Iruzid
Iruzid: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Use in the elderly
- 14. Drug interactions
- 15. Analogs
- 16. Terms and conditions of storage
- 17. Terms of dispensing from pharmacies
- 18. Reviews
- 19. Price in pharmacies
Latin name: Iruzid
ATX code: C09BA03
Active ingredient: Lisinopril dihydrate, hydrochlorothiazide
Manufacturer: BELUPO, drugs and cosmetics dd, Republic of Croatia
Description and photo update: 19.10.2018
Prices in pharmacies: from 292 rubles.
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Iruzid is a combined drug with an antihypertensive, diuretic effect.
Release form and composition
Iruzid dosage form - tablets: biconvex; 10 + 12.5 mg - blue, hexagonal; 20 + 12.5 mg - yellow, hexagonal; 20 + 25 mg - light pink, round (30 pcs. In blisters, 1 blister in a cardboard box).
Active ingredients in 1 tablet:
- lisinopril dihydrate (in terms of anhydrous lisinopril) - 10/20/20 mg;
- hydrochlorothiazide - 12.5 / 12.5 / 25 mg.
Additional components: indigo carmine, mannitol, calcium phosphate dihydrate, pregelatinized and corn starch, magnesium stearate.
Pharmacological properties
Pharmacodynamics
Iruzid is a combined antihypertensive drug. It has a diuretic and antihypertensive effect.
When combined, the active ingredients have an additive antihypertensive effect.
Lisinopril
Lisinopril is one of the ACE inhibitors (angiotensin converting enzyme), helps to reduce the formation of angiotensin II from angiotensin I. A decrease in the content of angiotensin II leads to a direct decrease in the release of aldosterone.
Other effects of lisinopril:
- a decrease in the degradation of bradykinin and an increase in the synthesis of prostaglandins;
- decrease in total peripheral vascular resistance, blood pressure (blood pressure), preload, pressure in the pulmonary capillaries;
- increased exercise tolerance and increased minute blood volume in patients with chronic heart failure;
- vasodilation (arteries to a greater extent than veins);
- a decrease in the severity of myocardial hypertrophy and the walls of resistive arteries (with prolonged therapy);
- improving the blood supply to the ischemic myocardium;
- prolongation of life expectancy in patients with chronic heart failure;
- slowing the progression of left ventricular dysfunction in patients who have had myocardial infarction without clinical manifestations of heart failure.
Some of the effects are attributed to the effect on tissue renin-angiotensin systems.
The antihypertensive effect begins to develop after about 6 hours, the effect lasts for 24 hours. The duration of the effect also depends on the size of the dose. The effect in arterial hypertension is observed in the first days after the start of therapy, a stable effect develops after 1–2 months.
In the case of abrupt withdrawal of Iruzid, a pronounced increase in blood pressure is not observed.
In addition to lowering blood pressure, lisinopril also reduces albuminuria. In case of hyperglycemia, taking Iruzid helps to normalize the function of the damaged glomerular endothelium.
Lisinopril does not affect the concentration of glucose in the blood in diabetic patients. Also, therapy does not cause an increase in cases of hypoglycemia.
Hydrochlorothiazide
Hydrochlorothiazide is a thiazide diuretic. Its diuretic effect is associated with impaired reabsorption of magnesium, potassium, sodium, chlorine and water ions in the distal nephron. The development of hypotensive action is provided by the expansion of arterioles. It has antihypertensive properties, delays the excretion of uric acid and calcium ions.
It practically does not affect normal blood pressure.
The development of diuretic action is observed after 1–2 hours, reaching a maximum after 4 hours. The duration of the effect is from 6 to 12 hours.
The antihypertensive effect develops after 3-4 days, but it may take 3 to 4 weeks to achieve the optimal therapeutic effect.
Pharmacokinetics
Lisinopril
It is absorbed from the gastrointestinal tract quickly, absorption does not depend on food intake and is 30%. C max is observed 6-8 hours later after taking the drug. The connection with blood proteins is weak, bioavailability is 29%. It crosses the blood-brain barrier in small quantities. It is excreted unchanged by the kidneys, without biotransformation in the body, the half-life is 12 hours.
