Captopril-LF tablets 50mg №10×4

Name Captopril-LF tabl. Reduces the formation of angiotensin II from angiotensin I. A decrease in the content of angiotensin II leads to a direct decrease in the release of aldosterone. This reduces the total peripheral vascular resistance, blood pressure, post- and preload on the heart. Expands arteries more than veins. It causes a decrease in the degradation of bradykinin (one of the effects of ACE) and an increase in the synthesis of Pg. The hypotensive effect does not depend on the activity of plasma renin, a decrease in blood pressure is noted at normal and even reduced concentrations of the hormone, which is due to the effect on the tissue renin-angitensin systems. Enhances coronary and renal blood flow. With prolonged use, it reduces the severity of myocardial hypertrophy and the walls of the arteries of the resistive type. It helps to reduce the content of Na + in patients with chronic heart failure. A decrease in blood pressure, unlike direct vasodilators (hydralazine, minoxidil, etc.), is not accompanied by reflex tachycardia and leads to a decrease in myocardial oxygen demand. In heart failure in an adequate dose does not affect the magnitude of blood pressure. In most patients, the hypotensive effect begins approximately 15-30 minutes after oral administration of captopril. The maximum decrease in blood pressure after oral administration is observed after 60-90 minutes. The duration of the hypotensive effect is dose-dependent and reaches optimal values within a few weeks. Stopping captopril is not associated with a rapid increase in blood pressure. Pharmacokinetics Absorption Captopril is well absorbed from the gastrointestinal tract. Bioavailability is 75%. Simultaneous ingestion of food slows down the absorption of captopril and reduces its bioavailability. Captopril is detected in the blood serum after 15 minutes, 50% peak concentration is reached after 30 minutes. The maximum plasma concentration is observed approximately 1 hour after ingestion. Distribution Captopril and its metabolites rapidly penetrate tissues but do not cross the blood-brain barrier. About 25-30% of captopril is transiently bound to serum proteins, mainly albumin. The volume of distribution at steady state is about 0.7 l/kg. Metabolism Captopril is rapidly metabolized in the liver. The main metabolic pathways are oxidation and the formation of disulfide dimers and other mixed disulfides. The disulfide metabolites of captopril are not active, but there is evidence of conversion of these metabolites to the active form. This explains the lack of an effect-concentration correlation for captopril and the duration of its hypotensive effect (longer than would be expected on the basis of pharmacokinetics). Excretion Captopril is rapidly excreted from the body, mainly unchanged by the kidneys. The average total clearance is 0.8 l / kg / hour, the average renal clearance is 0.4 l / kg / hour. The elimination half-life cannot be precisely determined, but it is assumed to be about 1.9 hours. Special groups of patients Lactation. In twelve women who took captopril 100 mg orally 3 times a day, the average peak concentration of captopril in milk was 4.7 μg / l and was detected 3.8 hours after the dose. The disulfide metabolites of captopril are excreted more slowly via the kidneys. Since these metabolites in the body are restored to captopril, then in patients with renal insufficiency, its accumulation is possible. The accumulation of captopril metabolites in patients with renal insufficiency leads to the development of a stronger pharmacodynamic effect and increases the duration of action. In such patients, the dose of captopril should be adjusted according to the actual level of renal insufficiency. In patients with impaired liver function, the renin-angiotensin system functions normally. Since captopril is a drug and not a prodrug, its effect is comparable to that in patients with hypertension without liver failure. In patients with heart failure, captopril is excreted more slowly. In such patients, captopril should be started at low doses and adjusted until the desired therapeutic effect is achieved. The pharmacokinetics of captopril in healthy elderly volunteers and in young people is the same. Elderly patients with arterial hypertension and normal renal function may be prescribed the usual daily dose of captopril. Indications for use Arterial hypertension, including renovascular. Chronic heart failure (as part of combination therapy). Left ventricular dysfunction after myocardial infarction in a clinically stable condition. Diabetic nephropathy against the background of type I diabetes mellitus (with albuminuria more than 30 mg / day). Dosage and administration The dosing regimen is set individually, taking into account the characteristics of the patient and the response from blood pressure. The recommended maximum daily dose is 150 mg. The drug should be taken before