Diroton 20mg tablets 28

Size chart
Women's clothing size
Euro 32/34 36 38 40
USA 0/2 4 6 8
Bust(in) 31-32 33 34 36
Bust(cm) 80.5-82.5 84.5 87 92
Waist(in) 24-25 26 27 29
Waist(cm) 62.5-64.5 66.5 69 74
Hips(in) 34-35 36 37 39
Hips(cm) 87.5-89.5 91.5 94 99
How To Measure Your Bust

With your arms relaxed at your sides, measure around the fullest part of your chest.

How To Measure Your Waist

Measure around the narrowest part of your natural waist, generally around the belly button. To ensure a comfortable fit, keep one finger between the measuring tape and your body.

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Active ingredient

20 mg


Active substance: lisinopril dihydrate 21.77 mg, which corresponds to the content of lisinopril 20 mg.

Excipients : Magnesium stearate, talc, mannitol, corn starch, calcium hydrogen phosphate dihydrate.

Pharmacological properties

Mechanism of action

Lisinopril inhibits the enzyme peptidyl peptidase (angiotensin-converting enzyme (ACE)), which catalyzes the conversion of angiotensin I to a vasoconstrictor peptide, angiotensin II. secretion of aldosterone by the adrenal cortex. Inhibition of ACE leads to a decrease in the concentrations of angiotensin II, as a result of which vasopressor activity decreases and aldosterone secretion decreases. A decrease in the latter can lead to an increase in the potassium content in the blood serum.

Clinical efficacy and safety

Arterial hypertension

It is believed that the mechanism by which lisinopril lowers blood pressure (BP) is primarily based on the inhibition of the renin-angiotensin-aldosterone system (RAAS), lisinopril reduces blood pressure even in patients with arterial hypertension with a low concentration of renin. ACE is identical to kininase II, an enzyme that breaks down bradykinin, which is a potent vasodilator peptide. Lisinopril prevents the degradation of bradykinin.

The onset of antihypertensive action - after 1 h. The maximum effect is observed after 6-7 hours and persists for 24 h. The duration of the effect also depends on the magnitude of the dose. With arterial hypertension, the effect is noted in the first days after the start of treatment, a stable effect develops after 1-2 months. With prolonged use, lisinopril reduces the severity of hypertrophy of the myocardium and the walls of the arteries of the resistive type. With a sharp withdrawal of lisinopril, there is no pronounced increase in blood pressure.

Chronic heart failure

The effect of lisinopril on morbidity and mortality in CHF was studied by comparing high and low doses of lisinopril (32.5 mg or 35 mg 1 fold / day and 2.5 mg or 5 mg 1 time / day) with an average follow-up period of 46 months (for surviving patients). A high dose of lisinopril provided a 12% reduction in the risk of Combined endpoint: all-cause mortality and hospitalization for all causes (p=0.002) and an 8% reduction in the risk of all-cause death and hospitalization for cardiovascular disease (p = 0.036) compared to low dose. There was a reduced risk of death from all causes (8%; p=0.128) and death from cardiovascular disease (10%; p=0.073). In retrospective analysis, the number of hospitalizations due to CHF decreased by 24% (p = 0.002) in patients receiving high doses of lisinopril compared with patients receiving low doses. The overall adverse event profiles in patients receiving high or low doses of lisinopril were similar in both nature and quantity. Predicted adverse events resulting from ACE inhibition, such as arterial hypotension or impaired renal function, responded well to correction and rarely led to discontinuation of treatment. Cough was less common in patients receiving high doses. lisinopril than in patients receiving low doses.

ACE inhibitors prolong life expectancy in patients with CHF, slow the progression of left ventricular dysfunction in patients who have had myocardial infarction without clinical manifestations of heart failure.

Acute myocardial infarction

Lisinopril improves the blood supply to the ischemic myocardium. Evaluation of the efficacy and safety of lisinopril (up to 10 mg / day) was carried out in patients with acute myocardial infarction (AMI). Lisinopril, administered in the first 24 hours after AMI, within 6 weeks led to a statistically significant reduction in overall mortality by 11% (2p = 0.03).

Diabetic nephropathy

In addition to reducing blood pressure, lisinopril reduces albuminuria. In a double-blind randomized multicenter a study that compared lisinopril with a slow calcium channel blocker in patients with arterial hypertension and type 2 diabetes mellitus with the initial stage of nephropathy manifesting as microalbuminuria, taking 10-20 mg of lisinopril 1 time / day for 12 months reduced systolic / diastolic blood pressure by 13/10 mm Hg, and albumin excretion in the urine by 40%.

In patients with hyperglycemia, lisinopril helps to normalize the function of the damaged glomerular endothelium.

Lisinopril does not affect the concentration of glucose in the blood in patients with diabetes mellitus and does not lead to an increase in cases of hypoglycemia.

