Indications for use of Prinivi.
Essential and renovascular hypertension, congestive heart failure (in combination with digitalis and/or diuretics)
It inhibits APF, prevents the transition of angiotensin I into angiotensin II, increases the concentration of endogenous vasodilating PG.
The drug reduces the formation of arginine vasopressin and endothelin1, possessing vasoconstrictor properties. It lowers peripheral vascular resistance, systemic arterial pressure, the after-load on the myocardium, the pressure in the pulmonary capillaries.
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The drug increases cardiac output and myocardial tolerance to stress of patients with heart failure.
It increases (again) the renin activity of blood plasma. The action manifests after 1 hour and is increasing during 6-7 h until 24 h. Antihypertensive effect reaches optimal values at repeated appointment within a few weeks.
The drug inhibits tissue renin-angiotensin systems in the heart, prevents the development of myocardial hypertrophy and dilatation of the left ventricle or contributes to their reverse development (cardioprotective effect).
It reduces the number of sudden deaths, reduces the likelihood of recurrent myocardial infarction, disorders of coronary blood flow and the occurrence of myocardial ischemia.
According to the ATLAS study, the use of lisinopril in high doses (35 mg), compared with its use in low doses (5 mg) by patients with chronic heart failure, reduced the combined end point: total mortality + all cause hospitalization by 12%, the number of hospitalization by 13%, the number of hospitalization for reason of decompensation of heart failure by 24%.
The results of the CALM study (combination therapy with candesartan and lisinopril) showed more pronounced renal protection and antihypertensive effects in patients receiving combination treatment after 24 weeks.
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The drug is not bound to any proteins of blood plasma (except ACE). It is not metabolized. The drug is completely excreted in the urine.
The use of the drug Prinivil during pregnancy
ACE inhibitors cause fetal and neonatal morbidity and mortality. The application of Prinivil during pregnancy is not recommended, except the cases when the use of other drugs is ineffective (a patient should be informed of the potential risk to the fetus). Prinivil penetrates the placenta.
If the drug is taken at later stages of pregnancy, it may cause fetal hypotension, renal failure and oligohydramnios. Oligohydramnios can cause contracture of the limbs and craniofacial deformation.
When the drug is used in II and III trimester, it may cause hyperglycemia, cranial hypoplasia. If there is oligohydramnios, Prinivil should be abolished, except those cases where its admission is considered necessary to save the mother’s life.
There are no data on the penetration of Prinivil in human milk. However it shouldn’t be prescribed to nursing mothers without a sufficiently serious reason.
Hypersensitivity, children’s age.
Angioedema of the face, lips, extremities, tongue, throat, dizziness, headache, confusion, weakness, asthenia, cough, orthostatic effects (including hypotension), tachycardia, myocardial infarction, dyspepsia, hepatitis, jaundice, urticaria, oliguria, uremia, renal failure, impotence, etc.
Method of application and doses.
The drug is taken inside before, during and after meals 1 times a day. In case of essential hypertension the usual starting dose is 10 mg per day; the effective maintenance dose is 20 mg per day.
The maximum daily dose is 80 mg. Patients, who can’t stop treatment with diuretics, should take Prinivil starting with 5 mg.
The selection of doses by patients with renal insufficiency should be based on creatinine clearance. In case of renovascular hypertension, the initial dose is 2.5–5 mg, the dose varies depending on the reaction of blood pressure.
If you suffer from congestive heart failure, than the initial dose should be 2.5 mg maintenance dose — 5-20 mg.
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Overdose is characterized by hypotension. The patient should be lain down and have an infusion of saline. Transient hypotension is not an indication for discontinuation of the drug.
Interaction with other drugs.
Indomethacin decreases the hypotensive effect. The combination with diuretics may cause hypotension, slows excretion of lithium.
The combination with potassium-sparing diuretics may cause hyperglycemia.