C.09.A.A.01 Captopril

Composition and release form of the drug

10 pieces. - contour cell packaging (2) - cardboard packs.
10 pieces. - contour cell packaging (3) - cardboard packs.
10 pieces. - contour cell packaging (4) - cardboard packs.
10 pieces. - contour cell packaging (5) - cardboard packs.
10 pieces. - contour cell packaging (6) - cardboard packs.

pharmachologic effect

Antihypertensive drug, ACE inhibitor. The mechanism of antihypertensive action is associated with competitive inhibition of ACE activity, which leads to a decrease in the rate of conversion of angiotensin I to angiotensin II (which has a pronounced vasoconstrictor effect and stimulates the secretion of aldosterone in the adrenal cortex). In addition, captopril appears to have an effect on the kinin-kallikrein system, preventing the breakdown of bradykinin. The hypotensive effect does not depend on the activity of renin; a decrease in blood pressure is observed at normal and even reduced concentrations of the hormone, which is due to the effect on the tissue RAAS. Increases coronary and renal blood flow.

Thanks to its vasodilating effect, it reduces roundabout percentage (afterload), wedge pressure in the pulmonary capillaries (preload) and resistance in the pulmonary vessels; increases cardiac output and exercise tolerance. With long-term use, it reduces the severity of left ventricular myocardial hypertrophy, prevents the progression of heart failure and slows down the development of left ventricular dilatation. Helps reduce sodium levels in patients with chronic heart failure. Dilates arteries more than veins. Improves blood supply to ischemic myocardium. Reduces platelet aggregation.

Reduces the tone of the efferent arterioles of the glomeruli of the kidneys, improving intraglomerular hemodynamics, and prevents the development of diabetic nephropathy.

Pharmacokinetics

After oral administration, at least 75% is quickly absorbed from the gastrointestinal tract. Simultaneous food intake reduces absorption by 30-40%. Cmax in blood plasma is reached within 30-90 minutes. Protein binding, mainly with, is 25-30%. Excreted in breast milk. Metabolized in the liver to form captopril disulfide dimer and captopril-cysteine ​​disulfide. Metabolites are pharmacologically inactive.

T1/2 is less than 3 hours and increases with renal failure (3.5-32 hours). More than 95% is excreted by the kidneys, 40-50% unchanged, the rest in the form of metabolites.

In chronic renal failure it accumulates.

Indications

Arterial hypertension (including renovascular), chronic failure (as part of combination therapy), left ventricular dysfunction after myocardial infarction in patients in a clinically stable condition. Diabetic nephropathy in type 1 diabetes mellitus (with albuminuria more than 30 mg/day).

Contraindications

Pregnancy, lactation, age under 18 years, hypersensitivity to captopril and other ACE inhibitors.

Dosage

When taken orally, the initial dose is 6.25-12.5 mg 2-3 times a day. If the effect is insufficient, the dose is gradually increased to 25-50 mg 3 times a day. In case of impaired renal function, the daily dose should be reduced.

Maximum daily dose is 150 mg.

Side effects

From the central nervous system and peripheral nervous system: dizziness, headache, feeling of fatigue, asthenia, paresthesia.

From the cardiovascular system: orthostatic hypotension; rarely - tachycardia.

From the digestive system: nausea, loss of appetite, disturbance of taste; rarely - abdominal pain, diarrhea or constipation, increased activity of liver transaminases, hyperbilirubinemia; signs of hepatocellular damage (hepatitis); in some cases - cholestasis; in isolated cases - pancreatitis.

From the hematopoietic system: rarely - neutropenia, anemia, thrombocytopenia; very rarely in patients with autoimmune diseases - agranulocytosis.

From the side of metabolism: hyperkalemia, acidosis.

From the urinary system: proteinuria, impaired renal function (increased concentrations of urea and creatinine in the blood).

From the respiratory system: dry cough.

Allergic reactions: skin rash; rarely - Quincke's edema, bronchospasm, serum sickness, lymphadenopathy; in some cases - the appearance of antinuclear antibodies in the blood.

Drug interactions

When used simultaneously with cytostatics, the risk of developing leukopenia increases.

