Captopril, the active ingredient Capoten is one of the best known drugs that lower blood pressure. Among ACE inhibitors, it was obtained first, and this is its great medicinal efficacy led to the development of the synthesis of similar drugs.
Release form and composition
Bonnet comes on the market in pill form. The shape and appearance of tablets vary depending on manufacturer. Tablets of 25 or 50 mg, usually white, biconvex, perhaps embossed. Cross-shaped chamfer (if any) help to divide a tablet into two equal halves with a weight of 12.5 mg (25 mg) or into four pieces weighing 6,25 mg (12.5 mg). Usually one pack is between 28 and 56 tablets.
Main substance: captopril 25 mg or 50 mg.
Excipients: lactose monohydrate, corn starch, microcrystalline cellulose, stearic acid.
How does Capoten
In the human body there are special systems that regulate the contraction or expansion of vessels with the help of their hormones. One of the main responsible for the contraction of the renin-angiotensin-aldosterone (RAAS). It regulates fluid balance, electrolytes, blood pressure and blood volume. It happens like this: the liver produces a protein angiotensinogen, which is under produced under certain conditions by the kidneys renin is converted to angiotensin I. This substance in itself does not affects the body; we need it only as “raw material” for the present employee – angiotensin II. And it constricts blood vessels, causing an increase in pressure.
The transition angiotenzina from the first form to the second cause of angiotensin converting enzyme ACE. Therefore, the development of reducing pressure medications scientists have long tried to find such drugs that would have suppressed the production of the enzyme and thereby preventing in the body angiotensin II, until the end of the last century from the venom of the Brazilian snake was the first ACE inhibitor – captopril. A new medication proved so effective that served as the basis for the synthesis of new drugs. Currently, there are more than 100 kinds of ACE inhibitors. As shown, the ACE inhibitors were the same (if not more) effective as traditional medicines for the treatment of hypertension – diuretics and beta-blockers.
In addition, ACE inhibitors have many useful properties. They are metabolically neutral, which is especially important for patients with comorbidities (e.g., diabetes). Even the Canopy has cardioprotective and nephroprotective action as well as when taking ACE inhibitors reduces the risk of recurrent stroke and cardiovascular complications.
The degree of absorption of captopril is approximately 75%. Peak concentrations are reached within 60-90 minutes after taking the medicine. The presence of food in the gastrointestinal tract reduces absorption of medication by about 30-40%.
The half-life is about 2 hours; more than 95% is excreted via the kidneys during the day. Patients with diseases of urinary system, especially at higher levels of urea and creatinine, you should inform your doctor.
Studies have shown that Capoten blood-brain barrier is not overcome.
Hypertension. Reduction in blood pressure occurs 60-90 minutes after ingestion Capoten. Duration of action is dose-dependent. The pressure reduction can be progressive, so to achieve maximum therapeutic effect may take several weeks.
Heart failure. Capoten is indicated for the treatment of chronic heart failure, characterized by a reduction of the systolic function of the ventricle. The drug can be administered together with diuretics and, if necessary, beta-blockers.
Myocardial infarction. Stable patients can receive Treatment within the first 24 hours after a heart attack.
Long-term prevention of symptoms of heart failure. Bonnet is shown for use in clinically stable patients with asymptomatic left ventricular dysfunction.
Diabetic nephropathy type I. Bonnet can be used for the treatment macroproteinuria diabetic nephropathy in patients with type I diabetes.
How to use Capoten
The dosage is calculated based on the individual patient’s profile and the indicators of its blood pressure. The maximum daily dose is 150 mg. Capoten can be taken with, before and after eating – its effectiveness meal time is not affected. Taken orally.
Hypertension. The recommended starting dose Capoten hypertension is 1-2 tablets of 25 mg per day in two doses. To achieve the desired pressure, the dose can be gradually increased (with the interval between changes at least two weeks) up to 100-150 mg per day in two doses. Capoten is indicated for use alone or with other pressure lowering agents. Particularly well captopril works in combination with thiazide diuretics (in this case, the Canopy can be taken once a day).
