Logimax®
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Clinical Pharmacology
Logimax is a drug that has antiarrhythmic, hypotensive and antianginal effects. When used, Logimax stably and effectively decreases blood pressure within 24 hours, that is, the entire interval between doses. Enhances blood flow in the coronary system, increases the blood supply to the ischemic zones of the myocardium without developing a decrease in the blood supply to the brain areas, activates the functioning of the circulatory pathways of blood, reduces peripheral vascular resistance. It also reduces high blood pressure during physical exertion, at rest and stress.
Indications
Hypertension, symptomatic arterial hypertension.
Composition
Felodipine 5 mg, metoprolol succinate (as 50 mg metoprolol tartrate) 47.5 mg.
Excipients: ethyl cellulose; hydroxypropylmethylcellulose; hydroxypropylcellulose; anhydrous lactose; polyoxyl 40 hydrogenated castor oil; MCC; paraffin; polyethylene glycol; propyl gallate; silicon dioxide; sodium aluminum silicate; sodium stearyl fumarate; titanium dioxide (E171); iron oxides (E172).
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Dosage and Administration
Orally, in the morning, without chewing, drinking water. Initial dose - 1 tab. Once a day, if necessary, double the dose.
There is no need to adjust the treatment regimen in patients with impaired renal function. Usually there is no need to adjust the treatment regimen in patients with impaired liver function, incl. in patients with cirrhosis of the liver. If there are symptoms of severe liver dysfunction (for example, in patients whose history has had operations with bypass surgery), the possibility of reducing the dose of the drug should be considered.
In patients of advanced age is usually enough 1 table. Once a day, if necessary - 2 times a day.
Adverse reactions
Decrease in blood pressure; headache, dizziness, peripheral edema, weakness, nausea, vomiting, dryness of the oral mucosa, constipation or diarrhea; gum hyperplasia;
increased activity of liver transaminases;
myalgia, arthralgia; allergic reactions (pruritus, angioedema);
AV block I Art., Bradycardia; thrombocytopenia; paresthesia, depression, reduced ability to concentrate, drowsiness, insomnia, anxiety, reduced potency, sexual dysfunction;
shortness of breath, bronchospasm, rhinitis;
blurred vision, dryness and / or eye irritation, conjunctivitis, tinnitus, taste disturbance; photosensitization.
Rarely - tachycardia, palpitations, gangrene (in patients with severe peripheral circulatory disorders), amnesia, confusion, hallucinations.
Contraindications
Hypersensitivity, acute myocardial infarction, unstable stenocardia, severe sinus bradycardia, AV block II-III degree, sick sinus syndrome, severe disorders of the peripheral circulation, decompensated heart failure, cardiogenic shock, pregnancy.
Drug interactions
Calcium channel blockers like verapamil potentiate the negative foreign and chronotropic effect. Enhances negative ino-and dromotropic action of antiarrhythmic drugs (analogs of quinidine, amiodarone), cardiodepressive - inhalation anesthetics. Increase the concentration of metoprolol in plasma cimetidine, hydralazine, alcohol, lowers - rifampicin. Indomethacin and other prostaglandins synthetase inhibitors weaken the hypotensive effect.
Pregnancy and Lactation
Contraindicated in pregnancy. At the time of treatment should stop breastfeeding.
Special instructions
Caution must be exercised when used in conjunction with cardiac glycosides. Logimax® may exacerbate the symptoms of peripheral circulatory disorders, for example, intermittent claudication. Special caution is required in the following conditions: severe renal failure (CC less than 30 ml / min), aortic stenosis, abnormal liver function, myocardial infarction complicated by acute heart failure, hypotension, which in susceptible patients can cause myocardial ischemia, acute metabolic acidosis.
It is not recommended to start treatment with Logimax® in patients who have not previously received antihypertensive therapy.
It is not recommended to prescribe the drug to patients with latent or identified heart failure with clinical manifestations without appropriate therapy.
