Lisinopril tablets 5 mg blister No. 20

Instructions Lisinopril tablets 5 mg blister No. 20

Composition

active ingredient: lisinopril;

1 tablet contains lisinopril dihydrate equivalent to lisinopril 5 mg or 10 mg or 20 mg;

excipients: calcium hydrogen phosphate, mannitol (E 421), corn starch, magnesium stearate, colloidal anhydrous silicon dioxide.

Dosage form

Pills.

Main physicochemical properties: white, flat-cylindrical tablets with beveled edges and a score.

Pharmacotherapeutic group

Angiotensin-converting enzyme (ACE) inhibitors.

ATX code C09A A03.

Pharmacological properties

Pharmacodynamics.

Lisinopril reduces plasma levels of angiotensin-II and aldosterone, while increasing the concentration of the vasodilator bradykinin. Lisinopril causes a decrease in peripheral vascular resistance and blood pressure, cardiac output may increase at a constant heart rate, and renal blood flow may also increase.

Blood pressure begins to decrease 1 hour after oral administration, the maximum hypotensive effect is achieved after 6 hours. The duration of action of lisinopril (about 24 hours) depends on the dose. With prolonged treatment, the effectiveness of the drug does not decrease. With abrupt cessation of treatment, large drops in blood pressure (withdrawal syndrome) do not occur.

Although the primary action of lisinopril is related to the renin-angiotensin-aldosterone system, the drug is also effective in low-renin hypertension.

In addition to directly lowering blood pressure, lisinopril reduces albuminuria by altering the histology and hemodynamics of the glomerular apparatus of the kidneys. In controlled trials in diabetic patients, neither fluctuations in blood sugar levels nor an increase in hypoglycemia were observed.

Plays a positive role in restoring the function of damaged endothelium in patients with hyperglycemia.

Pharmacokinetics.

Absorption

When lisinopril is taken orally, the maximum concentration (Cmax) in the blood serum is reached after approximately 7 hours. Taking into account the amount excreted in the urine, the average absorption rate of lisinopril is approximately 25% when taking a dose of 5-80 mg. The variability of indicators between patients can be from 6 to 60%. The absolute bioavailability of lisinopril is reduced to approximately 16% in patients with NYHA class II-IV heart failure. Food intake does not affect the absorption of lisinopril.

Distribution

Apart from binding to angiotensin-converting enzyme (ACE), lisinopril does not bind to other serum proteins. Animal studies have shown that lisinopril crosses the blood-brain barrier to a small extent.

Breeding

Lisinopril is not metabolized and is excreted exclusively by the kidneys in unchanged form. After increasing the dose, the effective half-life is 12.6 hours. The clearance of lisinopril is approximately 50 ml/min in healthy volunteers. After the elimination of a significant amount of free active substance, a slower elimination of the fraction bound to ACE follows.

Liver dysfunction

In patients with cirrhosis of the liver, the absorption of lisinopril is slowed down by approximately 30% (as determined by urinary excretion) depending on the degree of liver dysfunction. On the other hand, its excretion is reduced, leading to an increase in the efficacy of lisinopril by 50%.

Kidney dysfunction

Impaired renal function reduces the clearance of lisinopril, which is excreted by the kidneys. This reduction is clinically significant only when the glomerular filtration rate is less than 30 ml/min. If creatinine clearance is 30-80 ml/min, the mean area under the concentration-time curve (AUC) increases by only 13%. If creatinine clearance is 5 to 30 ml/min, however, the mean area under the curve increases by 4.5 times compared to normal. Lisinopril can be removed by dialysis.

Heart failure

In the presence of heart failure, the exposure to lisinopril is increased (AUC increases by approximately 25%). On the other hand, the absolute bioavailability of lisinopril is reduced to approximately 16% in patients with heart failure.

Children

The pharmacokinetic profile of lisinopril has been studied in hypertensive patients aged 6 to 16 years with a glomerular filtration rate of less than 30 ml/min/1.73 m2. At doses of 0.1 to 0.2 mg/kg, steady-state plasma concentrations of lisinopril achieved within 6 hours and the extent of absorption based on urinary excretion were approximately 28%. The values differed from those obtained in adult patients. The AUC and Cmax values in children in this study were similar to those obtained in adults.

Elderly patients.

