ tablet per dose. A gradual increase in the dose is possible, but the daily dosage should be selected so that the patient receives the smallest amount of the drug that ensures stabilization of blood pressure.

For impaired renal function

For moderate kidney dysfunction, the drug is prescribed at 75-100 mg per day. For more severe disorders, the maximum dose will be lower than the standard dose. Initially, 0.5 tablets are prescribed at a time.

Nitroglycerin along with this drug should be taken in low doses.

Caution should be exercised when prescribing ganglion blockers or alpha-blockers simultaneously.

In combination with non-steroidal anti-inflammatory drugs, captopril regulates blood pressure less effectively. This combination negatively affects kidney function and can cause acute renal failure.

The drug can cause an increase in the concentration of lithium in the bloodstream with the simultaneous administration of drugs containing this trace element.

Captopril potentiates the hypoglycemic effect of insulin.

Alcohol compatibility

Analogs

Analogues this tool are:

• Corinfar;
• Captopril;
• Moxonidine;
• Enap;
• Miril;
• Cardipril;
• Polapril;
• Ramigamma;
• Vitopril;
• Diroton;
• Dapril.

Photo of the drug

Latin name: Capoten

ATX code: C09AA01

Active substance: Captopril

Manufacturer: JSC "Chemical and Pharmaceutical Plant AKRIKHIN", Russia

Description is valid on: 22.11.17

Capoten is an antihypertensive drug, an ACE inhibitor.

Active substance

Captopril.

Release form and composition

Available in the form of tablets in blisters of 10 pieces (4 blisters in a pack) and 14 pieces (2 or 4 blisters in a pack).

Indications for use

• Functional disorders of the left ventricle (in particular, after myocardial infarction when the patient is in a stable condition).
• Arterial hypertension (including renovascular).
• Chronic heart failure (as part of combination treatment).
• Diabetic nephropathy caused by type I diabetes mellitus (with albuminuria more than 30 mg per day).

Contraindications

• Expressed functional disorders kidneys.
• Condition after kidney transplant.
• Arterial stenosis of a solitary kidney or bilateral renal artery stenosis with progressive azotemia.
• Combined use with aliskiren and aliskiren-containing drugs in patients with functional renal impairment or diabetes mellitus.
• Severe functional liver disorders.
• History of angioedema caused by the use of ACE inhibitors.
• Hypersensitivity to the components of the drug and other ACE inhibitors.
• Idiopathic/hereditary angioedema.
• Refractory hyperkalemia.
• Individual lactose intolerance, glucose-galactose malabsorption syndrome, lactase deficiency.
• Aortic stenosis and other obstructive changes that interfere with the outflow of blood from the left ventricle.
• The period of bearing a child and breastfeeding. The patient's age is under 18 years.

Prescribed with caution in severe autoimmune pathologies connective tissue (including scleroderma, SLE), cerebral ischemia, primary hyperaldosteronism, diabetes mellitus (the risk of developing hyperkalemia increases), coronary heart disease, conditions that provoke a decrease in circulating blood volume (including diarrhea, vomiting), chronic heart failure, arterial hypotension, liver and/or kidney dysfunction, inhibition of bone marrow hematopoiesis (there is a risk of developing agranulocytosis and neutropenia), during surgery/ general anesthesia, hemodialysis using high-strength membranes, LDL apheresis, desensitizing therapy.

The drug is also used with extreme caution in patients on hemodialysis, on a diet with low sodium intake, while taking potassium and lithium supplements, potassium-containing substitutes, potassium-sparing diuretics, procainamide, allopurinol, immunosuppressants (risk of developing agranulocytosis, neutropenia). Patients of the Negroid race and the elderly require dose adjustment.

Instructions for use Capoten (method and dosage)

The tablets are taken orally.

