Irumed
Irumed: 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: Irumed
ATX code: C09AA03
Active ingredient: lisinopril (Lisinopril)
Manufacturer: BELUPO, Pharmaceuticals & Cosmetics, dd (Croatia)
Description and photo update: 2020-28-07
Prices in pharmacies: from 139 rubles.
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Irumed is an ACE (angiotensin converting enzyme) inhibitor.
Release form and composition
Dosage form - tablets: round, scored on one side:
- dosage 2.5 mg: white, biconvex;
- dosage 5 mg: white, flat-cylindrical;
- dosage 10 mg: light yellow, flat-cylindrical;
- dosage 20 mg: peach-colored, flat-cylindrical.
The tablets are packed in blisters of 30 pcs. 1 blister and instructions for use of Irumed are placed in a cardboard box.
Composition of 1 tablet:
- active substance: lisinopril dihydrate - 2.5; five; 10 or 20 mg (in terms of anhydrous lisinopril);
- auxiliary components: colloidal silicon dioxide, corn starch, magnesium stearate, pregelatinized corn starch, calcium phosphate dihydrate, mannitol; additionally for tablets with a dosage of 10 mg - dye iron oxide yellow (E 172), for tablets with a dosage of 20 mg - dyes of iron oxide red (E 172) and iron oxide yellow (E 172).
Pharmacological properties
Pharmacodynamics
The main effect of lisinopril is to reduce the formation of angiotensin II from angiotensin I. This process directly causes a decrease in the release of aldosterone. The drug has the ability to increase the synthesis of prostaglandins and reduce the degradation of bradykinin.
Under the influence of lisinopril, blood pressure (BP), total peripheral vascular resistance (OPSR), preload and pressure in the pulmonary capillaries decrease, as well as the minute blood volume increases, and the myocardial tolerance to stress in patients with chronic heart failure (CHF) increases.
Lisinopril dilates the arteries more than the veins. With prolonged use, it reduces hypertrophy of the myocardium and arterial walls of the resistive type.
Another effect of the drug is to improve the blood supply to the ischemic area of the myocardium. Like other ACE inhibitors, in people with CHF, Irumed increases life expectancy, and in people who have had myocardial infarction and do not have clinical symptoms of heart failure, it slows down the further worsening of left ventricular dysfunction.
After taking the drug, the effect of lisinopril begins after 1 hour, the maximum effect is achieved after 6–7 hours and lasts up to 24 hours. With arterial hypertension, an improvement in the condition is observed already in the first days of using the drug, the condition is completely stabilized after 1–2 months. Abrupt withdrawal of Irumed does not cause a significant increase in blood pressure.
In addition to lowering blood pressure, the drug also reduces albuminuria. In hyperglycemia, it normalizes the function of the damaged glomerular endothelium.
Irumed can be used in diabetes mellitus, since it does not cause changes in blood glucose levels, does not increase the risk of hypoglycemia.
Pharmacokinetics
With oral administration of Irumed, approximately 25% of lisinopril is absorbed from the gastrointestinal tract. Simultaneous food intake does not affect this process.
The bioavailability of the drug is about 30%. The maximum plasma concentration is observed after about 6-8 hours.
It binds to plasma proteins slightly. It crosses the blood-brain barrier at very low concentrations.
Biotransformation in the body is not exposed.
The half-life is 12 hours.
Indications for use
- arterial hypertension (as monotherapy or as part of complex treatment in combination with other antihypertensive drugs);
- CHF (in combination with diuretics and / or digitalis drugs);
- acute myocardial infarction with stable hemodynamic parameters (treatment in the first 24 hours as part of combination therapy to maintain hemodynamic parameters, prevent heart failure and left ventricular dysfunction);
- diabetic nephropathy (to reduce serum albumin in urine in non-insulin-dependent patients with arterial hypertension and insulin-dependent patients with normal blood pressure).
Contraindications
Absolute:
- idiopathic edema;
- hereditary Quincke's edema;
- a history of angioedema of any genesis;
- period of pregnancy and lactation;
- age up to 18 years;
- hypersensitivity to any component of Irumed or other ACE inhibitors.
Relative (ACE inhibitor should be used with caution):
- arterial hypotension;
- cardiac ischemia;
- aortic stenosis;
- coronary insufficiency;
- hypertrophic obstructive cardiomyopathy;
- oppression of bone marrow hematopoiesis;
- cerebrovascular disease (including cerebrovascular accident);
- severe autoimmune systemic diseases of the connective tissue (for example, scleroderma or systemic lupus erythematosus);
- hyperkalemia;
- primary aldosteronism;
- azotemia;
- diabetes;
- conditions accompanied by a decrease in circulating blood volume (BCC), including diarrhea and vomiting;
- renal failure;
- condition after kidney transplantation;
- stenosis of an artery of a single kidney or bilateral stenosis of the renal arteries;
- the need for adherence to a diet involving restriction of table salt in the diet;
- elderly age.