In elderly patients, lisinopril levels are generally higher due to impaired renal function; AUC is approximately 60% higher than in younger patients.

Indication

Essential hypertension.

Heart failure (symptomatic treatment).

Treatment of initial nephropathy in patients with type II diabetes mellitus and hypertension.

Contraindication

Hypersensitivity to the active substance or to the excipients of the drug.

History of angioedema associated with previous treatment with other ACE inhibitors.

Hereditary or idiopathic angioedema.

Aortic or mitral valve stenosis or hypertrophic cardiomyopathy with impaired hemodynamics.

Primary hyperaldosteronism.

Renal artery stenosis (bilateral or unilateral).

Cardiogenic shock.

Hemodynamically unstable condition after acute myocardial infarction.

Use in patients undergoing hemodialysis using high-flux membranes (e.g. AN 69).

Serum creatinine level > 220 μmol/L.

Pregnancy or women planning to become pregnant (see section "Use during pregnancy or breastfeeding").

Interaction with other medicinal products and other types of interactions

Potassium-sparing diuretics and potassium supplements

Concomitant use of potassium-sparing diuretics (e.g. spironolactone, triamterene and amiloride), potassium and potassium-containing salt substitutes requires caution. Hyperkalemia can in some cases lead to impaired renal function. For this reason, this combination of drugs should only be prescribed under close medical supervision and with regular monitoring of serum potassium and renal function.

Diuretics

Concomitant administration of diuretics with lisinopril usually has a hypotensive effect. Particular caution should be exercised when adding lisinopril to the therapy of patients taking diuretics, since a significant decrease in blood pressure is possible due to a decrease in the volume of interstitial fluid and/or excessive excretion of sodium chloride from the body. In view of the above, the risk of developing symptomatic hypotension can be reduced by discontinuing diuretics and increasing fluid or salt intake before starting to determine the dosage of lisinopril, as well as when starting treatment with low doses of ACE inhibitors.

Other antihypertensive agents

Taking other concomitant antihypertensive drugs may enhance the antihypertensive effect of Lisinopril.

Concomitant use of nitroglycerin and other nitrates or other vasodilators may further reduce blood pressure.

Nonsteroidal anti-inflammatory drugs (including acetylsalicylic acid at a dosage of 3 g/day)

Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the hypotensive effect of ACE inhibitors. In addition, increases in serum potassium have been reported with NSAIDs and ACE inhibitors, which may lead to renal impairment. This effect is usually reversible and may occur primarily in patients with pre-existing renal impairment.

Acetylsalicylic acid, thrombolytic drugs, β-blockers, nitrates

Lisinopril can be used concomitantly with acetylsalicylic acid (in cardiological doses), thrombolytic drugs, β-blockers and/or nitrates under medical supervision.

Lithium preparations

ACE inhibitors may reduce the excretion of lithium, which may be accompanied by increased toxicity. Taking this into account, the simultaneous use of Lisinopril with lithium preparations is not recommended, but if the simultaneous use of these drugs is necessary, the level of lithium in the blood serum should be regularly monitored.

Antidiabetic agents

Concomitant use of antidiabetic agents with ACE inhibitors may potentiate the hypoglycaemic effect of insulin and sulphonylureas, increasing the risk of symptomatic hypoglycaemia. However, the improvement in glucose tolerance may reduce the required dose of insulin or sulphonylureas. This interaction is usually seen during the first week of combined treatment in patients with renal impairment.

Sympathomimetics

Sympathomimetics may reduce the hypotensive effect of ACE inhibitors. For this reason, the patient's blood pressure should be monitored more closely to determine whether the desired therapeutic effect has been achieved.

Tricyclic antidepressants, neuroleptics, anesthetics

Concomitant administration of tricyclic antidepressants, neuroleptics, or anesthetics may enhance the hypotensive effect of Lisinopril.

Gold

Nitritoid reactions (symptoms of vasodilation including flushing, nausea, dizziness and hypotension, which may be severe) following gold injections (e.g. sodium aurothiomalate) are more common in patients taking lisinopril.

Streptokinase

Lisinopril should be administered with caution to patients with acute myocardial infarction within 6-12 hours after the use of streptokinase (risk of developing arterial hypotension).

Concomitant use of lisinopril with narcotics, anesthetics, alcoholic beverages, and hypnotics causes an increase in the hypotensive effect.

