Bified 15mg Menarini treatment for hypertension, acute myocardial infarction (2 blisters x 14 tablets)

Bifril's treatment effect in patients with hypertension and acute myocardial infarction may be the main result of inhibiting the renin-angiotensin aldosteron system in plasma. The Australian effect on the enzyme is used for angiotensin (Ki 04 N.M on rabbit lungs when using zofenoprilate arginin salt) reduces the plasma angiotensin II concentration, reducing vascular activity and reducing Aldosteron secretion.

Despite the low reduction of aldosteron, the slight increase in serum potassium concentration, accompanied by fluid loss and sodium. When stopping the negative response of angiotensin II on the process of lenin secretion increases the activity of plasma renin. The activity of angiotensin in plasma shifts decreases at a rate of 53.4% ​​and 74.4% respectively 24 hours after using a single dose of 30 mg and 60 mg Zofenopril calcium.

Angiotensin shifting inhibition increases the activity of the kallikrein-pinin system in place and during circulation, causing peripheral vessels through the activity of the prostaglandin system. This mechanism may also be related to the hypotension effect of zofenopril calcium and may be the cause of some adverse reactions.

In patients with hypertension, using Bified drugs reduces both lying blood pressure and standing posture with the same level, without the phenomenon of increased compensation heart rate. The average resistance level of the vascular wall tends to decrease after using Bify.

In some patients, it is necessary to treat a few weeks to reach optimal hypotension. The effectiveness of hypertension treatment is maintained during long -term treatment.

Sudden stopping of the drug has no relationship with sudden hypertension. There are no updated data related to the impact of Bify on mortality and incidence rate in hypertension patients.

Although the lowering effect has been recorded on all races, black people (usually a population of hypertension patients with low renin activity) have a response to lower enzyme inhibitors than other populations. This difference is no more if using the drug simultaneously with diuretics.

Clinical effect when using Bified for patients after infarction may be related to many factors such as reducing the concentration of angiotensin II in plasma (this way helps limit ventricular restructuring process, a process that can adversely affect the long-term prognosis of infarction patients), and the increase in the concentration of vasodilators in plasma/tissue (Prostaglandin-oil).

A random clinical trial has been performed, comparing Zofenopril with fake fake conducted on 1556 patients with a history of myocardial infarction and not treated with fibrinolytic regimen. The regimen is started within 24 hours and lasts for 6 weeks. The combined output criteria (severe heart failure and/or death after 6 weeks) decreased on a group of patients treated with zofenopril (zofenopril 7.1%, placebo 10.6%). After 1 year, the survival rate is improved in the group of patients treated with Bify.

Two major, random, controlled clinical trials: ontarget (Telmisartan therapy and coordinate with Ramipril) and Nephron-D (diabetes-related kidney patients) have been established to evaluate the use of a coordination of an enamel inhibitors transferred to an Agiotensin II receptor inhibitors.

Ontarget is a study designed for patients with a history of cardiovascular disease or cerebrovascular disease, or type 2 diabetes with target organs. Nephron-D is a study in type 2 diabetics and patients with diabetes.

These studies show that there is no significant effect on the kidneys and/or cardiovascular disease and the survival rate while increasing the risk of hyperkalemia, acute kidney damage and/or hypotension compared to monomers.

Due to the same pharmacological properties, this result is also applied to other Angiotensin II receptor inhibitors.

Therefore, it is not advisable to use in combination with enzyme inhibitors and angiotensin II receptor inhibitors for patients with kidney disease related to diabetes.

Altitude (Aliskiren's clinical trial in type 2 diabetics with cardiovascular and kidney disease assessment) is a study designed to evaluate the effectiveness of adding Aliskiren to standard medications for enzyme inhibitors or Angiotensin II receptor inhibitors for type 2 diabetics and chronic kidney disease, or both.

This research ended early because of the increasing risk of side effects. The higher mortality due to cardiovascular disease and stroke in the group using Aliskiren compared to the placebo group and the frequency of side effects and serious side effects (hyperkalemia, hypotension, renal dysfunction) in the group using Aliskiren higher than the placebo group.

Dynamic pharmacokinetics

Zofenopril is a medication, because the active drug is a drug without sulfhydryl, zofenoprilat, this substance is made up of thio-anticipated hydropive reaction.

absorption

Zofenopril is absorbed quickly, almost completely through oral and metabolized almost completely into zofenoprilat, this drug reaches a nail concentration after 1.5 hours after drinking zofenopril. Single-dose dynamic in the dose range from 10 to 80 mg Zofenopril and there is no accumulated phenomenon after the dose of 15-60 mg Zofenopril within 3 weeks.

