Lodoz tabs 5mg +6.25mg #30

Lodoz tabs instruction for use

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Composition

The tablet contains 2 active components: hydrochlorothiazide (6.25 mg) and bisoprolol fumarate (2.5, 5.0, 10.0 mg).
Additional substances: monosubstituted calcium phosphate, MCC, corn starch (gelatinized form), crospovidone, magnesium stearate.
Composition of the shell: iron oxide (red or yellow), polysorbate, hypromellose, titanium dioxide, macrogol.

Form of issue

Lodoz is available in tablet form.
Tablets 2.5 + 6.25
Round, yellow color, biconvex, in the shell. On one side is engraved "2.5", and on the other hand - a figure in the form of a heart.
Tablets 5.0 + 6.25
Round, pink color, biconvex, in the shell. On the one hand, the figure "5" is engraved, and on the other hand - a figure in the form of a heart.
Tablets 10 + 6.25
Round, white, biconvex, in the shell. On the one hand, the figure is engraved "10", and on the other hand - the figure in the form of a heart.
Lodoz tablets are packed in blisters of 10 pieces. In a pack of cardboard is an instruction and 3, 5 or 10 blisters with tablets.

pharmachologic effect

Hypotensive combination.
Bisoprolol
Highly selective beta-1-adrenoblocker, which does not possess membrane-stabilizing and sympathomimetic activity. The principle of action of the active substance is based on a decrease in renin in the blood, a decrease in the pulse.
Hydrochlorothiazide
Thiazide diuretic with a pronounced antihypertensive effect.
The diuretic effect is due to the inhibition of the transportation of Na from the tubule of the kidneys to the systemic circulation, which prevents the reabsorption of sodium ions.
Clinical trials have proven the ability of two active substances to potentiate the action of each other. The combination of even the lowest possible dosages of active components 6.25 + 2.5 can control and maintain the blood pressure level in moderate to moderate arterial hypertension.
Negative reactions of bisoprolol and hydrochlorothiazide (asthenia, bradycardia, hypokalemia, headache) are dose-dependent, therefore in the preparation of Lodoz dosages of active components are reduced by 2-4 times.

Pharmacodynamics and pharmacokinetics

Bisoprolol
90% of the active substance is absorbed from the lumen of the digestive tract. The maximum concentration is recorded in the blood after 1-4 hours. A low effect of the initial passage through the hepatic system is typical, but the bioavailability reaches a maximum of 88%, and does not depend on the intake of food.
The kinetics for doses of bisoprolol from 5 to 40 grams is linear. With plasma proteins binds to 30%. Metabolites are inactive, metabolism is carried out in the hepatic system. The elimination half-life is 11 hours.
The hepatic and renal clearance is almost the same and comparable. ½ of the received dose is displayed in its original form together with metabolites. The total clearance is 15 liters per hour.
Hydrochlorothiazide
About 80% of the active substance is absorbed from the lumen of the digestive tract. The bioavailability index varies in the range of 60-80%. With plasma proteins binds to 40%.
The elimination half-life is 8 hours. The active component does not enter the processes of metabolism and in unchanged form is almost completely eliminated from the body by active secretion in the tubules and filtration in the glomeruli.
With cardiac / renal insufficiency, the renal clearance of the diuretic is reduced, the half-life increases. In elderly people an increase in the Cmax index is registered. Hydrochlorothiazide is able to secrete during lactation and penetrate the placenta.

Indications for use

Lodoz pills are prescribed for patients with arterial hypertension (medium and mild degrees of severity).

Contraindications

    COPD;
    arterial hypotension;
    cardiogenic shock;
    CHF in the stage of decompensation in the absence of the effect of drug therapy;
    severe course of bronchial asthma;
    sinoatrial blockade;
    pronounced bradycardia with heart rate less than 50 strokes;
    AV blockade of 2-3 degrees in the absence of an artificial pacemaker (pacemaker);
    SSSU;
    Raynaud's disease;
    angina of princemetal (variant form);
    pathology of peripheral circulation (severe course);
    diagnosed pheochromocytoma (with parallel therapy with drugs alpha-adrenoblockers);
    pathology of the renal system (QC value less than 30 ml / min);
    hypovolemia;
    hypokalemia;
    individual intolerance;
    simultaneous therapy with antiarrhythmics, Sultoprid, Floktaphenin, Li preparations;
    pronounced pathology of the hepatic system;
    age restriction - up to 18 years;
    drug allergy to other sulfonamides.

