The coronavirus drug Tocilizumab (Actemra), according to Italian doctors, works better than hydroxychloroquine

Nobasit as a cure for coronavirus. The Russian drug, which recently arrived in pharmacies, is an antiviral agent containing isonicotinic acid. The value of the medicine is that it has a complex effect. The patient no longer needs to take several medications at the same time. Not every antiviral drug has such properties.

Does Nobasit help against coronavirus? The question worries many, there is no definite answer, the purpose of this medicine is to help with ARVI. However, nobasit brings undoubted benefits - the medicine blocks the surface protein of the virus, with the help of which it attaches to the cell membrane. As a result, nobasite does not allow cells to multiply quickly and prevents the spread of the disease.

The drug has interferogenic properties, which is why the body fights the virus much more actively. However, nobasite has yet to prove its positive qualities in relation to Covid-19. As for the treatment of ARVI, nobazit has already gained popularity here.

Release form and composition

Iruzid is available in tablet form:

• dosage 10 mg + 12.5 mg: biconvex, hexagonal, blue (30 pieces in blisters, one blister in a cardboard pack);
• dosage 20 mg + 12.5 mg: biconvex, hexagonal, yellow (30 pieces in blisters, one blister in a cardboard pack);
• dosage 20 mg + 25 mg: biconvex, round, light pink (30 pieces in blisters, one blister in a cardboard pack).

Composition per 1 tablet:

• active ingredients: lisinopril dihydrate + hydrochlorothiazide – 10 mg + 12.5 mg; 20 mg + 12.5 mg or 20 mg + 25 mg (respectively);
• auxiliary components: calcium phosphate dihydrate, magnesium stearate, pregelatinized starch, mannitol, corn starch; additionally for a dosage of 10 mg + 12.5 mg – indigo carmine; additionally for a dosage of 20 mg + 12.5 mg – yellow iron oxide dye; additionally for a dosage of 20 mg + 25 mg – red iron oxide dye.

Generics

According to reviews, analogs of “Iruzida 10/12.5” are:

• "Lysoreticist."
• "Co-Diroton."
• "Lisinopril."
• "Liten N".
• "Rileys-Sanovel plus."
• "Listril Plus".
• "Sinoreside".
• "Scopril Plus"
• "Zonixem NL".

The drug must be stored at temperatures up to plus twenty-five degrees. This medication is available with a doctor's prescription.

Next, the most effective analogues of Iruzida 10/12.5 will be considered.

Pharmacological properties

Pharmacodynamics

Iruzide is a combined antihypertensive drug (lisinopril + hydrochlorothiazide) with diuretic and antihypertensive activity.

Lisinopril is an ACE (angiotensin-converting enzyme) inhibitor. It inhibits the synthesis of angiotensin II from angiotensin I. When the amount of angiotensin II decreases, the release of aldosterone decreases. Lisinopril reduces the degradation of bradykinin and increases the formation of prostaglandins. Under the influence of the substance, blood pressure, pressure in the capillaries of the lungs, total peripheral vascular resistance and preload are reduced; minute blood volume increases and resistance to physical activity increases in patients with chronic heart failure. Lisinopril dilates arteries rather than veins. If the treatment is long-term, the severity of hypertrophy of the walls of resistive vessels and myocardium decreases. The drug improves blood supply to ischemic myocardium. In patients with chronic heart failure, overall life expectancy is prolonged; in patients who have suffered a myocardial infarction without symptoms of heart failure, the progression of left ventricular dysfunction slows down.

The antihypertensive effect of Iruzide begins approximately 6 hours after taking the tablet and lasts throughout the day. The dose size also affects the duration of the therapeutic effect. A stable antihypertensive effect develops 1–2 months after the start of treatment. Abrupt withdrawal of the drug does not lead to a significant increase in blood pressure.

In addition to reducing blood pressure, lisinopril reduces albuminuria. During hyperglycemia, it normalizes the function of damaged glomerular endothelium. In patients with diabetes mellitus, the drug does not change the blood glucose level and does not increase the incidence of hypoglycemia.