When used simultaneously with potassium-sparing diuretics (including spironolactone, triamterene, amiloride), potassium preparations, salt substitutes and dietary supplements containing potassium, hyperkalemia may develop (especially in patients with impaired renal function), because ACE inhibitors reduce the content of aldosterone, which leads to potassium retention in the body while limiting the excretion of potassium or its additional intake into the body.

With the simultaneous use of ACE inhibitors and NSAIDs, the risk of developing renal dysfunction increases; hyperkalemia is rarely observed.

When used simultaneously with loop diuretics or thiazide diuretics, severe arterial hypotension is possible, especially after taking the first dose of the diuretic, apparently due to hypovolemia, which leads to a transient increase in the antihypertensive effect of captopril. There is a risk of developing hypokalemia. Increased risk of developing renal dysfunction.

When used simultaneously with anesthetics, severe arterial hypotension is possible.

When used simultaneously with azathioprine, anemia may develop, which is due to inhibition of erythropoietin activity under the influence of ACE inhibitors and azathioprine. Cases of the development of leukopenia have been described, which may be associated with additive suppression of bone marrow function.

When used simultaneously, the risk of developing hematological disorders increases; Cases of severe hypersensitivity reactions, including Stevens-Johnson syndrome, have been described.

With the simultaneous use of aluminum hydroxide, magnesium hydroxide, magnesium carbonate, the bioavailability of captopril decreases.

In high doses, it may reduce the antihypertensive effect of captopril. It has not been conclusively established whether acetylsalicylic acid reduces the therapeutic effectiveness of ACE inhibitors in patients with coronary artery disease and heart failure. The nature of this interaction depends on the course of the disease. Acetylsalicylic acid, by inhibiting COX and prostaglandin synthesis, can cause vasoconstriction, which leads to a decrease in cardiac output and worsening of the condition of patients with heart failure receiving ACE inhibitors.

There are reports of increased plasma concentrations of digoxin when captopril is administered concomitantly with digoxin. The risk of drug interactions is increased in patients with impaired renal function.

When used simultaneously with indomethacin and ibuprofen, the antihypertensive effect of captopril decreases, apparently due to inhibition of prostaglandin synthesis under the influence of NSAIDs (which are believed to play a role in the development of the hypotensive effect of ACE inhibitors).

When used simultaneously with insulins, hypoglycemic agents and sulfonylurea derivatives, hypoglycemia may develop due to increased glucose tolerance.

With simultaneous use of ACE inhibitors and interleukin-3, there is a risk of developing arterial hypotension.

When used simultaneously with interferon alpha-2a or interferon beta, cases of severe granulocytopenia have been described.

When switching from clonidine to captopril, the antihypertensive effect of the latter develops gradually. If clonidine is suddenly discontinued in patients receiving captopril, a sharp increase in blood pressure may occur.

With simultaneous use of lithium carbonate, the concentration of lithium in the blood serum increases, accompanied by symptoms of intoxication.

When used simultaneously with minoxidil and sodium nitroprusside, the antihypertensive effect is enhanced.

When used simultaneously with orlistat, the effectiveness of captopril may decrease, which can lead to increased blood pressure, hypertensive crisis, and a case of cerebral hemorrhage has been described.

With simultaneous use of ACE inhibitors with pergolide, the antihypertensive effect may be enhanced.

When used simultaneously with probenecid, the renal clearance of captopril is reduced.

When used simultaneously with procainamide, the risk of developing leukopenia may increase.

When used simultaneously with trimethoprim, there is a risk of developing hyperkalemia, especially in patients with impaired renal function.

When used simultaneously with chlorpromazine, there is a risk of developing orthostatic hypotension.

When used simultaneously with cyclosporine, there are reports of the development of acute renal failure and oliguria.

It is believed that the effectiveness of antihypertensive drugs may be reduced when used simultaneously with erythropoietins.

special instructions

Caution should be used if there is a history of angioedema during therapy with ACE inhibitors, hereditary or idiopathic angioedema, aortic stenosis, cerebrovascular and cardiovascular diseases (including cerebrovascular insufficiency, ischemic heart disease, coronary insufficiency), severe autoimmune connective tissue diseases (including SLE, scleroderma), with suppression of bone marrow hematopoiesis, with diabetes mellitus, hyperkalemia, bilateral renal artery stenosis, stenosis of the artery of a single kidney, condition after kidney transplantation, renal and/or liver failure, against the background sodium-restricted diets, conditions accompanied by a decrease in blood volume (including diarrhea, vomiting), in elderly patients.

