Atacand®
AstraZeneca
509 Items
2019-09-19
- done All payments are SSL encrypted
- done Full Refund if you haven't received your order
- done International shipping to the USA, UK and Europe
Clinical Pharmacology
atacandus Plus is a combination antihypertensive drug. Candesartan selectively blocks AT II receptors (a subtype of AT,). Prevents the development of the effects of AT II - increased blood pressure due to vasoconstriction, stimulation of the synthesis and release of aldosterone, renin, vasopressin, catecholamines, sodium reabsorption, increased heart rate. Reduces the round neck, increases renal blood flow and glomerular filtration rate. Causes a compensatory increase in plasma renin activity, concentrations of AT I and AT II.
Hydrochlorothiazide causes a moderate diuretic effect, increasing the excretion of sodium, chlorine, potassium and water from the body, reduces the volume of plasma, blood and extracellular fluid. Reduces the content of sodium ions in the vascular wall, reducing its sensitivity to vasoconstrictor effects and thereby enhancing the hypotensive effect of candesartan. Atacand® plus causes prolonged hypotensive action without an increase in heart rate.
Orthostatic hypotension at the first admission is not observed, after the end of treatment hypertension does not increase. The antihypertensive effect develops gradually and lasts up to 24 hours. The maximum therapeutic effect is usually achieved 4 weeks after the start of treatment. In the process of absorption in the mucous membrane of the digestive tract is subjected to hydrolysis with the formation of the active substance (candesartan).
Indications
Treatment of arterial hypertension in patients for whom combination therapy is indicated.
Composition
1 tab. contains candesartan cilexetil 16 mg, hydrochlorothiazide 12.5 mg.
No customer reviews for the moment.
Dosage and Administration
For oral use 1 time per day, regardless of the meal. The recommended dose - 1 table. 1 time per day.
It is recommended to titrate the dose of candesartan before transferring the patient to therapy with Atacandom Plus. If necessary, patients are transferred from Atacand monotherapy to Atacand Plus therapy.
The main hypotensive effect is achieved, usually in the first 4 weeks after the start of treatment.
Adverse reactions
Side effects identified during clinical studies were moderate and transient in nature and were comparable in frequency with the placebo group. The incidence of discontinuation due to side effects was similar when using candesartan / hydrochlorothiazide (3.3%) and placebo (2.7%).
In the combined analysis of the results of clinical studies, the following side effects were noted, caused by prescription of candesartan / hydrochlorothiazide. The described side effects were observed with a frequency of at least 1% more than in the placebo group.
From the side of the central nervous system: dizziness, weakness
Candesartan
The following side effects during post-marketing use of the drug were reported very rarely (
From the circulatory and lymphatic systems: leukopenia, neutropenia and agranulocytosis.
Metabolic disorders and diseases caused by metabolic disorders:hyperkalemia, hyponatremia.
From the side of the central nervous system: dizziness, headache.
From the digestive tract: nausea.
Liver and biliary tract: increased liver enzymes, abnormal liver function or hepatitis.
On the part of the skin: angioedema, rash, urticaria, pruritus.
From the musculoskeletal and connective tissues: back pain, arthralgia, myalgia.
From the urinary system: impaired renal function, including renal failure in predisposed patients.
Hydrochlorothiazide
When monotherapy with hydrochlorothiazide, usually at a dose of 25 mg or more, the following side effects were noted: often (> 1/100), sometimes (> 1/1000 and
From the hematopoietic and lymphatic systems: rarely - leukopenia, neutropenia / agranulocytosis, thrombocytopenia, aplastic anemia, bone marrow depression, anemia.
On the part of the immune system: rarely - anaphylactic reactions.
Metabolic disorders and diseases caused by metabolic disorders: often - hyperglycemia, hyperuricemia, hyponatremia and hypokalemia.
From the side of the central nervous system: often - slight dizziness, headache; rarely - sleep disturbance, depression, anxiety, paresthesia.
On the part of the organ of vision: rarely - transient image blurring.