Hydrochlorothiazide is a moderate-strength thiazide diuretic. Its diuretic effect is due to a violation of the reabsorption of water, potassium, sodium, magnesium and chlorine ions in the distal nephron. Hydrochlorothiazide slows down the excretion of uric acid and calcium ions. Antihypertensive properties are associated with the ability to dilate arterioles. Hydrochlorothiazide has almost no effect on normal blood pressure. The diuretic effect develops after 1–2 hours, the maximum effect is observed after 4 hours, the total duration of action is from 6 to 12 hours. The hypotensive effect occurs no earlier than after 3–4 days, but the optimal therapeutic effect appears only after 3–4 weeks.

With simultaneous use of lisinopril and hydrochlorothiazide, an additive hypotensive effect is observed.

Pharmacokinetics

The maximum serum concentration of lisinopril is achieved approximately 7 hours after taking the tablet. The connection with plasma proteins is weak. The average extent of absorption of lisinopril in the gastrointestinal tract is 25%, but it varies greatly (from 6 to 60%) in different patients. Eating does not affect the absorption of the substance. Lisinopril is not metabolized and is excreted only unchanged by the kidneys. After repeated administration of the drug, the effective half-life is 12 hours. The elimination of lisinopril slows down if renal function is impaired, but this fact is of clinical significance only if the glomerular filtration rate decreases to 30 ml/min or less. In elderly patients, the maximum concentration of lisinopril in the blood and the area under the concentration-time curve (AUC) are on average two times higher than those in younger people. The substance passes through the blood-brain barrier. Hemodialysis is effective in removing lisinopril from the body.

The maximum concentration of hydrochlorothiazide in the blood is achieved after 1–3 hours. The binding to plasma proteins ranges from 40 to 70%. Absolute bioavailability is about 60%. The volume of distribution is 0.8±0.3 l/kg. Hydrochlorothiazide is not metabolized. It is excreted by the kidneys almost unchanged. Approximately 60% of the dose taken is eliminated in the first 48 hours. Renal clearance is 250–300 ml/min. The half-life is from 10 to 15 hours. Plasma concentrations of the substance differ in women and men. Plasma concentrations of hydrochlorothiazide are generally higher in women than in men. If renal function is impaired, the rate of elimination is reduced (the half-life is extended to 34 hours).

"Sinoreside"

This is a complex antihypertensive drug that has antihypertensive and diuretic effects. The active ingredients are lisinopril and hydrochlorothiazide. The first disrupts the transformation of angiotensin one into the biologically active angiotensin two, which increases peripheral vascular tone and also helps produce aldosterone by the adrenal glands.

The drug reduces total peripheral capillary resistance, blood pressure, reduces load, as well as pressure in the pulmonary vessels, and provokes an increase in minute blood volume. The medication helps dilate arteries to a greater extent than veins.

Certain effects are explained by the influence on the human hormonal system, which regulates blood pressure and blood volume. With long-term use, it reduces the intensity of enlargement of the heart muscles and artery walls. Improves myocardial microcirculation. Angiotensin-converting enzyme inhibitors prolong the life of people with heart disease, and also slow down the further development of left ventricular disorders in patients who have had a myocardial infarction.

Sinoreside begins to act an hour after consumption, reaches its maximum concentration after about seven hours, and the duration of the effect is a day. With high blood pressure, the pharmacological effect can be observed on the first day of treatment, but stabilization of blood pressure occurs after one to two months.

Hydrochlorothiazide is a thiazide diuretic whose diuretic effect is associated with impaired reabsorption of chlorine ions, as well as potassium and magnesium.

This component of the drug inhibits the excretion of calcium and uric acid. It has antihypertensive effects. The hypotensive effect occurs due to the expansion of capillaries. Does not change normal blood pressure at all. The diuretic effect occurs two hours after consumption, reaches a maximum after four hours and lasts about twelve hours.

When used together, two active ingredients (lisinopril and hydrochlorothiazide) have an additive effect that lowers blood pressure.

When taking Sinoreside, a strong decrease in blood pressure, as a rule, appears when the volume of circulating blood decreases, provoked by treatment with diuretics.

In chronic heart disease, an intense decrease in blood pressure after starting to use angiotensin-converting enzyme inhibitors can lead to a deterioration in kidney function. Situations of acute renal failure have been reported when using the medicine.