meals. Tablets of the drug Captopril-LF 25 mg and 50 mg are not intended to be divided into smaller doses, the line on the tablet serves to facilitate the administration of the drug. If it is necessary to take the drug at a lower dosage, it is recommended to use other drugs with the appropriate dosage. Arterial hypertension: the recommended initial dose is 25-50 mg per day in two divided doses. If necessary, the dose is increased gradually, with an interval of at least 2 weeks, up to 100-150 mg per day in two divided doses to achieve the desired level of blood pressure. Captopril is used alone or combined with other antihypertensive agents, most often with thiazide diuretics. With joint antihypertensive therapy with thiazide diuretics, a single daily dose is sufficient. For patients with severe activity of the renin-angiotensin-aldosterone system (renovascular hypertension, hypovolemia, heart failure), the recommended dose of a single dose is 6.25 mg or 12.5 mg. Treatment should be started under the strict supervision of a physician. Gradually, with an interval of at least 2 weeks, the dose can be increased to 50 mg per day in one or two doses, and if necessary, up to 100 mg per day in one or two doses. Heart failure: treatment with captopril for heart failure should be initiated under close medical supervision. The initial dose is 6.25 mg – 12.5 mg two to three times a day. Titration at a maintenance dose (75-150 mg daily) should be based on the patient’s response to treatment, clinical condition, and tolerability. The maximum recommended daily dose is 150 mg in divided doses. The dose should be increased gradually, at intervals of at least 2 weeks, in order to be able to assess the patient’s response to treatment. Myocardial infarction: – short-term treatment: inpatient treatment with captopril should be initiated as soon as possible after the onset of signs and/or symptoms in hemodynamically stable patients. It is necessary to take a trial dose – 6.25 mg, then after 2 hours – 12.5 mg and after 12 hours – 25 mg. From the next day, with a guaranteed absence of undesirable hemodynamic reactions, it is necessary to take 100 mg of captopril per day in two divided doses for 4 weeks. After 4 weeks of treatment, the patient’s condition should be reassessed and a decision made to continue the treatment of the disease in the postinfarction period. – long-term treatment: if treatment with captopril is not started within the first 24 hours after an acute myocardial infarction, it is assumed that treatment of clinically stable patients will be started between 3 and 16 days after the infarction. Treatment should be initiated in a hospital with close monitoring of blood pressure until a dose of 75 mg is reached. The initial dose should be low, especially if the patient has normal or low blood pressure. Treatment should begin with a dose of 6.25 mg, then 12.5 mg daily for 2 days, and then 25 mg 3 times a day, if justified by the absence of adverse hemodynamic reactions. The recommended dose for effective cardioprotection in long-term treatment is 75-150 mg per day in two to three divided doses. In the event of symptomatic hypotension, the dose of diuretics and/or concomitant vasodilators may be reduced in order to achieve a stable dose of captopril. If necessary, the treatment regimen is adjusted depending on the clinical response of the patient. The drug can be used in conjunction with other drugs for the treatment of myocardial infarction, in particular thrombolytic agents, beta-blockers and acetylsalicylic acid. Type I diabetic nephropathy: in patients with type I diabetic nephropathy, the recommended daily dose of captopril is 75-100 mg per day in divided doses. Impaired renal function: since captopril is excreted primarily through the kidneys, the dosage should be reduced and the dosing interval increased for patients with renal insufficiency. Routine monitoring of potassium and creatinine is part of normal medical practice for these patients. Creatinine clearance (ml / min / 1.73 m2) ? 40 Initial daily dose (mg) 25-50 Maximum daily dose (mg) 150 Creatinine clearance (ml / min / 1.73 m2) 21-40 Initial daily dose (mg) 25 Maximum daily dose (mg) 100 Creatinine clearance (ml /min/1.73 m2) 10-20 Initial daily dose (mg) 12.5 Maximum daily dose (mg) 75 Creatinine clearance (ml/min/1.73 m2) < 10 Initial daily dose (mg) 6.25 Maximum daily dose (mg) 37.5 If concomitant diuretic therapy is required for patients with severe renal insufficiency, then loop diuretics (eg, furosemide) are preferred over thiazide diuretics, which should be avoided. Elderly patients: For elderly patients, as with other antihypertensive agents, treatment with captopril is recommended to start with the lowest dose (6.25 mg twice a day), since in this category of patients renal function may be reduced or other comorbidities observed. Children and adolescents: The efficacy and safety of captopril in children and adolescents