Zonixem

Zonixem is a drug from the ACE inhibitor category.

Indications Zonixema

It is used in the following conditions:

• primary hypertension (as monotherapy or in combination with other antihypertensive medications);
• CHF (as an element of combination treatment);
• exacerbation of myocardial infarction in individuals with normal hemodynamics and no signs of cardiogenic shock;
• renal disorders associated with diabetes mellitus - to reduce albuminuria in non-insulin-dependent patients with elevated blood pressure.

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Release form

The drug is released in tablet form, 14 pieces per blister pack, in the amount of 1, 2 or 4 packs per pack. Also, a plate may contain 10 tablets - a pack of such plates is 2, 3 or 6.

Pharmacodynamics

Zonixem is a peptidyl dipeptidase component inhibitor. The drug inhibits the activity of ACE, which is a catalyst for the transformation of angiotensin-1 into a vasoconstrictor peptide, angiotensin-2 (it also helps stimulate the release of aldosterone through the adrenal cortex). Suppression of the ACE element causes a decrease in angiotensin-2 levels, which reduces vasoconstrictor activity and the release of aldosterone. The latter process can provoke an increase in serum potassium values.

Lisinopril reduces blood pressure values - mainly through mechanisms of suppression of RAAS activity. This component has a hypotensive effect even in individuals with hypertension and low renin values. The ACE (kinase-2) element is an enzyme that reduces bradykinin levels. It is currently unknown whether increased levels of bradykinin, which is considered a potent vasodilator peptide, are important in the medicinal effect of lisinopril.

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Pharmacokinetics

Lisinopril is a highly active ACE inhibitor. It does not contain sulfhydryl.

Suction.

Following oral administration, serum Cmax values of lisinopril are observed after approximately 7 hours. In patients with exacerbation of myocardial infarction, there is a tendency for a slight delay in the time required to obtain serum Cmax. Taking into account urinary recovery, the rate of mean volume absorption of lisinopril is approximately 25% with individual variations (in the range of 6-60%) at all administered doses (5-80 mg).

Absolute bioavailability values are reduced by approximately 16% in people with heart failure. The presence of food in the gastrointestinal tract does not affect the extent of absorption of lisinopril.

Distribution processes.

Lisinopril does not participate in protein synthesis within the blood serum, excluding ACE, which circulates within the blood. Tests using rats show that the substance poorly crosses the BBB.

Excretion.

The drug does not participate in metabolic processes, being excreted unchanged in the urine. With repeated use, the substance shows a half-life of accumulation of 12.6 hours.

Dosing and administration

The medication should be taken orally, once a day, at approximately the same time. Food intake does not affect the absorption of the medication.

The portion size is selected individually, taking into account the patient’s illness and blood pressure response.

Primary hypertension.

At the initial stage, an adult with elevated blood pressure values who does not use other antihypertensive drugs should use 10 mg of the substance per day. Basically, the effective maintenance dose is 20 mg taken once per day.

Taking into account the blood pressure values, the dosage portion size can be increased to 40 mg per day. If the medicinal effect is weak, it is necessary to supplement the treatment with another antihypertensive medication.

In case of increasing the dose, it is necessary to take into account that 0.5-1 month must pass for the full development of the antihypertensive effect.

In case of RVH or hypertension observed during conditions associated with increased activity of the RAAS.

Initially, it is necessary to use 2.5-5 mg of the drug per day, carefully monitoring the values of blood pressure, renal function and serum potassium levels. The size of the maintenance dosage is determined by the level of blood pressure and is selected during the above monitoring.

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Use Zonixema during pregnancy

It is prohibited to prescribe the drug during pregnancy. If the patient is found to be pregnant, the use of Zonixem should be immediately discontinued (except in situations where it is a vital need for the woman).

The use of ACE inhibitors, including lisinopril, in the 2nd and 3rd trimesters can provoke a negative effect on the fetus with subsequent death. The occurrence of renal failure, hyperkalemia or hypotension in a pregnant woman (from 9-12 weeks) is due to the negative effect on the renal function of the fetus. Due to a decrease in the volume of amniotic fluid, fetal damage is possible, which causes facial and skull developmental anomalies, problems with limb development, and intrauterine death. There is no information on negative effects on the fetus when administered in the 1st trimester.

If there is a strict need to use the drug in a pregnant woman, it is necessary to monitor the development of the fetus using ultrasound. In case of a decrease in the volume of amniotic fluid, the use of the drug should be discontinued (unless the drug is absolutely vital). Both the doctor and the patient should know that a decrease in the volume of amniotic fluid occurs in cases where incurable changes in the fetus have already occurred. It is necessary to inform the patient about the possibility of a negative effect of the drug on the fetus.

The newborn infant should be monitored to determine whether hyperkalemia, hypotension, or oliguria is present.

There is no data on whether lisinopril can be excreted in breast milk. The administration of the drug during lactation is prohibited.

