Instructions for use DIROTON® (DIROTON®)

Pharmacodynamics and pharmacokinetics

( INN: Lisinopril) is considered an angiotensin-converting factor inhibitor and can interrupt the chain formed from angiotensin II to I. Lisinopril reduces the level of the vasoconstrictor effect of the substance - angiotensin II , while the concentration of aldosterone in the bloodstream decreases.

Lisinopril helps reduce the volume of atrial resistance. The drug Diroton, its use to lower blood pressure, does not affect the heart rate (HR) and leads to an increase in minute blood volume, as well as renal blood flow. To achieve the maximum effect, 6 hours are needed. In the future, it lasts for about a day and may vary depending on the dosage of the drug. Diroton from pressure with prolonged use reduces its effectiveness.

Pharmacokinetic data

The absorption process occurs from the gastrointestinal tract, then lisinopril , entering the blood plasma, does not bind to proteins. Typically, bioavailability is no more than 25-30%, and the diet does not change the rate of absorption. The drug is removed after 12 hours. Since the active substance is not metabolized, it is excreted unchanged in the urine. The drug Diroton does not cause withdrawal syndrome if therapy is abruptly stopped.

Diroton

The drug diroton (INN - lisinopril) is an angiotensin-converting enzyme (ACE) inhibitor, in other words, it prevents the transformation of angiotensin I into angiotensin II. This group of drugs is known to be widely used for the treatment of arterial hypertension and heart failure.

Arterial hypertension hangs like a thundercloud over the modern world, risking to exceed all conceivable limits in its prevalence. It is progressively “getting younger”, sinking its fangs into the most able-bodied part of the population and causing early disability of its victims, simultaneously reducing the quality and duration of their lives. Unfortunately, Russia has nothing to boast about here: our country traditionally occupies one of the leading places in mortality from the consequences of arterial hypertension - stroke and coronary heart disease. This is the inexorable WHO statistics. Arterial hypertension implies mandatory pharmacocorrection with drugs specially selected for this purpose. At the forefront of the fight against this disease are 6 pharmacological groups, among which the greatest evidence base for their influence on the survival of patients with heart failure and myocardial infarction are ACE inhibitors, which, among other things, have a cardioprotective effect (reverse myocardial hypertrophy). The decrease in myocardial mass is associated with a decrease in the concentration of angiotensin II in it. In this regard, there are reasons to believe that ACE inhibitors, along with the antihypertensive effect, also reduce mortality from coronary disease.

Diroton is a representative of the third generation of ACE inhibitors, produced by the Hungarian pharmaceutical company. A decrease in the content of angiotensin II under the influence of the drug automatically causes a number of beneficial effects for hypertensive patients: a decrease in general peripheral vascular resistance, blood pressure, preload on the heart, increased load tolerance of the myocardium, and improved blood supply to its ischemic areas.

The antihypertensive effect of the drug begins 1 hour after administration and reaches its apogee after 6-7 hours, persisting for another day (the duration of action of Diroton depends on the dose). In case of arterial hypertension, a noticeable effect can be achieved already in the first days of taking the drug. Stabilization of its effect is observed after 1-2 months. The antihypertensive effect of diroton is equally pronounced in both young and elderly patients. It is important that when taking the drug abruptly, the so-called rebound syndrome is not observed, i.e. There is no pronounced jump in blood pressure. Diroton can be safely taken by patients suffering from diabetes: the drug does not affect the level of glucose in the blood plasma and does not cause the risk of hypoglycemia.

Diroton is available in tablets. The frequency of administration is 1 time per day, regardless of diet. Only one thing is important: that the drug is taken at approximately the same time. Selecting a specific dose is an entire art, which is subject only to a person in a white coat (it is not for nothing that most cardiovascular drugs are dispensed with a doctor’s prescription and taken under his direct supervision). Alcohol and diroton are mutually exclusive concepts, so during treatment the patient must strictly adhere to the “prohibition law”. Due to the risk of dehydration and an unnecessarily sharp drop in blood pressure due to a decrease in the amount of circulating blood, caution should be exercised in hot weather and when performing physical exercise.