Hydrochlorothiazide
Absorption of hydrochlorothiazide - 60-80%, does not depend on food intake. The maximum concentration in the blood is observed after 3 hours from the moment of taking the drug. It binds to blood proteins by 40–70%, accumulates in erythrocytes, and is poorly metabolized.
Excretion from the body occurs in two phases, mainly with urine.
Indications for use
According to the instructions, Iruzid is prescribed for the treatment of arterial hypertension if there are indications for combination therapy.
Contraindications
Absolute:
- anuria;
- severe renal failure (with creatinine clearance <30 ml / min);
- angioneurotic edema (including a burdened history of this condition associated with the use of ACE inhibitors);
- hemodialysis using high-flow membranes;
- hypercalcemia;
- hyponatremia;
- porphyria;
- precom;
- hepatic coma;
- diabetes mellitus in severe forms;
- age up to 18 years;
- pregnancy and the period of breastfeeding;
- individual intolerance to the components of the drug, as well as other ACE inhibitors and sulfonamide derivatives.
Relative (diseases / conditions in the presence of which the appointment of Iruzid requires caution):
- primary hyperaldosteronism;
- hypertrophic cardiomyopathy / aortic stenosis;
- stenosis of an artery of a single kidney, proceeding with progressive azotemia;
- bilateral renal artery stenosis;
- renal failure (with creatinine clearance> 30 ml / min);
- conditions after kidney transplantation;
- bone marrow hypoplasia;
- arterial hypotension;
- hypovolemic conditions (including diarrhea, vomiting);
- hyponatremia (in patients on a low-salt or salt-free diet, there is an increased risk of arterial hypotension);
- diabetes;
- connective tissue diseases (scleroderma, systemic lupus erythematosus);
- oppression of bone marrow hematopoiesis;
- gout;
- hyperkalemia;
- hyperuricemia;
- cerebrovascular disease (including cerebrovascular accident);
- cardiac ischemia;
- liver failure;
- severe chronic heart failure;
- elderly age.
Instructions for the use of Iruzid: method and dosage
The drug is taken orally.
Usually, 1 tablet is prescribed (10 + 12.5 mg or 20 + 12.5 mg, in some cases 20 + 25 mg) once a day.
The use of Iruzid in renal failure:
- uncomplicated renal failure: initial dose - 5-10 mg of lisinopril;
- creatinine clearance 30–80 ml / min: the drug can be prescribed only after selecting the dose of individual components.
Symptomatic hypotension may develop after taking the initial dose of Iruzid. Most often, such cases are observed in patients who have had a loss of electrolytes and fluid due to the previous use of diuretics. In this regard, before taking the drug for 2-3 days, diuretic therapy is canceled.
Side effects
Disorders that most often develop during therapy are headache, dizziness.
Other adverse reactions:
- digestive system: taste changes, dry mouth, nausea, vomiting, abdominal pain, dyspepsia, diarrhea, anorexia, jaundice, pancreatitis, cholestatic / hepatocellular hepatitis;
- cardiovascular system: chest pain, marked decrease in blood pressure; rarely - tachycardia, orthostatic hypotension, bradycardia, violation of atrioventricular conduction, the appearance of symptoms of heart failure, myocardial infarction;
- skin: itchy skin, urticaria, photosensitivity, increased sweating, hair loss;
- respiratory system: bronchospasm, dyspnea, apnea;
- nervous system: convulsive twitching of the muscles of the limbs and lips, drowsiness, impaired concentration, mood lability, paresthesia, increased fatigue; rarely - confusion, asthenic syndrome;
- genitourinary system: oliguria / anuria, uremia, impaired renal function, decreased potency, acute renal failure;
- hematopoietic system: anemia (erythrocytopenia, decreased hematocrit, hemoglobin content), leukopenia, thrombocytopenia, agranulocytosis, neutropenia;
- laboratory parameters: hypochloremia, hyperglycemia, hyperuricemia, hypokalemia / hyperkalemia, hypomagnesemia, hyponatremia, hyperbilirubinemia, hypertriglyceridemia, hypercholesterolemia, hypercalcemia, increased plasma levels of creatinine and urea in the blood, decreased liver transmissibility, increased glucose tolerance, increased glucose tolerance kidney disease, renovascular hypertension and diabetes mellitus;
- allergic reactions: angioedema of the face, extremities, tongue, lips, larynx and / or epiglottis, eosinophilia, skin rashes, increased ESR, pruritus, vasculitis, fever, positive reactions to antinuclear antibodies;
- others: exacerbation of gout, fetal malformation, dry cough, arthritis, arthralgia, fever, myalgia.
