At a price of 150 to 400 rubles in a modern pharmacy you can buy a package of Co-Diroton tablets. The main active components that ensure the effectiveness of the drug are lisinopril, hydrochlorothiazide. The drug simultaneously activates urination and inhibits ACE. It is applied at elevated pressure. In pharmacies, it is sold only upon presentation of a prescription from a doctor. Do not use the medication at your own discretion: it has inherent contraindications and side effects, the likelihood of which is much higher if the drug is used incorrectly.
What's on the pharmacy shelves?
On sale, “Co-Diroton” is represented by tablets packed in cardboard boxes. One package contains from one to three dozen doses. Two main options for release: 10 / 12.5 and 20 / 12.5. The first figure indicates the amount of lisinopril in one tablet, the second indicates the content of hydrochlorothiazide.
For the manufacture of tablets, the manufacturer used auxiliary components that simplify administration and increase the efficiency, absorption of the active compounds. All of them are listed in the instructions for use of "Co-Diroton". You need to study the list carefully - it contains potential allergens. In tablets are present:
- starch;
- mannitol;
- magnesium stearate;
- calcium hydrogen phosphate;
- indigotine;
- iron oxide.
It is possible and impossible
The instructions for use compiled by the manufacturer for Co-Diroton indicate that the drug is used for hypertension. The medication is indicated for mild problems and moderate pathology.
But the list of contraindications to the medication is much wider than the indications. It includes:
- angioedema in the past, observed against the background of IPAF;
- hypersensitivity to any of the substances used by the manufacturer in the manufacture of Co-Diroton tablets;
- angioedema (idiopathic due to a hereditary factor);
- valvular, aortic stenosis;
- cardiac hypertrophic myopathy;
- severe liver diseases, as well as insufficiency of this organ in severe, terminal phases;
- pregnancy;
- conception planning;
- lactation;
- anuria
- acute gout;
- stenosis of the feeding kidney of an artery;
- cardiogenic shock;
- blood flow instability due to recent heart attack.
Do not use the drug if hyperuricemia, hyperaldosteronism are established. "Co-Diroton" is contraindicated during hemodialysis, if high-flow membranes are used. You can not use tablets if the creatinine level for the circulatory system is described by indicators greater than 220 μmol / L.
Terms of use
The manufacturer clarifies in the instructions: "Co-Diroton" is shown to adults with high blood pressure. You should not start the course of treatment with this medication: the combined composition is used only if the patient has previously taken drugs with lisinopril, hydrochlorothiazide. If it was possible to stabilize the patient's condition with dosages of medicines similar to those described by the described drug, you can switch to a combination agent.
According to the instructions, "Co-Diroton" is taken no more than once a day. A single dosage is one capsule. For maximum effect, the substance is used every day at the same time, keeping exactly 24 hours between doses. This rule is relevant not only for the tablets in question, but also for any other used once a day.
At the reception, prescribing the drug, the doctor tells how to take "Diroton". The doctor immediately gives instructions to the patient: if in a standard therapeutic dosage the product does not show a pronounced effect after half a month or even a month from the start of therapy, you can increase the dose: take a couple of tablets once a day.
Against the background of diuretics
If the patient previously took diuretics, after the first dose there is a possibility of hypotension. This is more typical for the use of Diroton tablets, if the patient has dehydrated body or lack of salts.
To avoid negative consequences, it is reasonable to stop using diuretics two or three days before switching to a new medication. There are cases when patients could not afford such a pause. To ensure the safety of patients when taking the drug "Diroton" in this case, it is reasonable to first use lisinopril alone in a dose of not more than 5 mg and only then gradually transfer the patient to a combination medicine.
Special occasion
"Co-Diroton" (10 mg or twice as much - this is the amount of lisinopril in the composition) is not used as a means for the initial stage of treatment, if the patient has kidney failure.
If the problem is assessed as a weak, moderate level, that is, creatinine clearance is less than 80, but more than 30 ml / min, then based on the results of titration of the dosage, tablets can be used. It is important that the condition is monitored by a doctor. Reviews of Diroton of both patients and doctors indicate that neglect of this rule can provoke severe negative reactions of the body.
The optimal dosage for starting a therapeutic course with the indicated creatinine clearance is 5-10 mg of lisinopril. First, the substance is used on its own and only after some time, if indications are preserved for this, they switch to the combined version, strictly following the instructions for use. Reviews of “Co-Diroton” contain references to the fact that doctors urge patients to strictly follow the recommendations. In addition, those who practiced self-medication with the drug, as well as patients who did not take into account the manufacturer's recommendations, often complained about the negative response of the internal organs to the tablets.