Contraindications

Absolute:

• severe renal failure (creatinine clearance level less than 30 ml/min);
• severe diabetes mellitus;
• anuria;
• hemodialysis using high-flow membranes;
• porphyria;
• hepatic coma;
• precoma;
• hyponatremia, hypercalcemia;
• Quincke's edema (including a history of Quincke's edema when using ACE inhibitors);
• children and adolescents up to 18 years of age;
• hypersensitivity to the components of the drug, sulfonamide derivatives and other ACE inhibitors.

Relative (Iruzid is used with caution):

• renal failure of moderate and mild severity (creatinine clearance level 30 ml/min or more);
• bilateral renal artery stenosis or unilateral arterial stenosis (in patients with one kidney) with progressive azotemia;
• recovery period after kidney and/or kidney transplantation;
• liver failure;
• cardiac ischemia;
• severe chronic heart failure;
• low blood pressure;
• hypertrophic cardiomyopathy/aortic stenosis;
• cerebrovascular diseases (including cerebrovascular insufficiency);
• suppression of hematopoiesis in the bone marrow;
• bone marrow hypoplasia;
• hypovolemia and hypovolemic conditions (including vomiting and diarrhea);
• primary hyperaldosteronism;
• diabetes;
• hyponatremia, hyperkalemia;
• hyperuricemia;
• connective tissue diseases;
• gout;
• elderly age.

Restrictions

The drug should not be used if you have the following conditions and ailments:

• Anuria (a pathological condition that is provoked by various diseases, the symptom of which is the cessation of urine flow into the bladder).
• Severe renal failure.
• Angioedema (an acute condition characterized by the rapid appearance of local swelling of the mucous membrane, as well as subcutaneous tissue and the skin itself).
• Hypercalcemia (increased calcium levels in blood plasma).
• Hyponatremia (a disease in which the concentration of sodium ions in the blood decreases below normal).
• Porphyria (congenital lesion, which is accompanied by a violation of the metabolism and structure of hemoglobin).
• Precoma (a serious life-threatening disease that precedes coma).
• Age up to eighteen years.
• Lactation.
• Individual intolerance to substances included in the drug.
• Primary hyperaldosteronism (the result of the production of aldosterone in the glomerular layer of the adrenal cortex).
• Hypertrophic cardiomyopathy (an autosomal dominant disease characterized by hypertrophy of the wall of the left or, in rare cases, the right ventricle).
• Aortic stenosis (narrowing of the aorta at the valve area, which impedes the flow of blood from the left ventricle).
• Stenosis of the artery of a single kidney (a disease that contributes to blockage of the carotid artery by a thrombus or atherosclerotic plaque, the main cause of ischemic stroke).
• Bilateral renal artery stenosis (narrowing of the lumen of the vessel, which is provoked by congenital pathologies, as well as atherosclerosis and inflammatory changes).
• Conditions after kidney transplantation.
• Bone marrow hypoplasia (a condition in which myeloid tissue is replaced by fatty tissue).
• Arterial hypotension (a common pathological disease that manifests itself as a constant and persistent tonometer reading below the standard level).
• Hypovolemic conditions (a pathological process that is caused by a rapid decrease in circulating blood volume).
• Hyponatremia (a disease in which the content of sodium ions in the blood falls below normal).
• Diabetes mellitus (a group of thyroid diseases that develop due to a deficiency or absence of insulin in the body, subsequently significantly increasing the glucose level in the blood).
• Systemic lupus erythematosus (a serious pathological condition in which the body’s own immune system perceives the human body’s cells as foreign).
• Deterioration of bone marrow hematopoiesis.
• Gout (a chronic metabolic disorder characterized by metabolic disorders and the inability of the kidneys to excrete uric acid).
• Hyperkalemia (a pathological condition that provokes an abnormally high level of potassium in the blood).
• Hyperuricemia (a disease in which the level of uric acid in the blood exceeds the limit).
• Cerebrovascular diseases (a group of brain diseases that are caused by pathologies of cerebral capillaries with impaired cerebral microcirculation).
• Coronary artery disease (organic and functional damage to the heart muscles, which is caused by a deficiency or cessation of myocardial microcirculation).

Iruzid: instructions for use (dosage and method)

Iruzid tablets should be taken orally. The daily dose is one tablet 10 mg + 12.5 mg or 20 mg + 12.5 mg. If necessary, the daily dose may be increased to one tablet 20 mg + 25 mg.