• For arterial hypertension, the lowest effective dose is indicated, selected individually.
• For mild to moderate hypertension, the initial dose is 12.5 mg 2 times a day. Maintenance dose – 25 mg 2 times a day. If necessary, the dose can be increased at intervals of 2-4 weeks. The effective therapeutic dose is 50 mg 2 times a day.
• For severe hypertension, an initial dose of 12.5 mg 2 times a day is prescribed, gradually increasing to 150 mg per day, divided into 3 doses. When combined with other antihypertensive drugs, the dose should be adjusted individually. The maximum daily dose is 150 mg.
• In case of heart failure, treatment is carried out under the supervision of a doctor. The initial dose is 5.25 mg 3 times a day. Maintenance – 25 mg 2-3 times a day. The dose increase interval is 2 weeks. The maximum daily dose is 150 mg.
• For myocardial infarction, treatment begins 3 days after the episode. The initial dose is 6 mg 3 times a day. Maintenance – 25 mg 3 times a day for several weeks. The maximum daily dose is 150 mg (50 mg 3 times a day). If there are signs of symptomatic hypotension, the dose should be reduced. Capoten can be combined with thrombolytics, acetylsalicylic acid and beta-blockers.
• For diabetic nephropathy, the recommended daily dose is 75-100 mg 2-3 times a day. In the case of insulin-dependent diabetes with microalbuminuria (albumin secretion of 30–300 mg per day), the drug is prescribed at a dose of 50 mg 2 times a day. If the total protein clearance is more than 500 mg per day, it is permissible to reduce the dose to 25 mg 3 times a day. Capoten can be combined with other antihypertensive drugs - diuretics, beta-blockers, centrally acting drugs, vasodilators.
• For mild to moderate renal dysfunction (creatinine clearance not less than 30 ml/min/1.72 m2), 75-100 mg per day, divided into 2-3 doses, is indicated. For severe renal dysfunction (creatinine clearance less than 30 ml/min/1.72 m2), 12.5 mg 2 times a day is indicated; if the dose is not effective enough, it is slowly increased at intervals of 1-2 weeks until a therapeutic effect occurs, provided reducing the maximum daily dose or increasing the interval between doses of the drug. If necessary, loop diuretics are additionally prescribed.

For elderly people, the dose is selected individually. Treatment begins with the lowest therapeutic dose and is maintained at this level.

The safety and effectiveness of the drug in children have not been studied.

Side effects

May cause the following side effects:

• Cardiovascular system: sometimes – cardiogenic shock, cardiac arrest; uncommon - angina pectoris, arrhythmia or tachycardia, palpitations, excessive decrease in blood pressure, orthostatic hypotension, Raynaud's syndrome, pallor, flushing of the face.
• Nervous system: sometimes – depression, confusion, disturbances cerebral circulation(including syncope and stroke), blurred vision; rarely - ataxia; uncommon – paresthesia, headache; often – insomnia, dizziness, drowsiness.
• Respiratory system: sometimes – rhinitis, bronchospasm, pulmonary edema, eosinophilic pneumonitis; often – shortness of breath, dry non-productive cough.
• Digestive system: sometimes - pancreatitis, glossitis, gum hyperplasia, gastric ulcer, increased activity of liver enzymes, cholestasis and functional liver disorders (including jaundice), hyperbilirubinemia, hepatitis (including rare cases of hepatonecrosis); rarely - aphthous stomatitis; infrequently – anorexia; often – irritation of the gastric mucosa, attacks of nausea and vomiting, constipation, diarrhea, pain in abdominal cavity, violation taste perception, dry mucous membranes oral cavity, dyspepsia.
• Musculoskeletal system: sometimes – arthralgia, myalgia.
• Immune system: sometimes – autoimmune diseases, increased titer of antinuclear antibodies.
• Hematopoietic system: sometimes - pancytopenia, neutropenia, agranulocytosis, thrombocytopenia, eosinophilia, lymphadenopathy, anemia (including hemolytic and aplastic forms).
• Reproductive system: sometimes – gynecomastia, impotence.
• Urinary system: sometimes – nephrotic syndrome; rarely - polyuria, frequent urination, oliguria, functional renal disorders (including renal failure).
• Skin and subcutaneous tissue: often – alopecia, pruritus, with or without rashes.
• Laboratory indicators: sometimes - hyperkalemia, proteinuria, hyponatremia, eosinophilia, increased concentrations of urea nitrogen, creatinine and bilirubin in the blood, decreased hemoglobin and hematocrit, platelets, leukocytes, hypoglycemia.
• Allergic manifestations: sometimes - Stevens-Johnson syndrome, urticaria, erythroderma, erythema multiforme, allergic alveolitis, photosensitivity, eosinophilic pneumonia, exfoliative dermatitis, pemphigoid reactions; rarely - angioedema of the intestine; uncommon – angioedema of the face, lips, tongue, larynx, pharynx and extremities.
• Other: rarely – hyperthermia; uncommon – chest pain, peripheral edema, asthenia, feeling of general malaise, increased fatigue.

Overdose

Symptoms of overdose: stupor, sharp decrease in blood pressure, bradycardia, shock, renal failure, water and electrolyte imbalance.

Gastric lavage, adsorbents and sodium sulfate within 30 minutes after taking the drug, 0.9% sodium chloride solution or other plasma replacement drugs, hemodialysis are indicated. For severe vagal reactions and bradycardia, atropine is prescribed. According to indications, an artificial pacemaker is prescribed. Peritoneal dialysis is ineffective.

Analogs

Analogs by ATX code: Alkadil, Captopril, Katopil, Epsitron.

Drugs with a similar mechanism of action (matching level 4 ATC code): Prestarium.

Do not make the decision to replace it yourself; consult your doctor.

pharmachologic effect

Capoten is an ACE inhibitor. It suppresses the formation of angiotensin II and eliminates its vasoconstrictive effect on arterial and venous vessels.

