Table of contents:
- Release form and composition
- Pharmacological properties
- Indications for use
- Liziprex, instructions for use: method and dosage
- Side effects
- special instructions
- Application during pregnancy and lactation
- Pediatric use
- With impaired renal function
- Use in the elderly
- Drug interactions
- Terms and conditions of storage
- Terms of dispensing from pharmacies
- Reviews about Liziprex
- Price for Lysiprex in pharmacies
- Lisiprex: prices in online pharmacies
Video: Liziprex - Instructions For Use, Analogues, Reviews, Price Of Tablets
Liziprex: 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. Use in the elderly
- 13. Drug interactions
- 14. Analogs
- 15. Terms and conditions of storage
- 16. Terms of dispensing from pharmacies
- 17. Reviews
- 18. Price in pharmacies
Latin name: Lisiprex
ATX code: C09AA03
Active ingredient: lisinopril (Lisinopril)
Producer: JSC "Irbitsky Chemical-Pharmaceutical Plant" (Russia)
Description and photo updated: 2019-29-07
Prices in pharmacies: from 60 rubles.
Lysiprex is an antihypertensive agent, an angiotensin converting enzyme (ACE) inhibitor.
Release form and composition
The drug is produced in the form of tablets: flat-cylindrical, round, white, with a chamfer (10 mg) or with a chamfer and a notch (5 and 20 mg) (10 pcs. In a blister strip, in a cardboard box 3 packages; 30 pcs. in a can of polymeric materials, in a cardboard box of 1 can. Each pack also contains instructions for the use of Lisiprex).
1 tablet contains:
- active substance: lisinopril (in the form of lisinopril dihydrate) - 5, 10 or 20 mg;
- additional components: mannitol, calcium hydrogen phosphate anhydrous, corn starch, magnesium stearate, talc.
The active substance of Lisiprex - lisinopril, is an ACE inhibitor, reduces the production of angiotensin-II from angiotensin I, which leads to a direct decrease in aldosterone secretion. Increasing the level of bradykinin content, by reducing its degradation, leads to an increase in the synthesis of prostaglandins. The drug provides a weakening of the total peripheral vascular resistance (OPSR), a decrease in blood pressure (BP), preload and pressure in the pulmonary capillaries. In patients with chronic heart failure (CHF), lisinopril increases the minute blood volume and increases exercise tolerance. The expansion of the arteries is noted to a greater extent than the veins. Individual effects of the drug are associated with the effect it exerts on the tissue renin-angiotensin systems (RAS). Against the background of long-term use of Lysiprex, a decrease in the severity of hypertrophy of the myocardium and the walls of the resistive type arteries is recorded, and blood flow to the ischemic area of the heart muscle improves.
Treatment with ACE inhibitors helps to lengthen life expectancy in patients with CHF, slow down the progression of left ventricular (LV) dysfunction in patients who have had myocardial infarction in the absence of clinical manifestations of heart failure.
The onset of antihypertensive action is observed 1 hour after oral administration, the maximum effect is achieved after 6-7 hours and lasts about 24 hours. In patients with arterial hypertension, the effect is observed in the first days after starting therapy, a stable effect is achieved after 1-2 months of treatment. In the case of a sharp cessation of taking Lisiprex, a pronounced increase in blood pressure is not recorded.
Taking lisinopril simultaneously with food does not affect its absorption, which is characterized by high variability - from 6 to 60% (on average 30%). The bioavailability of the drug is 29%, it binds to plasma proteins to an insignificant extent. The active substance enters the systemic circulation unchanged. The maximum concentration of lisinopril (C max) is achieved over a period (T Cmax) of 6 hours, when used in a daily dose of 10 mg C max is 32–38 ng / ml.
The drug hardly undergoes biotransformation and is eliminated unchanged by the kidneys. The fraction associated with ACE is excreted slowly, with normal renal activity, the half-life (T 1/2) is 12.6 hours. Lysiprex differs in insignificant passage through the blood-brain and placental barrier.
Indications for use
- arterial hypertension (as a monotherapy drug or in combination with other antihypertensive drugs);
- acute myocardial infarction (during the first 24 hours in the presence of stable hemodynamic parameters in order to maintain these indicators and prevent heart failure and LV dysfunction);
- CHF (as part of a combination treatment for patients receiving diuretics and / or cardiac glycosides);
- diabetic nephropathy [in order to reduce albuminuria in patients with type 1 diabetes mellitus (insulin-dependent) with normal blood pressure, and in patients with type 2 diabetes mellitus (non-insulin dependent) with arterial hypertension].