Overdose
The main symptoms are: dry mouth, marked drop in blood pressure, drowsiness, anxiety, urinary retention, constipation, irritability.
Therapy: symptomatic; intravenous fluid administration, control of blood pressure, urea, electrolytes and serum creatinine, as well as diuresis; measures aimed at correcting violations of the water-salt balance and dehydration.
special instructions
Most often, a pronounced decrease in blood pressure is observed with a decrease in fluid volume, which is caused by the use of diuretics, a decrease in the amount of salt in food, dialysis, vomiting, or diarrhea.
In chronic heart failure with / without renal failure, a marked decrease in blood pressure is also possible. This is most often observed in patients with severe heart failure, as a result of therapy with high doses of diuretics, impaired renal function, or hyponatremia. In such cases, it is necessary to start taking Iruzid under strict medical supervision. The same rules must be followed when prescribing a drug for ischemic heart disease, cerebrovascular insufficiency, since a sharp drop in blood pressure can cause a stroke or myocardial infarction.
A transient hypotensive reaction is not a contraindication for further administration of Iruzid.
Before starting therapy, if possible, it is necessary to normalize the sodium concentration indicators and / or replenish the lost volume of fluid; after taking the initial dose, the patient's condition should be closely monitored.
In chronic heart failure, a pronounced decrease in blood pressure after initiation of therapy may cause further deterioration in renal function. There is information about the development of acute renal failure. In patients with stenosis of the artery of a solitary kidney or bilateral stenosis of the renal arteries who received Iruzid, there was an increase in the level of creatinine and urea in the blood serum (as a rule, it is reversible).
In cases of development of angioedema of the face, extremities, tongue, lips, larynx, epiglottis, the drug is immediately canceled, after which the patient's condition is monitored. If the swelling occurs only on the lips and face, additional therapy is often not required, but antihistamines may be prescribed. Angioneurotic edema with laryngeal edema can be fatal. When covering the tongue, larynx or epiglottis, airway obstruction is possible, therefore immediate treatment (subcutaneously 0.3-0.5 ml of epinephrine solution 1: 1000) and / or measures to ensure airway patency is required.
In patients with a history of angioedema not associated with previous use of ACE inhibitors, an increased risk of its development is usually observed during the period of use of Iruzid.
During treatment, there may be a prolonged, dry cough, which passes after discontinuation of the drug (must be taken into account when conducting a differential diagnosis).
Anaphylactic reactions can also occur in patients who are on hemodialysis using dialysis membranes with high permeability. In such cases, it is recommended to consider using another drug with an antihypertensive effect or a different type of dialysis membrane.
It must be borne in mind that the use of Iruzid during major surgical interventions or during general anesthesia can block the formation of angiotensin II. A pronounced decrease in blood pressure, which is considered a consequence of this mechanism, can be eliminated by increasing the volume of circulating blood. Before surgery (including dentistry), the surgeon / anesthesiologist should be warned about taking the drug.
In some cases, taking Iruzid is accompanied by hyperkalemia. Risk factors include diabetes mellitus, renal failure, combined use with potassium preparations or drugs leading to an increase in the concentration of potassium in the blood, especially against the background of impaired renal function. In patients who have a likelihood of symptomatic hypotension (following a low-salt / salt-free diet) with / without hyponatremia, as well as patients receiving high doses of diuretics, the conditions listed above must be compensated for before starting therapy.
Thiazide diuretics can affect glucose tolerance, and therefore the dose of antidiabetic drugs must be adjusted.
Thiazide diuretics can cause hypercalcemia and decrease urinary calcium excretion. Severe hypercalcemia may be a symptom of latent hyperparathyroidism. It is not recommended to use the drug before the test to assess the function of the parathyroid glands.