Indications for use of Diroton

• the drug is effective in chronic heart failure (as part of combination therapy);
• if it is necessary to prevent left ventricular dysfunction , heart failure , as well as maintain stable hemodynamic Diroton tablets are used - for which they are effective, incl. in acute myocardial infarction ;
• for diabetic nephropathy (reduces albuminuria );
• indications for the use of Diroton tablets also include essential and renovascular hypertension (as monotherapy or combination treatment with other antihypertensive drugs).

Diroton, 5 mg, tablets, 28 pcs.

Inside,

1 time per day, regardless of meals, preferably at the same time.

Essential hypertension:

The recommended initial dose for patients not taking antihypertensive drugs is 1 table. 10 mg 1 time per day. The usual maintenance dose is 20 mg, it can be increased to 40 mg per day, depending on the dynamics of blood pressure. The maximum daily dose is 40 mg. When increasing the dose, it should be taken into account that it takes 2–4 weeks for the effect to fully develop. If the therapeutic effect is insufficient, therapy should be supplemented with another antihypertensive agent.

Patients taking diuretics should stop taking diuretics 2-3 days before starting therapy with Diroton®. In cases where this is not possible, the initial dose of Diroton® should not exceed 5 mg/day, and it is recommended to provide medical supervision to the patient after taking the first dose, because Symptomatic arterial hypotension may develop (the maximum effect occurs 6 hours after taking the drug).

Renovascular hypertension and other conditions associated with increased activity of the RAAS:

The recommended initial dose is 2.5–5 mg/day under close medical supervision (monitoring blood pressure, renal function, serum potassium levels). The maintenance dose, while continuing strict medical supervision, should be determined depending on the dynamics of blood pressure.

Kidney failure:

since lisinopril is excreted through the kidneys, the initial dose of Diroton® depends on creatinine Cl levels: with creatinine Cl 30-70 ml/min - 5-10 mg/day, with creatinine Cl 10-30 ml/min - 2.5-5 mg/day, less than 10 ml/min, incl. patients on hemodialysis - 2.5 mg/day. The maintenance dose depends on the clinical effect and is selected with regular measurement of kidney function, potassium and sodium concentrations in the blood.

Chronic heart failure:

The initial daily dose of Diroton®, equal to 2.5 mg, can be gradually increased after 3-5 days to the usual maintenance daily dose of 5-20 mg. The dose should not exceed the maximum daily dose of 20 mg. When used simultaneously with diuretics, the dose of the diuretic should be reduced first, if possible. Before starting treatment with Diroton®, and later during treatment, blood pressure, renal function, potassium and sodium levels in the blood should be regularly monitored to avoid the development of arterial hypotension and associated renal dysfunction.

Diabetic nephropathy:

The daily dose in patients with non-insulin-dependent diabetes mellitus with normal blood pressure is 10 mg in one dose. If necessary, the dose can be increased to 20 mg 1 time per day to reduce dBP to 75 mm Hg. Art., measured in a sitting position. Dose selection for patients with insulin-dependent diabetes mellitus and arterial hypertension is carried out according to the above scheme, however, the optimal dBP should be below 90 mm Hg. Art.

Acute myocardial infarction:

in the case of using the drug Diroton® on the first day after myocardial infarction, the initial dose of the drug is 5 mg, on the second day 5 mg is re-prescribed, on the third day - 10 mg, and subsequently the maintenance dose is 10 mg / day. In patients with acute myocardial infarction, the drug is used for at least 6 weeks. For low SBP (less than 120 mm Hg), treatment begins with a low dose of 2.5 mg/day. In the case of arterial hypotension, when SBP is less than 100 mm Hg. Art., the maintenance dose is reduced to 5 mg/day; if necessary, 2.5 mg/day can be temporarily prescribed. In case of prolonged pronounced decrease in blood pressure (sBP below 90 mm Hg for more than 1 hour), it is necessary to stop treatment with the drug.

Contraindications

• a history of idiopathic angioedema , including cases with the use of ACE inhibitors ;
• Quincke's edema hereditary;
• minors (≤ 18 years old);
• pregnant and breastfeeding women;
• known hypersensitivity to the current lisinopril or auxiliary components, as well as to other ACE inhibitors .