Irumed, instructions for use: method and dosage
Irumed tablets must be taken orally once a day in the morning. It is desirable that the time of admission is approximately the same every day. The medicine is recommended to be taken before or after breakfast.
Arterial hypertension
The initial dose for essential hypertension is 10 mg, the maintenance dose is 20 mg. If necessary, the doctor can increase the daily dose to the maximum allowable - 40 mg. When increasing the dose, it should be borne in mind that the optimal effect of lisinopril develops within 2-4 weeks of regular intake of the drug. If the therapeutic effect from the use of the maximum dose is not enough, the possibility of prescribing another antihypertensive agent should be considered.
If the patient took diuretics before Irumed's appointment, they should be discontinued and lisinopril should be started in 2-3 days. If it is not possible to take a break, the initial dose of Irumed should be reduced to 2.5 or 5 mg.
The minimum initial dose of 2.5 or 5 mg is also recommended for patients with renovascular hypertension or other conditions accompanied by an increase in the function of the renin-angiotensin-aldosterone system (RAAS). Treatment should be carried out under close monitoring of blood pressure, serum potassium concentration and renal function.
In the future, the maintenance dose is set individually, depending on how much blood pressure reduction was achieved.
For patients with renal insufficiency and who are on hemodialysis, the initial dose of Irumed is determined depending on the creatinine clearance (CC):
- CC 30–70 ml / min - 5–10 mg;
- CC 10-30 ml / min - 2.5 or 5 mg;
- CC <10 ml / min - 2.5 mg.
The maintenance dose is prescribed based on blood pressure readings. Treatment is carried out under the control of the functional state of the kidneys, the content of sodium and potassium in the blood.
Chronic heart failure
Irumed is used in combination with cardiac glycosides and / or diuretics. It is recommended to reduce the dose of the latter before starting lisinopril.
It is recommended to start treatment with a dose of 2.5 mg. If the effect is insufficient, it is gradually increased (by 2.5 mg every 3-5 days) until a daily dose of 5-10 mg is reached. In rare cases, it is possible to increase the dose to the maximum allowable dose of 20 mg.
Acute myocardial infarction
Irumed is prescribed in the first 24 hours as part of a combination therapy, subject to stable hemodynamic parameters.
In the first two days, 5 mg is prescribed 1 time per day, then - 10 mg 1 time per day. The duration of treatment should be at least 6 weeks.
In the case of initially low systolic blood pressure (≤ 120 mm Hg) in the first three days, the dose should be 2.5 mg once a day.
If systolic blood pressure drops to 100 mm Hg. Art. or lower after the start of taking Irumed, it is necessary to temporarily reduce the daily dose of the drug to 2.5 mg.
With a pronounced decrease in systolic blood pressure (<90 mm Hg within 1 hour), the drug should be canceled.
Diabetic nephropathy
Patients with non-insulin dependent diabetes mellitus are prescribed 10 mg per day. In some cases, it is possible to increase the daily dose to 20 mg in order to achieve a diastolic blood pressure of <75 mm Hg. Art. in a sitting position.
Patients with insulin-dependent diabetes mellitus are prescribed Irumed in the same dose to achieve a diastolic blood pressure of <90 mm Hg. Art. in a sitting position.
Side effects
- on the part of the cardiovascular system: chest pain, marked decrease in blood pressure; rarely - palpitations, aggravation of symptoms of heart failure, orthostatic hypotension, atrioventricular conduction disorder, bradycardia, tachycardia, myocardial infarction;
- from the respiratory system: dry cough, bronchospasm, dyspnea;
- from the hematopoietic system: anemia (erythrocytopenia, decreased hematocrit and hemoglobin concentration), agranulocytosis, neutropenia, leukopenia, thrombocytopenia;
- from the digestive tract: diarrhea, nausea, taste changes, dry mouth, abdominal pain, dyspepsia, jaundice (cholestatic or hepatocellular), pancreatitis, anorexia, hepatitis;
- from the genitourinary system: decreased potency, proteinuria, uremia, anuria, oliguria, impaired renal function, acute renal failure;
- from the central nervous system: headache, dizziness, increased fatigue, drowsiness, confusion, mood lability, convulsive twitching of the lips and muscles of the limbs, paresthesia; rarely - asthenic syndrome;
- on the part of the skin: itching, increased sweating, photosensitivity, alopecia, urticaria;
- hypersensitivity reactions: fever, itching, skin rashes, angioedema (edema of the lips, tongue, epiglottis and / or larynx, face, extremities), leukocytosis, eosinophilia, increased erythrocyte sedimentation rate (ESR), positive results of the antinuclear antibody test; very rarely - interstitial angioedema;
- laboratory parameters: hyponatremia, hyperkalemia; rarely - hyperbilirubinemia, an increase in the activity of liver enzymes, an increase in the concentration of creatinine and urea;
- others: arthritis, arthralgia, myalgia, vasculitis.
