Cardosal pills 20 mg №28

Dosage form

Coated tablets

Composition

In 1 tablet, film coated, contains: Olmesartana medoxomil - 20,00 mg

Excipients: Microcrystalline cellulose, giproloza (with a low degree of substitution), lactose monohydrate, giproloza (viscosity 6-10 mPa-C), Magnesium stearate

Shell composition: Titanium dioxide (E 171), talc, hypromellose (viscosity 5 mPa-C)

Packing

In the blister 14 tablets. In packing 2 blisters.

Mechanism of action

The active ingredient of the drug Cardosal 20 - Olmesartan medoxomil is a specific antagonist of angiotensin II receptors (type AT 1) for oral administration.

Angiotensin II is the primary vasoactive hormone of the renin-angiotensin-aldosterone system and plays a significant role in the pathophysiology of arterial hypertension via the AT 1 receptor. It is assumed that olmesartan blocks all the actions of angiotensin II mediated by AT 1 receptors, regardless of the source and route of synthesis of angiotensin II.

In hypertension, olmesartan causes a dose-dependent, prolonged decrease in blood pressure (BP).

There is no evidence of the development of arterial hypotension after taking the first dose of the drug, of tachycardia during long-term treatment or of the "withdrawal" syndrome (a sharp increase in blood pressure after discontinuation of the drug).

Taking olmesartan medoxomil 1 time per day provides an effective and mild decrease in blood pressure for 24 hours, and the effect after a single dose is similar to the effect of taking the drug twice a day in the same daily dose.

The antihypertensive effect of olmesartan develops, as a rule, already after 2 weeks, and the maximum effect develops after about 8 weeks. after initiation of therapy.

Indications and usage

Essential hypertension.

Contraindications

- Hypersensitivity to the active substance or to any of the excipients that make up the preparation (see the Composition section).
- Obstruction of the biliary tract.
- Renal failure (creatinine clearance (CC) less than 20 ml / min).
- Condition after kidney transplantation (no experience with clinical use).
- Pregnancy.
- Lactation period.
- Age up to 18 years (efficacy and safety have not been established).
- Lactase deficiency, galactosemia or malabsorption syndrome.

- Stenosis of the aortic or mitral valves.
- Hypertrophic obstructive cardiomyopathy.
- Primary aldosteronism.
- Hyperkalemia, hyponatremia (risk of dehydration, arterial hypotension, renal failure).
- Renal failure (CC more than 20 ml / min).
- Chronic heart failure.
- Bilateral renal artery stenosis or arterial stenosis of a single kidney.
- Coronary heart disease.
- Cerebrovascular diseases.
- Older age (over 65).
- Impaired liver function.
- Conditions associated with a decrease in circulating blood volume (including diarrhea, vomiting), as well as in patients on a sodium-restricted diet.
- When used simultaneously with diuretics.

Pregnancy and Breastfeeding

Pregnancy: Experience with olmesartan medoxomil in pregnant women is absent. However, due to the existing reports of severe teratogenic effects of drugs acting directly on the renin-angiotensin system, like any drug of this class, olmesartan is contraindicated during pregnancy. If pregnancy occurs during treatment with Cardosal 20, the drug should be withdrawn.

Lactation: It is not known whether olmesartan is excreted in breast milk, so if you need to use Kardosal 20 during lactation, breastfeeding for the period of taking the drug should be stopped.

Dosage and administration

Adults: it is recommended to take Cardosal 20 inside every day at the same time, regardless of the meal 1 time per day.

If necessary, an additional reduction in blood pressure can be increased to a maximum dose of 40 mg / day (use of the drug Cardosal 40 is possible) or a diuretic (hydrochlorothiazide) may be added.

The maximum daily dose is 40 mg.

Adverse reactions

Possible side effects are listed below in descending frequency of occurrence:

- Very often (> 1/10).
- Often (> 1/100, - Sometimes (> 1/1000, - Rarely (> 1/10000, - Very rarely (

On the part of the circulatory and lymphatic systems: Very rarely - thrombocytopenia.

On the part of the central nervous system: Sometimes - dizziness. Very rarely - a headache.

On the part of the respiratory system: Often - pharyngitis, rhinitis. Very rarely - cough, bronchitis.

On the part of the digestive tract: Often - diarrhea, dyspepsia, gastroenteritis. Very rarely - abdominal pain, nausea, vomiting.

On the part of the skin: Very rarely - itchy skin, rash, angioedema, allergic dermatitis, urticaria.

On the part of the musculoskeletal system: Often - back pain, bone pain, arthralgia, arthritis. Very rarely - muscle cramps, myalgia.

From the urinary system: Often - hematuria, urinary tract infection. Very rarely - acute renal failure.