From the CCC: sometimes - orthostatic hypotension; rarely - arrhythmia; necrotic vasculitis, cutaneous vasculitis.
On the part of the respiratory system: rarely, shortness of breath (pneumonia and pulmonary edema).
From the digestive tract: sometimes - loss of appetite, diarrhea, constipation; rarely - pancreatitis.
Liver: rarely, intrahepatic cholestatic jaundice.
On the part of the skin: sometimes - skin rash, urticaria, photosensitivity reactions; rarely - necrosis of the epidermis, reactions similar to cutaneous erythema, recurrent cutaneous erythematosus.
From the musculoskeletal and connective tissues: rarely myalgia.
From the kidneys and urogenital system: often - glycosuria; rarely, renal dysfunction and interstitial nephritis.
General violations: often - weakness; seldom - feeling hot.
Laboratory indicators: often - hypercholesterolemia, hypertriglyceridemia; rarely, increased creatinine levels.
An increase in plasma uric acid and ALT and blood glucose levels were noted as side effects occurring when using candesartan cilexetil (approximate frequency of complaints is 1.1, 0.9 and 1%, respectively) slightly more often than when using placebo (0 , 4, 0 and 0.2%, respectively). In some patients taking candesartan / hydrochlorothiazide, there was a slight decrease in hemoglobin concentration and an increase in AST in the blood plasma.
An increase in creatinine, urea, hyperkalemia and hyponatremia was also observed.
Carefully: severe chronic heart failure, bilateral renal artery stenosis, single kidney artery stenosis, hemodynamically significant stenosis of the aortic and mitral valve, in patients with cerebrovascular diseases and ischemic heart disease, hypertrophic obstructive cardiomyopathy, in patients with reduced BCC, patients with hepatic cirrhosis, patients with reduced BCC, patients with strains of the liver, people with strains of the brain , with impaired absorption of lactose and galactose, hyponatremia, primary hyperaldosteronism, surgery, in patients after kidney transplantation ki, renal failure, diabetes mellitus.
Drug interactions
In pharmacokinetic studies, the combined use of Atacanda Plus with hydrochlorothiazide, warfarin, digoxin, oral contraceptives (ethinyl estradiol / levonorgestrel), glibenclamide, nifedipine and enalapril was studied. No clinically significant drug interactions have been identified.
Candesartan is metabolized to the liver to a small extent (CYP2C9). Conducted interaction studies did not reveal the effect of the drug on CYP2C9 and CYP3A4, the effect on other isoenzymes of the cytochrome P450 system has not been studied.
The combined use of Atacanda Plus with other antihypertensive agents potentiates the hypotensive effect. The action of hydrochlorothiazide, leading to potassium loss, may be enhanced by other means leading to potassium loss and hypokalemia (for example, diuretics, laxatives, amphotericin, carbenoxolone, penicillin G sodium, salicylic acid derivatives).
Experience with other drugs acting on the renin-angiotensin-aldosterone system shows that concomitant therapy with potassium-saving diuretics, potassium preparations, salt substitutes containing potassium, and other means that increase serum potassium levels (eg, heparin) can lead to the development of hyperkalemia.
Induced diuretics hypokalemia and hypomagnesemia predispose to the possible cardiotoxic action of digitalis glycoside and antiarrhythmic agents. When taking Atacand Plus in parallel with these drugs requires monitoring the level of potassium in the blood.
In the combined prescription of lithium preparations with ACE inhibitors, there is a reversible increase in the concentration of lithium in the blood serum and the development of toxic reactions. Similar reactions can occur with the use of angiotensin II receptor antagonists, and therefore it is recommended to control the level of lithium in the blood serum with the combined use of these drugs.
The diuretic, natriuretic, and hypotensive actions of hydrochlorothiazide are weakened by NSAIDs.
Hydrochlorothiazide absorption is weakened by the use of colestipol, Kolestiramine.
The action of non-depolarizing muscle relaxants (for example, tubocurarine) can be enhanced by hydrochlorothiazide.