Application features

A significant decrease in blood pressure, accompanied by symptomatic hypotension, may occur in patients with hypovolemia and/or a decrease in the volume of interstitial fluid resulting from diuretic therapy or from salt restriction and other forms of fluid loss (increased sweating, prolonged vomiting, diarrhea, dialysis), as well as in heart failure. If hypotension occurs, the patient should be placed in a horizontal position, and intravenous fluid infusion (saline infusion) is recommended as a mandatory measure. Transient hypotension is usually not a contraindication to further treatment, but it may be necessary to temporarily discontinue or reduce the dose.

If possible, hypovolemia and/or interstitial fluid depletion should be corrected before initiating treatment with lisinopril and the effect of the initial dose on blood pressure should be carefully monitored. In cases of cerebrovascular accident or ischemic heart disease, a sharp initial decrease in blood pressure may be the cause of stroke or myocardial infarction.

In the event of acute myocardial infarction, lisinopril should not be used if treatment with vasodilators could worsen the patient's hemodynamic status (e.g., if systolic blood pressure is 100 mm Hg or lower) or in the event of cardiogenic shock. If systolic blood pressure is 120 mm Hg or lower, low doses (2.5 mg/day) should be used for the first 3 days after the infarction. In case of hypotension, maintenance doses should be reduced to 5 mg or temporarily to 2.5 mg. In case of persistent hypotension (systolic blood pressure below 90 mm Hg for more than 1 hour), treatment with this drug should be discontinued.

Aortic stenosis/hypertrophic cardiomyopathy

Like all vasodilators, ACE inhibitors should be used with caution due to pre-existing outflow tract obstruction.

Like other ACE inhibitors, lisinopril is not recommended for use in patients with mitral stenosis or obstruction in the outflow of blood from the left ventricle (as in aortic stenosis or hypertrophic cardiomyopathy).

Renal impairment In patients with renal impairment (creatinine clearance < 80 ml/min), the initial dose of lisinopril should be adjusted according to creatinine clearance (see section 4.2) and clinical response to treatment. In such patients, regular monitoring of serum potassium and creatinine is recommended.

In patients with heart failure, hypotension occurring after initiation of therapy with ACE inhibitors may lead to deterioration of renal function. Acute renal failure has been reported, which is usually reversible in such cases.

Some patients with bilateral renal artery stenosis or stenosis of the artery to a solitary kidney receiving ACE inhibitors have experienced increases in blood urea and serum creatinine, which are usually reversible after discontinuation of therapy. This is particularly true in patients with renal insufficiency. If renovascular hypertension also develops, the risk of severe hypotension and renal insufficiency increases. Treatment of such patients should be initiated under close medical supervision, with low doses of the drug and careful dose titration. Since diuretic therapy may be a contributing factor to the above phenomena, their use should be discontinued before the use of lisinopril and renal function should be monitored during the first weeks of treatment with lisinopril.

Use in kidney transplant patients

There is no experience with the use of lisinopril in patients who have recently undergone kidney transplantation. Therefore, treatment with lisinopril is not recommended.

Treatment should not be initiated in the event of acute myocardial infarction if the patient's renal function is at risk (serum creatinine level above 177 μmol/l and/or albuminuria above 500 mg/24 h). In the event of renal impairment developing during treatment (serum creatinine level above 265 μmol/l or twice the baseline level), the physician should consider discontinuing treatment.

Hypersensitivity, angioedema

Angioedema of the face, extremities, lips, tongue, pharynx and/or larynx has been reported rarely in patients treated with ACE inhibitors, including lisinopril. Edema may develop during treatment in 0.1-1.0% of patients. In such cases, treatment should be discontinued immediately and the patient should be kept under medical supervision until symptoms resolve.

Even with complete and rapid resolution of facial and lip swelling, antihistamines can be used to relieve symptoms. Angioedema affecting the larynx can be fatal. Involvement of the tongue, glottis, or trachea can cause airway obstruction, so appropriate treatment should be initiated immediately: 0.3-0.5 ml of 0.1% epinephrine solution (0.3-0.5 mg epinephrine) subcutaneously or 0.1 ml slowly intravenously, administration of glucocorticoids, antihistamines.

During abdominal surgery or general anesthesia with the use of drugs that provoke the development of arterial hypotension, lisinopril blocks the formation of angiotensin II against the background of compensatory release of renin. Arterial hypotension that develops as a result of the action of this mechanism can be eliminated by replenishing the volume of fluid.

