Fosinopril

Before starting treatment hypertension It is required to analyze the previously conducted antihypertensive drug therapy, the degree of increase in blood pressure, restrictions on the amount of salt and / or liquid and other clinical circumstances. If possible, antihypertensive treatment should be discontinued according to the previously used regimen a few days before the start of treatment with Monopril.
The recommended initial dose is 10 mg 1 time / day. The dose must be selected depending on the dynamics of lowering blood pressure. The average dose is 10-40 mg 1 time / day. In the absence of a sufficient hypotensive effect, the additional purpose of diuretics is possible.
If treatment with Monopril is initiated against the background of diuretic therapy, its initial dose should be no more than 10 mg with careful medical monitoring of the patient's condition. In order to reduce the risk of arterial hypotension, diuretics should be canceled 2-3 days before the start of Monopril.
In chronic heart failure The recommended initial dose is 10 mg 1 time / day. Depending on the therapeutic efficacy, the dose can be increased with a weekly interval, increasing it to a maximum of 40 mg 1 time / day. At the beginning and during treatment, careful medical observation is required. The development of arterial hypotension after the initial dose should not interfere with the careful selection of the dose of Monopril after effective relief of arterial hypotension. In case of heart failure, Monopril is recommended to be used in combination with a diuretic.

Monopril is contraindicated in pregnancy. The use of the drug in the II and III trimesters of pregnancy causes damage or death of the developing fetus.
Since fosinoprilat is excreted in breast milk, if you need to use Monopril during lactation, breastfeeding should be stopped.

With the development of angioedema on the background of taking Monopril, the drug should be immediately canceled. Patients should be warned that if there is swelling in the face, eyes, lips and tongue, laryngeal muscle spasm or shortness of breath, you should immediately stop taking the drug and consult a doctor. In such cases, it is necessary to promptly administer adrenaline solution (1: 1000) and take other emergency treatment measures.
Care must be taken when prescribing the drug to patients receiving desensitization therapy, because There is a risk of anaphylactoid reactions.
Anaphylactoid reactions have also been reported during the administration of Monopril during hemodialysis through highly permeable membranes, as well as during the apheresis of LDL with adsorption on dextran sulfate. In such cases, the use of another type of dialysis membrane or other medical treatment should be considered.
In rare cases, patients with uncomplicated arterial hypertension developed Monopril with hypotension. Symptomatic arterial hypotension with the use of ACE inhibitors is most likely in patients after intensive diuretic treatment and / or diet with limited salt content, as well as during kidney dialysis. Temporary hypotensive reaction is not a contraindication for the use of the drug after taking measures to hydrate the body.
In chronic heart failure with or without concomitant renal failure, treatment with ACE inhibitors can cause an excessive antihypertensive effect, which can lead to oliguria or azotemia, and in rare cases to acute renal failure and death. Therefore, in the treatment with monopril of chronic heart failure, it is necessary to carefully monitor the condition of the patients, especially during the first 2 weeks of treatment, as well as with any increase in the dose of fosinopril or diuretic.
Patients with normal or lowered blood pressure who have previously received intensive diuretic therapy, and those with low sodium levels in the blood, may need to lower the diuretic dose. Hypotension is not a contraindication for the further use of the drug Monopril. Some reduction in systemic blood pressure is a common and desirable effect at the beginning of the use of the drug in heart failure. The extent of this decrease is maximum in the early stages of treatment and stabilizes within 1-2 weeks of therapy. BP usually returns to the values ​​characteristic of the period before treatment begins, without reducing therapeutic efficacy.
If during the treatment with Monopril there is a noticeable yellowness and a pronounced increase in the activity of liver enzymes, the drug should be canceled and appropriate treatment should be prescribed.
With arterial hypertension in patients with renal artery stenosis of one or both kidneys, as well as the simultaneous use of diuretics without signs of renal vascular disease during treatment with ACE inhibitors, blood urea nitrogen and serum creatinine may be elevated. These effects are usually reversible and disappear after stopping treatment. May require a reduction in the dose of diuretic and / or drug Monopril.
In patients with severe chronic heart failure, in whom renal function may depend on the activity of the renin-angiotensin-aldosterone system, treatment with ACE inhibitors may lead to oliguria or to progressive azotemia and in rare cases to acute renal failure and / or death.
In patients with heart failure, diabetes, at the same time taking potassium-saving diuretics, potassium dietary supplements and / or salt substitutes containing potassium salts, or other drugs that increase the content of potassium in the blood (eg, heparin), the use of ACE inhibitors increases the risk of development hyperkalemia.
Since fosinopril is eliminated from the body in two ways, a dose reduction of Monopril is usually not required when treating hypertension and heart failure in patients with impaired renal or hepatic function.
There is no difference in the efficacy and safety of treatment with Monopril in patients aged 65 years and older and younger. However, in older patients, greater susceptibility to the drug cannot be ruled out.
Control of laboratory parameters
While taking Monopril, the number of leukocytes in the peripheral blood should be periodically determined, paying attention to patients with impaired renal function, especially against the background of collagenosis (systemic lupus erythematosus or scleroderma), since it has been reported that in rare cases, ACE inhibitors cause agranulocytosis and suppression of bone marrow function with a greater likelihood in this category of patients.
Use in Pediatrics
Safety and efficacy of the drug Monopril in children have not been established.

Symptoms: marked reduction in blood pressure, bradycardia, shock, impaired water and electrolyte status, acute renal failure, stupor.
Treatment: the drug should be stopped, gastric lavage, taking of sorbents (for example, activated carbon), vasopressor agents, infusion of 0.9% sodium chloride solution and further symptomatic and supportive treatment are indicated. The use of hemodialysis is ineffective.