• The drug reduces peripheral vascular resistance, afterload, lowers blood pressure, and also reduces preload, reduces pressure in the right atrium and pulmonary circulation.
• Reduces aldosterone production in the adrenal glands.
• The peak of effectiveness is noted 60-90 minutes after ingestion. The degree of decrease in blood pressure is the same in the position of the patient standing and lying down.
• When taken with food, absorption of the drug slows down by 30-40%. The half-life is 2-3 hours. The drug is excreted in the urine up to 50% - unchanged, the rest - in the form of metabolites.

special instructions

• Monitoring of renal function is required, especially in patients with chronic heart failure. It should be taken into account that when using ACE inhibitors, a characteristic transient non-productive cough occurs.
• Rarely, ACE inhibitors cause a syndrome that begins with the appearance of cholestatic jaundice, progressing to fulminant hepatonecrosis, sometimes with death. In this regard, if there are signs of jaundice or increased liver enzyme activity, treatment with ACE inhibitors should be discontinued.
• For kidney diseases, especially with severe stenosis renal artery, there is an increase in serum urea nitrogen and creatinine concentrations after a decrease in blood pressure. This phenomenon is reversible and goes away after discontinuation of the drug. If signs of this phenomenon appear, it is necessary to reduce the dose of Capoten or discontinue the drug.
• At long-term use in 20% of patients there is an increase in serum urea and creatinine concentrations by more than 20% compared to the norm or baseline value. In 5% of patients, an increase in creatinine concentration requires discontinuation of the drug.
• The use of double blockade of the RAAS caused by the simultaneous use of ACE inhibitors and angiotensin II receptor antagonists or aliskiren and aliskiren-containing drugs is not recommended. This is fraught increased risk the development of side effects, including arterial hypotension, hyperkalemia, and renal dysfunction. The combination of ACE inhibitors and angiotensin II receptor antagonists (dual blockade of the RAAS) is possible only under the supervision of a physician and monitoring of kidney function, electrolyte levels in the blood, and blood pressure.
• For diabetic nephropathy, a combination of ACE inhibitors and angiotensin II receptor antagonists is not recommended.
• Severe arterial hypotension during treatment is rarely observed. The risk increases with loss of fluid and salts, heart failure, dialysis. To reduce the risk, the diuretic is canceled 4-7 days before taking Kapoten, or the intake of sodium chloride is increased, or treatment is started with low doses (6.25-12.5 mg per day).
• Prescribed with caution when on a diet with reduced content sodium or salt-free diet.
• Blood pressure may decrease excessively during major surgery, when using anesthetics with a hypotensive effect. An increase in BCC is required.
• Excessive reduction in blood pressure during therapy antihypertensive drugs increases the risk of myocardial infarction or stroke in patients with coronary artery disease or cerebrovascular disease. In case of arterial hypotension, the patient should be transferred to horizontal position with a low headboard, according to indications, inject intravenously 0.9% sodium chloride solution.
• Be wary appoint patients with mitral / aortic stenosis / hypertrophic obstructive cardiomyopathy. The drug is contraindicated in cardiogenic shock and hemodynamically significant obstruction.
• It should be borne in mind that when taking ACE inhibitors, cases of neutropenia or agranulocytosis, thrombocytopenia and anemia are possible. Neutropenia is rare in patients with normal function kidneys in the absence of other disorders. At renal failure the risk is increased.
• The drug is prescribed with extreme caution for autoimmune connective tissue diseases, while taking immunosuppressants, allopurinol and procainamide, especially in the presence of pre-existing renal dysfunction. Patients in these groups have an increased risk of death when using ACE inhibitors. In this regard, the number of blood leukocytes should be monitored before starting treatment, in the first 3 months - every 2 weeks, then every 2 months.
• During treatment, all patients should be monitored monthly for the number of leukocytes in the blood during the first 3 months of therapy, then every 2 months. If the number of leukocytes decreases below 4000/μl, a repeat blood test is indicated; if the number is below 1000/μl, the drug is discontinued. The number of neutrophils is restored within 2 weeks after discontinuation of the drug. 13% of cases of neutropenia lead to fatal outcome, which is almost always observed against the background of connective tissue diseases, renal or heart failure, while taking immunosuppressants, or a combination of several factors.
• Therapy with Capoten may cause proteinuria in patients with impaired renal function or those taking higher doses of the drug. As a rule, after 6 months, regardless of whether therapy continued or was canceled, proteinuria disappeared or became less pronounced. Renal function parameters in patients with proteinuria were almost always within the normal range. In patients with kidney disease, the protein content in the urine should be determined before starting treatment during the course of therapy. Sometimes taking ACE inhibitors causes an increase in the content of potassium in the blood serum. The risk of hyperkalemia is increased in patients with renal insufficiency and diabetes mellitus, as well as in people taking potassium-sparing diuretics, drugs containing potassium or causing an increase in its content in the blood. The simultaneous use of potassium-sparing diuretics and potassium supplements should be avoided. When combining ACE inhibitors with thiazide diuretics, the risk of developing hypokalemia is not excluded.
• When conducting hemodialysis in patients receiving ACE inhibitors, the use of dialysis membranes with high permeability should be avoided, which is associated with an increased risk of developing anaphylactoid reactions. Anaphylactoid reactions have also been reported in patients undergoing LDL apheresis with dextran sulfate. If dialysis is required, the antihypertensive drug should be changed or a different type of dialysis membrane should be used.
• Rarely, during therapy with ACE inhibitors, life-threatening anaphylactoid reactions occur in patients undergoing desensitization with Hymenoptera venom (bees, wasps). In this case, it is recommended to temporarily discontinue ACE inhibitor therapy.
• With angioedema, it is required to cancel the drug and conduct medical supervision until the symptoms disappear completely. Angioedema of the larynx can be fatal. Facial swelling is not required special treatment, except for antihistamines to relieve symptoms. When swelling spreads to the tongue, pharynx or larynx and threatens obstruction respiratory tract, you should immediately enter epinephrine (adrenaline) subcutaneously (0.3-0.5 ml at a dilution of 1:1000). IN rare cases in patients after taking ACE inhibitors, angioedema of the intestine was noted, which was accompanied by pain in the abdominal cavity (with or without nausea and vomiting), sometimes - with normal values C-1-esterase activity and without previous facial edema. Bowel edema should be included in the spectrum differential diagnosis patients with complaints of abdominal pain when using ACE inhibitors.
• In representatives of the Negroid race, angioedema develops more often, and ACE inhibitors, which may be associated with low renin activity.
• In diabetes mellitus while taking hypoglycemic drugs, Kapoten therapy requires careful monitoring of glycemic levels, especially in the first month of therapy with ACE inhibitors.
• With extensive surgical operations or the use of general anesthesia with a hypotensive effect, while taking ACE inhibitors, there may be an excessive decrease in blood pressure. It is required to increase the BCC.
• May cause a false positive reaction when testing urine for acetone.
• Impact on the ability to drive vehicles and operate machinery
• May cause dizziness, during therapy it is not recommended to drive vehicles and potentially dangerous species activities, especially at the beginning of treatment.