Hemodialysis

Anaphylactoid reactions have been reported in patients dialyzed with high-flux polyacrylonitrile membranes (e.g. AN 69) and concomitantly treated with an ACE inhibitor. This combination should be avoided and consideration should be given to using a different type of dialysis membrane or a different class of antihypertensive agent.

Low-density lipoprotein (LDL) apheresis

Life-threatening anaphylactoid reactions (such as profound hypotension, respiratory distress, vomiting, allergic skin reactions) may occur in patients receiving ACE inhibitors during LDL apheresis using dextran sulfate. For this reason, ACE inhibitors used to treat hypertension or heart failure should be temporarily replaced by other drugs during LDL apheresis.

Desensitization to insect venom has been associated with anaphylactoid reactions in some patients taking ACE inhibitors. These life-threatening reactions can be avoided by early discontinuation of ACE inhibitors.

Neutropenia/agranulocytosis

Neutropenia/agranulocytosis, thrombocytopenia and anemia may develop during treatment with ACE inhibitors in patients with hypertension. These pathologies have been observed rarely in patients with normal renal function and in the absence of other complications. Neutropenia and agranulocytosis disappeared after discontinuation of treatment with ACE inhibitors. Lisinopril should be used with particular caution in patients with impaired renal function, in particular in diseases affecting the vascular system of both kidneys and connective tissue (for example, in the case of systemic lupus erythematosus or scleroderma), as well as during concomitant immunosuppressive therapy (for example, corticosteroids, cytotoxic agents, antimetabolites). The use of ACE inhibitors in such patients may be accompanied by the development of particularly severe infections, which in some cases do not respond to intensive antibiotic treatment.

In such patients, the level of white blood cells in the blood should be checked periodically during treatment with Lisinopril, and the patient should also be warned about the need to report the occurrence of any infections.

Proteinuria

There are isolated cases of proteinuria in patients, especially with reduced renal function or after taking high doses of lisinopril. In case of clinically significant proteinuria (more than 1 g per day), the drug should be used only after assessing the therapeutic benefit and potential risk and with constant monitoring of clinical and biochemical parameters.

Ethnic characteristics (race)

ACE inhibitors cause angioedema more often in dark-skinned patients than in fair-skinned patients.

As with other ACE inhibitors, the efficacy of lisinopril is increased in black patients, due to the presence of a larger number of patients with low-renin arterial hypertension compared with fair-skinned patients.

Liver failure

Very rarely, ACE inhibitors can precipitate cholestatic jaundice or hepatitis, which can lead to rapid necrosis and sometimes death. The underlying cause of this process is unknown. If patients taking Lisinopril develop jaundice or marked elevations in liver enzymes, the drug should be discontinued and treatment with alternative drugs should be continued.

Hyperkalemia

Treatment with lisinopril may be associated with the development of hyperkalemia, particularly in patients with renal insufficiency and/or heart failure. Potassium supplementation or treatment with potassium-sparing diuretics is generally not recommended as it may lead to a significant increase in serum potassium. If concomitant use of the above-mentioned drugs is necessary, frequent monitoring of serum potassium is recommended.

In elderly patients, the same doses of the drug may be accompanied by an increase in its concentration in the blood, for this reason, the dose should be determined with special caution and taking into account the patient's renal function. Despite this, no significant differences in the hypotensive efficacy of lisinopril were found between young and elderly patients.

Cough

Cough has been reported during treatment with ACE inhibitors. The cough was usually dry, without sputum, and resolved after discontinuation of treatment.

Diabetes mellitus

More careful glucose monitoring is required during the first month of treatment with ACE inhibitors in addition to prior treatment with insulin or oral hypoglycemic agents.

Lithium preparations

It is not recommended to combine lithium and lisinopril.

Use during pregnancy or breastfeeding

The drug is contraindicated for use in pregnant women or women planning to become pregnant. If pregnancy is confirmed during treatment with this drug, its use should be discontinued immediately and, if necessary, replaced with another drug approved for use in pregnant women.

It is known that prolonged exposure to ACE inhibitors during the second and third trimesters of pregnancy induces fetotoxicity (decreased renal function, oligohydramnios, skull ossification retardation) and neonatal toxicity (renal failure, hypotension, hyperkalemia). In case of exposure to ACE inhibitors during the second trimester of pregnancy, it is recommended to monitor renal function and skull bone by ultrasound.