In patients with hypovolaemia, renovascular hypertension and decompensation of the heart is preferable to start with a single dose of 6,25 mg (quarter tablets) or 12.5 mg (half tablets). Welcome Capoten such patients should be under close medical supervision. Gradually increase the dose to 50 mg (once or twice a day) and, if necessary, up to 100 mg per day (once or twice).
Heart failure. Treatment of heart failure with Capoten should be under constant medical supervision. Typically the reception starts with a quarter or half pill (6,25 mg or 12.5 mg). If the patient tolerates the treatment well, the dose can be gradually increased to 150 mg per day (in two doses). The interval between changes dosage should be at least two weeks.
Myocardial infarction. In patients with stable hemodynamics Bonnet shown to the application as soon as possible after the first signs of a heart attack. In the first 24 hours after a heart attack dose to start with 6,25 mg (a quarter pill), after two hours 12.5 mg, and after twelve hours, increase the dose to 25 mg. The next day, take the drug in 50 g twice a day for four weeks, provided that the adverse hemodynamic responses are absent. Four weeks after a heart attack the doctor needs to develop a new treatment plan.
If treatment in the first 24 hours has not begun, the Bonnet begin to take in the interval from 3 to 16 days after a heart attack provided that the patient has stable hemodynamics. In this case, the treatment is started in hospital under strict medical supervision; special attention should be paid to blood pressure. The initial dose should be low – usually starting with the 6.25 mg, then 12.5 mg 3 times a day for two days, and, if the hemodynamic response is normal, increase the dose to 75 mg (on 25 mg 3 times a day). The recommended dose for effective protection of the heart in this case is 75-150 mg daily in two or three divided doses.
If necessary, the dose Capoten deal depending on condition. Also the Canopy can be used in combination with other methods of treatment of myocardial infarction, such as beta-blockers, acetylsalicylic acid and thrombolytic preparations.
Nephropathy in type I diabetes. In these patients, the recommended daily dose Capoten is 75 to 100 mg per day (three to four doses). If you want to further reduce the pressure, the patient can be assigned to additional antihypertensive agents.
Patients with renal insufficiency. Because captopril is excreted mainly through the kidneys, the dosage and time of drug intake in these patients is corrected with consideration of the disease – usually either reduce the dose or increase the interval between doses of the drug. If you need concurrent diuretic therapy, patients with renal insufficiency to make a loop, not a thiazide, a diuretic, e.g., furosemide. The dose depends on the creatinine clearance; for example, if the clearance is more than 40, the reception Capoten start with 25-50 mg, the maximum dose is 150 mg. If ground clearance is low, less than 10, the initial dose is 6.25 mg and a maximum of 37.5 mg.
Bonnet for the elderly. One of the General rules in determining the dosage of receiving negative media pressure in the elderly is to start with a lower dose (6.25 mg), as these patients may be reduced kidney function.
Capoten for children. Use captopril for children can only be under close medical supervision. The initial dose is about 0.3 mg per kg of body weight of the child. If the patient suffers from renal dysfunction or is a newborn child or infant of one year, the starting dose should be only 0.15 mg captopril / kg weight. As a rule, children are given Treatment three times a day, and of course dosage should be calculated individually depending on the patient’s response to treatment.
Allergic reactions. If the patient or his family have experienced allergic reactions after ingestion of the drug, the use of Capoten is not recommended.
Increased individual sensitivity to captopril (or any other ACE inhibitor) or other members of the pills substances.
Renal failure. You cannot use the Bonnet for the treatment of patients with aortic stenosis or bilateral renal artery stenosis in a single functioning point.
Renal failure caused by diabetes. For such patients it is not recommended to use a Bonnet with iliskilendirmesi drugs.
Capoten in pregnancy and breastfeeding
Pregnancy. Capoten in pregnancy is prohibited to take, as the tool has a toxic effect on the fetus. If a patient plans to become pregnant and uses reliable methods of contraception, to use Capoten . If the pregnancy is planned, Treatment is recommended to replace anygivensunday alternative methods of treatment that can be used during pregnancy. In cases where a pregnancy arose Kapitanom treatment should be discontinued immediately and, if necessary, to start alternative therapy.
