Dorotril-H Domesco drug treatment for idiopathic hypertension (2 blisters x 14 tablets)

Dosage form Box of 2 blisters x 14 tablets
Specifications Lisinopril, hydrochlorothiazide
Ingredient High blood pressure

Ingredient

Composition information	Content
Lisinopril	20mg
Hydrochlorothiazide	12.5mg

Uses

indications

Dorotril - H drugs are indicated in the following cases:

Treatment of idiopathic hypertension with patients suitable for combined therapy. Both components have optimal effects and plus impact of hypotension.

lisinopril:

Lisinopril is an angiotensin transferring enzyme inhibitor and is a lysin conductor with an enalapril structure with a prolonged effect. Angiotensin converting enamel is endogenous enzymes that play the role of turning angiotensin I into angiotensin II. Angiotensin I increases in a number of diseases such as heart failure and kidney disease, due to response to hypercase. Angiotensin II has the effect of stimulating myocardial growth, myocardial hypertrophy, and vasoconstriction that causes hypertension. Angiotensin transferring enzyme inhibitors reduce the concentrations of angiotensin II and aldosteron thus reducing sodium and water stasis, peripheral vessels, reducing peripheral resistance at both circulation and pulmonary circulation. In addition, the drug also affects the Kallikrein - Kinin system, reducing the breakdown of Bradykinin, leading to an increase in Bradykinin levels, this is the cause of some unwanted effects such as angioed eagle and cough of angiotensin switching medications.

Angiotensin transferring enzyme inhibitors often reduce blood pressure unless hypertension is given by the power of Aldosteron. When treated, the change of blood pressure is closely related to plasma renin activity and angiotensin II concentration in plasma before treatment.

Angiotensin conversion inhibitors reduces the burden and reduces the tension into the circuit, increases the supply and cardiac index, increases the contraction of the heart and increases the systolic volume. Reduce the burden and reduce tension into diastolic vessels. Improve better hemodynamics, thus increasing exertion and inhibition of sympathetic nervous system. The blood flow in the brain and coronary artery still maintains well even when the blood pressure is lowered. Angiotensin transfer inhibitors are indicated for patients to reduce the systolic function, in order to prevent or slow down the progression of heart failure, reduce the rate of sudden death and myocardial infarction.

Lisinopril as well as other angiotensin enamel inhibitors are standard drugs in the treatment of heart attack patients with myocardial infarction within 24 hours after the beginning of the infarction. The drug also has the effect of preventing myocardial infarction.

Lisinopril and enzyme inhibitors Angiotensin slow kidney failure in diabetic kidney disease.

hydrochlorothiazid:

hydrochlorothiazid increases the secretion of sodium chlorid and water attached to the mechanism of inhibiting the reabsorption of sodium and chlorid ions in the distance. The excretion of other electrolytes also increases, especially potassium and magnesi, and calcium decreases. Hydrochlorothiazid also reduces the activity of the carbon dioxide, so it increases the secretion of bicarbonate but this effect is usually small compared to the excretory effect and does not significantly change the urine pH. Thiazids have a moderate diuretic effect, because about 90% of sodium ions have been reabsorbed before arriving in the distance is the main position of the drug.

hydrochlorothiazid has the effect of lowering hypotension due to decreased plasma volume and extracellular fluids related to sodium -ups. The effect of lowering blood pressure depends on the decrease in peripheral resistance, through the gradual adaptation of the blood vessels in the face of a decrease in the concentration of Na. Therefore, the hypotension effect of hydrochlorothiazid is shown slowly after 1-2 weeks, while diuretic effects occur quickly after a few hours. Hydrochlorothiazid increases the effects of other antihypertensive drugs.

pharmacokinetics

Simultaneous use of lisinopril and hydrochlorothiazide have little or no effect on the bioavailability of each drug. The tablet combined with 2 components, the biological balance is simultaneously using two individual ingredients.

lisinopril:

Lisinopril is absorbed slowly and incomplete through the gastrointestinal tract. The absorption of Lisinopril is very different between individuals, which may be from 6-60% of the absorbed dose, but on average about 25%. Food does not affect the absorption of drugs through the gastrointestinal tract. Lisinopril itself is a Diacid that is active when entering the body does not need to go through the metabolism to activate as some other angiotensin enamel inhibitors. Maximum plasma concentrations after about 7 hours and maintain the effect of about 24 hours. Lisinopril is not linked to plasma proteins. The drug excreted through urine in the form of unchanged. The time to sell discharged after taking multiple doses in patients with normal renal function is 12 hours. Lisinopril can be removed by hemorrhage.

hydrochlorothiazid:

After taken, hydrochlorothiazid is relatively fast, about 65-75% of the dose, but this ratio can be reduced in heart failure people. Hydrochlorothiazid accumulated in red blood cells. The drug excreted mainly through the kidneys, mostly in the form of non -metabolic. Hydrochlorothiazid's waste time is about 9.5 - 13 hours, but may last in the case of renal failure, so the dose adjustments need to be adjusted. Hydrochlorothiazid passes through the placenta, distributed and reaches high concentrations in the fetus.

diuretic effects appear after drinking 2 hours, reaching maximum after 4 hours and lasting about 12 hours.