Overdose
Taking an excessive dose of lisinopril can cause a marked decrease in blood pressure, drowsiness, dry mouth, urinary retention, constipation, increased irritability, and anxiety.
Overdose treatment is symptomatic. A 0.9% sodium chloride solution is injected intravenously. Vasopressors are prescribed whenever possible. Careful monitoring of blood pressure and water and electrolyte balance is required. If necessary, hemodialysis is performed.
special instructions
Symptomatic hypotension
An excessive decrease in blood pressure most often occurs in the case of a decrease in fluid volume caused by taking diuretics, diarrhea, vomiting, dialysis, and a decrease in salt in the diet.
In patients with CHF (including with concomitant renal failure), symptomatic arterial hypotension may develop. It occurs predominantly in people with severe heart failure due to renal dysfunction, hyponatremia, or high-dose diuretics. Treatment of such patients should be carried out under strict medical supervision, including special care is required at the stage of selecting the dose of Irumed and a diuretic.
The described rules also apply to patients with cerebrovascular insufficiency and ischemic heart disease, since a sharp decrease in blood pressure in them can cause a stroke or myocardial infarction.
If the patient's blood pressure decreases excessively, he should be put on bed and, if the condition requires it, intravenous sodium chloride 0.9% solution should be administered. A transient hypotensive reaction does not require a complete cessation of drug treatment.
In some cases of CHF in patients with normal or low blood pressure, Irumed can cause a decrease in blood pressure. In most cases, this is not a reason to discontinue the drug. If hypotension becomes symptomatic, the dose of lisinopril should be reduced or treatment discontinued.
Acute myocardial infarction
Patients with acute myocardial infarction are prescribed Irumed simultaneously with standard therapy (thrombolytics, beta-blockers, acetylsalicylic acid).
The drug can, if necessary, be used in combination with nitroglycerin in the form of intravenous solutions or transdermal systems.
Irumed should not be prescribed to patients if there is a risk of further deterioration in hemodynamic parameters after the use of vasodilators. This category includes patients with cardiogenic shock or systolic blood pressure ≤ 100 mm Hg. Art.
Hypersensitivity reactions
The risk of developing angioedema usually persists throughout the entire period of drug treatment, however, while taking ACE inhibitors, such cases are rare. If this does happen, Irumed should be canceled and the patient's condition should be carefully monitored until the condition is completely normalized.
Swelling of the face and lips usually does not require special treatment, but your doctor may recommend an antihistamine. Laryngeal edema is life-threatening. Swelling of the tongue, epiglottis and / or larynx may indicate developing airway obstruction, therefore, requires urgent medical attention (subcutaneous administration of 0.3-0.5 ml 1: 1000 epinephrine / adrenaline solution) or measures aimed at ensuring airway patency … Studies have noted that ACE inhibitors in black patients cause angioedema more often than in other races.
In patients with a history of angioedema, even if it was not associated with the use of ACE inhibitors, the risk of its development during the use of Irumed increases significantly, so the use of the drug is contraindicated.
In extremely rare cases, ACE inhibitors cause life-threatening anaphylactoid reactions in patients undergoing hymenoptera desensitization. You can prevent dangerous consequences if you temporarily stop taking lisinopril before each desensitization session.
Cough
ACE inhibitors cause dry, lingering cough in some patients. It goes away on its own after the end of treatment.
In the case of differential diagnosis, it should be borne in mind that a cough can be triggered by lisinopril.
Surgery / General anesthesia
During major surgery and during general anesthesia, Irumed can block the formation of angiotensin II. With regard to compensatory renin release, this fact is of secondary importance. A pronounced decrease in blood pressure, which developed as a result of this mechanism, can be eliminated by increasing the BCC.
Patients taking lisinopril should warn the doctor about this before surgery, even if it is a dental procedure.