Old age: features
According to reviews, Ko-Diroton is prescribed to people of different age groups, including elderly patients. This is due to the results of studies that have proved that the effectiveness of the composition among different age categories is approximately the same, is not determined by years lived, but depends on background diseases and other individual characteristics of the body.
The instruction says that lisinopril in an amount of 20-80 mg is equally effective when used by people older than 65 years and younger. You can use lisinopril as the only drug for treatment. For patients in advanced age, the drug is no less effective, as noted in the instructions, as analogues of "Diroton" on atenolol. Lisinopril has the same pronounced effect as hydrochlorothiazide.
The need for adjustment in old age occurs if kidney function is reduced. In this case, they are guided by the manufacturer's recommendations that apply to all patients with renal failure. No special binding to the age of doses or rules of admission is required.
Negative consequences: what is possible?
In the reviews of "Co-Diroton" there is a mention of various negative responses of the body that bothered patients who took the pills. All reactions are usually divided into several categories, evaluating the cause (lisinopril or hydrochlorothiazide), the peculiarity of the localization of the effect (organs, systems).
From the reviews on the use of "Diroton" it follows that lisinopril provokes adverse reactions similar to other agents from the IPAF group. Studies have proven the ability to:
- anemia, leukemia, thrombocyte, neutropenia, autoimmune disorders, inhibition of bone marrow;
- violations of the speed and rhythm of the heartbeat, low blood pressure, impaired blood flow in the brain, Raynaud's condition, heart attack (in people at high risk for such a violation);
- anxiety, sleep disturbance, confusion, difficulty in orientation, emotional changes;
- difficulty maintaining balance, paresthesia, impaired perception of smells, tastes, pain, and dizziness;
- vertigo;
- shortness of breath, bronchial spasm, alveolitis, pneumonia, runny nose;
- nausea, vomiting, stool disorders, dry mouth, glossitis, soreness and angioedema of the intestinal tract;
- hepatitis, jaundice, kidney failure;
- an allergic reaction, manifested on the skin with a rash, hair loss, itching, sweating and other similar phenomena;
- hypoglycemia;
- muscle spasms and weaknesses;
- incorrect production of ADH;
- fatigue, asthenia;
- anuria, the presence of protein in urine;
- gynecomastia, sexual dysfunction.
As indicated in the instructions for "Co-Diroton" (doctors' reviews confirm a rather high frequency of such a side effect), the drug can cause an increase in the activity of enzymes produced by the liver. This is revealed in a laboratory study of samples of biological fluids taken from patients. In the circulatory system, an increase in creatinine concentration, a decrease in hemoglobin and bilirubin, hematocrit is possible.
Features
The manufacturer draws attention to the fact that "Co-Diroton" can cause unproductive and persistent cough. The symptom disappears when the patient stops taking the pills. This phenomenon should be taken into account when diagnosing diseases, the symptoms of which are also coughing.
It is known that in extremely rare cases, against the background of the use of tablets, hepatitis appeared in patients, which led to liver failure. If therapy is accompanied by jaundice, and laboratory tests confirm an increased activity of liver enzymes, you should stop using tablets. Patients are shown a full examination in the clinic.
In extremely rare cases, the drug provoked angioneurotic edema, affecting:
- lips
- tongue;
- larynx;
- face;
- arms;
- legs;
- glottis.
In a small percentage of cases, against the background of the use of tablets, a whole complex of disturbing symptoms developed, including myalgia and fever, ANA, increased ESR activity, leukocytosis, skin rashes, eosinophilia, vasculitis. Despite the low probability of such an outcome, the risks must be taken into account when prescribing the patient a course.
Hydrochlorothiazide: its features
This component can also cause a negative response of the body, and the reaction is different from the one that provokes lisinopril. From clinical observations are known:
- sialodenitis;
- hypersensitivity;
- anaphylactic shock;
- leuko-, neutro-, thrombocytopenia;
- anemia;
- anorexia;
- bouts of gout;
- decreased glucose tolerance;
- excess calcium
- deficiency in the body of magnesium, potassium, sodium;
- depression;
- concern
- instability of mood;
- sleep disturbances;
- craving for sleep;
- pain, dizziness;
- paresthesia;
- seizure
- xantopsia;
- vertigo;
- rhythm failure, heart rate;
- low pressure;
- pulmonary edema;
- stool disorders;
- thirst;
- pancreatitis
- jaundice;
- cholecystitis;
- allergic skin reactions;
- sexual disorders;
- muscle spasm;
- nephritis;
- exhaustion.