The presence of food in the gastrointestinal tract reduces the speed but does not affect the level of absorption and area below the concentration curve (AUC) of zofenoprilat. Therefore, the pharmacokinetics of the drug are almost similar when drinking or hungry.

distribution

After using a dose of radioactive zofenopril, the measurement results under the Ex-Vivo condition show that about 88% of radioactive activity is attached to plasma proteins and the distribution volume in equilibrium is 96 liters.

transformation

After using a dose of radioactive zofenopril, there are eight metabolites, accounting for 76% of radioactive activity found in human urine. The main metabolites are zofenoprilat (22%), the metabolic product of many roads, including glucoronic complexes (17%), ring and glucoronic connection (13%), Cysteine ​​(9%) and methylation at the sulfur position of the Thiol group (8%).

Selling waste time of zofenoprilat is 5.5 hours and total clearance is 1300ml/minute after drinking zofenopril calcium.

Elimination

When used in injection, Zofenoprilat has radioactive emissions in urine (76%) and feces (16%), while if using a oral dose of zofenopril with radioactive mounting, 69% and 26% of radioactive activity are recovered in urine and fertilizers. This shows that excreted drugs through both roads (liver and kidneys).

Elderly pharmacokinetics

On the elderly, no dose should be adjusted if normal kidney function.

pharmacokinetic pharmacokinetics in patients with renal dysfunction

Based on the comparison of the main pharmacokinetic parameters of zofenoprilat measured after using a dose of zofenopril with radiation, patients with mild kidney failure (Creatinin clearance> 45 and 90 mL/minute).

On patients with average to severe renal failure (7-44 ml/minute), the elimination level decreased by about 50% compared to normal. Therefore, on this object, it is necessary to start using Bify at a dose equal to 1/2 of the usual dose.

On patients with end -stage renal failure with dialysis and peritoneal filter, the level of expenditure reduction is 25% compared to normal. Therefore, on this object, it is necessary to start using Bify at a dose equal to 1/4 of the usual dose.

After 6 weeks of treatment, the patient should be re -evaluated, if the patient does not show signs of loss of left ventricular function or heart failure, stop using the drug. If these signs are still there, it is necessary to continue the treatment regimen.

In the necessary cases, patients also need to use other standard medications such as nitrate, aspirin or channel blockers b.

Dosage on elderly:

Need to use Bifril cautiously in patients with myocardial infarction over 75 years old.

Dosage in patients with renal failure and separation:

Biftil's effectiveness and safety in patients with myocardial infarction with kidney failure or patients who are in the process of separation have not been set up. Therefore, do not use bifril on this patient object.

Dosage in patients with liver failure:

Bifril's efficiency and safety in patients with myocardial infarction with liver failure has not been set up. Therefore, do not use drugs on this patient object.

Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.What to do when overdose?

After taking overdose, patients need to be closely monitored, preferably in an active treatment unit. Electrolyte concentration and serum creatinine should be closely monitored. Clinical interventions depend on the nature and severity of the symptoms. If the patient is detected as soon as an overdose, measures should be taken to prevent drug absorption such as gastric lavage, can use adsorbent and sodium sulphate.

If the condition of hypotension appears, patients need to be treated as in the case of shock, may be used exactly the drugs develop fluid volume and/or treat with angiotensin II.

Slow heart rate or vagus reaction can be treated using atropine.

may consider using heart rate aids. It is possible to eliminate enzyme inhibitors from circulating by dialysis. You should avoid using high -line polyacrylonitril filter.

In an emergency, call the 115 emergency center immediately or go to the nearest local health station.

What to do when you forget 1 dose? However, if the time to relax with the next dose is too short, skip the dose and continue the calendar of the drug. Do not use double dose to compensate for missed dose.

Blood disorders and lymphatic systems:

Increased urea and blood creatinine levels, which can be recovered after stopping the drug, especially in patients with kidney failure, severe heart failure and kidney hypertension.

On a few patients, grass reports on hemoglobin reduction, haematocrit, platelets and white blood cells.

There are also some reports on increased blood and bilirubin levels in the blood.