- idiopathic angioedema or hereditary angioedema;
- a history of angioedema, including developing during treatment with ACE inhibitors;
- pregnancy and the period of breastfeeding;
- age up to 18 years;
- combined use with aliskiren and aliskiren-containing drugs in the presence of diabetes mellitus or impaired renal function;
- hypersensitivity to any of the constituents of the drug, including lisinopril, as well as to other ACE inhibitors.
Relative (requires the use of Lisiprex tablets with extreme caution):
- severe renal dysfunction;
- bilateral stenosis of the renal arteries or stenosis of an artery of a single kidney with progressive azotemia (taking the drug can provoke impaired renal function, acute renal failure, irreversible even after discontinuation of lisinopril);
- condition after kidney transplantation (no data on the use of Lysiprex);
- primary hyperaldosteronism;
- stenosis of the aorta or mitral valve, or hypertrophic obstructive cardiomyopathy;
- arterial hypotension;
- ischemic heart disease (CHD), CHF;
- cerebrovascular lesions (including cerebrovascular accident);
- oppression of bone marrow hematopoiesis;
- autoimmune systemic diseases of the connective tissue (including scleroderma, systemic lupus erythematosus);
- diabetes mellitus (during the first month of the course of treatment, regular monitoring of blood glucose is required);
- desensitizing therapy;
- surgical treatment / general anesthesia;
- low-density lipoprotein (LDL) apheresis (due to the risk of developing life-threatening anaphylactoid reactions; it is recommended to temporarily stop drug therapy before each apheresis procedure);
- hypovolemic conditions (including those associated with diarrhea, vomiting);
- adherence to a diet that limits the consumption of table salt;
- hemodialysis treatment using high-flow dialysis membranes with high permeability (during treatment with ACE inhibitors, cases of anaphylactic reactions have been recorded);
- belonging to the Negroid race;
- elderly age;
- combined use with potassium preparations, potassium-sparing diuretics, potassium-containing substitutes for table salt, lithium preparations.
Liziprex, instructions for use: method and dosage
Lysiprex tablets are taken orally once a day, preferably in the morning, at the same time, regardless of food intake.
The recommended dosage regimen of Lisiprex, taking into account the indications:
- arterial hypertension: when using lisinopril as a monotherapy drug, the daily dose is 5 mg, in the absence of the desired effect, it can be increased by 5 mg every 2-3 days until the average therapeutic daily dose is 20-40 mg; taking more than 40 mg per day, as a rule, does not cause a further decrease in blood pressure; the usual daily maintenance dose is 20 mg, the maximum allowable daily dose is 40 mg; when titrating the dose, it should be borne in mind that the full effect is observed, as a rule, 2–4 weeks after the start of the course of treatment; if the clinical effect is insufficient, Lisiprex can be combined with other antihypertensive drugs, if the drug is switched from the use of diuretics, then the latter must be completed 2-3 days before the start of lisinopril therapy. In the case when this is impossible to carry out,the daily dose of Liziprex should not be higher than 5 mg, and the patient, after receiving the first dose, due to the risk of an excessive decrease in blood pressure, must be under medical supervision for several hours - the maximum antihypertensive effect is observed on average after 6 hours;
- CHF: initial daily dose - 2.5 mg (it is recommended to use lisinopril in tablets with a dosage of 2.5 mg), with a further gradual increase in 3-5 days to 5-10 mg per day, but not higher than the maximum permissible daily dose - 20 mg;
- acute myocardial infarction (as part of a combination treatment): at a dose of 5 mg for the first 24 hours, then at a dose of 5 mg after 24 hours, 10 mg after 48 hours, then as a maintenance dose of 10 mg per day, the course - from 6 weeks or more;
- renovascular hypertension or other conditions with increased activity of the RAS: initial daily dose of Lisiprex - 5 mg, subject to enhanced medical supervision (renal function, blood pressure indicators, serum potassium ions in the blood); the maintenance dose with strict medical supervision is set depending on the dynamics of blood pressure;
- diabetic nephropathy: in patients with type 2 diabetes mellitus, the daily dose of Lisiprex is 10 mg, with a possible increase to 20 mg to achieve the optimal value of diastolic blood pressure (less than 75 mm Hg in the sitting position); patients with type 1 diabetes mellitus are recommended the same dose in order to achieve diastolic blood pressure less than 90 mm Hg. Art. in a sitting position.