In patients with chronic heart failure, captopril is used under close medical supervision.

Arterial hypotension that occurs during surgery while taking captopril is eliminated by replenishing fluid volume.

The simultaneous use of potassium-sparing diuretics and potassium supplements should be avoided, especially in patients with renal failure and diabetes mellitus.

When taking captopril, a false-positive reaction may occur in a urine test for acetone.

The use of captopril in children is possible only if other drugs are ineffective.

Impact on the ability to drive vehicles and operate machinery

Caution is required when driving vehicles or performing other work that requires increased attention, because Dizziness may occur, especially after the initial dose of captopril.

Use with caution in conditions after kidney transplantation or renal failure.

In case of impaired renal function, the daily dose should be reduced.

The simultaneous use of potassium-sparing diuretics and potassium supplements should be avoided in patients with renal failure.

For liver dysfunction

Use with caution in case of liver failure.

Use in old age

Use with caution in elderly patients.

Captopril-STI is prescribed primarily for high blood pressure. The mechanism of action of the drug is to dilate large blood vessels, which helps normalize blood pressure.

You can take the product only as prescribed by a doctor in order to avoid unwanted reactions, especially if a person is susceptible to various types of allergies.

Captopril is the name of the active component of the drug.

ATX

C09AA01 - code according to the anatomical-therapeutic-chemical classification.

Release forms and composition

The product is produced in tablet form. Tablets with a dosage of 50 mg of captopril are packaged in blister packs of 10 pcs. in each of them.

The drug is not produced in capsules.

pharmachologic effect

The medication is one of the antihypertensive drugs (ACE blocker).

There are a number of medicinal properties of high blood pressure tablets:

1. Reduces the rate of conversion of angiotensin, which constricts blood vessels and stimulates the production of aldosterone in the adrenal cortex.
2. It affects a group of blood proteins that play a role in inflammation, blood pressure control, coagulation and pain.
3. Normalizes blood pressure levels regardless of renin concentration.
4. Improves blood circulation through the blood vessels of the myocardium and in the kidneys.
5. With prolonged use, signs of thickening of the walls of the left ventricle become less pronounced.
6. Helps reduce sodium concentration in patients with chronic cardiac dysfunction.
7. Has a positive effect on the process of uniting (aggregation) of platelets.
8. Prevents the development of diabetic nephropathy.

Pharmacokinetics

After oral administration of the drug, more than half of it is absorbed from the digestive tract.

It is advisable to take tablets before or after meals, because if you perform these actions at the same time, the absorption process of the active ingredient slows down by 30%.

The maximum concentration of captopril in the blood plasma is observed within an hour. Metabolism occurs in the liver. Decomposition products are excreted in large quantities by the kidneys.

With renal dysfunction, accumulation of biologically active substances in the body is observed.

What does it help with?

The product is effective in a number of cases:

• arterial hypertension;
• heart failure during exacerbation or chronic course of the pathology;
• after myocardial infarction;
• an autoimmune disease of the endocrine system, the main diagnostic sign of which is chronic hyperglycemia.

Contraindications

The main contraindication is organic intolerance to the active component of the medication. Aortic stenosis is also included in the list of limitations.

Dosages

The maximum daily dose should not exceed 0.15 g of the active substance, because there is a high risk of developing arterial hypotension.

For diabetic nephropathy

Use 75 mg per day. You will need at least 2 doses during the day.

For chronic heart failure

You should start taking it with 6.25-12.5 mg three times a day. After 2 weeks, the dosage is doubled, taking up to 0.025 g of the active substance orally 3 times a day for a long period of time.

It is important to use diuretics during treatment with an ACE inhibitor.

Under pressure

One hour before meals, take 12.5 mg of the drug twice a day. If the dose taken is well tolerated within an hour, then treatment can be continued.

For myocardial infarction

The exact dosage, frequency and time interval for taking the drug is determined by the doctor. The medical specialist takes into account the severity of the pathological process and the individual characteristics of the body.

How to take Captopril-STI

It is important to study the instructions before starting therapy to avoid negative consequences.

