Source: Υπουργείο Υγείας (CY) Revision Year: 2019 Publisher: MEDOCHEMIE LTD, 1-10 Constantinoupoleos street, 3011 Limassol, Cyprus
Rilcapton is indicated for the treatment of hypertension.
Rilcapton is indicated for the treatment of chronic heart failure with reduction of systolic ventricular function, in combination with diuretics and, when appropriate, digitalis and beta-blockers (see sections 4.3, 4.4, 4.5 and 5.1).
Rilcapton is indicated for the treatment of macroproteinuric diabetic neuropathy in patients with type I diabetes.
Dose should be individualised according to patient’s profile (see section 4.4) and blood pressure response. The recommended maximum daily dose is 150 mg.
Rilcapton may be taken before, during and after meals.
The recommended starting dose is 25-50 mg daily in two divided doses. The dose may be increased incrementally, with intervals of at least 2 weeks, to 100-150 mg/day in two divided doses as needed to reach target blood pressure.
Rilcapton may be used alone or with other antihypertensive agents, especially thiazide diuretics (see sections 4.3, 4.4, 4.5 and 5.1).
A once-daily dosing regimen may be appropriate when concomitant antihypertensive medication such as thiazide diuretics is added.
In patients with a strongly active renin-angiotensin-aldosterone system (hypovolaemia, renovascular hypertension, cardiac decompensation) it is preferable to commence with a single dose of 6.25 mg or 12.5 mg. The inauguration of this treatment should preferably take place under close medical supervision. These doses will then be administered at a rate of two per day. The dosage can be gradually increased to 50 mg per day in one or two doses and if necessary to 100 mg per day in one or two doses.
Treatment with Rilcapton for heart failure should be initiated under close medical supervision. The usual starting dose is 6.25 mg-12.5 mg BID or TID. Titration to the maintenance dose (75-150 mg per day) should be carried out based on patient’s response, clinical status and tolerability, up to a maximum of 150 mg per day in divided doses. The dose should be increased incrementally, with intervals of at least 2 weeks to evaluate patient’s response.
Short-term treatment: Rilcapton treatment should begin in hospital as soon as possible following the appearance of the signs and/or symptoms in patients with stable haemodynamics. A 6.25 mg test dose should be administered, with a 12.5 mg dose being administered 2 hours afterwards and a 25 mg dose 12 hours later. From the following day, Rilcapton should be administered in a 100 mg/day dose, in two daily administrations, for 4 weeks, if warranted by the absence of adverse haemodynamic reactions. At the end of the 4 weeks of treatment, the patient’s state should be reassessed before a decision is taken concerning treatment for the post-myocardial infarction stage.
Chronic treatment: if Rilcapton treatment has not begun during the first 24 hours of the acute myocardial infarction stage, it is suggested that treatment be instigated between the 3rd and 16th day post-infarction once the necessary treatment conditions have been attained (stable haemodynamics and management of any residual ischaemia). Treatment should be started in hospital under strict surveillance (particularly of blood pressure) until the 75 mg dose is reached. The initial dose must be low (see section 4.4), particularly if the patient exhibits normal or low blood pressure at the initiation of therapy. Treatment should be initiated with a dose of 6.25 mg followed by 12.5 mg 3 times daily for 2 days and then 25 mg 3 times daily if warranted by the absence of adverse haemodynamic reactions. The recommended dose for effective cardioprotection during long-term treatment is 75 to 150 mg daily in two or three doses. In cases of symptomatic hypotension, as in heart failure, the dosage of diuretics and/or other concomitant vasodilators may be reduced in order to attain the steady state dose of Rilcapton. Where necessary, the dose of Rilcapton should be adjusted in accordance with the patient’s clinical reactions. Captopril may be used in combination with other treatments for myocardial infarction such as thrombolytic agents, beta-blockers and acetylsalicylic acid.
In patients with type I diabetic nephropathy, the recommended daily dose of captopril is 75-100 mg in divided doses. If additional lowering of blood pressure is desired, additional antihypertensive medications may be added.
Since captopril is excreted primarily via the kidneys, dosage should be reduced or the dosage interval should be increased in patients with impaired renal function. When concomitant diuretic therapy is required, a loop diuretic (e.g. furosemide), rather than a thiazide diuretic, is preferred in patients with severe renal impairment.
In patients with impaired renal function, the following daily dose may be recommended to avoid accumulation of captopril.
| Creatinine clearance (ml/min/1.73 m²) | Daily starting dose (mg) | Daily maximum dose (mg) |
|---|---|---|
| >40 | 25-50 | 150 |
| 21-40 | 25 | 100 |
| 10-20 | 12.5 | 75 |
| <10 | 6.25 | 37.5 |
As with other antihypertensive agents, consideration should be given to initiating therapy with a lower starting dose (6.25 mg BID) in elderly patients who may have reduced renal function and other organ dysfunctions (see above and section 4.4).
Dosage should be titrated against the blood pressure response and kept as low as possible to achieve adequate control.
The efficacy and safety of captopril have not been fully established. The use of captopril in children and adolescents should be initiated under close medical supervision. The initial dose of captopril is about 0.3 mg/kg body weight. For patients requiring special precautions (children with renal dysfunction, premature infants, new-borns and infants, because their renal function is not the same with older children and adults) the starting dose should be only 0.15 mg captopril/kg weight. Generally, captopril is administered to children 3 times a day, but dose and interval of dose should be adapted individually according to patient’s response.
Oral administration.
Symptoms of overdosage are severe hypotension, shock, stupor, bradycardia, electrolyte disturbances and renal failure.
Measures to prevent absorption (e.g. gastric lavage, administration of adsorbents and sodium sulphate within 30 minutes after intake) and hasten elimination should be applied if ingestion is recent.
If hypotension occurs, the patient should be placed in the shock position and salt and volume supplementation should be given rapidly. Treatment with angiotensin-II should be considered. Bradycardia or extensive vagal reactions should be treated by administering atropine. The use of a pacemaker may be considered.
Captopril may be removed from circulation by haemodialysis.
36 months.
Store below 25°C in the original package.
Rilcapton 25 mg:
PVC/PVDC-Al blisters. Packs of 20, 30 and 100 tablets.
PP/PE security bottles of 100, 500 and 1000 tablets.
Rilcapton 50mg:
PVC/PVDC-Al blisters. Packs of 20, 30, 100, 500 & 1000 tablets.
PP/PE security bottles of 1000 tablets.
Not all pack sizes may be marketed.
No special requirements for disposal.
Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
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