Use of Logimax® may affect carbohydrate metabolism or mask hypoglycemia, however, when using Logimax®, the risk of affecting carbohydrate metabolism is less than when using non-selective beta-blockers.
In some cases, the existing AV conduction disturbances may increase, leading to AV blockade.
Patients receiving Logimax® should not be administered intravenously BMCC type verapamil.
In patients with Prinzmetal angina, the frequency and severity of angina attacks may increase due to spasm of the coronary vessels caused by stimulation of alpha-adrenoreceptors. In this regard, it is not recommended to assign non-selective beta-blockers to this group of patients. Be careful to use selective beta1-blockers.
In patients with bronchial asthma or chronic obstructive pulmonary disease, it is necessary to carry out concomitant therapy with beta2-adrenomimetics.In the case when the patient begins to take Logimax®, it may be necessary to increase the dose of beta2-adrenomimetics.
Against the background of beta-blockers, anaphylactic shock may take a more severe form. The use of epinephrine (adrenaline) in the commonly used dose does not always lead to the expected therapeutic effect.
It is recommended that patients with pheochromocytoma be prescribed alpha-blockers in parallel with Logimax®.
The combined use of drugs that induce CYP3A4 isoenzyme leads to a significant decrease in the concentration of felodipine in the blood plasma and insufficient therapeutic effect from taking the drug (see the section “Interaction with other drugs and other types of interaction”). Co-administration of such drugs should be avoided.
The combined use of drugs inhibiting CYP3A4 isoenzyme, leads to a significant increase in the concentration of felodipine in the blood plasma.
You should avoid taking the drug Logimax® with grapefruit juice due to a significant increase in the concentration of felodipine in the blood plasma.
It is necessary to avoid abrupt withdrawal of beta-blockers, especially in patients with a high risk of cardiovascular complications, due to the possible increase in symptoms of chronic heart failure and an increased risk of myocardial infarction and sudden death. If necessary, the withdrawal of the drug Logimax® should be carried out gradually by reducing the dose within 1-2 weeks. In the case of surgery, the anesthesiologist should be warned that the patient is taking Logimax®.
It is not recommended to stop treatment with beta-adrenergic blockers in patients who are to undergo surgery. In the case of surgery, the anesthesiologist should be warned about the therapy received with Logimax®.
Cases of hyperplasia of the mucous membrane of the tongue and gums have been reported after taking felodipine in patients with severe gingivitis / periodontitis. This side effect can be avoided or reduced in its degree by observing careful oral hygiene.
Patients with pheochromocytoma are advised to simultaneously administer alpha-blockers.
Influence on ability to drive and work with equipment
During the period of therapy with Logimax®, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration of attention and quickness of psychomotor reactions (dizziness and increased fatigue may be observed).
Overdosage
Symptoms: hypotension, sinus bradycardia, AV blockade, heart failure, cardiogenic shock, cardiac arrest, bronchospasm, nausea, vomiting, cyanosis. The first signs appear after 20 minutes - 2 hours after administration.
Treatment: induction of vomiting, gastric lavage; symptomatic therapy: in the case of severe hypotension, bradycardia, or threat of heart failure, a beta1-agonist (i.v. with an interval of 2–5 minutes or infusion); either dopamine (iv) or atropine sulfate to block the vagus nerve; dobutamine, norepinephrine, glucagon (1–10 mg). If necessary - the use of a heart rhythm driver. For relief of bronchospasm - IV the introduction of beta2-agonist.
- Brand name: Logimax®
- Active ingredient: Metoprolol, Felodipine
- Dosage form: Pills.
- Manufacturer: AstraZeneca
- Country of Origin: Great Britain
Studies and clinical trials of Logimax (Click to expand)
- D15 - More effective blood pressure control with once daily felodipine-metoprolol(Logimax®) than with enalapril
- Acute and long-term adaptation of central hemodynamics and renal physiolology in hypertensive patients on logimax, a metoprolol/felodipine fixed dose combinat
- Cost-Effectiveness of Felodipine-Metoprolol (Logimax®) and Enalapril in the Treatment of Hypertension