Under the tongue or washed down

How long does it take to work?

Positive dynamics of clinical symptoms are observed within an hour.

How often can you drink

The frequency of administration should not exceed 3 times a day.

Side effects

The medicine can provoke a number of unwanted reactions.

Gastrointestinal tract

Possible stool upset, as well as nausea during long-term therapy. Decreased appetite is common in patients with chronic bacterial imbalance.

Blood-forming organs

Side effects are rarely observed.

central nervous system

Patients often complain of headaches, muscle weakness and sensations of numbness, tingling, and crawling sensations.

From the urinary system

The concentration of urea and creatinine in the blood increases against the background of renal failure.

From the respiratory system

Cases of dry cough are common.

From the skin

With increased sensitivity to the active substance, a rash occurs.

From the genitourinary system

Deviations from the norm are rarely observed.

Allergies

Angioedema is rarely observed.

Impact on the ability to operate machinery

You should avoid driving a car during treatment with the drug.

special instructions

It is worth considering a number of features during treatment with the drug.

Use during pregnancy and lactation

It is forbidden to take tablets in any trimester and while breastfeeding.

Alcohol compatibility

Overdose

Interaction with other drugs

It is important to consider the following:

1. Lecopenia can develop while taking immunosuppressants.
2. Potassium-sparing diuretics cause increased potassium levels in the blood (hyperkalemia).
3. A sharp and sustained decrease in pressure is typical in the case of simultaneous use of anesthesia.
4. Allergic reactions are observed when using Allopurinol.
5. The concentration of digoxin in the blood plasma increases with the simultaneous use of Captopril-STI.
6. A decrease in the number of granulocytes is observed when using drugs containing interferon.
7. A sharp jump in pressure to high levels is observed when taking Captopril-STI in patients after abrupt withdrawal of Clonidine.
8. Intoxication is possible when using lithium carbonate.

Can I buy it without a prescription?

It is allowed to sell tablets without a doctor's prescription.

Price for Captopril-STI

The cost of the product is about 60 rubles.

Storage conditions of the drug

It is important to limit children's access to the medicine.

Best before date

The tablets can be used for 3 years from the date of manufacture.

Captopril STI, the instructions for use of which include this drug in the group of angiotensin-converting enzyme inhibitors, is considered a popular remedy for high blood pressure.

Angiotensin-I in the blood, under the influence of various factors, is converted into angiotensin-II, which has a pronounced vasoconstrictor effect, resulting in an increase in blood pressure. An ACE inhibitor slows down this process, allowing blood pressure to remain normal for a longer period of time.

People suffering from various diseases of the heart and cardiovascular system, as well as those at risk - subject to severe stress, nervous, psycho-emotional and physical stress, can drink with the recommendation of a doctor and according to the instructions. The main indications for the use of Captopril STI in the instructions are as follows:


• hypertension;
• diabetic nephropathy;

Important! The maximum possible dose of the substance per day according to the instructions for use is 150 mg, above which the drug cannot be taken due to the risk of side effects.

Dosage for high blood pressure

The medicine can be taken in two ways - as regular therapy every day as prescribed by the attending physician, and also to relieve sudden increases in blood pressure of more than 15%.

1. For regular therapeutic use, the instructions for use of Captopril STI recommend drinking 12.5 mg twice a day 1 hour before meals. The tablet does not need to be chewed, taken whole with at least half a glass of clean water.
2. Depending on the severity of hypertension, the dosage of the drug can be increased to 50 mg three times a day.
3. If the hypotensive effect of the drug is insignificant, then the dosage can be gradually increased once every 2 weeks.

Some people take Captopril STI under the tongue during a sharp increase in blood pressure. The official instructions do not contain recommendations for sublingual administration, and patients taking the medicine in this way often complain of irritation of the oral mucosa and the appearance of stomatitis-type ulcers.

What to do if Captopril does not reduce blood pressure?

If regular use of Captopril STI according to the instructions does not reduce blood pressure, you should consult a physician or cardiologist. It is possible that there is a more serious disturbance in the functioning of the heart and blood vessels.

In some cases, the body is individually immune to the components of the drug, and it simply needs to be replaced with an analogue (for example, Dapril, Lizacard and others).