Infants whose mothers have taken lisinopril should be closely monitored for hypotension, oliguria, and hyperkalemia.

Breastfeeding period.

Since there is no information on the use of lisinopril during breastfeeding, taking lisinopril is not recommended.

Ability to influence reaction speed when driving vehicles or other mechanisms

Due to the possibility of dizziness and fatigue, lisinopril may affect the ability to drive and use machines, especially at the beginning of treatment. Therefore, driving and using machines should be avoided until individual response to the drug is established.

Method of administration and doses

Take once a day, at the same time, regardless of meals.

Essential hypertension.

Initial dose. The recommended initial dose is usually 10 mg. In patients with a strongly activated renin-angiotensin-aldosterone system (especially in renovascular hypertension, excessive sodium excretion and/or dehydration, cardiac decompensation or severe hypertension), an excessive decrease in blood pressure may occur after the first dose. Therefore, at the beginning of treatment, such patients should be under medical supervision, the recommended initial dose is 2.5*-5 mg.

Patients with renal insufficiency also require a reduced starting dose (see table).

Maintenance dose. The usual effective maintenance dose is 20 mg once daily. If the desired therapeutic effect is not achieved after 2-4 weeks of use of the prescribed dose, the dose may be increased. The maximum daily dose should not exceed 80 mg.

If patients are taking diuretics, these should be discontinued 2-3 days before starting lisinopril therapy. If this is not possible, the initial dose of lisinopril should not exceed 5 mg per day, and it is recommended to ensure medical supervision of the patient after taking the first dose, since symptomatic hypotension may develop (the maximum effect is manifested 6 hours after taking the drug).

Hypotension may occur at the beginning of treatment with lisinopril. This is most likely to occur in patients already receiving diuretics. Since dehydration and/or excess sodium excretion may occur in these patients, the drug should be used with caution.

Heart failure.

Lisinopril can be used concomitantly with diuretics and/or digitalis. If possible, the dose of the diuretic should be reduced beforehand. The initial daily dose of lisinopril, which is 2.5* mg, can be gradually increased to a maintenance dose of 5-20 mg per day.

The recommended dose increase rate after 2 weeks is no more than 10 mg.

The maximum daily dose of lisinopril is 35 mg/day.

Before starting treatment with lisinopril and during treatment with the drug, blood pressure, kidney function indicators, potassium and sodium concentrations in the blood should be regularly monitored to avoid the development of arterial hypotension and associated renal dysfunction.

Diabetic nephropathy.

The daily dose for non-insulin-dependent diabetic patients with arterial hypertension is 10 mg once a day. If necessary, the dose can be increased to 20 mg per day in order to achieve optimal diastolic blood pressure (should be below 90 mm Hg).

Acute myocardial infarction.

In the case of using lisinopril in the first 24 hours after myocardial infarction, the initial dose of the drug should be 5 mg per day, after 24 hours 5 mg is re-administered, after 48 hours - 10 mg, then the maintenance dose is 10 mg per day. The duration of the treatment course is 6 weeks. If necessary, treatment is carried out according to the usual scheme in such cases, for example, thrombolytic drugs, acetylsalicylic acid and β-blockers are prescribed.

At low systolic blood pressure (≤ 120 mm Hg) or during the first 3 days after myocardial infarction, a low dose (2.5* mg per day) is indicated, after which, if the patient's condition allows, treatment can be continued with a higher dose. In case of arterial hypotension (systolic blood pressure ≤ 100 mm Hg), it is recommended to reduce the maintenance dose to 5 mg per day, if necessary - with an intermediate reduction to 2.5* mg per day.

If heart failure develops, the dosage instructions set out in the relevant section must be followed.

* If a dose of 2.5 mg is required, lisinopril should be used in the appropriate dosage or dosage form.

Patients with impaired renal function.

Since lisinopril is eliminated by the kidneys, the initial dose depends on creatinine clearance, the maintenance dose depends on the clinical response and is selected with regular measurement of kidney function, potassium and sodium concentrations in the blood.

* Lisinopril may be discontinued during dialysis.

The dose and frequency of taking the drug are determined by the parameters of blood pressure reduction.

The maximum dose of lisinopril is 40 mg/day.

