Cilzec 40 MSN medicine for high blood pressure (3 blisters x 10 tablets)

Dosage form Box of 3 blisters x 10 tablets
Specifications Telmisartan
Ingredient High blood pressure

Ingredient

Composition information	Content
Telmisartan	40mg

Uses

Indications

Cilzec 40 drugs are used for high blood pressure , can be used individually or in combination with other high blood pressure treatments.

Pharmacokic

angiotensin I convert into angiotensin II thanks to the catalysis of angiotensin transferring enzymes (ACE, Kinjase II). Angiotensin II is the main component causing hypertension of the Rennin-Anotensin system, which has vasoconstrictor effect, stimulates synthesis and releases Aldosterone, stimulates the heart, and has nephrotic reabsorption in the kidney.

Telmisartan inhibits the effect of vascular shrinkage and release aldosterone of angiotensin II by inhibiting the cohesion of Angiotensin II into the AT1 receptor in many tissues in the body such as blood vessel 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 not clear whether AT2 helps stabilize cardiovascular or not.

Telmisartan has a stronger AT1 receptor than AT2 (> 3000 times). Reducing the impact of the Renin Angiotensin system with angiotensin transferring enzyme inhibitors (Angiotensin II biosynthesis from angiotensin I) has been widely used in the treatment of hypertension.

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. This difference whether or not the clinical correlation is not yet known.

Telmisatan does not see affinity for other receptors or select ion 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 eennin 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 dose. Telmisartan absolute bioavailability depends on the dose.

with a dose of 40mg and 160mg, the corresponding bioavailability is 42% and 58% respectively. The peak concentration of plasma and the area under the curve shows the drug concentration in plasma over time (AUC) does not increase proportional to the dose (at the dose 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 in plasma according to the exponential coefficient of 1.5 to 2.0 when repeating the dose 1 time/day.

Metabolism and elimination

Telmisartan is metabolized by combining to form acylgluc-Rasonic without pharmacological activity; In humans, glucuronic of the original substance is the only metabolic substance found in plasma and urine.

Isoenzyme Cytocrom P450 is not involved in the metabolism of telmisar-tan.

Distribution

Telmisartan is strongly connected to plasma proteins (> 99.5%), mainly albumin and Al - Glycoprotein acid. Integrated with stable plasma proteins when used in recommended dose.

Telmisartan's distribution volume is about 500 liters, including tissue cohesion.

Before taking Cilzec 40 MSN medicine for high blood pressure (3 blisters x 10 tablets)

How to use

Telmisartan tablets can be used in combination with other antihypertensive drugs, which can be shared or not with food.

Dosage

Dosage depending on each patient.

The starting dose is usually 40mg, once/day.

Patients with intravascular volume exhausted should be treated before using Telmisartan or must have a close supervision of a physician when starting to use Telmisartan.

Patients with biliary obstruction 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.

What to do when overdose? Symptoms of Telmisartan overdose include: Hypotension , dizziness, fast heartbeat, slow heartbeat may occur when stimulating sympathetic nerves. If symptoms of hypotension occur, supportive treatment should occur. Telmisartan is not excluded from the body due to blood decomposition.

What to do when you forget the dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Do not drink twice as prescribed.

Side Effects

Adultery actions such as back pain, sinusitis, diarrhea, sore throat occur in the Telmisartan group with a frequency of 1% higher than the placebo group, regardless of the cause.

In addition, the following adverse effects may occur at 1%frequency, but at least equivalent to the frequency of the place where the place of use: symptoms like flu, indigestion, muscle pain, urinary infection, abdominal pain, headache, dizziness, pain, fatigue, cough, hypertension, 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%).

Notify the doctor the unwanted effects when taking the drug.

Warnings

Contraindicated

Contraindicated in patients with hypersensitivity to any component of the drug.

Precautions when taking drugs

Liver function failure

Most of Telmisartan excreted in bile, so the clearance of drugs will be reduced in patients with biliary obstruction or liver function. Be careful when taking the drug in these patients.

Renal function

The drug has the effect of inhibiting the Rennin-Anotensin-Aldosterone system, so it can change the kidney function in sensitive patients.

Distant and/or hemorrhage progressive and rarely) Acute renal failure and/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 antagonists with Angioten-SIN receptors).

Similar results can occur in patients treated with Telmisar - inhibiting the Rennin - Angiotensin - Aldosteron system: The drug has the effect of inhibiting the Rennin -Anotensine -Aldostion system, so there are reports on cases of changing renal function (including acute renal failure).

Be cautious and closely monitor kidney function when it inhibits the Rennin-Anotensin-Adosterone system (for example, a combination of enzyme inhibitors and Angiotensin II receptor antagonists).

The ability to drive and operate machinery

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.

Pregnancy and lactation

Pregnancy

Telmisartan has a direct impact on the Renin Angiotensin system that can cause damage even death for the fetus. Therefore, it is not advisable to specify pregnant women in the middle 3 months and the last 3 months of pregnancy. When detected pregnancy, should stop taking the drug as soon as possible.

Breastfeeding period

It is not clear whether the drug is excreted through breast milk, but Telmisartan is found in breast milk. Due to the risk of side effects for children, it is necessary to decide to stop the drug or stop breastfeeding depending on the importance of the drug for the mother.

Special objects (elderly, children, allergies)

Safety and efficiency in children have not been set up.

In the elderly: In general, there is no difference in the safety and effectiveness of the drug on the elderly compared to the young.

Children: Telmisartan's 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.

Sex: The plasma drug concentration in women is 2-3 times higher than that of 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 hepatic failure: Research in patients with hepatic impairment shows an increase in drug concentration in plasma and absolute bioavailability up to nearly 100%.

Medicinal interaction

Digoxin : simultaneously used with Telmisartan may increase the peak concentration of plasma of Digoxin (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 : simultaneously used with telmisartan for 10 days reduces the average bottom concentration of Warfarin in plasma, but does not change the international standardized ratio (INR).

Other drugs: Telmisartan simultaneous use with acetaminophen, amlodipine, glibenclamide, simvastatin, hydrochlorothiazide or ibupro-fen clinically clinically.

Telmisartan does not metabolize through the Cytocrom P450 system and has no influence on in vitro for cytocrom P450 enzyme, except for a few inhibitors on CYP2C19. Telmisar-tan does not interact with the cytocrom P450 enzyme inhibitors, nor does it interact with the metabolic drugs through the CyP250 cytocrom P450 system that can inhibit the metabolism of metabolic drugs by CYP2C19.

Cancer, causing mutations and decreased 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.

Storage

You should store at room temperature, avoid moisture and avoid light. No storage in the bathroom or in the freezer. You should remember that each drug may have different storage methods. Therefore, you should read carefully storage instructions on the packaging or ask the pharmacist.

Keep pills out of reach of children and pets.

Expiry date: 24 months from the date of manufacture.

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