It is prohibited to take caffeine-containing drugs (Citramon, Caffetin). It is better to limit alcohol intake during hypertension as much as possible or completely eliminate it, since it causes a short-term dilation of the walls of blood vessels, which then spasm. You should also limit or completely eliminate the consumption of coffee and strong tea, as these products contribute to an increase in blood pressure.

Useful video

For more information about hypertension, watch this video:

Conclusion

1. Captopril STI is a fairly effective antihypertensive agent that helps many patients keep blood pressure within normal limits, but in some cases it is not effective enough when the pressure rises above 185 at the upper level.
2. Self-administration of medication without consulting a specialist is unacceptable.
3. With diagnosed arterial hypertension, each patient should be monitored by a cardiologist.

Captopril - indications and instructions for use (how to take tablets), analogues and reviews. At what dosage of the drug does blood pressure normalize? Action when applied under the tongue

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Captopril is a drug from the group of angiotensin-converting enzyme (ACE) inhibitors that lowers blood pressure. Captopril is used to treat arterial hypertension, chronic heart failure, myocardial dystrophy and diabetic nephropathy.

Varieties, names, composition and release form

Currently, Captopril is available in several of the following varieties:
• Captopril;
• Captopril-Vero;
• Captopril Hexal;
• Captopril Sandoz;
• Captopril-AKOS;
• Captopril-Acri;
• Captopril-Ros;
• Captopril-Sar;
• Captopril-STI;
• Captopril-UBF;
• Captopril-Ferein;
• Captopril-FPO;
• Captopril Stada;
• Captopril-Egis.
These varieties of the drug actually differ from each other only by the presence of an additional word in the name, which reflects the abbreviation or well-known name of the manufacturer of a particular type of drug. Otherwise, the varieties of Captopril are practically no different from each other, since they are produced in the same dosage form, contain the same active substance, etc. Moreover, often even the active substance in the varieties of Captopril is identical, since it is purchased from large manufacturers China or India.

The differences in the names of the varieties of Captopril are due to the need for each pharmaceutical company to register the drug they produce under an original name that is different from others. And since in the past, during the Soviet period, these pharmaceutical plants produced the same Captopril using exactly the same technology, they simply add another word to the well-known name, which is an abbreviation of the name of the enterprise and, thus, a unique name is obtained, from a legal point of view different from all others.

Thus, there are no significant differences between the varieties of the drug, and therefore, as a rule, they are combined under one common name “Captopril”. Further in the text of the article we will also use one name - Captopril - to refer to all its varieties.

All varieties of Captopril are available in a single dosage form - this tablets for oral administration. As an active substance tablets contain substance captopril, the name of which, in fact, gave the name to the drug.

Varieties of Captopril are available in different dosages such as 6.25 mg, 12.5 mg, 25 mg, 50 mg and 100 mg per tablet. Such a wide range of dosages allows you to choose the optimal option for use.

As auxiliary components Varieties of Captopril may contain different substances, since each company can modify their composition, trying to achieve optimal production efficiency. Therefore, to clarify the composition of the auxiliary components of each specific type of drug, it is necessary to carefully study the attached leaflet with instructions.

Recipe

The prescription for Captopril in Latin is written as follows:
Rp: Tab. Captoprili 25 mg No. 50
D.S. Take 1/2 - 2 tablets 3 times a day.

The first line of the prescription after the abbreviation “Rp” indicates the dosage form (in this case Tab. – tablets), the name of the drug (in this case – Captoprili) and its dosage (25 mg). After the “No” icon, the number of tablets that the pharmacist must dispense to the owner of the prescription is indicated. In the second line of the recipe after the abbreviation "D.S." provides information for the patient containing instructions on how to take the drug.

What does Captopril help with (therapeutic effect)

Captopril lowers blood pressure and reduces the load on the heart. Accordingly, the drug is used in the treatment of arterial hypertension, heart diseases (heart failure, condition after myocardial infarction, myocardial dystrophy), as well as diabetic nephropathy.

