Atacand Plus tabs 16mg/12.5mg #28

Atacand Plus instruction

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See also - Atacand

Composition

One Atacand Plus tablet contains 12.5 mg of hydrochlorothiazide and 16 mg of cilexetil candesartan.
Excipients: giprolose, carmellose calcium, magnesium stearate, lactose monohydrate, starch, yellow iron oxide dye, macrogol, red iron oxide dye.

Form of issue

Atacand Plus is oval, biconvex tablets of pink color with serifs on both edges and "A / CS" pattern from one side.

pharmachologic effect

It blocks the first type of angiotensin receptors, has a diuretic and pressure-lowering effect.

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

Atacand Plus is an antihypertensive combination drug. Angiotensin of the second type is important in the pathogenesis of heart failure, arterial hypertension and other diseases of the circulatory system. The main effects of angiotensin of the second type are vasoconstriction, stimulation of aldosterone synthesis, correction of the water-electrolyte state and activation of cell growth. Effects are associated with the interaction of angiotensin type II with angiotensin type 1 receptors.
Candesartan - selective antagonist of angiotensin receptor 2, does not inhibit angiotensin converting enzyme (ACE converts the first type I to angiotensin second type, which inactivates bradykinin), does not cause accumulation of bradykinin and substance P. Dose-dependent increase in the content of the first type of angiotensin, renin, angiotensin second type and a decrease in the content of aldosterone in the blood occurs as a result of the suppression of type II angiotensin type AT1 receptors.
Candesartan does not interact with other receptors other than the above, and does not inhibit ion channels.
Hydrochlorothiazide - thiazide diuretic from the group actively inhibits the reabsorption of sodium ions in the distal renal tubules and stimulates the release of chlorine ions, sodium and water. The excretion of magnesium and potassium by the kidneys is stimulated dose-dependent, and calcium is reabsorbed to a much greater extent than before.
Reduces the volume of extracellular fluid and plasma, suppresses the intensity of blood transport through the heart, lowers the pressure. After long-term treatment, the effect develops because of the increase in arterioles.
Candesartan and hydrochlorothiazide have a combined hypotensive effect. In people with arterial hypertension, the drug causes a prolonged decrease in pressure without increasing the contractile activity of the heart. Orthostatic hypotension at the initial stages of treatment is not observed, after completion of the treatment, arterial hypertension does not increase.
After a single dose, the hypotensive effect is detected after 2 hours. The use of the drug once a day gently and effectively lowers the pressure for 24 hours. With prolonged treatment, a reliable reduction in pressure occurs four weeks later.
The effectiveness of the drug does not depend on age or gender.

Pharmacokinetics

Candesartan cilexetil. Prodrug for internal administration. When the intestinal absorption of candesartan cilexetil, subjected to ester hydrolysis, is rapidly converted into the active substance is firmly associated with the receptors of the AT1 - candesartan. Absolute bioavailability reaches 14%. Eating does not affect the pharmacokinetics.
The maximum concentration in the blood occurs four hours after the drug is used. The interaction of candesartan with plasma proteins reaches 99%. Pharmacokinetic parameters do not depend on the sex of the patient.
It is excreted in the urine and bile in its original form, undergoes little change in the liver. The half-life of candesartan is approaching 9 o'clock. Accumulation of the drug in the body is not detected.
Hydrochlorothiazide. Quickly absorbed from the intestine. Bioavailability reaches 70%. A joint with food intake increases the suction level by 15%. Interaction with plasma proteins is 60%. It is not metabolized and excreted through the kidneys. The half-life is 8 hours. 70% of the dose is excreted by the kidneys within two days.

Indications for use

Arterial hypertension, if the patient is recommended for complex therapy.

Contraindications

    Anuria.
    Lesion of the liver or cholestasis.
    Defeat of the kidneys.
    Refractory hypercalcemia and hypokalemia.
    Gout.
    Pregnancy.
    Lactation.
    Age is less than 18 years.
    Hypersensitivity to derivatives of sulfonamides.
    Hypersensitivity to the components of the drug.
With care use Atacand Plus in severe forms of heart failure of chronic type, bipolar stenosis of the arteries of the kidneys, hemodynamically significant narrowing of the aortic or mitral valves, cerebrovascular diseases, coronary heart disease, obstructive hypertrophic cardiomyopathy, cirrhosis, reduced blood volume, primary hyperaldosteronism, lactose intolerance, renal failure, hyponatremia, surgical interventions, kidney transplantation and diabetes mellitus.