The most common negative side effects while taking lisinopril: fatigue, headache, dizziness, dry cough, nausea, diarrhea.
Other systemic organ side effects of Lisiprex:
- hematopoietic organs: rarely - neutropenia, leukopenia, thrombocytopenia, agranulocytosis; with prolonged therapy - anemia (decreased hematocrit, hemoglobin, erythropenia);
- cardiovascular system: often - orthostatic hypotension, marked decrease in blood pressure; rarely - bradycardia, tachycardia, chest pain, impaired atrioventricular conduction, aggravation of CHF symptoms, myocardial infarction;
- respiratory system: rarely - shortness of breath, bronchospasm;
- skin: rarely - increased sweating, skin itching, urticaria, photosensitivity, alopecia;
- nervous system: often - drowsiness, confusion, mood lability, paresthesia, convulsive twitching of the lips / muscles of the limbs; rarely - asthenic syndrome;
- digestive system: rarely - dryness of the oral mucosa, taste changes, dyspepsia, abdominal pain, anorexia, jaundice (cholestatic or hepatocellular), pancreatitis, hepatitis;
- genitourinary system: rarely - oliguria, impaired renal function, anuria, acute renal failure, proteinuria, uremia, sexual dysfunction;
- allergic reactions: rarely - angioedema of the face, lips, tongue, epiglottis and / or larynx, extremities; pruritus, skin rashes, fever, false positive test results for antinuclear antibodies, increased erythrocyte sedimentation rate (ESR), eosinophilia, leukocytosis; in some cases - intestinal angioedema;
- laboratory parameters: often - hyponatremia, hyperkalemia; rarely - increased activity of liver enzymes, hypercreatininemia, hyperbilirubinemia, increased levels of creatinine and urea;
- others: rarely - myalgia, arthralgia / arthritis, vasculitis.
Symptoms of an overdose of Lysiprex, developing with a single dose of 50 mg, include: drowsiness, dry mouth, constipation, increased irritability, anxiety, a marked decrease in blood pressure, urinary retention.
If an overdose is suspected, symptomatic therapy, gastric lavage, laxatives and enterosorbents are prescribed. Intravenous (IV) administration of 0.9% sodium chloride solution is recommended. If treatment-resistant bradycardia develops, the use of a pacemaker should be considered. It is necessary to monitor blood pressure and indicators of water and electrolyte balance. To remove lisinopril from the general circulation, hemodialysis is effective. There is no specific antidote.
A significant decrease in blood pressure during therapy in most cases is observed with a decrease in circulating blood volume (BCC) associated with taking diuretics, dialysis, the appearance of prolonged diarrhea or vomiting, and a decrease in the consumption of table salt. In patients with CHF and with or without renal dysfunction, a pronounced decrease in blood pressure may also be recorded.
In patients with cerebrovascular insufficiency, coronary artery disease, Lysiprex should be used under close medical supervision, since a sharp decrease in blood pressure in such patients can cause myocardial infarction or stroke.
With the development of arterial hypotension, the patient should be transferred to a horizontal position with raised legs. To replenish the BCC, intravenous administration of a 0.9% sodium chloride solution is indicated. As a rule, transient arterial hypotension is not a contraindication for further drug treatment. After the restoration of BCC and blood pressure, therapy can be continued.
Sometimes in patients with CHF and normal / low blood pressure when using Lysiprex, a drop in blood pressure can be observed, which in most cases does not require discontinuation of treatment.
If possible, before the start of the course, you should replenish the BCC and / or normalize the sodium concentration, and carefully monitor the effect of the initial dose on blood pressure.
With the development of acute myocardial infarction, it is recommended to carry out standard therapy using thrombolytics, beta-blockers, acetylsalicylic acid, as an antiplatelet agent. Lysiprex can be used in combination with IV administration of nitroglycerin or with the use of therapeutic transdermal systems with this substance.
Against the background of therapy with Lisiprex, hyperkalemia may develop. The main risk factors for such a complication include diabetes mellitus, decreased renal function, renal failure, age after 70 years, acute heart failure, dehydration, metabolic acidosis, combination therapy with potassium-sparing diuretics and / or potassium preparations, intake of potassium-containing substitutes for table salt. Hyperkalemia can cause serious, sometimes fatal, heart rhythm disturbances. If necessary, the simultaneous administration of Liziprex with the above agents requires regular monitoring of the concentration of potassium in the blood.