Thiazide-like diuretics can cause an increase in the level of calcium in the blood due to a decrease in its excretion. If you need to use calcium supplements or vitamin D, you should monitor the level of calcium in the blood plasma and, if necessary, adjust the dose.
Thiazide-like diuretics enhance the hyperglycemic effect of beta-blockers and diazoxide.
Anticholinergics (for example, atropine, biperidine) can increase the bioavailability of thiazide-like diuretics due to decreased GI motility.
Thiazide-like diuretics may increase the risk of adverse effects of amantadine.
Thiazide-like diuretics can slow down the elimination of cytostatic drugs (such as cyclophosphamide, methotrexate) from the body and increase their myelo-suppressive effect.
The risk of hypokalemia may increase with concomitant use of GCS or ACTH.
On the background of the use of the drug Atacand Plus may increase the frequency of orthostatic hypotension when taking alcohol, barbiturates or general anesthetics.
In the treatment of thiazide-like diuretics, glucose tolerance may decrease, and therefore it may be necessary to select a dose of hypoglycemic drugs (including insulin).
Hydrochlorothiazide may reduce the effects of vasoconstrictor amines (eg, epinephrine).
Hydrochlorothiazide may increase the risk of developing acute renal failure, especially when combined with large doses of iodinated vehicle.
Significant interaction of hydrochlorothiazide with food was not detected.
Special instructions
Patients whose vascular tone and kidney function are primarily dependent on the activity of the renin-angiotensin-aldosterone system (for example, patients with severe chronic heart failure, kidney diseases, including renal artery stenosis) are particularly sensitive to drugs acting on renin-angiotensin-aldosterone the system. The administration of such drugs is accompanied in these patients by acute arterial hypotension, azotemia, oliguria and, less commonly, acute renal failure. The possibility of the development of these effects is not excluded when using angiotensin II receptor antagonists. A sharp decrease in blood pressure in patients with ischemic cardiopathy, cerebrovascular diseases of ischemic genesis when using any antihypertensive drugs can lead to the development of myocardial infarction or stroke.
The manifestation of hypersensitivity reactions to hydrochlorothiazide is most likely in patients with bronchial asthma, a history of allergic reactions; which does not exclude the appearance of allergic symptoms in other patients.
When using thiazide-like diuretics, there have been cases of exacerbation or the appearance of symptoms of congestive seborrhea.
The drug contains lactose, so it should not be taken in patients with rare hereditary diseases, manifested in the absence of lactose tolerance, lactose deficiency or impaired glucose absorption and lactose.
Use in Pediatrics
The safety and efficacy of Atacanda Plus in children and adolescents under the age of 18 years have not been established.
Influence on ability to drive motor transport and control mechanisms
The effect on driving ability or working with equipment has not been studied, but the pharmacodynamic properties of the drug indicate that there is no such effect. Patients should be cautious when driving a vehicle or working with equipment, as dizziness may occur during treatment and increased fatigue may occur.
Overdosage
Symptoms: analysis of the pharmacological properties of the drug suggests that the main manifestation of overdose may be a clinically pronounced decrease in blood pressure and dizziness. Individual cases of drug overdose (up to 672 mg of candesartan), which ended in the recovery of patients without serious consequences, were described.
The main manifestation of hydrochlorothiazide overdose is an acute loss of fluid and electrolytes. Also, symptoms such as dizziness, lower blood pressure, dry mouth, tachycardia, ventricular arrhythmia, loss of consciousness and muscle cramps were observed.
Treatment: With the development of a clinically pronounced decrease in blood pressure, it is necessary to carry out symptomatic treatment and monitor the patient's condition. Lay the patient on his back and lift his legs. If necessary, the bcc should be increased, for example, by intravenous injection of isotonic sodium chloride solution. If necessary, sympathomimetic agents may be prescribed. Withdrawal of candesartan and hydrochlorothiazide using hemodialysis is unlikely.
- Brand name: Atacand®
- Active ingredient: Hydrochlorothiazide, Candesartan
- Dosage form: Pills.
- Manufacturer: AstraZeneca
- Country of Origin: Great Britain
8 other products in the same category:
arrow_upward