The blood pressure medicine Diroton has instructions for use with caution

• with stenosis of the renal arteries or aortic mouth ;
• after kidney transplantation ;
• patients with renal failure with CC less than 30 ml/min;
• for obstructive hypertrophic cardiomyopathy ;
• at the primary stage of hyperaldosteronism ;
• with arterial hypotension ;
• patients with cerebrovascular diseases or cerebrovascular insufficiency;
• severe forms of diabetes mellitus ;
• for scleroderma , ischemic heart disease , systemic lupus erythematosus ;
• severe chronic heart failure;
• patients with depressed bone marrow hematopoiesis;
• in a hypovolemic state , with hyponatremia ;
• elderly patients;
• persons on hemodialysis with high-flow dialysis membranes (AN69) , as an anaphylactic reaction .

Instructions for use DIROTON® (DIROTON®)

Symptomatic hypotension

Symptomatic hypotension rarely occurs in patients with uncomplicated hypertension. In patients with arterial hypertension while taking lisinopril, arterial hypotension is more likely to occur against the background of hypovolemia, for example, when using diuretics, limiting sodium in the diet, during dialysis, diarrhea or vomiting, or the presence of severe renin-dependent hypertension. In patients with heart failure, regardless of the presence of concomitant renal failure, the development of symptomatic hypotension was observed. Symptomatic hypotension is most likely to develop in patients with more severe heart failure, in which higher doses of loop diuretics are used, hyponatremia, or functional renal failure. In patients at increased risk of developing symptomatic hypotension, careful monitoring of the condition is necessary when initiating therapy or when adjusting the dose. The same applies to patients with coronary artery disease or cerebrovascular disease, in whom an excessive decrease in blood pressure can lead to myocardial infarction or cerebrovascular accident.

If arterial hypotension occurs, the patient should be placed in a horizontal position; if necessary, intravenous infusion of 0.9% sodium chloride solution is recommended. Transient arterial hypotension is usually not a contraindication for further treatment; further treatment usually proceeds without complications after blood pressure is restored as a result of correction of hypovolemia.

In some patients with heart failure and normal or low blood pressure, an additional reduction in systemic blood pressure may be possible with the use of lisinopril. This effect is expected and is not a reason to stop treatment. If hypotension leads to clinical manifestations, dose reduction or discontinuation of lisinopril may be indicated.

Arterial hypotension in acute myocardial infarction

In the event of acute myocardial infarction, if treatment with vasodilators may seriously worsen hemodynamic status (eg, if systolic blood pressure is 100 mm Hg or lower, or in the case of cardiogenic shock), lisinopril is contraindicated. During the first 3 days after myocardial infarction, it is necessary to reduce the dose if systolic blood pressure is 120 mmHg. Art. or lower. Maintenance doses should be reduced to 5 mg or temporarily to 2.5 mg if systolic blood pressure is 100 mmHg. Art. or lower. In case of persistent arterial hypotension (systolic blood pressure below 90 mm Hg for more than 1 hour), lisinopril should be discontinued.

Aortic and mitral valve stenosis/hypertrophic cardiomyopathy

As with other ACE inhibitors, lisinopril should be used with caution in patients with mitral valve stenosis and left ventricular outflow tract obstruction, such as aortic valve stenosis or hypertrophic cardiomyopathy.

Renal dysfunction

In case of impaired renal function (creatinine clearance <80 ml/min), the initial dose of lisinopril should be adjusted depending on the plasmatic clearance (see table 1), and then on the patient’s clinical response to therapy. Routine monitoring of serum potassium and creatinine concentrations is part of standard medical practice in treating these patients.

In patients with heart failure, hypotension following administration of ACE inhibitors may lead to further deterioration of renal function. Acute renal failure, usually reversible, has been reported in this situation.

In some patients with bilateral renal artery stenosis or solitary renal artery stenosis treated with ACE inhibitors, increases in blood urea and serum creatinine were observed, usually reversible after discontinuation of therapy. This effect is more likely to occur in patients with renal impairment. In the presence of concomitant renovascular hypertension, the risk of severe arterial hypotension and renal failure increases. In such patients, treatment should be initiated under close medical supervision, using low doses and carefully titrating the dose. Because Diuretics may aggravate this condition and should be discontinued during the first weeks of lisinopril therapy and renal function monitored.

In some patients with arterial hypertension who do not have any concomitant renal vascular disease, increases in serum urea and creatinine concentrations have been observed, usually mild and short-lived, especially with simultaneous use of lisinopril and a diuretic. This effect is more likely to occur in patients with renal impairment. A dose reduction and/or discontinuation of the diuretic and/or lisinopril may be required.