Breast-feeding. Although the number of captopril entering the breast milk is negligible, its use is not recommended in breastfeeding preterm infants in the first few weeks after birth. Hypothetically there is a risk of cardiovascular and renal adverse effects in children. Clinical studies of the effects Capoten on newborn babies was carried out. If the child is older, the receiving Capoten when breastfeeding is possible if the benefits of the drug outweigh its harm to mother and child. In any case, the status of both mother and child must be constantly monitored.
The incidence of side effects: very common (1/10 to 1/100); frequently (1/100 to 1/100), rare (1/10000 to 1/1000) and very rare (1 case per 10,000 people or more).
|Very often||Often||Rarely||Very rarely|
|Circulatory system||Neutropenia, agranulocytosis, acetoine (especially in patients with renal dysfunction), anemia, thrombocytopenia, lymphadenopathy|
|Digestive system||Loss of appetite|
|Metabolism||Hyperkalemia, hyponatremia, hypoglycemia|
|Nervous system||Dizziness||Headache, sensation of tingling on the skin tingling (paresthesia)||Drowsiness||Faint|
|Heart||Tachycardia, arrhythmia, angina, palpitations.||Cardiac arrest, cardiogenic shock|
|Vessels||Hypotension, reddening of the skin, pallor, orthostatic hypotension|
|Respiratory system||Dry cough, shortness of breath||Bronchospasm, rhinitis, alveolitis, allergic pneumonia|
|Gastrointestinal tract||Nausea, vomiting, abdominal pain, diarrhea, constipation, dry mouth, peptic ulcer, dyspepsia||Stomatitis, angiodystrophic the small intestine||Pancreatitis|
|Liver||Abnormal hepatic function, cholestasis, jaundice, hepatitis, hepatic necrosis, increased levels of bilirubin in the blood, increased levels of transaminases|
|Leather||Itching with or without rash||Angiodystrophic||Urticaria, erythema multiforme, photosensitivity, exfoliating dermatitis|
|Bones, muscles, connective tissue||Myalgia, arthralgia|
|Urinary system||Renal failure, kidney failure, polyuria, oliguria||Nephrotic syndrome|
|Reproductive system||Erectile dysfunction, gynecomastia|
|Common disorder||Chest pain, fatigue, asthenia||Pyrexia|
There are not all the side effects that may cause Capoten; in many ways their presence is due to the individual reaction of the organism. If a person thinks that after taking Capoten arise unfavorable effects, you should inform your doctor.
The negative pressure. Most often, hypotension is found in patients, the amount of sodium in the blood which is reduced due to the use of diuretics, restriction of salt in connection with diet, diarrhoea, vomiting or after hemodialysis. Before taking captopril and other ACE inhibitors it is recommended to compensate for the deficiency of sodium, and to appoint lower initial dose.
If low pressure in a patient is a consequence of heart failure, it is recommended that a lower starting dose. This is true for the first-second week after the start of treatment; then you go to the normal dosage. Increase dosage Capoten or diuretic for such patients should be under the supervision of a physician.
Such precautions are caused by the fact that excessive reduction of pressure in patients with cardiovascular or cerebrovascular disease may increase the risk of myocardial infarction or stroke. If the pressure is very low, the patient should be in supine position; may require a saline drip.
With extreme caution should be applied Bonnet for babies (especially newborns); they may be more susceptible to adverse pressure changes. You may experience the following complications: unpredictable and long-lasting reduction of pressure, oliguria, convulsions.
Renovascular hypertension. In patients with bilateral renal artery stenosis or stenosis of the artery at the same functioning kidneys, there is an increased risk of hypotension and renal failure. Kapitanom therapy in these patients is under close medical supervision; the patient is prescribed a reduced dose of medication, and the condition of his kidneys should be under constant supervision.
Renal failure. If creatinine clearance is less than 40 ml/min, the initial dose Capoten is calculated from this figure. Regular monitoring of the level of potassium and creatinine is part of normal medical practice for these patients.
Allergic reactions. In patients taking Capoten, you may experience various allergic reactions, including angioedema. This can happen at any time after the start of treatment with the use of the drug. Application Capoten in such cases, should immediately stop, and to stop the symptoms of allergies in a patient. If an allergic reaction limited to swelling of the face and lips, the Capoten can be taken (best in combination with antihistamines). If swelling affects the tongue, throat or larynx and possible airway obstruction, the patient hospitalitynet and take measures to eliminate the symptoms.
