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| Generic Name | Lisinopril Tablets 20mg |
| Strength | 20mg |
| Packing | 10tabs/blister,3blisters/box |
| Origin | China |
This product is pink.
High blood pressure:
This product is used to treat essential hypertension and renal vascular hypertension. It can be taken alone or in combination with other antihypertensive drugs.
Congestive heart failure:
This product can be combined with digitalis or diuretics as an adjunct treatment for congestive heart failure.
Acute myocardial Infarction:
It is used to treat patients with hemodynamic stability within 24 hours after acute myocardial infarction, and can prevent the development of left ventricular insufficiency or heart failure and improve survival. Patients should receive conventionally recommended treatments such as antisuppositories, aspirin, and beta-blockers when appropriate.
Usage and dosage:
This product should be taken orally, once a day. Like other medications that should be taken once a day, this product should be taken at approximately the same time each day. The absorption of this product is not affected by food. Dosage should be adjusted individually according to the patient's condition and blood pressure response (see [Precautions]).
Essential hypertension:
This product can be used alone or in combination with other types of antihypertensive drugs.
Initial dose
The usual recommended initial dose for patients with essential hypertension is 10 mg daily. Patients with highly activated renin-angiotensin-aldosterone systems (especially those with renal vascular hypertension, hyposaline or hypovolemic states, cardiac decompensation, or severe hypertension) may experience excessive blood pressure reduction after the first dose. The recommended starting dose for these patients is 2.5-5mg and treatment should be initiated under medical supervision. Patients with renal insufficiency require a lower dose.
Maintenance dose
The most effective maintenance dose is 20mg once a day. In general, if the desired therapeutic effect is not achieved within 2 to 4 weeks of treatment, the dose can be further enhanced. The maximum dose used in long-term controlled clinical trials was 80mg a day.
Patients who use diuretics
Symptomatic hypotension may occur on initial use of this product, which is more common in patients taking diuretics, so special attention should be paid to patients who may have low blood volume or low blood sodium. Stop taking diuretics two to three days before starting treatment with this product (see [Precautions]). For hypertensive patients who cannot stop taking diuretics, the initial dose of this product is 5 mg. Renal function and serum potassium should be monitored, and the dosage should be adjusted according to blood pressure. If necessary, the use of diuretics can be resumed. (See "Precautions" and "Drug Interactions").
Dose adjustment in patients with renal impairment
Dose adjustment in patients with renal failure should be based on creatinine clearance as shown in Table 1.
Table 1
Creatinine clearance (ml/min) Initial dose (mg/ day)
Less than 10 (including dialysis patients) 2.5mg*
10-30 2.5-5mg
31-70 5-10mg
* Dosage and/or number of doses should be adjusted according to blood pressure.
The dose can be gradually increased to control blood pressure or to a maximum dose of 40 mg per day.
Congestive heart failure
In patients with symptomatic heart failure, the initial dose of this product is 2.5mg once daily as an adjunct to digitalis and diuretic therapy. To reduce the risk of death and hospitalization combined with treatment, the dose should not be increased by more than 10mg at intervals shorter than 2 weeks. The dose should be adjusted according to the clinical response of the individual patient.
The general effective dose range is once a day, 5 to 20mg each time.
For patients at high risk of symptomatic hypotension, such as salt loss with or without hyponatremia, patients with low blood volume, and patients receiving strong diuretics, the above conditions should be corrected, if possible, before treatment with this product, and blood pressure should be closely monitored at the time of initial administration.
Acute myocardial infarction
This product can be used within 24 hours of the onset of myocardial infarction symptoms. Treatment should not be started if the systolic blood pressure is below 100mmHg. The first dose was 5mg orally, followed by 5mg and 10mg orally 24 hours later and 48 hours later, followed by 10mg once a day. Patients with low systolic blood pressure (120mmHg or less) should be given a lower dose (2.5mg) at the beginning of treatment or within three days after the infarction (see Precautions). If hypotension occurs (systolic blood pressure less than or equal to 100mmHg), the daily maintenance of 5mg can be temporarily reduced to 2.5mg if necessary. If hypotension persists (systolic blood pressure below 90mmHg for more than one hour), discontinue use of this product.
The drug should be used for six weeks. Patients with symptoms of heart failure should continue to use this product (see "Congestive heart Failure" section in [Usage and Dosage]).
This product can be used with intravenous or transdermal absorption of nitroglycerin.
Children: The safety and efficacy of this product have not been established in children, so it is not recommended for children.
Older adults: In clinical studies, drug safety or efficacy was not associated with changes in patient age. In senile renal function decline, the initial dose of this product should be determined by referring to the principles in Table 1 (see Dose Adjustment for Renal function Impairment). Subsequent doses should be adjusted according to changes in blood pressure.
Kidney transplant patients: There is no recent experience of using this product in kidney transplant patients, so it is not recommended for kidney transplant patients.
