Description
Diroton Pharmacodynamics
ACE inhibitor, reduces the formation of angiotensin II from angiotensin I. Reduction of angiotensin II leads to a direct reduction of aldosterone excretion. Reduces bradykinin degradation and increases prostaglandin synthesis. Reduces RPS, BP, preload, pulmonary capillary pressure, causes an increase in the minute blood volume and increases myocardial tolerance to exercise in patients with chronic heart failure. Dilates arteries to a greater extent than veins. Some effects are explained by the effect on tissue renin-angiotensin systems. Long-term use reduces myocardial hypertrophy and resistive arterial wall hypertrophy. It improves the blood supply to the ischemic myocardium.
ACE inhibitors prolong life expectancy in patients with chronic heart failure, slow the progression of left ventricular dysfunction in patients who have had myocardial infarction without clinical manifestations of heart failure.
The onset of drug action is within 1 hour, reaches a maximum after 6-7 hours and lasts for 24 hours. The duration of the effect also depends on the dose taken. For arterial hypertension, the effect is noted during the first days after the start of treatment, the stable effect develops after 1-2 months. During abrupt withdrawal of the drug, no pronounced increase in BP was observed.
Diroton® reduces albuminuria. In patients with hyperglycemia, it normalizes the function of the damaged glomerular endothelium. It does not affect the blood glucose concentration in diabetic patients and does not lead to increased incidence of hypoglycemia.
- Orally. Once daily, regardless of meals, preferably at the same time.
- Essential hypertension.
- The recommended starting dose for patients not taking antihypertensive agents is 1 tablet of 10 mg per day. The usual maintenance dose is 1 tablet of 20 mg per day; depending on BP values, the dose can be increased to 40 mg/day. The maximum daily dose is 40 mg/day. When increasing the dose, it should be taken into account that it takes 2-4 weeks for the full manifestation of the hypotensive effect. If the therapeutic effect is insufficient, the therapy should be supplemented with another antihypertensive agent.
- Patients who take diuretics, 2-3 days prior to the start of therapy with Diroton® taking diuretics should be discontinued. If this is not possible, the initial dose of the preparation Dinrotoi® should not exceed 5 mg/day, and it is recommended to ensure medical supervision of the patient after the first dose, as symptomatic arterial hypotension may develop (maximum effect is seen 6 hours after the drug intake).
- Renovascular hypertension and other conditions associated with increased activity of the renin-angiotensin-aldosterone system. The recommended initial dose is 2.5-5 mg/day under intensive medical supervision (BP control, renal function, serum potassium). The maintenance dose, continuing close monitoring by physician, should be determined depending on the dynamics of BP.
- Renal failure
Since excretion of lisinopril is through the kidneys, the initial dose of Diroton® depends on IQ: at IQ 30-70 ml/min – 5-10 mg/day, at IQ 10-30 ml/min – 2.5-5 mg/day, less than 10 ml/min, including patients on hemodialysis – 2.5 mg/day. The maintenance dose depends on the clinical effect and is selected with regular measurements of renal function, blood potassium and sodium concentrations. - Chronic heart failure
The initial daily dose of Diroton® 2.5 mg may be gradually increased after 3-5 days to the usual maintenance daily dose of 5-20 mg. The dose should not exceed the maximum daily dose of 20 mg. If used concomitantly with diuretics, the dose of the diuretic should be decreased beforehand, if possible.
Before starting treatment with Diroton® and later during treatment, blood pressure, renal function, potassium and sodium in blood should be monitored regularly to avoid the development of hypotension and associated renal dysfunction. - Diabetic nephropathy.
The daily dose in patients with insulin-independent diabetes mellitus with normal blood pressure is 10 mg in one dose. If necessary, the dose may be increased to 20 mg once daily to decrease diastolic blood pressure to 75 mm Hg measured in sitting position.
Dose selection for patients with insulin-dependent diabetes mellitus with arterial hypertension follows the above scheme, but the optimal diastolic BP should be below 90 mm Hg. - Acute myocardial infarction
In case of using Diroton® during the first day after myocardial infarction, the initial dose is 5 mg, on the second day, 5 mg is prescribed again, on the third day – 10 mg, thereafter the maintenance dose is 10 mg per day. In patients with acute myocardial infarction, the drug shall be used for at least 6 weeks. - In patients with low systolic blood pressure (less than 120 mmHg), treatment should be started with a low dose (2.5 mg/day). In case of arterial hypotension when systolic blood pressure is less than 100 mmHg, the maintenance dose is reduced to 5 mg/day, if necessary 2.5 mg/day may be temporarily prescribed.
- In case of prolonged marked BP decrease (systolic BP below 90 mmHg for more than 1 hour), the drug treatment should be stopped.