Treatment with lisinopril should not be started in acute myocardial infarction in patients with impaired renal function with a serum creatinine concentration of more than 177 µmol/l and/or proteinuria exceeding 500 mg/24 hours. In the case of renal impairment that develops during treatment (creatinine concentration in serum level above 265 µmol/L or twice the initial level), discontinuation of lisinopril should be considered.

Hypersensitivity/angioedema (Quincke's edema)

In rare cases, angioedema of the face, extremities, lips, tongue, glottis and/or larynx has been reported with the use of ACE inhibitors, including lisinopril. Swelling may develop at any time during treatment. In this case, you must immediately discontinue lisinopril. The patient should receive appropriate treatment and be under medical supervision in a hospital until symptoms are completely resolved. Even if swelling appears only in the tongue area, without concomitant respiratory dysfunction, the patient may require long-term observation, because Therapy with antihistamines and corticosteroids may not be sufficient.

In very rare cases, death has been reported due to the development of angioedema of the larynx or tongue. Patients with involvement of the tongue, glottis, or larynx are at higher risk of airway obstruction, especially in the presence of airway surgery. In such cases, emergency treatment is indicated, which may include the administration of epinephrine and/or maintaining a patent airway. The patient should be under strict medical supervision until complete and sustained resolution of symptoms.

ACE inhibitors are more likely to cause angioedema in black patients than in patients of other races.

Patients who have previously had angioedema not associated with treatment with ACE inhibitors may be at greater risk of developing angioedema while taking an ACE inhibitor.

Anaphylactoid reactions in patients on hemodialysis

Anaphylactoid reactions have been reported in patients undergoing hemodialysis using high-flux, high-permeability dialysis membranes (eg, AN69) and concomitantly receiving an ACE inhibitor. In such patients, consideration should be given to using a different type of dialysis membrane or a different class of antihypertensive drug.

Anaphylactoid reactions during LDL apheresis

In rare cases, life-threatening anaphylactoid reactions may develop in patients receiving ACE inhibitors during LDL apheresis using dextran sulfate. Such reactions were avoided if the ACE inhibitor was temporarily stopped before each apheresis.

Desensitization

During desensitization (eg, insect venom) in patients receiving ACE inhibitors, persistent anaphylactoid reactions are observed. In the same patients, the occurrence of such reactions was avoided when therapy with ACE inhibitors was temporarily suspended, but they reappeared when accidentally taking these drugs.

Liver failure

In very rare cases, during therapy with ACE inhibitors, a syndrome has developed that begins with cholestatic jaundice and progresses to fulminant necrosis and (sometimes) leading to death. The mechanism of development of this syndrome has not been studied. If signs of jaundice appear or if liver enzyme activity increases significantly, treatment with lisinopril should be discontinued. The patient must be under appropriate medical supervision.

Neutropenia/agranulocytosis

Neutropenia/agranulocytosis, thrombocytopenia and anemia have been reported in patients receiving ACE inhibitors. In patients with normal renal function without other aggravating factors, neutropenia rarely develops. Neutropenia and agranulocytosis disappeared after cessation of treatment with ACE inhibitors. Lisinopril should be used with extreme caution in patients with collagen vascular disease, as well as in patients receiving immunosuppressive therapy, allopurinol or procainamide, or a combination of these complicating factors, especially if renal impairment is also present. Some of these patients developed serious infections, which in some cases did not respond to intensive antibiotic therapy. If lisinopril is used in such patients, periodic monitoring of white blood cell counts is recommended; In addition, patients should be taught the need to report any signs of infection.

Double blockade of the RAAS

There is evidence that the concomitant use of ACE inhibitors, angiotensin II receptor antagonists or aliskiren increases the risk of arterial hypotension, hyperkalemia and decreased renal function (including acute renal failure). Double blockade of the RAAS through the combined use of ACE inhibitors, angiotensin II receptor antagonists or aliskiren is not recommended for this reason.

If double blockade is absolutely necessary, treatment should be carried out under medical supervision with frequent close monitoring of renal function, electrolytes and blood pressure. In patients with diabetic nephropathy, combination therapy with ACE inhibitors and angiotensin II receptor antagonists should not be used.

Race

In black patients, ACE inhibitors cause angioedema more often than in patients of other races. As with other ACE inhibitors, lisinopril may be less effective in lowering blood pressure in black patients than in patients of other races, which is likely due to the higher incidence of low renin conditions in black patients with arterial hypertension. hypertension.