Relative contraindications:

    thyrotoxicosis;
    water-electrolyte disturbances;
    AV blockade of 1 degree;
    CHF in the stage of decompensation;
    IHD;
    psoriasis;
    gout;
    hypercalcemia;
    elderly age;
    hypokalemia;
    hyponatremia.

Side effects

Subcutaneous tissues, skin:

    skin rash;
    photodermatitis;
    tides of blood flow to the skin of the face;
    itching;
    psoriasis-like rash;
    red cutaneous lupus erythematosus;
    alopecia;
    exacerbation of existing psoriasis;
    hives.

Metabolism:

    metabolic alkalosis;
    impaired appetite;
    hyperuricemia;
    hyponatremia;
    hyperglycemia;
    hypochloremia;
    hypomagnesemia;
    hyponatremia;
    other manifestations of violations of water-electrolyte balance.

The cardiovascular system:

    violation of AV conductivity;
    bradycardia;
    deterioration of the prognosis for CHF;
    orthostatic form of hypotension;
    feeling of numbness in the limbs;
    coldness of hands, feet.

Other reactions:

    agranulocytosis;
    decrease in the number of platelets and white blood cells - leukocytes;
    insomnia;
    depressive state;
    headaches like migraines;
    pancreatitis;
    muscle cramps;
    dizziness;
    discomfort in epigastrium;
    glucosuria;
    hyperglycemia;
    nightmares;
    diarrheal syndrome;
    increased ALT and AST;
    weakness in the muscles;
    violation of potency;
    hypercholesterolemia;
    hallucinations;
    visual impairment;
    constipation;
    bronchospasm in predisposed persons (with airway obstruction, bronchial asthma);
    allergic rhinitis.

Instruction on Lodoz (Method and dosage)

Lodoz tablets are for internal administration; it is preferable to take the medicine before breakfast, or after eating. It is not recommended to chew the tablet.
The dosage is selected individually, taking into account the accompanying pathology, the level of the blood pressure rise, the tolerance of the active components.
Instructions for use Lodoz recommends starting with a combination of 6.25 + 2.5. In the absence of the expected antihypertensive effect, the combination is switched to 6.25 + 5, then the transition to 6.25 + 10 is possible, if necessary.
Long-term hypotensive therapy is suggested. Elderly, dose adjustment is not required. The medication is not used in pediatric practice because of the lack of safety information and proven efficacy.

Overdose

Clinical manifestations:
    severe bronchospasm;
    a drop in blood pressure;
    severe bradycardia;
    hypoglycemia;
    atrioventricular block;
    acute heart failure.
In chronic overdose, there is a loss of electrolytes, hypovolemia, increased drowsiness, dizziness, nausea.

Therapy

The medicine is canceled. Effectively the appointment of enterosorbent drugs (Polysorb, Activated Carbon, Smecta), gastric lavage, conduction of post-syndrome therapy.
When diagnosing arterial hypotension, plasma-substituting solutions, vasopressor drugs, are injected intravenously.
With pronounced bradycardia, timely intravenous infusion of Atropine is recommended. In the absence of proper effect, the use of drugs that have a pronounced positive chronotropic effect is recommended.
In some cases, it is recommended to install an electrocardiostimulator (artificial pacemaker).
In diagnosing atrioventricular blockade of 2 or 3 degrees, beta-adrenomimetics, Epinephrine, are prescribed. If the therapy is ineffective, implantation of ECS is indicated.
With bronchospasm, Aminophylline and / or beta-adrenomimetics are used.
With worsening of the course of CHF intravenously administered vasodilators, drugs that have a positive inotropic effect, diuretic drugs.
When hypoglycemia is intravenously poured glucose / dextrose solution.
One of the active components - Bisoprolol is excreted by hemodialysis, but to a small extent. There are no data on excretion of hydrochlorothiazide.

Interaction

Invalid combinations

Lodoz and Sultopride are incompatible, because Bisoprolol increases the risk of starting ventricular arrhythmias.