Doubt -doubt reports: The suspected report of unwanted effects after the drug is circulating is very important. This allows the evaluation of the benefits/risks of the drug. Health staff must report any undesirable effects on the national reporting system.

Instructions on how to handle ADR:

Notify the physician the unwanted effects when using the drug.

Caution when using

Hypotension:

Like other transferred inhibitors, Bified can sharpen blood pressure, especially right after the first dose. However, the condition of hypotension is less recorded in patients with no complications of hypertension. This condition is more common in patients who have reduced the volume of circulatory or electrolyte disorders when taking diuretics, diets that limit salt, juris, go outside, vomit, or in patients with hypertension dependent on the severity of the Renin level (see more the item of drug interaction and unwanted effect).

On patients with heart failure, with or without renal failure, there have been cases of symptomic hypotension. This phenomenon is at risk of appearing more in patients with severe heart failure, manifested by the use of high -dose dosage drugs, hypoglyc sodium or impaired renal function. On patients there are many risks of hypotension, when starting to use medication, it is necessary to monitor strict health, preferably monitoring at the hospital, it is necessary to start low doses and gradually increase the dose carefully.

If possible, diuretics should be temporarily suspended when starting to use Bifril. This should also pay special attention when using drugs for patients with angina or patients with brain vascular disease. Because in these patients, rapid and sudden hypotension can cause myocardial infarction or stroke.

If the blood pressure appears, the patient is on the back, and the volume of fluid should be placed with a conventional intravenous saline solution. Even when the hypotension occurs after the initial dose, it is still possible to gradually increase the dose of each component of the drug after taking measures to control the lower pressure effectively.

On patients with heart failure with bonus or low blood pressure, increased lowering effects may appear when using Bified. This effect can be predicted and rewarded is not the reason for the stopping of the drug. If hypotension becomes a regular symptom, need to reduce the dose or stop using Bifril.

Hypotension in patients with acute myocardial infarction

Do not start using bifril in patients with acute myocardial infarction if the patient is at risk of severe hemodynamic reduction due to vasodilators. These are the heads of patients with systolic blood pressure

In the case of prolonged hypotension (systolic blood pressure

Patients with myocardial infarction with liver failure:

Efficiency and safety of Bifril in patients with myocardial infarction with liver failure has not been set up. Therefore, should not be used for this object.

Elderly:

Need to be carefully used Bifril in patients with myocardial infarction over 75 years old

Patients with kidney hypertension:

In patients with 2 -sided kidney stenosis or one side stenosis and only one kidney left, using transferred enzyme inhibitors can increase the risk of serious hypotension and kidney failure. Treatment with diuretics can be a factor that contributes to this risk.

Periodic impairment can be manifested by a slight change of serum creatinine concentration even for patients with kidney stenosis on the one side. If it is really necessary, it is necessary to start biformil treatment at the hospital, accompanied by strict monitoring, starting with low doses and gradually increasing the dose. Temporary diuretics should be temporarily suspended when starting to use Befril and closely monitoring the kidney function during the first few weeks of treatment.

Patients with renal failure:

Bified need to be used carefully in patients with renal failure because this object needs to reduce the dose. During the course of treatment, it is necessary to closely monitor kidney function by appropriate measures. There have been reports on some cases of renal failure related to the use of enzyme inhibitors, especially in patients with severe heart failure or kidney disease, including kidney stenosis. Some patients who do not have the previous kidney disease have appeared to increase urea and creatinin in the sample, especially when using enamel inhibitors simultaneously with diuretics.

In this case, a reduced dose of medication inhibitors and/or stop using diuretics. Should monitor tight kidney function in the first weeks of treatment.

Efficiency and safety of bifril in patients with myocardial infarction with kidney failure has not been fully studied. Therefore, biformil should not be used for patients with myocardial infarction with renal failure (serum creatinine concentration ≥ 2.1 mg/dl and proteinuria level of 2500 mg/day).

Patients are being separated:

Patients are being separated from using high -line polyacrylonitrile (for example, An 69) and being treated with a conversion inhibitor may experience anaphylactic reaction with manifestations such as swelling of the face, blushing, lowering blood pressure and shortness of breath in the first few minutes after the beginning of dialysis. In this case, another type of filter should be used or another medication for hypertension.