Too much!
If you do not follow the instructions for taking (in particular, at what pressure), the instructions for using Diroton in other aspects, neglecting the doctor’s advice regarding the choice of dose, you may encounter an overdose. In this case, no specific treatment is prescribed, symptomatic therapy is conducted. In case of an overdose, the following are possible:
- low pressure;
- heart rhythm failures;
- imbalance in electrolytes;
- kidney failure;
- dizziness;
- cough;
- concern
- dehydration;
- seizure
- depression of consciousness.
In severe cases, a coma is possible.
If an overdose is detected, the use of the drug is stopped, the state of the patient is controlled. It is necessary to take measures to accelerate the withdrawal of active substances from the body, at the same time give the patient compounds that prevent absorption, if one has not yet happened.
First aid
If the patient has neglected the recommendations for Co-Diroton (at what pressure, in what volume to use the tablets), there is a risk of lowering the indicators to very low levels. First aid to the patient in such a situation involves the adoption of a prone position. The legs should be slightly above the head. Immediately install a dropper, pour saline into a vein.
In some cases, if possible, angiotensin II is allowed. Lisinopril can be eliminated through dialysis. In hospital conditions, indicators of creatinine level, electrolyte content in the body are checked. If an overdose causes resistant bradycardia, the only reliable method is to use a pacemaker. To maximize the effectiveness of measures, it is important to regularly monitor the basic vital signs of the body.
In the absence of a pronounced positive result, catecholamines are used. Atropine can be used to reduce bradycardia.
Teratogenic effect
There is no case in which the Diroton instructions for use would be allowed during the bearing of a child. You can not use the composition if it is planned to conceive soon. If pregnancy is confirmed during use of the composition, therapy is stopped immediately. If there is a need to use drugs to reduce blood pressure, only those admitted in an interesting position are taken.
At the moment, there is no exact confirmed information about what kind of effect tablets can have if they are used during the bearing of a child, especially in the first third of the term. You can not replace the medication with other IPAFs. If after the termination of the course there remains the need to adjust the pressure, strictly alternative means are used that do not belong to this group, and those for which safety is established during pregnancy for mother and fetus. There is no such advantage that the instructions for using Diroton would justify the use of the composition - there are too many risks, many factors of influence have yet to be finally determined.
If information on the first trimester has not yet been finalized, then for the second and third it was possible to identify fetotoxic effects, neonatal toxicity. There is a third trimester of bearing a child accompanied by the use of IPAF, it is necessary to regularly do ultrasound, monitoring the condition of the fetus. The baby immediately after birth should be under medical supervision - there is a high probability of persistently reduced pressure.
The use of diuretic compounds during pregnancy is contraindicated, since the risk of jaundice, thrombocytopenia in a child increases. Other negative effects of the above, characteristic of adult patients, are possible. Hydrochlorothiazide during childbearing can cause a reduced plasma volume, which means that it will lead to a deterioration in blood flow in the placenta and uterus.
Lisinopril can be removed from the circulatory system of the newborn by dialysis. Presumably, you can cleanse the body of the drug by making a blood transfusion. There is no information about the possibility of removing hydrochlorothiazide from the baby’s body.
Lactation: features
Experiments in rats showed that lisinopril penetrates into the mother’s milk. This suggests that the effect is similar for humans, therefore, the use of "Co-Diroton" during lactation is strictly prohibited. It was possible to detect hydrochlorothiazide in breast milk. Concentrations are high enough to affect the child's body.
Against the background of breastfeeding in children, whose mothers use the described tablets, severe side effects and reactions may develop. The best option is to refuse lactation and transfer the baby to artificial nutrition. An alternative way is to replace the medication with an acceptable one during breastfeeding. As can be seen from the reviews, there are analogues of Diroton that are allowed to mothers, although the list of such funds is seriously limited.
Features of use
"Co-Diroton" is not used until reaching adulthood. At the moment, there is no information about possible side effects associated with taking the medication. The effectiveness of this composition has not been established when used by patients until they are 18 years old.
It is impossible to give a universal answer to the question of what pressure “Diroton” is shown at. In the instructions for use, it is mentioned that pills help from an increased, but the individual characteristics of the body are different for everyone: what is categorically high pressure for some is perceived by others as normal.