The effect of Captopril is to suppress the activity of the enzyme that ensures the conversion of angiotensin I to angiotensin II, therefore the drug is classified as an ACE inhibitor (angiotensin-converting enzyme). Due to the action of the drug, the body does not produce angiotensin II, a substance that has a powerful vasoconstrictor effect and, accordingly, increases blood pressure. When angiotensin II is not produced, the blood vessels remain dilated and, accordingly, blood pressure is normal, not elevated. Thanks to the effect of Captopril, when taken regularly, blood pressure decreases and is kept within acceptable and acceptable limits. The maximum decrease in pressure occurs 1 - 1.5 hours after taking Captopril. But to achieve a lasting reduction in blood pressure, the drug must be taken for at least several weeks (4 – 6).

Also the drug reduces the load on the heart, expanding the lumen of blood vessels, as a result of which the heart muscle needs less effort to push blood into the aorta and pulmonary artery. Thus, Captopril increases the tolerance of physical and emotional stress in people suffering from heart failure or who have suffered a myocardial infarction. An important property of Captopril is the lack of effect on blood pressure when used in the treatment of heart failure.

In addition, Captopril increases renal blood flow and blood supply to the heart, as a result of which the drug is used in the complex therapy of chronic heart failure and diabetic nephropathy.

Captopril is well suited for inclusion in various combinations with other antihypertensive drugs. In addition, Captopril does not retain fluid in the body, which distinguishes it from other antihypertensive drugs that have a similar property. That is why, while taking Captopril, there is no need to additionally use diuretics to eliminate swelling caused by the antihypertensive drug.

Indications for use

Captopril is indicated for use in the treatment of the following diseases:
• Arterial hypertension (as monotherapy or as part of combination therapy. The drug is most effective in combination with thiazide diuretics, such as Hydrochlorothiazide, etc.);
• Congestive heart failure;
• Impaired left ventricular function in people who have had a myocardial infarction (applies only if the patient’s condition is stable);
• Diabetic nephropathy developed in type I diabetes mellitus (used for albuminuria more than 30 mg/day);
• Autoimmune nephropathies (rapidly progressive forms of scleroderma and systemic lupus erythematosus).


For people suffering from both hypertension and bronchial asthma, Captopril is the drug of choice.

Captopril - instructions for use

General provisions and dosages

Captopril should be taken one hour before meals, swallowing the tablet whole, without biting, chewing or crushing in any other way, but with a sufficient amount of water (at least half a glass).

The dosage of Captopril is selected individually, starting with the minimum and gradually increasing to an effective one. After taking the first dose of 6.25 mg or 12.5 mg, blood pressure should be measured every half hour for three hours to determine the response and severity of the drug in a particular person. In the future, when increasing the dose, the pressure should also be measured regularly an hour after taking the tablet.

It must be remembered that the maximum permissible daily dosage of Captopril is 300 mg. Taking the drug in an amount of more than 300 mg per day does not lead to a stronger decrease in blood pressure, but provokes a sharp increase in the severity of side effects. Therefore, taking Captopril in a dosage of more than 300 mg per day is impractical and ineffective.

Captopril for blood pressure(for arterial hypertension) start taking 25 mg once a day or 12.5 mg 2 times a day. If after 2 weeks the blood pressure does not drop to acceptable values, then the dosage is increased and taken 25–50 mg 2 times a day. If, when taking Captopril at this increased dosage, the pressure does not decrease to acceptable values, then hydrochlorothiazide 25 mg per day or beta-blockers should be additionally added.

For moderate or mild hypertension, a sufficient dosage of Captopril is usually 25 mg 2 times a day. In severe forms of hypertension, the dosage of Captopril is adjusted to 50–100 mg 2 times a day, doubling it every two weeks. That is, in the first two weeks a person takes 12.5 mg 2 times a day, then over the next two weeks - 25 mg 2 times a day, etc.

For high blood pressure caused by kidney disease, Captopril should be taken 6.25 - 12.5 mg 3 times a day. If after 1 - 2 weeks the pressure does not decrease to acceptable values, then the dosage is increased and taken 25 mg 3 - 4 times a day.

For chronic heart failure Captopril should be started at 6.25 – 12.5 mg 3 times a day. After two weeks, the dosage is doubled, bringing it to a maximum of 25 mg 3 times a day, and the drug is taken for a long time. For heart failure, Captopril is used in combination with diuretics or cardiac glycosides.