Patients are using sample filtration techniques to eliminate LDL:

Patients treated with enzyme inhibitors simultaneously use dialysis techniques to eliminate LDL cholesterol using Dextran Sulphat may experience anaphylactic reaction similar to what is recorded in patients with dialysis using high -line membrane (see details above). In this case, the drug should be selected in a group of other hypertension drugs to use for patients.

Anaphylactic reaction during sensitivity or after earth insects:

Rarely, some cases have recorded patients using enzyme inhibitors during the treatment of sensitivity (for example, sensitivity with venom of winged bugs) or after being burned with insects has encountered life -threatening anaphylactic reactions.

On these patients themselves, after stopping the medication inhibitors, if accidentally used, it may reappear the reaction of anaphylaxis. Therefore, it is necessary to be cautious when using enzyme inhibitors transferred to patients who are in the hypersensitive treatment cycle.

Patients with kidney transplantation:

In fact, there are not many cases of using Bified for patients who have just experienced kidney transplant. Therefore, it is not recommended to use drugs on this patient.

Primitive Aldosteron syndrome:

Patients with integer Aldosteron intense syndrome that do not respond to drugs for hypertension are acting through the renin-angiotensin system. Therefore, zofenopril should not be used in this case.

The vascular coverage on the face, limbs, lips, tongue, subjects and/or larynx can appear on patients treated with enzyme inhibitors and often appear in the first weeks of treatment. However, in some rare cases, serious vascular coverage may appear after long -term treatment with enzyme inhibitors. Need to stop the enzyme inhibitors and replace it with another group to treat hypertension.

The phenomenon of angioedema related to the tongue, bar or larynx can be life -threatening. Emergency measures should be taken such as subcutaneous injection immediately 1: 1000 adrenalin solution (0.3 to 0.5 ml) or slow intravenous intravenous 1mg/ml (need to dilute in accordance with the instructions) and closely monitor ECG, blood pressure. Also can take other emergency measures. Patients need to be hospitalized and monitored at least 12 to 24 hours and must not be discharged from the hospital until they completely resolve the symptoms completely.

Even in cases where patients only have tongue covered, showing signs of respiratory failure, patients still need to be monitored due to antihistamine and corticosteroid treatments may not be enough to control.

The ratio of angioedema event when using enamel inhibitors in black and black enamel on black people is higher on other populations.

Patients who have a history of vascular coverage are not related to enzyme inhibitors may increase the risk of vascular coverage when using enamel inhibitors (see the contraindications).

ho:

While bifril treatment may appear dry cough, they do not have pus sputum, this condition may end after stopping treatment. They are due to the transferred enzyme inhibitors that need to be considered a part of the common diagnosis with them.

Hepatic failure:

In some rare cases, the enzyme inhibitors are associated with a symptom of jaundice and gradually progresses into liver necrosis and (sometimes) can lead to death.

This mechanism has not been well known. If the patient uses a yeast inhibitor that appears jaundice or has a significant increase in liver enzymes, it is necessary to stop the medication inhibitors and monitor medical care carefully.

Hemorrhage:

Hemorrhage hyperkalemia may occur during the treatment of transferred enzyme inhibitors. Patients are at risk of hyperkalemia, including: Patients with renal impairment, diabetes, patients who use simultaneous diuretics to keep potassium, potassium -supplements or salt -containing substances containing potassium, patients using active ingredients that are at risk of hyperkalemia (such as heparin). If using the above -mentioned drugs, it is necessary to monitor the concentration of potassium sample in a regular way (see more drug interaction).

Use combination of Rennin-Anotension-Andosterone inhibitors:

There has been evidence that the sharing of enzyme inhibitors transferred to Angiotensin II or Aliskiren receptor inhibitors increases the risk of hypotension, hyperkalemia and impaired renal function (including acute renal failure). Therefore, it is not combined to use enzyme inhibitors with Angiotensin II or Aliskiren receptor inhibitors (see more drug interactions and energy characteristics).

If the combination of rennin-angiotension-aldosterone inhibitors is really necessary, it is necessary to pay special attention and control of the renal function, electrolyte concentration and regular blood pressure for patients.

Do not use in combination with enzyme inhibitors with angiotensin II receptor inhibitors in patients with diabetes -related kidney disease.

surgery/anesthesia:

Transfer inhibitors can cause hypotension or even shock due to hypotension in patients undergoing major surgery or during anesthesia, because these drugs block the formation of the secondary angiotensin II to compensate for the threadin secretion. If it is not possible to stop using enzyme inhibitors, closely monitor plasma volume and intravascular fluid volume.