under 18 years of age have not been fully studied. Captopril should only be given to children and adolescents when treatment with other antihypertensive agents is not effective enough. Treatment with captopril should be initiated under close medical supervision. The initial dose in children is 0.3 mg/kg of body weight. For patients requiring special precautions (children with impaired renal function, premature infants, newborns and infants), the initial dose of captopril should be 0.15 mg/kg body weight. As a rule, captopril is prescribed to children 3 times a day, but the dose and interval should be adapted individually depending on the response of the patient. Use during pregnancy and lactation Pregnancy: the use of the drug is contraindicated during pregnancy. The use of captopril is not recommended during the first trimester of pregnancy. Appropriate controlled studies of the use of ACE inhibitors in pregnant women have not been conducted. The limited data available on the effects of captopril in the first trimester of pregnancy indicate that the use of ACE inhibitors does not lead to fetal malformations associated with fetotoxicity. Epidemiological evidence suggesting a risk of teratogenicity following exposure to ACE inhibitors in the first trimester of pregnancy has not been conclusive, but some increased risk cannot be ruled out. If pregnancy is planned or confirmed, it is necessary to switch to an alternative therapy that has an established safety profile for use during pregnancy as soon as possible. Captopril is contraindicated in the second and third trimesters of pregnancy. Long-term exposure to captopril in the second and third trimesters causes toxicity in the fetus (decreased renal function, oligohydramnios, delayed ossification of the skull bones), as well as in newborns (neonatal renal failure, arterial hypotension, hyperkalemia). If the patient took captopril during the second and third trimester of pregnancy, it is recommended to conduct an ultrasound examination to assess the condition of the skull bones and fetal kidney function. The use of ACE inhibitors during pregnancy can cause developmental disorders and fetal death. Once pregnancy is established, captopril should be discontinued as soon as possible. Breastfeeding: Captopril is contraindicated during breastfeeding. Approximately 1% of the accepted dose of captopril is found in breast milk. Due to the risk of serious adverse reactions in the child, breastfeeding should be discontinued or drug therapy should be discontinued in the mother for the period of breastfeeding. Influence on the ability to drive vehicles and work with mechanisms As with other antihypertensive drugs, the ability to drive a car and other mechanisms may decrease, especially at the beginning of treatment, either when the dosage is changed, or when taken together with alcohol; these effects depend on the individual sensitivity of the patient. Precautions Hypotension: Rarely observed in patients with uncomplicated hypertension. Symptomatic hypotension is more typical of hypertensive patients with reduced blood volume and/or hyponatremia as a result of intensive diuretic therapy, low salt intake, diarrhea, vomiting, or hemodialysis. Decreased blood volume and sodium must be corrected before using captopril, with low starting doses being preferred. It should be remembered that, as with all cases of the use of antihypertensive drugs, the reduction of high blood pressure in patients with cardiovascular or cerebrovascular diseases is associated with an increased risk of myocardial infarction or stroke. With the development of hypotension, the patient should be brought to a horizontal position. Intravenous saline may be required to replenish blood volume. Renovascular hypertension: in case of kidney damage (creatinine clearance - 40 ml / min), the initial dose of captopril is determined in accordance with creatinine clearance. Hypersensitivity. Angioedema: During treatment with ACE inhibitors, including captopril, angioedema of the face, extremities, lips, tongue, pharynx and/or larynx may develop. The development of angioedema can occur at any time from the start of treatment. In rare cases, edema may develop after prolonged use of the drug. In this case, as a rule, it is enough to stop taking the drug and monitor the patient's condition until the symptoms disappear. Usually, angioedema of the face and lips does not require special treatment, but antihistamine drugs can be used to relieve symptoms. Angioedema of the tongue, pharynx, or larynx can be fatal. If edema spreads to the tongue, pharynx or larynx, epinephrine (0.3-0.5 ml of a 1:1000 epinephrine solution, subcutaneously) should be immediately injected and the airway should be secured. The patient must be hospitalized and under the supervision of doctors for at least 12-24 hours until the condition normalizes and symptoms disappear. It has been reported that black patients treated with