Cough

Cough has been reported during treatment with ACE inhibitors. The cough is usually dry, persistent, and stops after discontinuation of the drug. In the differential diagnosis of cough, the possibility of cough induced by ACE inhibitors should be considered.

Surgery/anesthesia

During major surgery or general anesthesia with the use of drugs that provoke the development of arterial hypotension, lisinopril can block the formation of angiotensin II after a compensatory release of renin. If arterial hypotension develops as a result of the above mechanism, correction can be made by increasing the volume of blood volume.

Hyperkalemia

Increases in serum potassium levels have been observed in some patients receiving ACE inhibitors, including lisinopril. The risk of hyperkalemia is greater in patients with renal insufficiency, diabetes mellitus, concomitant use of potassium-sparing diuretics, dietary supplements or salt substitutes containing potassium, and in patients taking drugs that may increase serum potassium levels (eg, heparin). If simultaneous use of the above drugs is mandatory, regular monitoring of serum potassium levels is recommended.

Patients with diabetes mellitus

In patients with diabetes mellitus, more careful monitoring of glucose concentrations is required in the first month of treatment with an ACE inhibitor in addition to previous treatment with insulin or oral hypoglycemic drugs.

Lithium preparations

As a rule, simultaneous use of lithium and lisinopril is not recommended.

Impact on the ability to drive vehicles and operate machinery

When driving vehicles or operating machinery, the possible development of dizziness or fatigue should be taken into account.

Side effects

These blood pressure pills can cause undesirable reactions such as dizziness and headaches (in approximately 5-6% of patients), possible weakness, diarrhea, skin rash, nausea, vomiting, dry cough (in 3%), orthostatic hypotension , chest pain (in 1-3%).

Other side effects with an incidence of less than 1% can be divided according to the organ systems from which they occur:

• CVS: decreased blood pressure, tachycardia , bradycardia , manifestations of heart failure, impaired atrioventricular conduction, possible myocardial infarction .
• Digestive system: anorexia , dry mouth, indigestion, impaired sense of taste, development of pancreatitis , hepatitis , jaundice , hyperbilirubinemia , increased activity of liver enzymes - transaminases.
• Skin: urticaria , increased sweating, photosensitivity , alopecia , itching.
• Central nervous system: sudden changes in mood, impaired attention, paresthesia , fatigue and drowsiness, confusion, cramps of the limbs and lips, asthenic syndrome .
• Respiratory system: apnea , dyspnea , bronchospasm .
• Hematopoietic system: neutropenia , leukopenia , thrombocytopenia , agranulocytosis , anemia .
• Immune system: vasculitis , angioedema , positive reaction (screening) to antinuclear antibodies , increased ESR , eosinophilia .
• Genitourinary system: decreased potency, anuria , uremia , oliguria , renal dysfunction up to acute renal failure.
• Metabolism: increased or decreased potassium content in the blood, decreased concentration of sodium, magnesium, chlorine, increased concentration of calcium, uric acid , urea , creatinine , cholesterol , hypertriglyceridemia .
• Among others: arthralgia , fever , arthritis , myalgia , exacerbation of gout .

Side effects of the drug Diroton

dizziness, headache, feeling of weakness, diarrhea, dry cough, vomiting, nausea, orthostatic effect, skin rash, chest pain, angioedema of the face, limbs, lips, tongue, epiglottis, larynx. If angioedema develops, the drug is discontinued, and adequate emergency therapy is prescribed to prevent airway obstruction: 0.3–0.5 ml of 0.1% epinephrine solution subcutaneously or 0.1 ml (0.1 mg) intravenously slowly, corticosteroids, antihistamines. When using the drug, changes in laboratory parameters are possible: agranulocytosis, decreased levels of hemoglobin and hematocrit, hyperkalemia, increased levels of creatinine and urea nitrogen in the blood serum (especially in the presence of kidney disease, diabetes mellitus, renovascular hypertension).

Diroton tablets, instructions for use (Method and dosage)

The medicine is taken orally once a day, regardless of diet, preferably at approximately the same time of day.