For myocardial infarction You can take Captopril on the third day after the end of the acute period. In the first 3–4 days you need to take 6.25 mg 2 times a day, then the dose is increased to 12.5 mg 2 times a day and drink for a week. After this, if the drug is well tolerated, it is recommended to switch to 12.5 mg three times a day for 2 to 3 weeks. After this period of time, subject to normal tolerability of the drug, they switch to taking 25 mg 3 times a day with monitoring of the general condition. Captopril is taken for a long time at this dosage. If the dosage of 25 mg 3 times a day is not sufficient, then it is allowed to increase it to the maximum - 50 mg 3 times a day.


For diabetic nephropathy Captopril is recommended to be taken 25 mg 3 times a day or 50 mg 2 times a day. For microalbuminuria (albumin in urine) more than 30 mg per day, the drug should be taken 50 mg 2 times a day, and for proteinuria (protein in urine) more than 500 mg per day Captopril should be taken 25 mg 3 times a day. The indicated dosages are increased gradually, starting with the minimum and doubling every two weeks. The minimum dosage of Captopril for nephropathy may vary, as it is determined by the degree of renal impairment. The minimum dosages with which you need to start taking Captopril for diabetic nephropathy, depending on kidney function, are shown in the table.


The indicated daily dosages should be divided into 2 to 3 doses per day. Elderly people (over 65 years of age), regardless of kidney function, should start taking the drug at 6.25 mg 2 times a day, and after two weeks, if necessary, increase the dosage to 12.5 mg 2-3 times a day.

If a person suffers from any kidney disease (not diabetic nephropathy), then the dosage of Captopril for him is also determined by creatinine clearance and is the same as for diabetic nephropathy.

Captopril under the tongue

Captopril is taken under the tongue in exceptional cases when it is necessary to quickly reduce blood pressure. When absorbed under the tongue, the effect of the drug develops after 15 minutes, and when taken orally, only after an hour. That is why Captopril is taken under the tongue to relieve a hypertensive crisis.

Use during pregnancy and breastfeeding

Captopril is contraindicated for use throughout pregnancy, since experimental studies on animals have proven its toxic effect on the fetus. Taking the drug from the 13th to the 40th week of pregnancy can lead to fetal death or developmental defects.

If a woman is taking Captopril, it should be discontinued immediately as soon as pregnancy becomes known.

During the entire period of use of Captopril, it is necessary to monitor kidney function. In 20% of people, while taking the drug, proteinuria (protein in the urine) may appear, which goes away on its own within 4 to 6 weeks without any treatment. However, if the protein concentration in the urine is above 1000 mg per day (1 g/day), then the drug must be discontinued.

Captopril should be used with caution and under close medical supervision if a person has the following conditions or diseases:

• Systemic vasculitis;
• Diffuse connective tissue diseases;
• Bilateral renal artery stenosis;
• Taking immunosuppressants (Azathioprine, Cyclophosphamide, etc.), Allopurinol, Procainamide;
• Carrying out desensitizing therapy (for example, bee venom, SIT, etc.).
In the first three months of therapy, take a general blood test every two weeks. Subsequently, blood tests are performed periodically until the end of Captopril administration. If the total number of leukocytes decreases to less than 1 G/l, then the drug should be discontinued. Typically, the normal number of leukocytes in the blood is restored 2 weeks after discontinuation of the drug. In addition, it is necessary to determine the concentration of protein in the urine, as well as creatinine, urea, total protein and potassium in the blood during the entire period of taking Captopril every month. If the protein concentration in the urine is above 1000 mg per day (1 g/day), then the drug must be discontinued. If the concentration of urea or creatinine in the blood progressively increases, then the dosage of the drug should be reduced or discontinued.

To reduce the risk of a sharp decrease in blood pressure when starting to use Captopril, it is necessary to discontinue diuretics 4–7 days before the first dose of tablets or reduce their dosage by 2–3 times. If, after taking Captopril, blood pressure decreases sharply, that is, hypotension develops, then you should lie on your back on a horizontal surface and raise your legs up so that they are above your head. You need to lie in this position for 30–60 minutes. If hypotension is severe, then to quickly eliminate it, you can inject a regular sterile saline solution intravenously.

Since the first doses of Captopril quite often provoke hypotension, it is recommended to select the dosage of the drug and begin its use in a hospital setting under the constant supervision of medical personnel.