Aortic valve stenosis or secondary valve /myocardial hypertrophy:

Can use enamel inhibitors carefully in the patient with secondary valve stenosis and obstruction of the flow in the left belt.

Provincial leukocytes/granulocytes:

There have been some reports on neutropenia/grain leukemia, thrombocytopenia and anemia in patients using enzyme inhibitors. The risk of neutropenia is tended to be related to dosage, drug form and depend on the patient's clinical condition.

This situation is rarely found in patients with non -complicated clinical characteristics but may appear in patients with impaired renal function, especially when patients have epidermal diseases such as system lupus, stiffness and are being treated with immunosuppressive drugs, Allopurinol or processinol treatment, or combining the above factors. Some of these patients have appeared severe infections that did not respond to strong antibiotics during the first time.

If using Zofenopril in these patients, the total number of white blood cells should be checked and the number of each white blood cell line should be checked before starting the regimen, then checks continuously every 2 weeks during the first 3 months of Zofenopril treatment, the months after the periodic test.

During treatment, it is necessary to guide all patients on reporting as soon as there are any signs of infection (such as sore throat, fever) while the number of white blood cell lines is controlled. Zofenopril should be stopped and the same drugs (see drug interaction) if detected or suspected neutropenia symptoms (neutral leukemia less than 1000/mm3).

This situation will recover after stopping using enzyme inhibitors.

Psoriasis:

Need to use carefully enamel inhibitors on patients with psoriasis.

proteinuria:

proteinuria may appear, especially in patients with renal failure or patients using high doses of enzyme inhibitors. Patients who have had kidney disease should be assessed for proteinuria concentration (in the first urine during the day), this test is done before the start of treatment and then periodically proceeded.

Patient Thao Duong:

Blood sugar concentration should be closely monitored in patients with diabetes that have been previously treated with oral or insulin treatment drugs, during the first month of treatment with enzyme inhibitors (see drug interaction).

Lithi:

The combination of lithium and bifril is generally not recommended (see drug interactions).

Race:

Like other enzyme inhibitors, Zofenopril may be less effective in reducing blood pressure on black people compared to other races.

Transfer inhibitors can be covered with a higher ratio of black people than in other races.

Pregnant women:

Do not start treatment with enzyme inhibitors during pregnancy. Unless the use of enzyme inhibitors is considered an urgent, other cases, patients intended to be pregnant should be transferred to another medication for hypertension that has clear data on safety in pregnant women. Once you have been confirmed to be pregnant, it is necessary to stop the enzyme inhibitors immediately, if necessary, must start the treatment of other hypertension to replace.

This specialist contains lactose. Patients with genetic problems in galactose tolerance, lapp-lactase enzyme deficiency or poor absorption of glucose-galactose should not use this special medicine.

Using drugs for pregnant or lactating women

do not recommend the use of yeast inhibitors in the first 3 months of pregnancy. Contraindicated use of enzyme inhibitors in the middle 3 months and the last 3 months of pregnancy.

Epidemiological evidence related to fetal defects after using enzyme inhibitors in the first 3 months of pregnancy has not been fully concluded. However, it does not exclude the drug that increases the risk of deformities. Unless the use of enzyme inhibitors is considered to be really necessary, pregnant patients need to be transferred to another medication for hypertension that has sufficient data on safety during pregnancy. When a woman is diagnosed with pregnancy, it is necessary to stop the enzyme inhibitors immediately, if necessary, immediately use an alternative regimen.

The use of enzyme inhibitors in the middle and the last 3 months of pregnancy is known as toxicity on human embryos (reducing kidney function, reducing amniotic fluid, slow processing of skull fire) and toxicity on newborns (causing kidney failure, hypotension, hyperkalemia).

If the enzyme inhibitor has been used in the middle of the 3 months of pregnancy, the ultrasound is required to check the kidney function and check the fetal skull. Babies born from a mother who have used enamel inhibitors should be strictly supervised to combine hypotension.

Due to the lack of adequate information related to the use of Befril during breastfeeding, Bified is not recommended for this object. A replacement regimen should be used with safety data on pregnant women who have been fully studied, especially in the period of nurturing newborn or premature babies.

The effect of the drug on driving and operating machinery

There has been no research on the impact of Bify on the ability to operate machinery and trains. When driving or using machines, it should be noted that symptoms may appear such as sleeping, dizziness or fatigue.