Serum potassium
There are known cases of hyperkalemia while taking Irumed. Risk factors for its development are renal failure, diabetes mellitus, as well as the joint use of potassium-containing salt substitutes, potassium preparations, potassium-sparing diuretics. If necessary, the use of the listed funds should be regularly monitored the potassium content in the blood serum.
Influence on the ability to drive vehicles and complex mechanisms
There is no information confirming the negative effect of Irumed on the speed of reactions and the ability to concentrate if it is used in accordance with the recommendations of a doctor. However, it should be borne in mind that sometimes the drug causes dizziness, therefore, extreme caution should be exercised when driving a car and performing potentially dangerous types of work.
Application during pregnancy and lactation
During pregnancy, Irumed tablets are not prescribed. If the pregnancy is confirmed already during treatment with the drug, it should be canceled immediately. It has been established that ACE inhibitors used in the II and III trimesters can cause death of the fetus or newborn. If a woman, while pregnant, took lisinopril, her newborn child should be closely monitored in order to timely identify possible violations: hyperkalemia, oliguria, lowering blood pressure. There are known cases of oligohydramnios (oligohydramnios), development of lung hypoplasia in newborns, deformation of the bones of the skull and face and hypoplasia of the bones of the skull, as well as impaired renal function.
During lactation, Irumed is contraindicated. If its appointment is clinically justified, breastfeeding should be discontinued.
Pediatric use
Irumed is not used to treat patients under the age of 18.
With impaired renal function
Renal failure, condition after kidney transplantation, stenosis of an artery of a single kidney and bilateral stenosis of the renal arteries are relative contraindications to the appointment of Irumed. The dose of the drug is determined based on the QC indicators.
In patients with CHF and concomitant renal dysfunction, a pronounced decrease in blood pressure under the action of ACE inhibitors can cause further deterioration in renal function. There are known cases of acute renal failure.
In stenosis of the renal artery (s), ACE inhibitors can increase serum urea and creatinine. This process is usually reversible after treatment ends.
Irumed should not be prescribed for acute myocardial infarction in patients with severe renal impairment: serum creatinine concentration> 177 mmol / l and / or proteinuria> 500 mg / day. If renal dysfunction develops already during treatment with the drug, the feasibility of further use of lisinopril should be assessed.
In patients receiving hemodialysis using a membrane of high permeability, anaphylactoid reactions occur more often while taking ACE inhibitors. For this reason, it is necessary either to use a different type of membrane for dialysis, or to prescribe another antihypertensive drug.
For violations of liver function
There is no information on the need to adjust the dose of Irumed for patients with functional liver disorders.
Use in the elderly
In old age, Irumed should be used with caution.
Drug interactions
Potassium-containing salt substitutes, potassium supplements, potassium-sparing diuretics (eg, amiloride or triamterene) increase the risk of hyperkalemia, especially in people with concomitant renal dysfunction.
The simultaneous use of diuretics enhances the effect of Irumed in reducing blood pressure.
When lisinopril is combined with other antihypertensive drugs, an additive effect develops.
The hypotensive effect of Irumed is reduced by adrenostimulants, estrogens, non-steroidal anti-inflammatory drugs.
When combined with drugs containing lithium, lisinopril slows down the elimination of lithium.
Cholestyramine and antacids reduce the absorption of Irumed in the gastrointestinal tract.
The effect of Irumeda is enhanced by alcohol.
Analogs
Irumed's analogs are Akcupro, Amprilan, Berlipril 5, Vasolong, Diroton, Kapoten, Quadropril, Lizoril, Lizacard, Liziprex, Parnavel, Perineva, Ramipril, Renitek, Tritace, Fosinopril, Fosinap, Hartil, Enitapril, Edam, Edam.
Terms and conditions of storage
Keep out of the reach of children at a temperature not exceeding 25 ° C.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Irumed
Patients or their relatives leave positive reviews about Irumed: the drug effectively reduces high blood pressure, does not cause serious side effects, and has an affordable cost. The convenience of reception is noted separately - only 1 time per day.
Price for Irumed in pharmacies
The approximate price for Irumed, depending on the dosage of tablets, is: 5 mg (30 pcs. In a package) - 150 rubles, 10 mg (30 pcs. In a package) - 200-230 rubles, 20 mg (30 pcs. In a package) - 300-330 rubles.
Irumed: prices in online pharmacies
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Drug name Price Pharmacy |
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Irumed 5 mg tablets 30 pcs. 139 RUB Buy |
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Irumed 10 mg tablets 30 pcs. 199 RUB Buy |
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Irumed 20 mg tablets 30 pcs. 299 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!