During pregnancy and breastfeeding

Contraindicated during pregnancy and lactation.

In childhood

Contraindicated for children under 18 years of age.

In old age

Prescribed with caution; dose adjustment is required.

For impaired renal function

Contraindicated in severe renal impairment, with mild and moderate impairment is prescribed with caution.

For liver dysfunction

Contraindicated in severe liver dysfunction; in mild to moderate cases, it is prescribed with caution.

Drug interactions

• Capoten may potentiate the hypotensive effect of diuretics. An excessive decrease in blood pressure is possible with strict restriction of salt intake, hemodialysis and usually occurs within the first hour after taking the first prescribed dose of the drug.
• During therapy, vasodilators should be used in the lowest effective doses due to the risk of excessive reduction in blood pressure.
• When combining Capoten and drugs that affect the sympathetic nervous system, caution should be exercised.
• At joint use with indomethacin, a decrease in the hypotensive effect is possible, especially in arterial hypertension accompanied by low renin activity. In elderly patients, or those with hypovolemia, impaired renal function, or those taking diuretics, the combination of NSAIDs and ACE inhibitors may lead to deterioration of renal function, including acute renal failure. Usually the disorders are reversible. Monitoring of renal function is required.
• Against the background of taking Kapoten, potassium-sparing diuretics, potassium preparations, potassium supplements, salt substitutes are prescribed only with proven hypokalemia.
• The combination of ACE inhibitors and lithium preparations can lead to an increase in the content of lithium in the blood serum and an increase in its toxic effects. Monitoring of lithium levels in blood serum is required.
• The combination of insulin and oral hypoglycemic agents with ACE inhibitors can lead to an excessive decrease in blood glucose concentration. It is necessary to control the concentration of glucose at the beginning of therapy with Capoten and adjust the dose of the hypoglycemic drug.
• Dual blockade of the RAAS, caused by the simultaneous use of ACE inhibitors and angiotensin II receptor antagonists or aliskiren and aliskiren-containing drugs, was associated with an increased incidence of side effects such as arterial hypotension, hyperkalemia, decreased renal function (including acute renal failure).
• The use of Kapoten while taking allopurinol or procainamide increases the risk of developing neutropenia and / or Stevens-Johnson syndrome.
• The combination with immunosuppressants increases the risk of developing hematological disorders.

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