Combinations used with extreme caution (not recommended)

Hypotensive medications for central exposure (moxonidine, clonidine, rilmenidine, methyldopa): cardiac output decreases, heart rate drops, vasodilation is registered because of a decrease in sympathetic central tone.
It is not recommended to abruptly stop hypotensive therapy without consulting a doctor because of the risk of developing a ricochet arterial hypertension.
Calcium channel blockers (diltiazem to a lesser extent, Verapamil in the larger): disrupt atrioventricular conduction, reduce the rate of contractility of the myocardium.
With intravenous infusion of verapamil develops severe arterial hypotension, AV blockade.
Lithium preparations: there is an increase in neurotoxicity and cardiotoxicity due to a slower rate of elimination of Li from the body.

Combinations that require caution

Calcium channel blockers, dihydropyridine derivatives (Amlodipine, Nifedipine): together with Bisoprolol, the risk of hypotension increases. With CHF, the forecast for the functionality of the right and left ventricles worsens.
Phenothiazine derivatives, barbiturates, tricyclic antidepressants, and baclofen increase the risk of developing hypotension.
Enalapril, Captopril and other ACE enzyme inhibitors: hyponatremia may develop.
Antiarrhythmics of the first class (Flecainide, Lidocaine, Quinidine, phenytoin, Propafenone, Dizopiramid): the inotropic negative effect is amplified, AV conduction is slowed down and deteriorates.
Antiarrhythmic drugs that can provoke tachycardias like pirouettes (Sotalol, Amiodarone, Dizopyramid, Hydroquinidine, Ibutilide, Dofetilide): a high risk of ventricular arrhythmia, tachycardia of the type "pirouette".
A similar effect is observed in the treatment of Vincamin, Terfenadine, Pentamidine, Halofantrine, neuroleptics, Astemizol, Sparfloxacin, Erythromycin.
Antiarrhythmics of the third class (Cordaron, Amiodarone): worsening of atrioventricular conduction.
M-holinomimetiki: worsen atrioventricular conductivity, provoke bradycardia.
Medications for general anesthesia: arterial hypotension develops, the risk of cardiodepressant action of beta-blocker increases.
Hypoglycemic drugs, Insulin: increased severity of hypoglycemic effect. Possible masking of signs of hypoglycemia (tachycardia).
Cardiac glycosides: the bradycardia develops, the time of impulse conduction increases. Less often is recorded hypomagnesemia / hypokalemia, increased severity of negative reactions of cardiac glycosides.
Beta-adrenomimetics (Dobutamine, Isoprenalin): there is a mutual inhibition of activity.
Amphotericin B, tetracosactide, corticosteroids, Furosemide, laxatives: I increase the excretion of potassium.
Kolestypol, Kolestyramin: inhibit the absorption of hydrochlorothiazide.

Special combinations

MAO inhibitors: development of hypertensive crisis, increased antihypertensive effect of beta-blockers.
Glucocorticosteroids: suppress the severity of the antihypertensive effect of the drug (due to fluid retention in the body and Na).
Mefloquine: the risk of bradycardia increases.

Terms of sale

To buy Lodoz you don't need a prescription.

Storage conditions

Transportation and storage of tablets is possible at a temperature of 18-25 degrees.
Shelf life - 3 years.

special instructions

It is unacceptable to abruptly cancel the medication. It is recommended that the dose be gradually reduced within two weeks.
In individuals with COPD and bronchial asthma, therapy is conducted with caution, and treatment begins with minimal dosages. It is effective to perform preliminary special respiratory functional tests. If necessary, bronchodilators can additionally be used.
At a heart rate of less than 50-55 beats per minute, the risk of aggravation of breezycardia increases. With care, the medication is prescribed with AV blockade of the first degree.
With Prinzmetal angina, the frequency and duration of episodes of vasospasm increases. With pathology of peripheral circulation, the course of the disease may worsen.
Patients with pheochromocytoma require careful monitoring of blood pressure, the appointment of alpha-blockers.

In pregnancy and lactation

The thiazide diuretic, which is part of the medicament, does not allow Lodoz to be used during pregnancy. At the moment there is no reliable information about the isolation of bisoprolol with breast milk.
Thiazide diuretics are secreted by lactation. It is recommended to stop breastfeeding while taking the pills.

Reviews of Lodoz

The drug is actively used in the treatment of hypertensive disease, tk. contains 2 active components, which makes taking medication more convenient for patients, and the hypotensive effect is greatly enhanced due to the synergism of the active substances.
Side effects are less pronounced, because Dosages of bisoprolol and Hypothiazide are minimal, in comparison with monotherapy.
The doctors' comments about Lodoz are positive, the drug allows you to monitor blood pressure, preventing the development of hypertensive crises with complications.