During the period of therapy, it is necessary to regularly monitor blood plasma glucose, potassium, urea, fats and lipids.
The use of alcoholic beverages during the use of Iruzid must be abandoned, since ethanol leads to a significant decrease in blood pressure.
Care should be taken when exercising and during hot weather, as there is a possibility of dehydration and an excessive decrease in blood pressure, which is associated with a decrease in circulating blood volume.
Influence on the ability to drive vehicles and complex mechanisms
Due to the likelihood of dizziness, care must be taken when driving vehicles, especially at the beginning of the use of the drug.
Application during pregnancy and lactation
Pregnancy and lactation are contraindications for taking Iruzid.
The use of the drug in the II – III trimesters of pregnancy adversely affects the fetus. Possible consequences: hyperkalemia, renal failure, cranial hypoplasia, marked decrease in blood pressure, intrauterine death. For the condition of newborns / infants who have been exposed to intrauterine exposure to the drug, it is recommended to establish observation.
Pediatric use
Patients under 18 years of age are not prescribed Iruzid (safety and effectiveness of its use have not been established).
With impaired renal function
With severe renal failure (with creatinine clearance of 30 ml / min Iruzid should be used with caution.
For violations of liver function
In liver failure, the drug should be used with caution.
Use in the elderly
Elderly patients should take iruzid with caution.
Drug interactions
Possible interactions:
- vasodilators, barbiturates, phenothiazines, tricyclic antidepressants, ethanol: increasing the hypotensive effect of Iruzid;
- potassium-sparing diuretics (triamterene, spironolactone, amiloride), potassium preparations, salt substitutes with potassium content: an increase in the likelihood of hyperkalemia, especially against the background of impaired renal function (before prescribing this combination, the doctor must assess the benefit-risk ratio; regular monitoring of serum potassium levels is required and renal function);
- lithium preparations: slowing down the excretion of lithium from the body (increasing its neurotoxic / cardiotoxic effect);
- non-steroidal anti-inflammatory drugs, estrogens: decrease in the antihypertensive effect of lisinopril;
- salicylates: increased neurotoxicity;
- antacids, cholestyramine: decreased absorption of the drug in the gastrointestinal tract;
- cardiac glycosides: enhancement of their effects (including side effects);
- oral hyperglycemic drugs, norepinephrine, epinephrine, drugs with anti-gout effects: weakening their action;
- quinidine: reducing its excretion;
- peripheral muscle relaxants: enhancing their action;
- ethanol: strengthening the hypotensive effect of Iruzid;
- oral contraceptives: decrease in their effectiveness;
- methyldopa: increased likelihood of hemolysis.
Analogs
Iruzid's analogs are: Ko-Diroton, Lisinopril ND-KRKA, Lisinopril NL 20-KRKA, Lisinopril NL-KRKA, Listril Plus, Liten N, Lizoretic, Rileis-Sanovel plus.
Terms and conditions of storage
Store at temperatures up to 25 ° C. Keep out of the reach of children.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Iruzid
According to reviews, Iruzid is an effective drug in cases where combination therapy is indicated. It is noted that blood pressure decreases rapidly and sharply, however, after the correct selection of the dose, the drug is well tolerated.
Price for Iruzid in pharmacies
The approximate price for Iruzid (30 tablets in a blister) is:
- 10 + 12.5 mg: 360-510 rubles;
- 20 + 12.5 mg: 440-620 rubles;
- 20 + 25 mg: 470-670 rubles.
Iruzid: prices in online pharmacies
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Drug name Price Pharmacy |
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Iruzid 10 mg + 12.5 mg tablets 30 pcs. 292 r Buy |
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Iruzid 20 mg + 25 mg tablets 30 pcs. RUB 350 Buy |
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Iruzid 20 mg + 12.5 mg tablets 30 pcs. RUB 417 Buy |
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Iruzid tablets 20mg + 25mg 30 pcs. RUB 481 Buy |
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Iruzid tablets 20mg + 12.5mg 30 pcs. 487 r Buy |
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