Patients in whom there was some kind of allergic reaction in the past (even if they are not caused by ACE inhibitors) are at increased risk of allergies when Capoten.
Also sometimes after taking Capoten the patient may begin to complain of pain in the abdomen, nausea, vomiting. These symptoms can also be caused by allergies to ACE inhibitors or substances included in the tablets Capoten.
Cough. Sometimes after taking the ACE inhibitors, the patient may cough. It continues during the course of treatment Capatina and terminated itself after its cancellation.
Liver failure. In rare cases, the intake of ACE inhibitors, including Capoten, causes patients cholestatic jaundice, which may lead to necrosis of the liver and even death. Why this happens is still unclear. Thus patients undergoing treatment with ACE inhibitors should be kept under observation; if there is a suspicion of jaundice or observed increase in levels of liver enzymes, intake of Capoten and other ACE inhibitors should be discontinued immediately.
Hyperkalemia. The risk of hyperkalemia is increased in patients with renal failure, diabetes and those using potassium-sparing diuretics, regularly take supplements potassium, eat potassium-containing salt substitutes. At risk also include patients taking medications that can cause increase in blood potassium level (e.g. heparin). So if you assign Capoten reception of these substances or medicines should be stopped and if this is not possible, it is recommended to constantly monitor the level of potassium in the blood.
Stenosis of the aorta and mitral valve, hypertrophy obstructive cardiomyopathy, cardiogenic shock. In patients with blockage of valves and outflow of the left ventricle ACE inhibitors should be used with caution. If the patient is in cardiogenic shock and hemodynamically significant obstruction. Bonnet is not prescribed.
Neutropenia or agranulocytosis. Reported cases of neutropenia or agranulocytosis, thrombocytopenia and anaemia in patients treated with ACE inhibitors, Capoten and including. If kidney function in the patient’s normal, neutropenia is rare. With extreme caution the Canopy should be used in patients taking immune suppressing drugs, allopurinol, procainamide; especially careful should I be, if the patient has impaired renal function. Some of these patients suffered serious infections, the pathogens which did not respond to intensive antibiotic therapy.
If the application Capoten for such patients must regularly conduct the counting of white blood cells every two weeks for the first three months after the start of treatment Kapitanom. Patients should be warned that they informed the doctor about any signs of infection (e.g., sore throat, high temperature). If the patient is suspected neutropenia, receiving Capoten to stop immediately. In most patients, the neutrophils are normal after discontinuation of treatment with captopril.
Proteinuria. If the patient has impaired renal function or assigned to high-dose ACE inhibitors (more than 150 mg per day), there is a risk of proteinuria. In most cases it passes by itself within six months, regardless of continued reception Capoten or not. In patients with renal insufficiency should regularly assess the protein in urine before treatment and from time to time after its termination.
Patients undergoing surgery or undergoing treatment with the use of anesthetic drugs. Since anesthetic drugs have the property to lower blood pressure, dosage Capoten should be calculated taking into account this factor.
Diabetes. During the first month after starting treatment with ACE inhibitors (and Kapitanom) in patients who had previously taken antidiabetic agents or insulin, monitor blood sugar levels.
Heart failure. In long-term care Kapitanom creatinine levels of patients rises to 20% above normal or baseline. Less than 5% of patients (usually with severe renal insufficiency), required discontinuation of treatment due to the gradual increase in creatinine.
The risk of hypokalemia. If ACE inhibitors to use in combination with a thiazide diuretic may develop hypokalemia. Therefore, you should monitor the level of potassium in the blood.
Lactose. Capoten contains lactose, therefore its application is not recommended for patients with a rare disease of metabolism in which there is lactose intolerance.
Dual blockade of the RAAS. There is evidence that concurrent use of ACE inhibitors (including Capoten), and blockers of receptors of aliskiren increases the risk of hypotension, hyperkalemia and reduced renal function (including acute renal failure). Therefore, dual blockade of the RAAS with the use of these funds is not recommended. If therapy with dual blockade is absolutely necessary, this should only occur under constant special observation and monitoring of renal function, electrolytes in blood and blood pressure.