Indications for use
  • essential and renovascular arterial hypertension (in the form of monotherapy or in combination with other antihypertensive drugs);
  • chronic heart failure (as part of combination therapy);
  • early treatment of acute myocardial infarction (in patients with stable hemodynamic indicators in the first 24 hours for the prevention of left ventricular dysfunction and heart failure);
  • diabetic nephropathy (in order to reduce albuminuria in patients with type 1 diabetes mellitus with normal blood pressure and in patients with type 2 diabetes mellitus with arterial hypertension).
  • hypersensitivity to lisinopril and other components of the drug;
  • angioedema in the anamnesis (including associated with the use of ACE inhibitors);
  • idiopathic angioedema;
  • hereditary edema of Quincke;
  • pregnancy;
  • the period of breastfeeding;
  • age up to 18 years (efficacy and safety have not been established);
  • simultaneous use with aliskiren and preparations containing aliskiren in patients with diabetes mellitus and / or moderate or severe renal impairment (GFR less than 60 ml / min / 1.73 m 2 surface area of the body);
  • simultaneous use with angiotensin II receptor antagonists (ARA II) in patients with diabetic nephropathy;
  • simultaneous use with inhibitors of neutral endopeptidase (for example, with drugs containing sacubitril) due to the high risk of developing angioedema.

With caution: aortic stenosis, hypertrophic obstructive cardiomyopathy, mitral stenosis, bilateral renal artery stenosis, single kidney artery stenosis, condition after kidney transplantation, renal failure (QC less than 30 ml / min), primary hyperaldosteronism, arterial hypotension, depression bone marrow hematopoiesis, immunosuppressive therapy, simultaneous use of allopurinol or procainamide, or a combination of these complicating factors (risk of developing neutropenia and agranulocytosis), hyponatremia (increased risk of arterial hypotension in patients on a low-salt or salt-free diet), hypovolemic conditions (including diarrhea, vomiting), systemic connective tissue diseases (including systemic lupus erythematosus, scleroderma), diabetes mellitus, gout, hyperuricemia, hyperkalemia, coronary heart disease, cerebrovascular diseases (including cerebral circulation failure), chronic heart failure, hemodialysis using high-flow dialysis membranes with high permeability (AN69) ® ), advanced age (over 65 years), simultaneous use with potassium-sparing diuretics, potassium preparations, potassium-containing substitutes for edible salt, simultaneous use with drugs lithium, burdened allergic history, simultaneous desensitization with an allergen from hymenopteran venom, simultaneous implementation of the procedure of apheresis of low-density lipoproteins (LDL-apheresis) using dextran sulfate, use during major surgical interventions or during general anesthesia, use in patients of the Negroid race.

Dosage and Administration

Inside, 1 time per day, regardless of food intake, preferably at the same time.

Essential hypertension: the recommended initial dose for patients not taking antihypertensive drugs is 1 table. 10 mg 1 time per day. The usual maintenance dose is 20 mg, it can be increased to 40 mg per day, depending on the dynamics of blood pressure. The maximum daily dose is 40 mg. When increasing the dose, it should be borne in mind that 2-4 weeks are required for the full development of the effect. If the therapeutic effect is insufficient, it should be supplemented therapy with another antihypertensive agent.

Patients taking diuretics, 2-3 days before the start of therapy with Diroton ® diuretics should be discontinued. In cases where this is not possible, the initial dose of diroton ® should not exceed 5 mg / day, while it is recommended to provide medical supervision of the patient after taking the first dose, because it is possible to develop symptomatic arterial hypotension (the maximum effect is manifested 6 hours after taking the drug).

Renovascular hypertension and other conditions associated with increased activity of RAAS: the recommended initial dose is 2.5-5 mg / day under enhanced medical supervision (control of blood pressure, kidney function, potassium content in the blood serum). The maintenance dose, continuing strict medical supervision, should be determined depending on the dynamics of blood pressure.

Renal failure: since excretion of lisinopril is carried out through the kidneys, the initial dose of the drug Diroton ® depends on the indicators of Cl creatinine: with Cl creatinine 30-70 ml / min - 5-10 mg / day, with Cl creatinine 10-30 ml / min - 2.5-5 mg / day, less than 10 ml / min, incl. patients on hemodialysis - 2.5 mg / day. The maintenance dose depends on the clinical effect and is selected with regular measurement of renal function, the concentration of potassium and sodium in the blood.

Chronic heart failure: the initial daily dose of Diroton ® , equal to 2.5 mg, can 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. With simultaneous use with diuretics, preliminarily, if possible, the dose of diuretic should be reduced. Before proceeding with treatment with Diroton ® , and later, during treatment should be done regularly control blood pressure, kidney function, potassium and sodium content in the blood in order to avoid the development of arterial hypotension and associated renal dysfunction.

Diabetic nephropathy: the daily dose in patients with non-insulin-dependent diabetes mellitus with normal blood pressure is 10 mg in one dose. If necessary, the dose can be increased to 20 mg 1 time per day to reduce dADI to 75 mm Hg. art., measured in a sitting position. The selection of the dose for patients with insulin-dependent diabetes mellitus suffering from arterial hypertension is carried out according to the above scheme, but the optimal dADI should be below 90 mm Hg. Art.