ACE inhibitors had a higher incidence of angioedema. Patients with a history of angioedema unrelated to treatment with ACE inhibitors may be at an increased risk of developing angioedema while receiving ACE inhibitors. Rare cases of intestinal angioedema have been reported during therapy with ACE inhibitors. Patients reported abdominal pain (with or without nausea and vomiting); in some cases without facial edema, C-1 esterase levels were normal. Diagnosis of angioedema should include abdominal computed tomography, ultrasound, or examination by a surgeon. Symptoms disappear after discontinuation of the ACE inhibitor. The possibility of developing intestinal angioedema should be considered when examining patients taking ACE inhibitors and complaining of abdominal pain. Cough: Cough is often observed when taking ACE inhibitors. This cough is unproductive and disappears when the ACE inhibitor is stopped. Liver failure: a rare complication. This complication of ACE inhibitors has been observed in association with cholestatic jaundice and progressive fulminant hepatonecrosis (sometimes fatal). The mechanism of development of the syndrome is unknown. With the development of jaundice and a significant increase in the activity of liver enzymes, ACE inhibitors should be discontinued. Hyperkalemia: An increase in serum potassium has been observed in some patients taking ACE inhibitors. Hyperkalemia can develop in patients with renal insufficiency, diabetes mellitus, when using potassium-sparing diuretics and other drugs that increase potassium (eg, heparin). In these cases, monitoring of potassium in the blood serum is recommended. Lithium: The combination of captopril and lithium is not recommended. Aortic and mitral stenosis/obstructive cardiomyopathy: ACE inhibitors should be used with caution. Neutropenia/Agranulocytosis: Cases of neutropenia/agranulocytosis, thrombocytopenia and anemia have been reported with ACE inhibitors, including captopril. In patients with normal renal function and other complicating factors, neutropenia is very rare. Captopril should be used with extreme caution in patients with collagenoses, vascular disease, immunosuppressive therapy, allopurinol or procainamide treatment, or a combination of these complicating factors, especially if there is pre-existing renal impairment. Some of these patients developed serious infections, which in some cases were resistant to intensive antibiotic therapy. If captopril is used in such patients, it is necessary to monitor the number of leukocytes before starting treatment and then every 2 weeks during the first 3 months of captopril therapy and periodically thereafter. During treatment, all patients should be instructed to report any signs of infection (eg, sore throat, fever). Captopril should be discontinued if neutropenia (neutrophils less than 1000/mL3) is present. In most patients, the neutrophil count quickly returns to normal when captopril is discontinued. Proteinuria: Proteinuria may occur in patients with impaired renal function or in response to high doses of ACE inhibitors (>150 mg/day). Nephrotic syndrome occurs in 1/5 of patients with proteinuria. In most cases, proteinuria decreases or disappears after 6 months, regardless of the use of captopril. Anaphylactoid reactions during desensitization: Life-threatening anaphylactic reactions are rare in patients undergoing desensitization while taking captopril. The development of these reactions can be avoided if captopril is temporarily canceled during desensitization. In this regard, caution should be exercised when conducting desensitization while taking captopril. Anaphylactic reactions in patients undergoing hemodialysis: Anaphylactic reactions have been reported in patients undergoing hemodialysis using high-flow membranes (eg, AN 69) and concomitantly treated with ACE inhibitors. These patients should be offered to change their dialysis membranes to another type of membrane or use a different class of antihypertensive drug. Risk of hypokalemia: With the simultaneous use of an ACE inhibitor and a thiazide diuretic, the risk of developing hypokalemia cannot be excluded. Potassium levels should be monitored regularly. Laboratory Tests: Captopril may cause a false positive urine reaction to acetone. Surgery / Anesthesia: In major surgical interventions, hypotension may occur with the use of anesthetics. Hypotension can be corrected by correcting the circulating blood volume. Patients with diabetes mellitus: in the first months of taking ACE inhibitors, patients with diabetes mellitus need to more carefully control blood sugar. Race: Like other ACE inhibitors, captopril is less effective in lowering blood pressure in dark-skinned patients than in Caucasians due to the predominance of low renin fractions in dark-skinned patients. Lactose: The drug is not recommended for patients with rare hereditary problems of galactose intolerance, lactase deficiency or