Symptoms of overdose are severe hypotension, shock, stupor, bradycardia, renal failure. If overdose Kapitanom happened within half an hour after ingestion, deal with it you can use induction of vomiting, gastric lavage, administration of adsorbents. If the pressure begins to drop, use of medical tools through the use of a pacemaker. Captopril also can be removed from the body of an adult with hemodialysis.
Capoten interaction with other drugs
Potassium-sparing diuretics or supplements with potassium. Such diuretics, food supplements or substitutes of potassium can lead to a significant increase in potassium in the blood. If these drugs must be used due to severe hypokalemia, they should be used with caution and to regularly monitor the level of potassium.
Thiazide or loop diuretics. If before therapy Kapitanom patient was taking thiazide diuretics, there is a risk of hypotension. The symptoms of low blood pressure can be reduced if stop taking thiazide diuretics or to reduce the dose Capoten. When checking the joint action of Capoten with a loop diuretic such as furosemide, side effects were found.
Other pressure reducing means. Combined use of these drugs in conjunction with Kapitanom can increase its hypotensive effects. Treatment with vasodilators should be interpreted with caution.
Alpha-blockers. If Capoten be taken in conjunction with alpha-blockers, there is a risk of orthostatic hypotension.
The drugs used for the treatment of acute myocardial infarction. Bonnet can be used together with acetylsalicylic acid, with thrombolytic drugs and beta-blockers in patients with myocardial infarction.
Lithium containing medicines. There is information about a reversible increase in the concentration of lithium in the blood while taking lithium drugs with ACE inhibitors, including Capoten that can cause poisoning. The increase in the level of toxicity of lithium may serve as the thiazide diuretics. So use with Conventional lithium-containing drugs is not recommended. If it seems the doctor needs necessary to carefully monitor the level of lithium in the blood.
Tricyclic antidepressants and antipsychotics. ACE inhibitors, including Capoten, can exacerbate the effects of these drugs. In the result, there may be postural hypotension.
Immunosuppressive funds, allopurinol, procainamide, cytostatic. Sharing them with Kapitanom use may lead to a greater risk of leukopenia, especially if you exceed the recommended dose.
Nonsteroidal anti-inflammatory drugs. If these drugs to use together with ACE inhibitors, potassium levels in the blood can rise and kidney function decrease. Both effects are reversible. In rare cases, may occur with acute renal failure, especially in patients with renal function which was already broken (for example, elderly or suffering from dehydration).
The sympathomimetics. The co-administration of sympathomimetic agents with ACE inhibitors may reduce the antihypertensive effect of the latter; carefully monitor patients.
Antidiabetic drugs. AFP inhibitors, including Capoten, can enhance the effect of lowering the blood sugar level when used in conjunction with insulin and diabetic agents taken orally. This happens very rarely; in such cases it may be necessary to decrease the dose of antidiabetic agents.
Clinical biochemistry. Capoten may cause a false positive urine test for acetone.
Capoten impact on the ability to drive
For the first time after you start taking Capoten, and if there is a change of dosage, the patient’s ability to drive and perform actions that require a high level of concentration, can be reduced. It is recommended to refrain from such activities, until the patient feel better.
Capoten interaction with alcohol
Dependent on individual patient response.
Terms of sale
According to the recipe.
Store Capoten at room temperature (15° to 25°), away from direct sunlight and in low humidity, out of reach of children and Pets. It is recommended to store the drug in the original packaging to protect it from moisture.
The price of the drug depends on the manufacturer, the pricing policies of pharmacies and the number of pills in the pack. Typically, the range is from 160 to 300 rubles.
Drugs, the main active ingredient of which is captopril: Captopril, Captopril Sandoz Captopril-STI.
Other ACE inhibitors, the action of which is similar to captopril (with some differences):
Drugs, an active substance for which actions must undergo metabolic transformation in the liver (so they have longer compared to Kapitanom effect): enalapril, ramipril, perindopril, benazepril, renitek, trandolapril.
ACE inhibitors, combined with diuretics: male.
It should be added that although the main effects of ACE inhibitors are similar, they differ in chemical composition and have different ways of excretion, duration of action and therefore different dosage. So you should not independently change one medication from the group of ACE inhibitors to another without consulting your doctor.