Acute myocardial infarction: in case of diroton ® on the first day after myocardial infarction, the initial dose of the drug is 5 mg, on the second day 5 mg is re-prescribed, on the third day - 10 mg, in the future the maintenance dose is 10 mg / day. In patients with acute myocardial infarction, the drug apply at least 6 weeks. With low blood control (less than 120 mm Hg), treatment begins with a low dose of 2.5 mg / day. In the case of arterial hypotension, when the blood pressure is less than 100 mm Hg. art., the maintenance dose is reduced to 5 mg / day, if necessary, 2.5 mg / day can be temporarily prescribed. In the case of a prolonged pronounced decrease in blood pressure (blood pressure below 90 mm Hg. st. more than 1 h), it is necessary to stop treatment with the drug.

Side effects

During treatment with lisinopril, the following adverse drug reactions (NLR) have been reported. NLR is represented by system-organ classes in accordance with the MedDRA classification and with the frequency of occurrence: very often - 1/10 of appointments (≥10%), often - 1/100 of appointments (≥1%, but <10%), infrequently - 1/1000 of appointments (≥0.1%, but <1%), rarely - 1/10,000 of appointments (≥0.01%, but <0.1%), very rarely - less than 1/10,000 of appointments (<0.01%), frequency unknown - impossible to estimate on the basis of available data.

Within each frequency group, adverse reactions are presented in descending order of severity.

On the part of the hematopoietic system: very rarely - inhibition of bone marrow hematopoiesis, agranulocytosis, leukopenia, neutropenia, thrombocytopenia, hemolytic anemia, anemia, lymphadenopathy.

On the part of the immune system: very rarely - autoimmune disorders; frequency unknown - anaphylactic/anaphylactoid reaction.

From the endocrine system: rarely - syndrome of inadequate secretion of antidiuretic hormone.

From the side of metabolism and nutrition: very rarely - hypoglycemia.

Mental disorders: infrequently - mood changes, sleep disorders, hallucinations; rarely - mental disorders; the frequency is unknown - depression.

From the nervous system: often - dizziness, headache; infrequently - vertigo, paresthesia, dysgeusia; rarely - confusion, drowsiness, muscle cramps, back pain, parosmia (impaired sense of smell); frequency unknown - fainting.

From the cardiovascular system: often - a pronounced decrease in blood pressure, orthostatic hypotension and related symptoms; infrequently - myocardial infarction (due to a pronounced decrease in blood pressure in high-risk groups of patients), tachycardia, heart palpitations, acute cerebral circulation disorder (due to a pronounced decrease in blood pressure in groups of high-risk patients), Raynaud's syndrome.

From the respiratory system: often - cough; infrequently - chest pain, rhinitis; Very much rarely - bronchospasm, allergic alveolitis / eosinophilic pneumonia, sinusitis.

From the digestive system: often - diarrhea, vomiting; infrequently - abdominal pain, nausea, digestive disorders; rarely - dry mouth; very rarely - pancreatitis, anorexia, angioedema of the intestine.

From the liver and biliary tract: very rarely - liver failure, hepatic cell hepatitis or cholestatic, jaundice.

From the skin and subcutaneous tissues: infrequently - skin rash, skin itching; rarely - psoriasis, urticaria, alopecia, hypersensitivity / angioedema of the face, hands and feet, lips, tongue, glottis and / or larynx; very rarely - toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, pemphigus vulgaris, hyperhidrosis, pseudolymphoma of the skin *.

From the musculoskeletal system: rarely - pain in the limbs.

From the urinary system: often - impaired renal function; rarely - acute renal failure, uremia; very rarely - oliguria / anuria.

From the genitals and mammary gland: infrequently - impotence; rarely - gynecomastia, sexual dysfunction.

General disorders and disorders at the injection site: infrequently - increased fatigue, asthenia.

Laboratory and instrumental data: infrequently - an increase in the concentration of urea and creatinine in the blood serum, hyperkalemia, increased activity of liver enzymes; rarely - a decrease in hemoglobin and hematocrit, hyperbilirubinemia, hyponatremia.

* A symptom complex has been reported, which may include one or more of the following symptoms: fever, vasculitis, myalgia, arthralgia/arthritis, a positive reaction to antinuclear antibodies (AHA), an increase in the erythrocyte sedimentation rate (ESR), eosinophilia and leukocytosis, skin rash, photosensitization, or other changes in the skin.

Storage conditions

The drug should be stored out of the reach of children at a temperature not exceeding 30 ° C.

Shelf life - 3 years. Do not use after the expiry date which is stated on the carton.

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Product Details

Data sheet

Gedeon Richter Ltd
Dosage form
20 mg
Number of tablets
INN Russian
Russian title
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