Matters needing attention:
Symptomatic hypotension
Symptomatic hypotension is rarely seen in uncomplicated hypertensive patients. Symptomatic hypotension is more likely to occur in hypertensive patients treated with this product when low blood volume is present, such as during diuretic therapy, low-salt diet, dialysis, diarrhea, and vomiting (see Drug interactions and Adverse reactions). Symptomatic hypotension has been reported in patients with congestive heart failure, whether accompanied by renal insufficiency or not. Patients with severe heart failure (characterized by higher dose loop diuretics, hyponatremia, or functional kidney impairment) have a higher risk of symptomatic hypotension. For patients at high risk of symptomatic hypotension, close medical supervision should be given when starting treatment and dose adjustment. The same consideration should be given to patients with ischaemic heart disease or cerebrovascular disease, whose excessive drop in blood pressure can lead to myocardial infarction or cerebrovascular accident.
In the event of hypotension, the patient should lie on his back and be given intravenous saline if necessary. A brief hypotensive reaction should not be a contraindication for continued medication, and remedication is usually feasible once the blood pressure rises after dilatation.
As with other vasodilators, this product should be treated with caution in patients with aortic sclerosis or hypertrophic cardiomyopathy.
In patients with congestive heart failure with normal or low blood pressure, taking this product will further reduce blood pressure. This is to be expected and treatment should not be discontinued. If symptomatic hypotension occurs, it may be necessary to reduce the dosage of this product or stop treatment.
Hypotension during acute myocardial infarction
Patients with acute myocardial infarction who are at risk of further hemodynamic deterioration after vasodilator therapy should not be treated with this product. These patients often have a systolic blood pressure of 100mmHg or less or are associated with cardiogenic shock. The dosage should be reduced if the systolic blood pressure is 120mmHg or lower within three days of a heart attack. If the systolic blood pressure is 100mmHg or lower, maintenance should be reduced to 5mg or temporarily reduced to 2.5mg. If hypotension persists (systolic blood pressure below 90mmHg for more than one hour), use of this product should be discontinued.
Renal impairment
In patients with congestive heart failure, hypotension resulting from ACE inhibitors may lead to further renal impairment. Reversible acute renal failure has been reported.
Increases in blood urea and serum creatinine have been observed after treatment with ACE inhibitors in some patients with bilateral renal artery stenosis or one-kidney renal artery stenosis, which is more likely to occur in patients with renal insufficiency. If renal vascular hypertension is present, there is an increased risk of severe hypotension and renal insufficiency. In these patients, treatment should be initiated at a low dose under strict medical testing, and the dose should be raised cautiously. Because diuretic therapy may cause these conditions, diuretics should be discontinued and renal function monitored during the first week of treatment with this product.
In some hypertensive patients who did not previously have significant renal vascular disease, there has been a slight and temporary increase in blood urea and serum creatinine, especially in those who take this product with diuretics. This is especially the case in patients with pre-existing renal insufficiency, and the use of diuretics and/or this product should be reduced and/or discontinued if necessary.
It is clear that acute myocardial infarction patients with renal insufficiency should not start the treatment of this product. Renal dysfunction is defined as a serum creatinine concentration exceeding 177mmol/l and/or urinary protein concentration exceeding 500mg/24h. If renal insufficiency occurs during treatment with this product (serum creatinine concentration exceeding 265mmol/l or twice the pre-treatment level), the doctor should consider discontinuing the use of this product.
hemodialysis
Anaphylaxis has been reported in patients receiving certain hemodialysis treatments (e.g., high-filtration membrane AN69) combined with ACE inhibitors. Such patients should consider different types of dialysis membranes or other classes of antihypertensive drugs.
Allergic/angioneurotic edema
Angioneurotic edema of the face, hands and feet, lips, tongue, glottis, and/or larynx in patients using ACE inhibitors, including this product, has rarely been reported. For these patients, the use of this product should be stopped immediately and appropriate monitoring should be taken, and the patient can not be allowed to leave until the symptoms have completely disappeared. If the allergy is limited to the face and lips, it will generally return to normal after stopping the drug. The use of anti-allergy drugs can reduce symptoms.
Laryngeal edema associated with angoneurotic edema is fatal because edema of the tongue, glottis, and larynx is highly likely to cause airway obstruction and should be treated immediately and appropriately including the use of epinephrine and/or keeping the airway open. These patients should be under close medical supervision until their symptoms have completely and consistently resolved.
Patients with a history of angioneurotic edema who receive ACE inhibitors are at an increased risk of developing angioneurotic edema, even if the cause is unrelated to ACE inhibitors. (See Taboos)
race
Angiotensin converting enzyme inhibitors have a higher incidence of angioedema in black patients than in non-black patients.
hyposensitization
Patients who receive ACE inhibitors during desensitization (insect toxins) may experience a persistent allergic reaction, which can be avoided in the same patients by temporarily discontinuing ACE inhibitors, but can reoccur if they are stimulated by allergens.
cough
It has been reported that the use of ACE inhibitors can cause cough, which is characterized by a phlegmless, persistent cough that disappears after discontinuation. Cough due to ACE inhibitors should be considered as one of the differential diagnoses of cough.
Surgery/Anesthesia
In patients undergoing major surgery or using anaesthetics that produce hypotension, it inhibits angiotensin II formation secondary to compensatory renin release. If the occurrence of hypotension is believed to be caused by this mechanism, it can be corrected by dilatation.
Effects on driving and mechanical ability
No special precautions.
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