For essential hypertension

If therapy with other antihypertensive drugs , then the initial daily dose should not exceed 10 mg, maintenance is usually raised to 20 mg. After studying the dynamics, it can be increased to a maximum of 40 mg, taking into account that the full development of the effect is observed in 2–4 weeks. If the patient's therapeutic effect is not sufficiently pronounced, then therapy is supplemented with another antihypertensive drug .

Attention! Before taking Diroton, it is necessary to discontinue diuretic approximately 2-3 days in advance, otherwise the initial dose of Diroton should not exceed 5 mg/day. Treatment is carried out under medical supervision due to the risk of developing symptomatic arterial hypotension .

For renovascular hypertension and other conditions caused by increased activity of the RAAS hormonal system

It is recommended to begin therapy with a daily dose of 2.5–5 mg/day, preferably in a hospital under enhanced monitoring, including monitoring of blood pressure , renal function, and serum potassium concentration. The maintenance dose is determined based on monitoring the dynamics of blood pressure.

People with renal failure

Dose adjustment is required, which is based on regular assessment of creatinine clearance. So, at a Cl of 30–70 ml/min, treatment begins with 5–10 mg of lisinopril per day, at 10–30 ml/min – 2.5–5 mg/day.

hemodialysis patients should not exceed 2.5 mg.

For chronic heart failure

The initial daily dose is 2.5 mg, which can be gradually increased after 3-5 days to a standard maintenance dose of 5 to 20 mg. If diuretics , then their dose is reduced to the maximum possible. Treatment should begin with a study and be subsequently accompanied by monitoring of blood pressure , renal function, potassium and sodium concentrations, which will prevent the development of arterial hypotension , as well as impaired renal function.

For diabetic nephropathy

The recommended daily dose is 10 mg, which can be increased to a maximum of 20 mg. This gives a lasting reduction in diastasis. Blood pressure up to 75 mm Hg, which should be measured with the patient in a sitting position.

Instructions for use of Diroton for patients who have suffered acute myocardial infarction

On day 1 after a myocardial infarction, the patient is given an initial dose of 5 mg, on day 2 - again 5 mg, on day 3 - 10 mg, continuing treatment with a maintenance daily dose of no more than 10 mg for 6 weeks. If patients have low systemic blood pressure , it is recommended to start treatment with a lower dose of 2.5 mg.

Use of the drug Diroton

Orally 1 time per day in the morning. Since food intake does not have a significant effect on the absorption of lisinopril, it can be taken before or after meals at the same time. Essential hypertension (arterial hypertension) The recommended starting dose for adults not receiving other antihypertensive drugs is 10 mg once daily. The usual maintenance dose is 20 mg/day, which, taking into account the dynamics of blood pressure, can be increased to 40 mg/day. If the drug at the indicated dose does not provide the desired therapeutic effect, another antihypertensive agent can be additionally prescribed. A 2-4 week course of treatment may be required to develop the full therapeutic effect, which should be taken into account when increasing the dose. If the patient has previously received diuretic therapy, diuretics should be stopped 2-3 days before starting Diroton. If this is not possible, the initial dose of the drug should not exceed 5 mg/day. In this case, after taking the first dose, it is recommended to monitor the patient’s condition for several hours (the maximum effect is achieved after about 6 hours), since symptomatic hypotension may occur. Renovascular hypertension (arterial hypertension) For renovascular hypertension (arterial hypertension), accompanying conditions with increased activity of the renin-angiotensin-aldosterone system, it is advisable for adults to prescribe lisinopril in a low initial dose - 2.5-5 mg / day, under careful monitoring of blood pressure, function kidneys, serum potassium levels. The maintenance dose is determined taking into account the dynamics of blood pressure. Renal failure Due to the fact that lisinopril is excreted by the kidneys, the initial dose is determined taking into account creatinine clearance, then, depending on the response to therapy, a maintenance dose is established while continuing to monitor renal function, potassium and sodium levels in the blood serum.

Heart failure Diroton can be used in combination with diuretics and/or cardiac glycosides. Before prescribing it, the dose of the diuretic should be reduced if possible . The initial daily dose in adults is 2.5 mg, which can subsequently be increased to the usual maintenance dose of 5–10 mg/day. The maximum daily dose for adults is 20 mg.

Overdose

Possible symptoms

Reduced blood pressure , dry mouth, constipation, drowsiness, anxiety, urinary retention, increased irritability.