From the laboratory indicators: Very rarely - an increase in serum creatinine and urea levels, an increase in the activity of liver enzymes.

Cardiovascular: Rarely - excessive decrease in blood pressure. Sometimes - angina, tachycardia.

On the part of metabolism: Often - increased levels of creatine phosphokinase, hypertriglyceridemia, hyperuricemia. Rarely: hyperkalemia.

Other disorders: Often - chest pain, flu-like symptoms, peripheral edema. Very rarely - asthenia, fatigue, malaise, drowsiness.

Special notes

Symptomatic arterial hypotension, especially after taking the first dose of the drug, can occur in patients with reduced blood volume and / or low sodium levels due to intensive diuretic therapy, restriction of salt intake with food in the diet, and also due to diarrhea or vomiting. Relevant factors should be eliminated before using Cardosal 20.

In patients whose vascular tone and renal function depend to a large extent on the activity of the renin-angiotensin-aldosterone system (for example, in patients with severe chronic heart failure or impaired renal function, including renal artery stenosis), treatment with other drugs acting on this system is associated with the possibility of the development of acute arterial hypotension, azotemia, oliguria, or, in rare cases, acute renal failure. The possibility of a similar effect cannot be excluded when using angiotensin II receptor antagonists.

There is an increased risk of developing severe arterial hypotension and renal failure if a patient with bilateral renal artery stenosis or arterial stenosis of a single functioning kidney receives therapy with drugs that affect the renin-angiotensin-aldosterone system.

When using the drug Cardosal 20 in patients with impaired renal function, it is recommended to periodically monitor the level of potassium and creatinine in the blood serum. Experience with the use of the drug Cardosal 20 in patients with recent kidney transplantation or in patients with the last stage of impaired renal function (for example, CC less than 12 ml / min) is absent.

As in the case of other angiotensin II receptor antagonists and ACE inhibitors, hyperkalemia may develop with treatment with Cardosal 20 if the patient has impaired renal function and / or chronic heart failure. In patients of this risk group, it is recommended to monitor the level of potassium in the blood serum.

As in the case of other angiotensin II receptor antagonists, a combination of lithium and cardosal 20 is not recommended.

As in the case of other angiotensin II receptor antagonists, in patients of the Negroid race suffering from arterial hypertension, the effectiveness of therapy with Cardosal 20 is slightly lower than in patients of other races.

As in the case of any antihypertensive agent, an excessive decrease in blood pressure in patients with ischemic heart disease or cerebrovascular insufficiency can lead to myocardial infarction or stroke.

- Influence on the ability to drive vehicles and mechanisms The effect of the drug Cardosal 20 on the ability to drive vehicles and control mechanisms has not been studied, therefore, during the period of treatment with Cardosal 20, care should be taken when driving vehicles and engaging in potentially hazardous activities that require increased concentration and speed psychomotor reactions (dizziness and weakness are possible).

Combined use with potassium-sparing diuretics, potassium preparations, salt substitutes containing potassium, or other drugs that can increase the level of potassium in the blood serum (eg, heparin) is not recommended, this may lead to an increase in the level of potassium in the blood serum.

The antihypertensive effect of olmesartan therapy can be enhanced when combined with other antihypertensive drugs.

Non-steroidal anti-inflammatory drugs (NSAIDs), including Acetylsalicylic acid in doses of more than 3 g / day, as well as cyclooxygenase-2 inhibitors (COX-2), and angiotensin II receptor antagonists can act synergistically, reducing glomerular filtration. With simultaneous use of NSAIDs and angiotensin II receptor antagonists, there may be a risk of developing acute renal failure, therefore, monitoring renal function at the beginning of treatment is recommended, as well as regular intake of sufficient amounts of fluid. However, simultaneous treatment can reduce the antihypertensive effect of angiotensin II receptor antagonists, leading to a partial loss of their therapeutic efficacy.

With simultaneous use with antacids (aluminum and magnesium hydroxide), a moderate decrease in the bioavailability of olmesartan is possible.

There are reports of a reversible increase in serum lithium concentration and toxicity during simultaneous use of lithium preparations with angiotensin-converting enzyme inhibitors (ACE) and angiotensin II receptor antagonists, therefore, the use of olmesartan medoxomil in combination with lithium preparations is not recommended (see section Special instructions). If necessary, the use of appropriate combination therapy is recommended to regularly monitor the level of lithium in the serum.

- Symptoms: pronounced decrease in blood pressure.
- Treatment: when there is a pronounced decrease in blood pressure, it is recommended to lay the patient on his back, raising his legs. Recommended gastric lavage and / or reception of Activated carbon, therapy aimed at correcting dehydration and disorders of water-salt metabolism, replenishment of circulating blood volume.

Store at a temperature not higher than 30? С.

3 years.