Use in elderly patients

Studies have not shown any difference in the efficacy or safety of lisinopril treatment based on age. Since renal function is often reduced in the elderly, the dose should be determined based on renal insufficiency.

Use in kidney transplant patients

There is no experience with the use of lisinopril in patients immediately after kidney transplantation, therefore, treatment with lisinopril is not recommended in such patients.

Children.

The drug is not used in children.

Overdose

Human overdose data are limited. Symptoms associated with overdose of ACE inhibitors may include hypotension, circulatory shock, electrolyte imbalance, renal failure, hyperventilation, tachycardia, palpitations, bradycardia, dizziness, restlessness, and cough.

Treatment. Symptomatic therapy. In addition to general measures aimed at removing lisinopril from the body (gastric lavage, taking adsorbents and potassium sulfate within 30 minutes after taking lisinopril), vital signs should be monitored and corrected in the intensive care unit. Continuous monitoring of electrolyte levels and serum creatinine concentration is necessary.

The recommended treatment for overdose is intravenous administration of standard saline and volume replacement. If these measures are not effective, intravenous administration of a catecholamine should be considered. Treatment with angiotensin II should also be considered.

Bradycardia can be reduced by atropine. Pacemaker implantation should be considered if bradycardia develops that is refractory to treatment.

Lisinopril can be removed from the general circulation by hemodialysis. The use of polyacrylonitrile membranes with high flux density should be avoided during dialysis.

Side effects

Side effects are usually mild and short-lived, and discontinuation of treatment is necessary in extreme cases.

From the blood system: bone marrow depression, anemia, thrombocytopenia, leukopenia, neutropenia, agranulocytosis, hemolytic anemia, lymphadenopathy.

Immune system disorders: autoimmune disease, angioedema.

On the part of the endocrine system: syndrome of inappropriate secretion of antidiuretic hormone.

Metabolic disorders: hypoglycemia.

From the nervous system: dizziness, headache, paresthesia, vertigo, taste disturbance, fainting.

On the part of the psyche: mood changes, sleep disturbances, confusion, depression.

Cardiovascular: palpitations; tachycardia; myocardial infarction is possible as a complication of excessive arterial hypotension in high-risk patients; orthostatic phenomena (including arterial hypotension); cerebrovascular accident is possible as a complication of excessive arterial hypotension in high-risk patients; Raynaud's phenomenon.

When using lisinopril in patients with acute myocardial infarction, atrioventricular block of the 2nd-3rd degree, severe arterial hypotension and/or impaired renal function, and in rare cases cardiogenic shock, are possible, especially in the first 24 hours.

On the part of the respiratory system: cough, inflammation of the nasal mucosa, bronchospasm, sinusitis, allergic alveolitis, eosinophilic pneumonia.

From the digestive tract: vomiting, diarrhea, nausea, abdominal pain, dyspepsia, dry mouth, pancreatitis, intestinal angioedema.

From the hepatobiliary system: hepatocellular or cholestatic jaundice, hepatitis, liver failure.

From the urinary system: renal dysfunction, uremia, acute renal failure, oliguria/anuria.

From the reproductive system: impotence, gynecomastia.

General disorders: chest pain, fatigue, asthenia.

Laboratory indicators: increased urea and creatinine levels in blood serum, increased liver enzyme activity, hyperkalemia, increased hematocrit, decreased hemoglobin levels, increased serum bilirubin levels, hyponatremia.

Regarding the safety of lisinopril-containing products, the following adverse reactions have also been reported: balance disorders, disorientation, smell disorders, glossitis, fainting, muscle spasms, shortness of breath, upper respiratory tract infections, decreased appetite, constipation, skin flushing, proteinuria.

Safety data from clinical trials indicate that lisinopril is generally well tolerated in pediatric patients with hypertension, and the safety profile in this age group is comparable to that in adults.

Expiration date

3 years.

Storage conditions

Store in the original packaging at a temperature not exceeding 25 °C.

Keep out of reach of children.

Packaging

10 tablets in a blister; 1 or 2 or 3 blisters in a box.

Leave category.

According to the recipe.

Vacation category

According to the recipe.

Producer

"ASTRAPHARM" LLC.

Address

08132, Kyiv region, Kyiv-Svyatoshynskyi district, Vyshneve town, Kyivska st., 6.