Cilzec 20 mega We Care medicine for high blood pressure (3 blisters x 10 tablets)
Dosage form Box of 3 blisters x 10 tablets
Specifications Telmisartan
Ingredient MSN Laboratories Limited
Ingredient
| Composition information | Content |
| Telmisartan | 20mg |
Uses
Indications
Cilzec 20mg drug is indicated in the following cases:
Angiotensin II is the main component causing hypertension of the Rennin - Angiotensin system, which has vasoconstrictor effect, synthesized and releases Aldosterone, stimulating the heart and reabsorption of sodium in the kidneys.
Telmisartan inhibits the effect of vascular shrinkage and release of Angiotensin II by inhibiting the cohesion of Angiotensin II into the AT1 receptor in many tissues in the body such as blood vessels and adrenal glands. Thus, the effect of Telmisartan is not related to the synthesis of angiotansin II. The AT2 receptor is also found in many tissues, but it is unclear whether AT2 helps stabilize cardiovascular. Telmisartan has a stronger AT1 receptor than AT2 (> 3000 times).
Reduce the impact of the Renin Angiotensin system with angiotensin transferring enzyme inhibitors (Angiotensin II biosynthesis from angiotensin I) has been widely used in hypertension treatment.
Bradykinin is catalyzed by yeast, so the enzyme inhibitors also inhibit the breaking of Bradykinin. Telmisartan does not inhibit the enzyme (Kiniase II), so it does not affect the breakdown of Bradykinin.
whether this difference is clinically correlated or not, it is not yet known. Telmisatan does not see affinity for other receptors or ionic channels that have been known to play an important role in the cardiovascular regulation.
Angiotensin II receptor is isolated, which inhibits the reverse air conditioning reaction of angiotensin II on Rennin excretion but the increase in the activity of Rennin and the Angiotensin II concentration in plasma does not affect the effect of Telmisartan on blood pressure.
Pharmacokinetic
General
After taken, the peak concentration (CMAX) of Telmisartan is achieved after 0.5 - 1 hour. Telmisartan's bioavailability is slightly reduced by food, the area under the curve showing the drug concentration in plasma over time (AUC) can be reduced by about 6% at a dose of 40mg and about 20% at 160mg.
Telmisartan's absolute bioavailability depends on doses. With a dose of 40mg and 160mg, the corresponding bioavailability of 42% and 58% respectively. The peak concentration of plasma and the area under the curve shows the plasma concentration in time (AUC) increases in no proportion to the dose (at the dose of 20mg - 160mg).
Telmisartan is dynamic decomposition according to the second level, the last waste sale time is about 24 hours. The bottom concentration of Telmisartan in plasma is about 10-25% compared to the peak concentration when taken once a day. Telmisartan accumulates plasma in a exponential coefficient of 1.5 to 2.0 when a dose 1 time/day.
Metabolism and elimination
Telmisartan is metabolized by combining to form acylglucuronic without pharmacological activity. In humans, glucuronic of the original substance is the only metabolite found in plasma and urine. Isoenzyme Cytocrom P450 is not involved in the metabolism of Telmisartan.
Distribution
Telmisartan is strongly connected to plasma proteins (> 99.5%), mainly albumin and glycoprotein acid. Mount with stable plasma protein when used in recommended dose. Telmisartan's distribution volume is about 500L, including tissue cohesion.
Special cases
Children
Telmisartan pharmacokinetics have not been studied in patients under 18 years old.
Older people
There is no difference in pharmacokinetics in the elderly and patients under 65 years old.
Gender
Plasma concentration in women is 2-3 times higher than men. However, clinical test results do not see an increase in the effects of the drug on blood pressure or on the incidence of hypotension standing in women. Therefore, no dose adjustment.
Patients with renal failure
No dose adjustment in patients with renal function. Dialysis does not exclude Telmisartan from the blood.
Patients with liver failure
Research in patients with liver failure shows an increase in drug concentration in plasma and absolute bioavailability up to nearly 100%.
Before taking Cilzec 20 mega We Care medicine for high blood pressure (3 blisters x 10 tablets)
How to use
Cilzec 20mg oral medicine.
Telmisartan tablets can be shared or not with food.
Dosage
Dosage depending on each patient.
The starting dose is usually 40mg, once/day.
Dose for response on blood pressure is 20 - 80mg.
Special cases
Patients with intravascular volume exhausted should be treated before using Telmisartan or must have a close monitoring of a physician when starting to use Telmisartan. Patients with bile clogged or liver failure should start treatment under the close supervision of the physician.
Most cases achieve the effectiveness of hypotension within 2 weeks and achieve maximum effectiveness after 4 weeks of treatment. When the effectiveness of hypotension has not achieved the desired results, Telmisartan 80mg can be used in combination with diuretics.
No need to adjust the starting dose in older patients or patients with renal impairment, including patients with dialysis. In patients with feces may have a vertical hypotension, need to check blood pressure carefully in these patients.