In patients with mild to moderate renal failure (creatinine level 30–80 ml/min), Iruzide can be used after preliminary selection of doses of the individual components. The initial dose of lisinopril in patients with uncomplicated renal failure is 5 to 10 mg per day.

After taking the initial dose of Iruzide, symptomatic hypotension may occur. This situation is more often observed in patients with loss of electrolytes and fluid due to previous diuretic therapy, so diuretic treatment should be discontinued 2-3 days before the first dose of the drug.

Side effects

The most common side effects during Iruzid therapy are headache and dizziness. Adverse reactions from the following systems and organs are also possible:

• digestive tract: dry mouth, change in taste, dyspeptic disorders, nausea, abdominal pain, vomiting, anorexia, pancreatitis, loose stools, jaundice, cholestatic and hepatocellular hepatitis;
• circulatory system: chest pain, marked decrease in blood pressure; rarely - decreased heart rate, tachycardia, impaired atrioventricular (AV) conduction, symptoms of heart failure, orthostatic hypotension, myocardial infarction;
• respiratory system: bronchospasm, cessation of respiratory movements, impaired frequency and depth of breathing;
• nervous system: impaired concentration, feeling of numbness in the limbs, drowsiness, mood lability, convulsive twitching of the lips and muscles in the arms and legs, increased fatigue; rarely – asthenia, confusion;
• genitourinary system: decreased potency, impaired renal function, decreased amount of urine excreted by the kidneys, complete absence of urine in the bladder, uremia, acute renal failure;
• skin: increased sweating, hair loss, urticaria, increased sensitivity to ultraviolet radiation, itching;
• allergic reactions: skin rash, itching, eosinophilia, increased erythrocyte sedimentation rate, vasculitis, angioedema of the tongue, lips, face, larynx, epiglottis, extremities, fever, positive reaction to antinuclear antibodies;
• hematopoietic system: anemia, leukopenia, neutropenia, thrombocytopenia, agranulocytosis;
• laboratory test indicators: hyponatremia, hypochloremia, hypokalemia, hypomagnesemia, hypercalcemia, hyperkalemia, hyperbilirubinemia, hyperuricemia, hypercholesterolemia, hyperglycemia, hypertriglyceridemia, increased plasma creatinine and urea, increased activity of liver enzymes, decreased glucose tolerance (especially in patients with kidney disease, renovascular hypertension and diabetes mellitus);
• other reactions: arthritis, arthralgia, dry cough, exacerbation of gout, myalgia, impaired fetal development, fever.

Overdose

According to reviews of the medicine, Iruzid, if used incorrectly, can provoke the following reactions:

• Increased fatigue.
• Asthenic syndrome (a psychopathological disease that is characterized by progressive development and accompanies most diseases of the body).
• Oliguria (decrease in the amount of urine excreted compared to the norm).
• Anuria (a pathological condition that is provoked by various reasons. A symptom of the disease is the cessation of urine flow into the bladder).
• Uremia (acute or chronic disease that occurs with severe kidney damage due to retention of nitrogenous metabolic products and other toxic substances in the body).
• Anemia (a condition of the human body characterized by a low concentration of hemoglobin per unit volume of blood).
• Erythrocytopenia (low levels of red blood cells per unit volume of blood).
• Leukopenia (low level of leukocytes in the overall cellular composition of the blood).
• Thrombocytopenia (a pathological condition characterized by a decrease in the number of blood clots circulating in the peripheral blood).
• Agranulocytosis (a pathology in which there is a decrease in the level of leukocytes due to granulocytes and monocytes).
• Neutropenia (reduced level of neutrophil granulocytes in the general cellular composition of the blood).
• Hypochloremia (decreased concentration of chlorine minerals in the blood).
• Hyperglycemia (a pathological condition that is accompanied by diabetes mellitus of the first and second types, and is also characterized by a significant increase in sugar levels).
• Hyperuricemia (a disease in which the level of uric acid in the blood is higher than normal).
• Hypokalemia (decreased potassium concentration).
• Hyperkalemia (a pathological condition that provokes an abnormally high level of potassium in the blood).
• Hypomagnesemia (a disease in which the human body contains a small amount of magnesium).
• Hyponatremia (pathology, which is based on a decrease in the content of sodium ions in the blood).
• Hyperbilirubinemia (a pathological disease of the blood serum, which manifests itself in an increase in bilirubin content).
• Hypertriglyceridemia (increased concentration of triglycerides in blood plasma).
• Hypercholesterolemia (a pathological condition in which there is an abnormal increase in cholesterol levels in the blood).
• Hypercalcemia (increased calcium concentration in blood plasma).
• Renovascular hypertension.
• Eosinophilia (a condition in which there is an absolute or relative increase in the number of eosinophils).
• Itching.
• Vasculitis (autoimmune inflammation of the vascular wall, which can affect any vessels of different sizes: arterioles, veins, arteries, venules).
• Fever.

