Accupril
Accupril
Accupril (Quinapril)Pharmacological action
Accupril inhibits activity circulating and fabric APF and thanks to it reduces angiotonic activity and Aldosteronum development. Depression of level of angiotensin II on a feedback mechanism leads to augmentation of secretion of a renin and its activity in plasma.
As the main mechanism of antihypertensive Accupril (Quinapril) action consider suppression of activity a system renin-angiotensin-aldosteronovoj, however a preparation shows effect even at patients with a lowrenine arterial hypertensia. Remains to unknown persons, whether has value rising of levels of a bradikinin for therapeutic Accupril (Quinapril) effect. Duration of antihypertensive action Quinapril was above duration of its inhibiting effect on circulating APF.
The antihypertensive effect is shown during 1 h and usually reaches a maximum during 2-4 h after preparation reception. At some patients the maximum antihypertensive effect is observed in 2 weeks after the treatment beginning.
Antihypertensive action of a preparation in recommended doses at the majority of patients proceeds 24 h and remains against long therapy.
Hemodynamic research at patients with an arterial hypertensia has shown, that BP depression under influence Accupril is accompanied by resistance of renal vessels while the CARDIAC CONTRACTIONS RATE, the warm index, a renal blood flow, rate of a glomerular filtration and filtrational fraction vary slightly or do not vary.
Therapeutic action of a preparation in identical daily doses comparably at older persons (65 years or more) and at patients of younger age; at older persons frequency of the undesirable phenomena is not enlarged.
Accupril application at patients with a chronic heart failure leads to depression of peripheric vascular resistance, an average BP, systolic and diastolic pressure, pressure of jamming of pulmonary capillaries and rising of warm emission.
At patients with the confirmed coronary atherosclerosis which do not have arterial hypertensia or a heart failure, Accupril improves the broken function of an endothelium in coronary and humeral arteries.
Endothelium dysfunction consider as the important mechanism of development of a coronary atherosclerosis. Clinical value of improvement of endothelial function is not established.
Indications
- An arterial hypertensia;
- A chronic heart failure (in a combination with diuretics and-or warm glycosides).
Dosage regimen
At carrying out of monotherapy of an arterial hypertensia recommended initial Accupril dose at the patients who are not receiving diuretics, makes 10 mg or 20 mg of 1 times/days Depending on clinical effect a dose it is possible to raise (enlarging twice) to a maintenance dose of 20 mg or 40 mg/24h which usually prescribe in 1 reception or divide into 2 parts. As a rule, to change a dose follows with intervals in 4 weeks. From the majority of patients to achieve the adequate control of a BP at long treatment the Maximum daily dose - 80 mg is possible by application of a preparation of 1 times/days.
At the patients continuing reception of diuretics, recommended initial Accupril dose makes 5 mg; in the subsequent it raise (as it is specified above) until the optimum effect will be reached.
At a chronic heart failure preparation application is shown as addition to diuretics and-or warm glycosides. The recommended initial dose at patients with a chronic heart failure makes 5 mg 1 or 2 times/sut; after reception of a preparation of the patient it is necessary to observe for the purpose of revealing of a symptomatic arterial hypotension. If shipping of initial Accupril dose good it can be raised to an effective dose which usually makes 10-40 mg/24h in 2 receptions in a combination to accompanying therapy.
Taking into account clinical and pharmacokinetic data at patients with disturbances of function of kidneys the initial dose is recommended to be selected as follows.
Side effect
The undesirable phenomena at Accupril application are weakly expressed and transient.
From party TSNS and peripheric nervous system: a headache (7.2 %), giddiness (5.5 %), undue fatigability (3.5 %), depression (0 %), hypererethism (0 %), drowsiness (0 %), sight weakening (0 %).
From respiratory system: tussis (3.9 %) (unproductive, proof also passes after the treatment termination), a rhinitis (3.2 %).
From the alimentary system: a nausea and-or vomiting (2.8 %), dryness in a mouth or a throat (0 %), a meteorism (0 %), a pancreatitis (less than 0.5 %).
From hemopoiesis system: a hemolitic anaemia, a thrombocytopenia (less than 0.5 %); in single instances - an agranulocytosis and a neutropenia though their communication with Accupril reception remains obscure.
Dermatological reactions: an itch, diaphoresis intensifying, an eruption (0 %), an alopecia, an exfoliative dermatitis, photosensitivity (less than 0.5 %).
From urinary system: infections of urinary ways (0 %). Rising (more than at 1.25 time in comparison with the top border of norm) creatinine level in blood serum and a blood urea nitrogen was observed at 2 % and 2 % of the patients receiving Accupril monotherapy, accordingly. Probability of augmentation of these indicators at the patients simultaneously receiving diuretics, above, than against reception Accupril only. At therapy continuation both indicator often come back to norm.
From sexual system: potency depression (0 %).
Contraindications
- Children's and teenage age till 18 years;
- A hypersensibility to any component of a preparation.
With care it is necessary to prescribe a preparation at presence in the anamnesis of the
Overdosage
Symptoms: the expressed arterial hypotension.
Treatment: expediently i.v. liquid introduction; spend symptomatic therapy. The hemodialysis and a peritoneal dialysis make small impact on Accupril deducing.
Medicinal interaction
Application of Tetracyclinum with Accupril was accompanied by depression of an absorption of Tetracyclinum approximately on 28-37 % at the expense of presence of magnesium of a carbonate as an inactive component of the Accupril form for intake. At simultaneous Accupril appointment and Tetracyclinum it is necessary to consider possibility of similar interaction.
To prescribe the specified preparations simultaneously follows cautiously; at treatment definition of level of lithium in Serum is shown. Simultaneous reception of a diuretic can strengthen risk of an intoxication lithium.
Signs of clinically significant pharmacokinetic Accupril interaction with propranolol, Hydrochlorthiazidum, digoxin or Cimetidinum it is not taped.
Conditions and periods of storage
B.Preparat's list should be stored in a place inaccessible to children at temperature not above 30 C. The Period of validity - 3 years.
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