glucose-galactose malabsorption. Double blockade of the renin-angiotensin-aldosterone system Double blockade of the renin-angiotensin-aldosterone system is associated with an increased risk of hypotension, hyperkalemia and renal dysfunction (including acute renal failure) compared with monotherapy. Dual RAAS blockade with an ACE inhibitor, ARB II, or Aliskiren cannot be recommended for any patient, especially those with diabetic nephropathy. In some cases, when the combined use of an ACE inhibitor and ARB II is absolutely indicated, careful observation by a specialist and mandatory monitoring of kidney function, water and electrolyte balance, and blood pressure are necessary. This refers to the use of candesartan or valsartan as add-on therapy to ACE inhibitors in patients with chronic heart failure. Conducting a double blockade of the RAAS under the close supervision of a specialist and mandatory monitoring of kidney function, water and electrolyte balance and blood pressure is possible in patients with chronic heart failure with intolerance to aldosterone antagonists (spironolactone), who have persistent symptoms of chronic heart failure, despite other adequate therapy. Interactions with other drugs Potassium-sparing diuretics or potassium: ACE inhibitors reduce potassium loss. Potassium-sparing diuretics (eg, spironolactone, triamterene, or amiloride) can lead to a significant increase in serum potassium. If the concomitant use of these drugs is indicated, for example, in hypokalemia, they should be used with caution and constantly monitor serum potassium levels. Diuretics (thiazide or loop diuretics): administration of high doses of diuretics may lead to a fall in circulating blood volume and the risk of hypotension with subsequent administration of captopril. At the same time, there were no drug interactions with hydrochlorothiazide and furosemide. Alpha-blockers: Concomitant use of drugs blocking ?-adrenergic receptors may increase the antihypertensive effect of captopril and increase the risk of orthostatic hypotension. Other antihypertensive agents: Captopril has been shown to be safe when administered concomitantly with other antihypertensive agents (?-blockers and long-acting calcium channel blockers). Use with caution in combination with nitroglycerin and other vasodilators. Treatment of acute myocardial infarction: Captopril may be used concomitantly with acetylsalicylic acid (in cardiac doses), thrombolytics, ?-blockers and/or nitrates in patients with myocardial infarction. Lithium: A reversible increase in serum lithium concentrations and its toxicity have been reported with the simultaneous use of lithium and ACE inhibitors. Concomitant use of thiazide diuretics may increase the risk of lithium toxicity and exacerbate the already increased risk of lithium toxicity in combination with ACE inhibitors. The use of captopril with lithium is not recommended, but if the combination proves necessary, close monitoring of serum lithium levels is necessary. Tricyclic antidepressants/antipsychotics: ACE inhibitors may enhance the hypotensive effect of some tricyclic antidepressants and antipsychotics. Postural hypotension is possible. Allopurinol, procainamide, cytostatic and immunosuppressive drugs: Concomitant use with ACE inhibitors may lead to an increased risk of leukopenia, especially when the latter are used at doses higher than recommended. Non-steroidal anti-inflammatory drugs: Cases have been described where non-steroidal anti-inflammatory drugs (NSAIDs) and ACE inhibitors have an additive effect on increasing serum potassium levels, while there may be a decrease in renal function. These effects are reversible. Rarely, acute renal failure may develop, especially in patients with impaired renal function, such as the elderly or when dehydrated. Long-term use of NSAIDs may reduce the antihypertensive effect of ACE inhibitors. Sympathomimetics: possible decrease in the antihypertensive effect of ACE inhibitors. Careful monitoring of the patient’s condition is required. Antidiabetic agents: Pharmacological studies have shown that in patients with diabetes mellitus, ACE inhibitors, including captopril, may enhance the glucose-lowering effect of insulin and oral antidiabetic agents such as sulfonylurea. Dual blockade of the renin-angiotensin-aldosterone system Based on available data, dual blockade of the RAAS with an ACE inhibitor, ARB II, or aliskiren cannot be recommended in any patient, especially in patients with diabetic nephropathy. In patients with diabetes mellitus or moderate/severe renal impairment (GFR <60 ml/min/1.73 m2), concomitant use of aliskiren with an ACE inhibitor or ARB II is contraindicated. In some cases, when the combined use of an ACE inhibitor and ARB II is absolutely indicated, careful observation by a specialist and mandatory monitoring of kidney function, fluid and electrolyte balance and blood pressure are necessary. Contraindications Hypersensitivity