Anti -hypertension effect is much slower than diuretic effects and can only achieve adequate effect after 2 weeks, even with the optimal dose between 12.5 - 25 mg/day anti -hypertension effect of hydrochlorothiazid usually achieved optimal at 12.5 mg dose. Should use the lowest and optimal dose reduces the risk of harmful effects.

Before taking Dorotril-H Domesco drug treatment for idiopathic hypertension (2 blisters x 14 tablets)

How to use

oral medication.

Dosage

Definitely hypertension:

The usual dose is 1 tablet, once used only a day. Should be taken at the same time of the day. If the treatment effect is not achieved in 2-4 weeks, the dose can be increased to 2 tablets, 1 time/day.

Dosage for patients with renal failure:

Dorotril - H must not be used for initial treatment in patients with renal failure.

Patients with creatinine clearance from 30 - 80 m/min, dorotril - H can be used but only after adjusting the dose according to each separate ingredient of the drug combination.

The starting dose of Lisinopril is recommended when using a single mild renal failure patient is 5 - 10 mg.

Previous diuretic treatment:

Should stop treatment with diuretics 2-3 days before using dorotril - H. If you cannot stop diuretics, you should only start separate treatment with lisinopril at a dose of 5mg.

Use drugs in children:

Safety and effectiveness of drugs in children has not been established.

Use drugs in the elderly:

Efficiency and intolerance of Lisinopril and Hydrochlorothiazid used in combination are similar in both the elderly and young people with hypertension.

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? The main treatment is to prevent the absorption and increase of drug excretion.

Lisinopril related: Overdose manifestation is to reduce blood pressure. In case of an intravenous surgery, the isometric salt solution or hemorrhage.

Hydrochlorothiazid related: Signs and symptoms are most common due to electrolyte decline (hypokalemia, hypoglycemia, hypoglyc sodium) and dehydration due to excessive diuretic. If used with Digitalis cardiac support, blood potassium hypoglycemia can cause arrhythmia.

What to do when forgetting 1 dose?

Not recorded.

Side Effects

When using Dorotril-H medicine, you may experience unwanted effects (ADR).

Common, ADR> 1/100

Dizziness, headache, paresthesia, posture impact (including hypotension), fainting, cough, diarrhea, nausea, vomiting, rash, cramps, fatigue, weakness, hyper urea, hyperurine serum, hyper enzyme, hemoglobin decrease.

Uncommon, 1/1000

Depression, brushing chest, dry mouth, hypersensitivity/nervous edema - Facial veins, limbs, lips, tongue, bars and/or larynx, fever, helplessness, uncomfortable chest area, reducing hematocrit.

Instructions on how to handle ADR

When experiencing side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

Contraindicated

Dorotril - H drugs in the following cases:

Sensitive to any ingredients of the drug.

Patient in vague.

Patients with a history of angioedema related to treatment with previous transferred inhibitors and patients with genetic or idiopathic angiography.

Patients sensitive to sulphonamid derivatives.

Pregnant women.

Do not use lisinopril for patients with aortic valve stenosis, or congested cardiomyopathy, kidney stenosis on both sides or in a single kidney and people who are too hypersensitive to the drug.

Hypersensitivity to thiazids and sulphonamid derivatives, gout, hyperuricemia, auria, Addison disease, blood calcium hypertension, liver and kidney failure.

Caution when used

The starting of treatment and adjustment of the dose should be closely monitored in patients at high risk of symptomatic hypotension.

When treating patients with ischemic heart disease or cerebrovascular disease, especially because of excessive hypotension can lead to myocardial infarction or stroke.

Use cautiously in patients with aortic stenosis or hypertrophic myocardial disease like other vasodilators.

thiazid diuretics may not be suitable in patients with kidney damage and ineffective in patients with creatinine clearance

Dorotril - H should not be used for patients with renal impairment (creatinine clearance

Should monitor the renal function and adjust the dose carefully in some patients with 2 -sided kidney stenosis or the kidney stenosis of the kidney.