In some cases, against the background of therapy with ACE inhibitors, a syndrome of the development of cholestatic jaundice was recorded, turning into fulminant necrosis of the liver, in some cases up to death. The cause of this syndrome is unknown. If during the period of use of Lysiprex jaundice occurs or the activity of liver enzymes is significantly increased, it is necessary to stop taking it and provide appropriate medical monitoring of the patient's condition.
When carrying out major surgical interventions, as well as the use of other drugs that lead to a decrease in blood pressure, taking lisinopril can cause an unpredictable significant decrease in blood pressure due to blocking the production of angiotensin II. It is possible to eliminate arterial hypotension resulting from the influence of Lysiprex by replenishing the BCC. The surgeon or anesthetist must be made aware that the patient is receiving ACE inhibitors.
In some cases, during therapy with ACE inhibitors, severe infections developed, sometimes showing resistance to intensive antibiotic therapy. When using Lysiprex, such patients should periodically monitor the level of leukocytes in the blood. The patient needs to inform the doctor about the appearance of any signs of infectious lesions (fever, sore throat, etc.).
In patients receiving ACE inhibitors, cases of the development of anaphylactoid reactions have been recorded during the period of desensitizing therapy, including the venom of hymenoptera. It is necessary to use Lysiprex with extreme caution in persons prone to allergic reactions and who are prescribed desensitization procedures. When receiving bee venom immunotherapy, treatment with ACE inhibitors should be avoided. At the same time, it is possible to prevent the occurrence of an anaphylactoid reaction by temporarily discontinuing the drug before desensitization begins.
Very rarely, during treatment with ACE inhibitors, cases of the development of angioedema of the intestine were recorded, in which abdominal pain was noted in combination with nausea and vomiting or without them. Complication symptoms resolved after discontinuation of ACE inhibitors. If abdominal pain is observed during therapy, it is necessary to take into account the possibility of angioedema of the intestine when performing differential diagnosis.
When using Lysiprex in black patients, the risk of angioedema is higher. In such patients, the effectiveness of lisinopril in reducing blood pressure is also reduced.
Influence on the ability to drive vehicles and complex mechanisms
Due to the aggravation of the threat of dizziness and arterial hypotension during therapy with lisinopril, patients who drive motor vehicles or other potentially dangerous moving mechanisms should take Lisiprex with extreme caution.
Application during pregnancy and lactation
Taking Lisiprex during pregnancy is contraindicated. If pregnancy is confirmed during drug therapy, its use must be stopped immediately. It has been established that treatment with ACE inhibitors in the II-III trimesters of pregnancy can lead to the appearance in the fetus of a pronounced decrease in blood pressure, impaired renal function, hyperkalemia, hypoplasia of the skull bones, and intrauterine death.
There are no data on the negative effects of lisinopril on the fetus when using the drug in the first trimester. Babies whose mothers received ACE inhibitors during pregnancy should be closely monitored for the timely detection of a possible significant decrease in blood pressure, hyperkalemia, oliguria.
The drug passes through the placenta, there is no information on the excretion of lisinopril into breast milk. If taking Lysiprex is necessary during lactation, then breastfeeding should be completed.
For children and adolescents, treatment with Lisiprex is contraindicated, since there is no data confirming the safety and efficacy of its administration in patients under 18 years of age.
With impaired renal function
Due to the fact that the drug is excreted by the kidneys, the initial daily dose of Lisiprex should be set taking into account the CC indicators (including in patients on hemodialysis):
- 30–70 ml / min: initial dose - 5–10 mg;
- 10-30 ml / min: initial dose - 5 mg.
Further, titration of the dose of Lysiprex is performed depending on the individual response of the patient with regular monitoring of renal function, serum potassium and sodium in the blood. In the case of persistent arterial hypertension, long-term maintenance therapy is prescribed, the daily dose can vary from 10 to 15 mg.
Use in the elderly
Elderly patients should be especially careful to set the dose of Lisiprex, since when the same dose is taken by young patients and elderly people, the latter have a higher level of lisinopril in the blood.