to captopril and other ACE inhibitors, any other component of the drug; Angioedema (Quincke's edema) in history associated with taking other ACE inhibitors, hereditary / idiopathic angioedema; Severe impaired liver and / or kidney function; Refractory hyperkalemia; Condition after kidney transplantation; Pregnancy; Lactation; Aortic stenosis and similar changes that impede the outflow of blood from the left ventricle; Hemodynamically significant bilateral stenosis of the renal arteries or hemodynamically significant stenosis of the artery of a single kidney. Simultaneous use of angiotensin-converting enzyme inhibitors or ATII receptor blockers with Aliskiren in patients with diabetes mellitus or moderate / severe renal insufficiency (GFR <60 ml / min / 1.73 m2) is contraindicated. Composition Each tablet contains: Active substance: captopril - 50 mg; Excipients: corn starch, microcrystalline cellulose, magnesium stearate, lactose monohydrate. Overdose Symptoms of overdose are severe arterial hypotension, shock, stupor, bradycardia, electrolyte disturbances and renal failure. Treatment: when taking a large number of tablets, it is recommended to wash the stomach, take activated charcoal and sodium sulfate within 30 minutes after taking the tablets. The patient should have blood pressure, respiratory rate, serum urea and potassium levels, creatinine, diuresis checked. In case of hypotension, the patient should be transferred to a horizontal position with raised legs, if necessary, infuse saline (9 mg / ml sodium chloride solution). Blood pressure, respiratory rate, serum levels of urea and potassium, creatinine, diuresis should be monitored. The introduction of angiotensin II is allowed. In case of bradycardia, atropine is recommended. The need for a pacemaker should be assessed. In severe cases, captopril can be removed by hemodialysis (clearance - from 1.33 ml / s to 2 ml / s, depending on the hemodialyzer used). Side effectEstimation of undesirable effects is based on the following data on the frequency of occurrence: very often (? 1/10), often (? 1/100 to <1/10), infrequently (? 1/1000 to <1/100), rarely (? 1/10000 to <1/1000), very rare (<1/10000), frequency unknown (cannot be estimated from available data). Blood and lymphatic system disorders: very rarely - neuropenia / agranulocytosis, pancytopenia (especially in patients with renal insufficiency), anemia (aplastic or hemolytic), thrombocytopenia, lymphadenopathy, eosinophilia, autoimmune diseases. Metabolic and nutritional disorders: rarely - anorexia; very rarely - hyperkalemia, hypoglycemia. Mental disorders: often - sleep disturbance; very rarely - confusion, depression. Nervous system disorders: often - taste disturbance, dizziness; rarely - drowsiness, headaches, paresthesia; very rarely - cerebrovascular incidents, including stroke and syncope. On the part of the organ of vision: very rarely - visual impairment. Cardiovascular disorders: infrequently - tachycardia, tachyarrhythmia, angina pectoris, palpitations; very rarely - cardiac arrest, cardiogenic shock. Vascular disorders: rarely - hypotension, Raynaud's syndrome, erythema, pallor. Respiratory, thoracic and mediastinal disorders Common: dry, irritating cough and shortness of breath; very rarely - bronchospasm, rhinitis, allergic alveolitis / eosinophilic pneumonia. Gastrointestinal disorders: often - nausea, vomiting, stomach irritation, abdominal pain, diarrhea, constipation, dry mouth; rarely - stomatitis / aphthous ulcers; very rarely - glossitis, peptic ulcer, pancreatitis. On the part of the liver and biliary tract: very rarely - impaired liver function and cholestasis (including jaundice), hepatitis, including necrosis, increased levels of liver enzymes and bilirubin. Skin and subcutaneous tissue disorders: often - itching with or without rash, rash and baldness; infrequently - angioedema; very rarely - urticaria, Steven-Jones syndrome, erythema multiforme, photosensitivity, pemphigoid reaction and exfoliative dermatitis. Violation of the musculoskeletal, connective and bone tissues: very rarely - myalgia, arthralgia. Renal and urinary disorders: rarely - renal failure, including polyuria, oliguria and frequent urination; very rarely - nephrotic syndrome. Reproductive system and mammary gland disorders: very rarely - impotence, gynecomastia. General disorders: rarely - chest pain, fatigue, malaise; very rarely - fever. Laboratory indicators: very rarely - proteinuria, eosinophilia, increased serum potassium, decreased serum sodium, increased urea, creatinine and bilirubin in serum, decreased hemoglobin, hematocrit, leukocytes, platelets, increased ANA-titer, increased ESR. Captopril can cause a false-positive urinalysis for acetone. Storage conditions In a place protected from moisture and light at a temperature not exceeding 25 ° C. Keep out of the reach of children. Buy Captopril-LF tablets 50mg No. 10x4 Price for Captopril-LF tablets 50mg No. 10x4