Activities carried out for treatment

• purpose of activated carbon ;
• gastric lavage;
• replenishment of blood volume (for example, intravenous plasma replacement solutions );
• symptomatic therapy;
• hemodialysis;
• control of vital functions.

Interaction

• Carrying out therapy simultaneously with potassium-sparing diuretics (for example, Spironolactone , Triamterene , Amiloride ) and other potassium-containing drugs increases the likelihood of hyperkalemia .
• With sodium aurothiomalate a symptom complex occurs , including nausea, vomiting, flushing and arterial hypotension .
• β-blockers , slow Ca channel blockers , diuretics and other antihypertensive drugs potentiate the hypotensive effect.
• With NSAIDs , including selective COX-2 inhibitors , estrogens , and adrenergic agonists , the antihypertensive effect is reduced.
• With vasodilators , tricyclic antidepressants , barbiturates , phenothiazines , ethanol-containing drugs, the hypotensive effect is also potentiated.
• lithium excretion is slowed down , which enhances its cardiotoxic and neurotoxic effects.
• Antacids and Cholestyramine reduce the rate of absorption from the gastrointestinal tract.
• Lisinopril is able to enhance the neurotoxicity of salicylates , weaken the effect of hypoglycemic drugs , Epinephrine , Norepinephrine , anti-gout drugs , enhance the effects (including undesirable ones) of cardiac glycosides , peripheral muscle relaxants , and reduce the rate of elimination of Quinidine .
• Reduces the effect of oral contraceptives .
• With Methyldopa , the risk of hemolysis increases.

During pregnancy and lactation

Due to the fact that the drug is able to penetrate the placental barrier, there is a risk of developing in the fetus (II and III trimester):

• hypoplasia of the skull;
• pronounced decrease in blood pressure ;
• hyperkalemia;
• renal failure;
• Possible lethal outcome - intrauterine death .

Newborns exposed to ACE inhibitors require careful medical monitoring due to the risk of developing a persistent decrease in blood pressure , hyperkalemia , and oliguria .

Diroton analogs

Level 4 ATC code matches:
Dilaprel

Prenesa

Enap

Lipril

Renipril

Parnavel

Fozinap

Tritace

Enam

Zokardis

Fosinopril

Lisinopril

Captopril

Monopril

Renitek

Hartil

Phosicard

Amprilan

Ramipril

Perindopril

The price of Diroton analogues does not fluctuate significantly - within 50-100 rubles. depending on the number of tablets, country of production and other pricing factors. You should look for what can replace this antihypertensive drug based on monitoring the dynamics of blood pressure and the individual susceptibility of the body, in consultation with your doctor. There are drugs that have the same active substance, among them are:

• Aurolaise;
• Vitopril;
• Dapril;
• Lizinocore.

Diroton price, where to buy

The average price of Diroton 5 mg (No. 14) is 92 rubles, 2.5 mg (No. 28) is 115 rubles, 20 mg (No. 28) is 450 rubles, while the price of Diroton 10 mg (large package No. 56 ) is 515 rubles.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine
• Online pharmacies in KazakhstanKazakhstan

ZdravCity

• Diroton Plus capsules with mod.
  release 1.5mg+20mg 28 pcs. JSC Gedeon Richter / Gedeon Richter-RUS JSC RUR 329 order
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• Diroton tablets 20 mg 28 pcs. Gedeon RichterGedeon Richter-RUS ZAO

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• Diroton tablets 10 mg 56 pcs. Gedeon Richter-RUS ZAO

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Pharmacy Dialogue

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• Diroton Plus (caps. with modified highs. 1.5 mg + 10 mg No. 28) Gedeon-Richter-RUS ZAO

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Pharmacy24

• Diroton 20 mg No. 56 tablets VAT "Gedeon Richter", Ugorshchina
  397 UAH. order
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PaniPharmacy

• Co-Diroton tablets Co-Diroton tablets. 20mg+12.5mg No. 30 Poland, Gedeon Richter Poland

  237 UAH order

• Diroton tablets Diroton tablets. 10mg No. 56 Hungary, Gedeon Richter

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• Diroton tablets Diroton tablets. 20 mg No. 56 Hungary, Gedeon Richter

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• Diroton tablets Diroton tablets. 5mg No. 56 Hungary, Gedeon Richter

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• Diroton tablets Diroton tablets. 5mg No. 28 Hungary, Gedeon Richter

  107 UAH order

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