special instructions

If angioedema develops affecting the tongue, lips, larynx, epiglottis, face and/or extremities, it is necessary to discontinue treatment with lisinopril as soon as possible and monitor the patient until symptoms disappear completely. If swelling occurs only on the lips and face, no specific treatment is usually required. Sometimes it is possible to prescribe antihistamines. Swelling of the larynx is deadly, as it can cause airway obstruction. In this case, it is necessary to urgently take emergency measures (subcutaneous administration of 0.3–0.5 ml of adrenaline or epinephrine solution, ensuring airway patency).

Before surgery (including dentistry), you must warn your doctor about the use of Iruzid.

Doses of antidiabetic medications may need to be adjusted in patients with diabetes mellitus as thiazide diuretics may alter glucose tolerance.

Due to a possible decrease in urinary calcium excretion and resulting hypercalcemia, it is recommended to discontinue treatment with Iruzid until a test is performed to assess the function of the parathyroid glands. This is due to the fact that severe hypercalcemia may be a sign of hidden hyperparathyroidism.

During treatment, the level of glucose, potassium, and lipids in the blood should be regularly determined.

The simultaneous use of Iruzide and alcoholic beverages is not recommended, since ethanol enhances the antihypertensive effect of the drug.

Patients taking Iruzid should take special care during hot weather and during physical exertion, as the decrease in circulating blood volume increases the risk of dehydration and an excessive decrease in blood pressure.

Impact on the ability to drive vehicles and complex mechanisms

During the period of treatment with Iruzid, it is recommended to refrain from driving vehicles and other mechanisms, as dizziness and headaches may occur, especially at the beginning of the therapeutic course.

Is Nobasit effective against coronavirus?

Nobasit is designed for use as a prophylaxis against acute respiratory viral infections, but the drug includes elements that can also be effective in combating other infections. The list of such diseases includes coronavirus, the outbreak of which occurred quite recently. But why were tablets against ARVI and influenza effective against coronavirus infection?

The answer lies in the virus itself. The rise of epidemics does not occur very often due to the complexity of spread. All coronaviruses have a basis in the form of serious diseases, and this can also be the flu, which, although leading the list in terms of the number of deaths, does not spread across the planet so quickly.

With the flu, a person’s immunity decreases, so the chances of additional infection with coronavirus are high. The virus needs to be treated urgently before it causes complications, which is why Nobasit is used. It is powerless against coronavirus, but it will help support the body.

Does he help or not?

The answer to this question is ambiguous; this is due to the peculiarities of the interaction between the virus and the body. Sometimes the virus can appear in the body at the same time as the flu.

In other words, to understand whether a pill can save the body from the influence of third-party microbes, you need to find out what nature the disease has in the human internal system. To find out, you should consult a doctor and conduct a series of tests.

Relevant: At what temperature does coronavirus die?

Nobasit may be effective if a person has:

• The average body temperature has been 39˚C for several days.
• Muscles and joints begin to ache, and later fatigue appears.
• Headache.
• The cough is dry, but there are exceptions.

We can say that Nobasit will help a person cope with a number of viral pathologies, but this medicine does not provide a guarantee of healing.

Use during pregnancy and lactation

Lisinopril is contraindicated in pregnant women. If pregnancy occurs, taking Iruzid should be stopped as soon as possible. ACE inhibitors have an adverse effect on the fetus in the second and third trimesters of pregnancy (a marked decrease in blood pressure, hyperkalemia, renal failure, cranial hypoplasia, and intrauterine fetal death may occur). There are no data on the effect of Iruzid on the fetus in the first trimester. Newborns and infants whose mothers took ACE inhibitors during pregnancy should be monitored for early detection of hyperkalemia, oliguria and excessive reduction in blood pressure.