- blockers of slow calcium channels (BMCC), beta-blockers, diuretics, tricyclic antidepressants / neuroleptics and other antihypertensive drugs: increase the severity of the antihypertensive effect of Lysiprex;
- cyclosporine, potassium-sparing diuretics (triamterene, amiloride, spironolactone and its derivative - eplerenone), potassium preparations, salt substitutes containing potassium: the threat of hyperkalemia is aggravated, especially with functional disorders of the kidneys, as a result of which these drugs can be combined with lisinopril only with systematic monitoring renal activity and serum potassium levels in the blood;
- cholestyramine, antacids: reduced absorption of lisinopril in the digestive tract;
- lithium preparations: the excretion of these agents slows down, it is required to regularly monitor the lithium content in the blood serum;
- adrenomimetics, non-steroidal anti-inflammatory drugs (NSAIDs) [including selective inhibitors of cyclooxygenase-2 (COX-2)], estrogens: the antihypertensive effect of lisinopril is weakened; combined use with NSAIDs can cause deterioration of renal function, including acute renal failure and an increase in serum potassium levels in the blood, mainly against a background of weakened renal function; caution is required with this combination, especially in elderly patients; patients need to receive an adequate amount of fluid and carefully monitor kidney activity both at the beginning of the course and during further treatment;
- cytostatics, procainamide, allopurinol: leukopenia may appear;
- selective serotonin reuptake inhibitors: the risk of developing severe hyponatremia increases;
- antidiabetic agents for oral administration, insulin: there is an increase in the hypoglycemic effect of these drugs up to the onset of hypoglycemia; this reaction is mainly recorded in the first weeks of combination therapy and in the presence of renal dysfunction;
- gold preparations (including intravenous administration of sodium aurothiomalate): in rare cases, the development of a symptom complex may appear, including nausea, vomiting, facial flushing, lowering blood pressure;
- angiotensin II receptor antagonists (ARA II): in patients with heart failure diagnosed with atherosclerotic disease or diabetes mellitus with target organ lesions against the background of this combination, an increase in hyperkalemia, syncope, arterial hypotension, and deterioration of renal activity (including acute renal failure) when compared with the incidence of these disorders in the case of using only one drug that affects the ASD; in patients of this risk group, the combination is contraindicated; in other patients, the combined use of ARA II and lisinopril, leading to a double blockade of the RAS, should be limited to individual cases with careful monitoring of renal function, blood pressure and potassium levels;
- aliskiren: the threat of hyperkalemia, deterioration of renal function, an increase in the incidence of cardiovascular morbidity and mortality in patients with diabetes mellitus or with renal dysfunction is aggravated with a glomerular filtration rate (GFR) of less than 60 ml / min; this combination is contraindicated;
- baclofen: the antihypertensive activity of ACE inhibitors increases, blood pressure and the dosage of antihypertensive drugs must be monitored;
- estramustine: the threat of side effects, including angioedema, increases;
- saxagliptin, linagliptin, vitagliptin, sitagliptin (gliptins): the risk of developing angioedema increases when combined with ACE inhibitors as a result of the inhibition of dipeptidylpeptidase IV (DPP-IV) activity by glyptin;
- antipsychotics (neuroleptics), tricyclic antidepressants, agents for general anesthesia: enhance the antihypertensive effect of Lysiprex;
- sympathomimetics: reduce the hypotensive activity of ACE inhibitors.
Liziprex analogs are Dapril, Irumed, Diropress, Lizacard, Diroton, Lisinopril, Rileis-sanovel, Lisonorm, Lizigamma, Lizinoton, etc.
Terms and conditions of storage
Store in a place protected from moisture and light, at a temperature not exceeding 25 ° C.
Shelf life is 2 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Liziprex
Reviews of Lysiprex on medical sites are very rare and are usually positive. Patients note that the drug has proven itself well in the treatment of CHF, arterial hypertension and acute myocardial infarction.
The disadvantages of the drug include the appearance of adverse reactions against the background of its reception.
Price for Lysiprex in pharmacies
The price for Lysiprex for a pack containing 30 tablets can be:
- dosage of 5 mg: 30-60 rubles;
- dosage of 10 mg: 50-80 rubles;
- dosage 20 mg: 60–110 rubles.
Lisiprex: prices in online pharmacies
Liziprex 5 mg tablets 30 pcs.
Liziprex 10 mg tablets 30 pcs.
Liziprex 20 mg tablets 30 pcs.
Maria Kulkes Medical journalist About the author
Education: First Moscow State Medical University named after I. M. Sechenov, 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!