Side effects

Side effects of cilexetil candesartan:
    from the hematopoietic system - neutropenia, leukopenia, agranulocytosis;
    on the part of the digestive system - nausea, liver damage, increased levels of hepatic enzymes, hepatitis;
    from the musculoskeletal system - arthralgia, lumbalia, myalgia;
    from the side of the nervous system - headache, dizziness;
    from the side of the genitourinary system - kidney damage;
    from the side of metabolism - hyponatremia, hyperkalemia;
    allergic reactions - urticaria, rash, angioedema, itching.
Side effects of hydrochlorothiazide:
    from the hematopoietic system - neutropenia, leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia, bone marrow depression;
    from the nervous system - dizziness, headache, depression, sleep disturbance, paresthesia;
    on the part of sensory organs - blurred image;
    on the part of the circulatory system - orthostatic hypotension, necrotizing vasculitis, arrhythmia, cutaneous vasculitis;
    from the respiratory system - difficulty breathing;
    on the part of the digestive system - pancreatitis, diarrhea, constipation, cholestatic jaundice;
    from the musculoskeletal system - myalgia;
    from the genitourinary system - glucosuria, kidney damage, nephritis;
    from the side of metabolism - hyperuricemia, hyperglycemia, hypokalemia, hyponatremia, hypertriglyceridemia, hypercholesterolemia, increase in the level of creatinine;
    allergic reactions - anaphylactic reactions, rash, urticaria, erythematous skin reactions.

Instructions for use Atacand Plus (Method and dosage)

The drug should be taken once a day for 1 tablet. It is advised to titrate candesartan before starting therapy with Atacand Plus. Confident hypotensive effect develops 4 weeks after the initiation of therapy.
For people at risk of developing arterial hypotension, titration of candesartan (Atacand monotherapy) is recommended starting at a dosage of 4 mg.
In older people, dose adjustment is not required.

Overdose

Symptoms: The main manifestations of an overdose of candesartan are marked depression of pressure and dizziness. The main symptoms of hydrochlorothiazide overdose are acute loss of water and electrolytes. Symptoms such as dizziness, lowering of pressure, ventricular arrhythmia, tachycardia, muscle cramps are possible.
Treatment: symptomatic, stabilizing the patient's condition. Recommended lying position with raised legs. If it is necessary to increase the volume of circulating blood, an isotonic solution of sodium chloride is injected intravenously. Hemodialysis is not effective.

Interaction

Hydrochlorothiazide, Digoxin, Warfarin, Glibenclamide, oral contraceptives, Nifedipine and Enalapril do not reveal any peculiarities of interaction with components of Atacand Plus.
Using Atacand Plus with other antihypertensive drugs increases the hypotensive effect. The effects of hydrochlorothiazide, which cause potassium loss, can be potentiated by other agents that stimulate hypokalemia and potassium loss (diuretics, amphotericin, laxatives, Penicillin G sodium, Carbenoxolone, salicylic acid derivatives).
Potassium-sparing diuretics, potassium-containing salt substitutes, potassium preparations and other means that increase the potassium content in the blood with a joint admission with Atacand Plus lead to the appearance of hyperkalemia.
Simultaneous therapy with lithium drugs causes a reversible increase in the concentration of lithium in the blood and the development of characteristic toxic reactions.
The absorption of hydrochlorothiazide is weakened by the use of Colestipol and Colestyramine.
Thiazide-like diuretics cause an increase in the calcium content in the blood, increase the hyperglycemic effect of beta-adrenoblockers and diazoxide, increase sensitivity to glucose, slow the excretion of cytostatics (cyclophosphamide, methotrexate) and activate their mielopod effect.
The effects of nondepolarizing muscle relaxants are enhanced by hydrochlorothiazide.
Anticholinergic drugs (Biperidin, Atropin) increase the bioavailability of diuretics from the group of thiazides because of the weakening of intestinal motility.
Hydrochlorothiazide can weaken the action of vasoconstrictive amines (epinephrine) and increase the likelihood of acute renal failure.

Terms of sale

To buy Atacand Plus you don't need a prescription.

Storage conditions

Store at temperatures up to 30 degrees. Keep away from children.
Shelf life - three years.

special instructions

The appearance of allergic reactions to hydrochlorothiazide is most often in patients with bronchial asthma, history of hypersensitivity reactions; however, the appearance of such a symptomatology in other patients is not excluded.
When thiazide-like diuretics were used, cases of the appearance of signs of congestive seborrhea were noted.
The drug contains lactose in its composition, so it is forbidden to take it to patients with a low tolerance to lactose, a lack of lactase or a violation of the absorption of glucose or lactose.
Care must be taken during Atacand Plus treatment when driving.

Children

Safety of the drug when used in children is not established.

With alcohol

Against the background of alcohol consumption during the period of Atakandom Plus treatment, the frequency of symptoms of orthostatic hypotension may increase.

During pregnancy (and lactation)

The drug is contraindicated in pregnancy. Possible application for strict indications during breastfeeding.

Reviews for Atacand Plus

In general, Atacand Plus received good marks, both doctors and patients.