While using Captopril, any surgical interventions, including dental ones (for example, tooth extraction), should be performed with caution. The use of general anesthesia while taking Captopril can provoke a sharp decrease in blood pressure, so the anesthesiologist should be warned that the person is taking this drug.

While using Captopril, a person may develop a rash on the body, which usually occurs in the first 4 weeks of treatment and goes away with a reduction in dosage or additional intake of antihistamines (for example, Parlazin, Suprastin, Fenistil, Claritin, Erius, Telfast, etc.). Also, while taking Captopril, a persistent non-productive cough (without sputum discharge), loss of taste and weight loss may occur, but all these side effects disappear 2 to 3 months after stopping the use of the drug.

Impact on the ability to operate machinery

Since Captopril can cause dizziness, during its use it is recommended to avoid potentially dangerous activities that require high reaction speed and concentration.

Overdose

An overdose of Captopril is possible and is manifested by the following symptoms:
• A sharp decrease in blood pressure (hypotension);
• Stupor;
• Bradycardia (decrease in heart rate less than 50 beats per minute);
• Cerebrovascular accident;
• Myocardial infarction;
• Angioedema;
• Water and electrolyte imbalances.
To eliminate an overdose, it is necessary to completely stop taking the drug, perform gastric lavage, place the person on a flat horizontal surface and begin replenishing the volume of circulating blood and electrolytes. To do this, saline solution, plasma substitutes, etc. are administered intravenously. In addition, symptomatic therapy is provided, aimed at maintaining the normal functioning of vital organs and systems. For symptomatic therapy, adrenaline (increases blood pressure), antihistamines, hydrocortisone, artificial pacemaker (pacemaker) are used, and if necessary, hemodialysis is performed.

Interaction with other drugs

Captopril should not be taken with drugs that increase the concentration of potassium in the blood, such as potassium-sparing diuretics (Spironolactone, Triamterene, Veroshpiron, etc.), potassium compounds (Asparkam, Panangin, etc.), heparin, potassium-containing salt substitutes.

Captopril enhances the effect of hypoglycemic drugs (Metformin, Glibenclamide, Gliclazide, Miglitol, Sulfonylurea, etc.), therefore, when used in combination, blood glucose levels should be constantly monitored. In addition, Captopril enhances the effect of drugs for anesthesia, painkillers and alcohol.

The simultaneous use of Captopril with immunosuppressants (Azathioprine, Cyclophosphamide, etc.), Allopurinol or Procainamide increases the risk of developing neutropenia (a decrease in the level of leukocytes in the blood below normal) and Stevens-Johnson syndrome.

The use of Captopril against the background of ongoing desensitizing therapy, as well as in combination with Estramustine and gliptins (Linagliptin, Sitagliptin, etc.) increases the risk of anaphylactic reactions.

The use of Captopril with gold preparations (Aurothiomolate, etc.) causes redness of the facial skin, nausea, vomiting and a decrease in blood pressure.

Side effects of Captopril

Captopril tablets can cause the following side effects from various organs and systems:

1. Nervous system and sensory organs:

• Increased fatigue;
• Dizziness;
• Central nervous system depression;
• Confusion;
• Ataxia (impaired coordination of movements);
• Paresthesia (feeling of numbness, tingling, “pins and needles” in the limbs);
• Impaired vision or smell;
• Taste disturbance;
2. Cardiovascular system and blood:
• Hypotension (low blood pressure);
• Orthostatic hypotension (a sharp drop in blood pressure when moving from a sitting or lying position to a standing position);
• Angina;
• Myocardial infarction;
• Arrhythmia;
• Acute cerebrovascular accident;
• Peripheral edema;
• Tides;
• Pale skin;
• Cardiogenic shock;
• Neutropenia (decrease in the number of neutrophils in the blood);
• Agranulocytosis (complete disappearance of basophils, eosinophils and neutrophils from the blood);
• Thrombocytopenia (low platelet count below normal);
• Eosinophilia (increased number of eosinophils above normal).
3. Respiratory system:
• Bronchospasm;
• Interstitial pneumonitis;
• Non-productive cough (without sputum production).
4. Gastrointestinal tract:
• Taste disturbance;
• Ulcers on the mucous membrane of the mouth and stomach;
• Xerostomia (dry mouth due to insufficient salivation);