The drug is contraindicated during breastfeeding.

Patient opinions

According to reviews, Iruzid is considered an effective remedy in situations where complex treatment is indicated. It is noted that blood pressure decreases sharply, but after the correct dosage is selected, the medication is well tolerated by patients.

Many people write that at the beginning of treatment they are frightened by the impressive list of contraindications and side effects. However, nothing bad happens if you take the pills following the dosage prescribed by your doctor.

Some people lament that the drug cannot be bought in pharmacies without a prescription. But this is correct, since uncontrolled taking of pills can only cause harm.

The cost of the drug varies from 400 to 700 rubles.

Drug interactions

Co-administration with potassium supplements, potassium-sparing diuretics and salt substitutes containing potassium increases the risk of hyperkalemia, especially in cases of impaired renal function.

Barbiturates, ethanol, tricyclic antidepressants, phenothiazines and vasodilators enhance the hypotensive effect of Iruzid.

Estrogens and non-steroidal anti-inflammatory drugs reduce the antihypertensive effect of lisinopril.

Cholestyramine and antacids reduce the absorption of the drug in the digestive tract.

Iruzid slows down the excretion of lithium; weakens the effect of epinephrine, norepinephrine, hypoglycemic agents for oral administration, drugs against gout and oral contraceptives; enhances the neurotoxic effect of salicylates; increases the effects of peripheral muscle relaxants and cardiac glycosides; reduces the excretion of quinidine; increases the risk of hemolysis when combined with methyldopa.

Reviews about Iruzid

The drug has a number of advantages compared to other ACE inhibitors. Clinical studies have proven that lisinopril has the lowest incidence of such side effects as dry cough. In the reviews about Iruzide left by patients, these data are confirmed. Many patients who used the drug for several years did not complain of side effects from the respiratory system.

Due to the fact that lisinopril is not metabolized in the liver, it can be used for liver diseases. In addition, it normalizes blood pressure more effectively than those drugs that are metabolized in the liver.

Patients note that the drug is convenient to take, since the daily dose is only one tablet at a time.

Some patients complained of a sharp drop in blood pressure after taking Iruzid, but this situation was most often observed with an incorrectly selected dose of the drug. After reducing the daily dose, the pressure decreased smoothly, without sudden jumps.

Nobasit in the list of drugs against COVID-19

Literally a month ago - in April 2021, during the next adjustment to the list of recommended drugs for the treatment of COVID-19 disease, caused by a new type of coronavirus, Nobasit was included. Other medicines that contain a similar active ingredient - enisamium iodide, for example, Amizon, can also be used.

Nobasit tablets are one of the forms of release of this medicine.

More specifically, these recommendations apply to all cases of mild forms of acute respiratory viral infection, each case of which is currently considered as a possible infection with coronavirus. The use of Nobasit is entirely based on the information specified in the instructions for use, the reliability of which has been confirmed over many years. It should be noted that Nobazit cannot be a substitute for a specific medicine against coronavirus, since it is unable to negatively affect the pathogen.

It is included in the list of recommended drugs as a drug for complex therapy, and its use without other antiviral drugs would be inappropriate. For clarity, it is necessary to compare Nobasit with other antiviral drugs that have different capabilities, due to which, according to scientists, they are able to resist SARS-CoV-2.

Nobazit and Remdesivir

Both of these drugs are included in the list of recommended therapeutic measures against COVID-19, but given the abilities they have, their roles are accordingly different. Even though these drugs belong to the same group of antiviral drugs.

Initially, the difference lies in the type of medicine itself. Nobasit is a tablet or capsule for influenza and ARVI; simply put, it is a common antiviral drug with a powerful effect. Remdesivir is a specific medicine, the newest antiviral drug in the class of nucleotide analogues.

A significant difference is present in the pharmacological action of the drugs, which is directly due to the main active component. Nobasit, as mentioned above, is a derivative of isonicotinic acid (enisamium iodide). The active substance effectively suppresses the symptoms of influenza and ARVI due to its inhibitory effect on the process of introduction of viruses through the cell membrane, that is, it simply does not allow the pathogen to penetrate inside.