Contraindications

Main contraindications:

• severe hypersensitivity to the components of the drug or other ACE inhibitors;
• a history of Quincke's edema, which developed due to the administration of ACE inhibitors, as well as in cases of Quincke's edema that are idiopathic or hereditary;
• stenosis (of the mitral valve or aortic orifice) that has hemodynamic significance;
• hypertrophic cardiomyopathy accompanied by obstruction in the outflow tract;
• cardiogenic shock;
• in case of hemodynamics of an unstable nature, after an exacerbation of myocardial infarction;
• stenosis affecting the arteries inside the kidneys (1- or 2-sided);
• Conn's syndrome.

Side effects Zonixema

The use of a therapeutic substance may lead to the appearance of certain side effects:

• disorders associated with the activity of the cardiovascular system: orthostatic collapse often develops. Rarely, increased heart rate, myocardial infarction, orthostatic symptoms (including hypotension) and tachycardia are observed;
• problems with the nervous system function: headaches or dizziness often occur. Rarely, a stroke develops (may be associated with a sharp drop in blood pressure in people with a high predisposition), mood lability, a feeling of confusion and paresthesia;
• Disorders associated with the respiratory system, mediastinum and sternum: pain in the sternum or cough often appears. Rarely, bronchial spasm develops;
• Gastrointestinal tract lesions: vomiting, diarrhea or nausea often occur. Dry mouth, abdominal pain, cholestatic or hepatocellular hepatitis, as well as pancreatitis or jaundice occasionally occur. Quincke's intestinal edema may occasionally occur;
• problems associated with renal function and the urinary tract: occasionally, acute renal failure, proteinuria, anuria or oliguria develop, as well as uremia and renal dysfunction;
• lesions of the subcutaneous tissue and epidermis: a rash is often observed. Rarely, alopecia, itching or urticaria with diaphoresis are recorded, and in addition, Quincke's edema, affecting the tongue with lips, and in addition, the limbs, larynx or glottis, as well as the limbs;
• systemic disorders: a feeling of weakness often appears. Asthenia occasionally develops;
• Disorders affecting the mammary glands and the reproductive system: impotence is occasionally observed.

There is evidence of the development of a complex of manifestations, including myalgia, arthritis or arthralgia, fever, eosinophilia, vasculitis, increased ESR, leukocytosis, and a positive test result for antinuclear factor. Photosensitivity, rashes, or other dermatological signs may occur.

In case of hypersensitivity reaction, Quincke's edema may occur, which causes swelling in the area of the lips, larynx, face, palate with tongue and extremities. If such symptoms develop, it is necessary to immediately stop using lisinopril, and then the patient should remain under medical supervision until the disorders completely disappear.

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Overdose

Signs of ACE inhibitor poisoning include circulatory shock, renal failure, decreased blood pressure, electrolyte imbalance, tachycardia with hyperventilation, as well as dizziness, bradycardia, cough, and anxiety.

If signs of hypotension appear, symptomatic measures should be taken and vital functions monitored. The patient is placed horizontally with the legs raised.

If fluid loss needs to be replaced, saline solution should be administered intravenously. Vital signs, blood pressure, blood creatinine and electrolytes should be monitored and adjusted as needed.

Lisinopril can be excreted from the systemic circulation through hemodialysis.

Interactions with other drugs

Diuretics.

When a diuretic is used during treatment with Zonixem, the antihypertensive activity is usually potentiated.

In individuals using diuretic drugs (especially those who have just started using them), an excessive decrease in blood pressure may occur from the moment the drug is administered. To reduce the risk of developing signs of hypotension from the use of Zonixem, it is necessary to stop the administration of the diuretic before starting treatment with the drug.

Lisinopril should be used with extreme caution in combination with similar medications.

Potassium-sparing diuretics, salt substitutes that contain potassium, or supplements of the element K.

Hyperkalemia may occur in diabetes mellitus, renal failure, and with concomitant use of potassium-sparing diuretics (e.g., amiloride, spironolactone, or triamterene), potassium supplements, or potassium-containing salt substitutes.

The use of the elements mentioned in the subtitle, especially in individuals with renal dysfunction, can provoke a significant increase in serum potassium values.

When using the drug together with diuretics that provoke potassium loss, hypokalemia enhanced by the latter may be potentiated even more. In this regard, the combination of such drugs is allowed only after assessing the possible consequences, as well as under the condition of constant monitoring of serum potassium levels and renal function.

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Storage conditions

Zonixem should be stored in a place closed to small children. Temperature values - no higher than 25°C.

Shelf life

Zonixem can be used for a period of 3 years from the date of release of the pharmaceutical product.

Application for children

Zonixem should not be used in pediatrics.

Analogues

Analogues of the drug are the medications Iruzid, Liten N, Co-Diroton, as well as Lisoretic with Lisinoton N.

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