Telmisartan tablets can be used in combination with other antihypertensive drugs.
Use in children
Safety and efficiency in children have not been established.
Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.
What to do when overdose? Symptoms of Telmisartan overdose include: Hypotension, dizziness, fast heartbeat, slow heartbeat may occur when stimulating sympathetic nerves. If millions occur hypotension, should conduct supportive treatment. Telmisartan is not excluded from the body due to blood decomposition.
What to do when forgetting a dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Note that it should not be used double the prescribed dose.
Side Effects
When using Cilzec 20mg, you may experience unwanted effects (ADR).
Adjusting such as back pain, sinusitis, diarrhea, sore throat occurs in the Telmisartan group with 1% higher frequency than the placebo group, regardless of the cause.
In addition, the following adultery may occur at a frequency of 1%, but at least equivalent to the frequency encountered in the placebo group: symptoms like flu, indigestion, muscle pain, urination, abdominal pain, headache, dizziness, pain, fatigue, cough, chest pain, nausea, peripheral edema.
There is no relationship between unwanted effects with dosage, gender, age, and race of the patient.
The incidence of coughs occurs in the Telmisartan group equivalent to the placebo group (1.6%).
Instructions on how to handle ADR
Notify the doctor the unwanted effects when taking the drug.
Warnings
Before using the drug you need to read the instructions carefully and refer to the information below.
Contraindicated
Cilzec medicine 20mg contraindicated in the following cases:
Precautions when using
Liver function failure
Most of Telmisartan excreted in bile, so the clearance of drugs will be reduced in patients with bile congestion or liver function. Be careful when taking the drug in these patients.
Renal function
Distant to progress and (rarely) acute renal failure or death in patients with renal function depending on the activity of the Rennin - Angiotensin - Aldosterone system (for example, patients with severe congestive heart failure) may be related to the treatment of enzyme inhibitors and antagonistic drugs with Angiotensin receptor receptor. Similar results can occur in patients treated with Telmisartan. Rennin - angiotensin - Aldosteron system inhibitors Hypotension in patients decreased volume In patients where the Rennin - Angiotensin system is activated as a patient with a decrease in a volume or salt (for example, a patient being treated with high doses of diuretic), hypotension may occur immediately after starting treatment with Telmisartan tablets. Therefore, these abnormalities need to be adjusted before caught treatment. Telmisartan or must reduce Telmisartan and began treatment under the close supervision of the physician. When hypotension, patients should be on their backs and intravenously with regular salt water if needed. In the case of transient hypotension without contraindications, it is often possible to continue treating when blood pressure is stable again. There is no data showing that Telmisartan has an influence on driving and operating machinery. However, when driving and operating machinery, it must be noted that dizziness or drowsiness may occasionally appear when using high blood pressure medication. There is no clinical experience in using Telmisartan tablets for pregnant women. It is necessary to notify women of reproductive age about the consequences that the drug acts on the Renin - Angiotensin system may cause if taking the medication in the middle and the last 3 months of pregnancy, and should also notify the patient that these consequences do not seem to occur in the first 3 months of pregnancy despite the exposure of drugs in the uterus. Need to stop the drug and notify the doctor about pregnancy as soon as possible. It is unclear whether the drug is excreted through breast milk or not Due to the risk of children, they must decide to stop the drug or stop breastfeeding depending on the importance of the drug with the mother. digoxin Concentrated with Telmisartan may increase the peak concentration of digoxin plasma (49%) and bottom concentration (20%). Therefore, it is necessary to check the concentration of digoxin at the beginning of treatment, when adjusting the dose or stop using Telmisartan to avoid not enough or overdose Digoxin. warfarin Concentrated with Telmisartan for 10 days reduces the average base concentration of Warfarin in plasma, but does not change the international standardized ratio (INR). Other drugs Simultaneous use of Telmisartan with acetaminophen, amlodipine, glibenclamide, simvastatin, hydrochlorothiazide or ibuprofen does not cause clinical interactions. Telmisartan does not metabolize through the Cytocrom P450 system and has no influence on in vitro for the cytocrom P450 enzyme, except for a few inhibitors on CYP2C19. Telmisartan does not interact with the cytocrom P450 enzyme inhibitors, nor does it interact with the metabolic drugs through the Cytocrom P450 system, except that can inhibit the metabolism of metabolic drugs by CYP2C19. Cancer, causing mutations and decline in fertility There is no evidence of cancer when rats and rats eat diets containing telmisartan for 2 years. No drugs have an effect on the fertility of male mice and female mice using telmisartan dose of 100mg/kg/day (maximum dose), about 13 times MRHD of Telmisartan based on mg/m2. The ability to drive and operate machinery
Pregnancy
Breastfeeding period
Drug interaction
Storage
Store at temperatures below 25 ° C, in a cool dry place, avoid light and avoid moisture.
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