Some patients with hypertension without a clear kidney disease have had a phenomenon of hyperurine and serum creatinine, usually mild and transient, especially when Lisinopril is simultaneously used with diuretics. If the above condition occurs when treated with Dorotril - H, this combination must be stopped. It may be used but must reduce the dose or use each separate ingredient of the drug combination.

Use cautiously in patients with liver function damage or progressive liver disease because of minor changes on water and electrolytes that can cause liver coma.

In patients with surgery or during anesthesia with drugs that cause hypotension, Lisinopril may inhibit the formation of secondary angiotensin II due to clearing renagal release. If hypotension occurs due to this mechanism, it can be adjusted by compensating the circulatory volume.

thiazid may reduce glucose tolerance. The dose of diabetes should be adjusted, including insulin.

Stop thiazid before performing thiazid parathyroid function tests can reduce calcium secretion, causing slight increase and each concentration of calcium serum.

All patients using diuretic thiazid (including hydrochlorothiazid) must be monitored in serum and urine periodically, especially patients using corticosteroids, acth or digitalis, quinidine (risk of vibration -causing vibration).

Hydrochlorothiazid's hypotension effects increased in patients after removal of sympathetic nerve.

Thiazid may cause increased cholesterol and triglycerides.

Be cautious in patients who are treating sensitive solutions.

Evaluation on the face, lips, tongue, bar and/or larynx have been noted in patients treated with enzyme inhibitors. This symptom can occur at any time during treatment. Dorotril - H should be discontinued immediately, conducting appropriate treatment and monitoring to ensure that the symptoms are completely resolved before the patient discharged from the hospital. Even in the case of swelling only localized in the tongue, not causing respiratory fall, patients need to continue observing and treatment with antihistamines and corticosteroids may not respond.

In several very rare cases, the death of angels related to laryngeal edema or tongue edema. Patients with angels in the tongue, bar or larynx can cause obstruction of the respiratory tract, especially in people with a history of respiratory surgery. In these cases, it is necessary to quickly treat emergency treatment. This case may use Adrenalin and/or maintain airway ventilation. It is necessary to monitor the patient carefully until the symptoms are completely and stable.

The enamel inhibitor causes angelica in black people with a higher rate in people with other skin colors.

Patients with a history of an exorcic angelicaemia may have a more risk of enzyme inhibitors when using enamel inhibitors.

In patients using thiazid, hypersensitivity reaction may occur whether the patient has a history of allergies or not in patients with bronchial asthma. The system lupus erythematosus may be serious or outbreaks that have been reported on several cases of thiazid.

Do not use for patients with kidney failure.

The ability to drive and operate machinery

Caution when driving and operating machinery.

Pregnancy

Contraindicated for pregnant women because they can cause death increases the risk of deformities and causes fetal and infant.

The period of breastfeeding

It is unclear whether lisinopril is secreted through breast milk, but thiazid goes through breast milk. Because hydrochlorothiazid is likely to cause serious reactions in children, it is necessary to calculate the importance of the drug to the mother to decide to stop breastfeeding or stop using Dorotril - H.

Interactive drug

taken at the same time with potassium supplements, potassium -keeping drugs or salt substitutes containing potassium, especially in patients with kidney function damage, which can significantly increase serum potassium.

Not used with lithium due to lithium reduces lithium clearance through the kidneys and increases the risk of lithium toxicity.

Combining other hypertension drugs can cause plus hypotension.

Indomethacin can reduce the effectiveness of hypertension treatment when used simultaneously with hydrochlorothiazid and lisinopril.

In patients with kidney damage being treated with nonsteroidal anti -inflammatory drugs (NSAID), simultaneously used with Lisinopril may lead to more reduced renal function.

Thiazid may increase the response to tubocurarin.

Nitritoid reaction (symptoms of vasodilation, may be very serious including: flushing, nausea, dizziness and hypotension) after using gold in the form of injection (sodium aurothiomalate) has been recorded frequently in patients treated with enzyme inhibitors.

Estrogen is used with lisinopril causing fluid fluids that can increase blood pressure.

Thiazid may increase the potential of hypotension when used with alcohol, barbiturates or addictive sleeping pills.

Thiazid is used with anti -diabetes (oral and insulin drugs): The dose adjustment is needed due to hyperglycemia.

Thiazid is used with corticosteroids, ACTH: increases power outages, especially reducing potassium.

Thiazid is used with amino hypertension (norepinephrin): may reduce response to hypertension amine.

Thiazid reduces the effects of anticoagulants and gout drugs.

Thiazid increases the effects of anesthesia, glycosid, vitamin D.

cholestyramin or colestipol: The potential to attach thiazid diuretics, reducing the absorption of these drugs through the gastrointestinal tract.

Storage

In a dry place, temperatures below 30 ° C, avoid light.

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