It is important to use the medication only under the supervision of a doctor. The doctor writes him out, analyzing the patient's condition. The drug is strong enough, can lead to negative reactions of the body, requires proper preparation for the beginning of the course, so you can not start taking pills only because of the tonometer readings above a certain limit.
Allergy: what is possible?
It is known that in isolated cases, the use of Co-Diroton tablets provoked angioedema. The reaction can occur on the face, larynx and arms, legs and lips, ligaments. There is a likelihood of such an effect at any stage of the therapeutic course. , , . . , . , , . , .
There are several cases where angioedema has affected the tongue, throat and has been fatal. The manufacturer of the tablets warns that such an allergic response can provoke obstruction of the respiratory system, which means that the patient needs emergency care. Measures are required to keep the airways passable. Medical monitoring of the condition is needed until the symptoms disappear.
When taking pills, it is important to remember that there is a risk of angioedema, localized in the intestine. At the same time, the stomach hurts, the patient vomits and feels sick, the stool is loose.
National features
Studies have shown that more often angioedema develops in individuals with dark skin than in representatives of other races. In this group of patients, lisinopril less effectively lowers blood pressure. There is no exact explanation for this fact at the moment, but it is assumed that this is due to the increased frequency of low-corinine hypertension.
Activity Specific Features
"Co-Diroton" is an effective combination agent, the components of which complement each other and enhance effectiveness. Lisinopril belongs to the class of inhibiting peptidyl dipeptidase substances, that is, it suppresses ACE activity, under the influence of which the first angiotensin can be transformed into the second, stimulating the adrenal cortex to produce aldosterone. Proper use of tablets reduces vasopressor activity, aldosterone production. A long course can cause an increase in the concentration of potassium in the circulatory system.
Hydrochlorothiazide simultaneously shows the effect on pressure and on the functioning of the urinary system. A vivid effect of the drug is observed in the study of the distal tubular renal region. Approximately equally increases the rate of excretion of chloride, sodium from the body. To some extent, the loss of bicarbonates and potassium is possible.
Drug kinetics
The combination of lisinopril and hydrochlorothiazide does not affect the bioavailability of each of the components separately. According to one version, there is such an effect, but it is too small and therefore cannot be detected. It was not possible to identify interactions between these substances of such a level as to give them clinical significance.
Soon after the tablets enter the digestive system, lisinopril is absorbed; the highest concentrations of this compound in the circulatory system are achievable approximately seven hours after taking the dose. On average, the component with urine is excreted by a quarter, although in different patients the indicators vary greatly: from 6 to 60%. Bioavailability is reduced by an average of 16% if heart failure is established. The absorption efficiency is not adjusted by meals. Presumably, the substance does not interact with plasma proteins, with the exception of ACE. The substance may cross the blood-brain barrier, but penetration is estimated to be quite low.
Lisinopril in the body does not undergo transformation, therefore it is excreted in the initial state by the kidneys. The half-life with a long course is estimated at 12.6 hours, and the clearance in a healthy person, as shown by experiments, is close to 50 ml / min.
Hydrochlorothiazide is also absorbed at a high rate, up to 70% of the substance penetrates the body when passing through the intestinal tract. The process is independent of food intake. The highest concentration indicators in the circulatory system are observed within a couple of hours after the substance is ingested. The volume of distribution is estimated at 0.8-3 l / kg. The active component is not involved in biochemical reactions, elimination is carried out by the kidneys. Up to 61% is excreted unchanged 24 hours after the composition was ingested.
Analogs
Diroton can be replaced by:
- "Iruzid";
- Lisinopril;
- Lysoretic
- "Liprazide".
Replacement must be agreed with your doctor. There is a likelihood of an ineffective alternative drug, as well as an increased risk of adverse reactions.
Release Features
"Co-Diroton" on sale is represented by two options: tablets contain 10 or 20 mg of lisinopril, and hydrochlorothiazide is present in an amount of 12.5 mg. The manufacturer makes tablets flat, round. The smaller dosage option is covered with a thin film of a light bluish tint, the second format is painted in a light green color.
In any of the release options, Co-Diroton is sold strictly according to a doctor’s prescription. In the instructions for use, the manufacturer indicates the inadmissibility of dispensing from the drugstore of the drug without a medical permit.
The drug is strictly forbidden to take after the expiration date.