Interactive drug

Interactivity is not recommended for use

Diuretics keep potassium or potassium supplements: Yeast inhibitors reduce the level of potassium loss due to diuretics. Potassium diuretics such as spironolacton, triamteren, or amilorid, potassium supplements, or salt -containing potassium replacements can lead to excessive hyperkalemia. If the hypokalemia has been recorded and need to use them simultaneously, they must be used cautiously, regularly monitor the concentration of blood potassium and electrocardiography.

Transfer inhibitors, Angiotensin II or Aliskiren receptor inhibitors

There has been clinical data showing that the combination of Rennin-Anotension-Aldosterone inhibitors through the use of enzyme inhibitors with Angiotensin II or Aliskiren receptor inhibitors increases the frequency of unwanted effects such as lowering blood pressure, increasing sample potassium and reducing kidney function (including acute renal insufficiency) compared to using system inhibitors inhibitors inhibitors inhibitors inhibitors Rennin-Anotension-Aldosterone Single Treatment (See also Contraindications, Precautions and Warnings and Terms of Hoc Hoc).

Interactive should be cautious

diuretics (thiazid or diuretic)

Treatment with high -dose dietary diuretics can lead to fluid loss and the risk of hypotension at the beginning of the treatment regimen with Zofenopril. The impact of hypotension can be reduced by using diuretics, enhancing fluid, salt compensation or need to catch
at the beginning of the regimen with low doses of Zofenopril.

lithium

Increase lithium recovery in serum and have a toxic report that occurs when indicated simultaneously lithium with enzyme inhibitors. Simultaneously used with thiazid diuretics may increase the risk of toxicity of lithium and worsen the inherent toxic risks due to the use of lithium along with enzyme inhibitors.

Therefore, Bified is not recommended to use with Lithi. In the case of really necessary, lithium concentration must be monitored carefully.

Gold

Using enzyme inhibitors has been recorded as an increase in the frequency of nitrite reactions (symptoms of vasodilation including blush, nausea, dizziness and hypotension, this symptom can be very serious) in patients using gold salt by injection (for example, sodium aurothomalate).

Anesthesia: Yeast inhibitors can enhance the lowering effects of some anesthesia.

Sleeping drugs/antidepressants 3 rounds/anti -psychotic/Barbiturat drugs: can cause vertical blood pressure lower.

Other drugs for hypertension (for example, beta receptor blockers, alpha receptor blockers, calcium channel blockers): may increase the effect or potential for hypotension. Caution should be careful when treated with nitroglycerin and other nitrate compounds, or other vasodilators.

cimetidine: may increase the risk of hypotension.

Cyclosporin: Increased risk of kidney dysfunction when used simultaneously with enzyme inhibitors.

Allopurinol, processAnamid, cytostatic or immunosuppressive drugs: increased the risk of hypersensitivity reactions when used simultaneously with enzyme inhibitors. Data from other enzyme inhibitors shows an increased risk of leukemia when used with these drugs.

Diabetes treatment: In some rare cases, transferred inhibitors can enhance the hypoglycemia of insulin and oral diabetes treatment drugs such as sulphonylure in diabetes patients. In these cases, it may be necessary to reduce the dose of sugar removal of sugar during the treatment period with enzyme inhibitors.

Colored with high -line filtration: Increases the risk of anaphylactic reaction when used with enzyme inhibitors.

Spelopomy or immunosuppressive drugs, corticosteroids use systemic or processed sugar. Simultaneously used with transferred enzyme inhibitors will increase the risk of leukopenia.

Interactive should be noted

Non -steroid anti -inflammatory drugs (including 23g/day aspirin): Using nonsteroidal anti -inflammatory drugs can reduce the hypotension of enzyme inhibitors.

In addition, anti -inflammatory drugs and enzyme inhibitors are known to cause cumulative effects in increasing serum potassium concentration while renal function may decline. In principle, these effects can recover and especially appear in patients with impaired renal function. In some rare cases, acute renal failure may appear, especially in patients with kidney function begins to be damaged like the elderly or in patients with dehydration.

antacids: Reducing the bioavailability of enzyme inhibitors.

Similar drugs: Can reduce the effectiveness of hypertension of the enzyme inhibitors, need to monitor patients carefully to make sure to achieve treatment destination.

Food: may slow down but do not reduce the absorption level of zofenopril calcium.