Cilzec Plus Mega We Care medicine for hypertension (3 blisters x 10 tablets)

Be cautious when using

The effect of drugs on the fetus/infant

Telmisartan has a direct impact on the Renin Angiotensin system that can cause damage even death for the fetus when taking drugs for pregnant women.

Babies with a history of exposure to Angiotensin II receptor drugs in the uterus should be closely monitored with symptoms of hypotension, urinary disorders and hyperkalemia. Thiazide penetrates the placenta and is found in the umbilical cord blood. Therefore, the risk of jaundice, thrombocytopenia in the fetus and infants and may occur other adverse effects when the baby grows.

Hypotension in patients decreased volume

Be careful to start treating hypertension in patients that the Renin - Angiotensin system is activated, such as patients with sodium impairment or intravascular volume.

Hepatic failure

Be careful when taking thiazide diuretics in patients with liver failure or progressive liver disease.

Hypersensitivity reaction

may occur hypersensitivity reactions in patients with or without a history of allergies or bronchial asthma.

System Reds

Thiazide diuretics can be worse or activate systemic lupus erythematosus.

electrolytes in serum

Telmisartan and Hydrochlorothiazde: There is no report on the case of stopping the drug due to hypokalemia when treated with Telmisartan combined with hydrochlorothiazde.

hydrochlorothiazde: Periodically check the electrolytes in serum to detect electrolyte imbalance. Clinical signs should be monitored warning signs of water and electrolyte imbalance in patients treated with Thiazide.

Hemorrhage can occur or gout may appear in a few patients using Thizide therapy.

In diabetics, it may be necessary to adjust insulin or oral hypoglycemic drugs. Hyperglycemia can occur when taking thiazde diuretics.

The hypotension effect of the drug may increase when taking the drug in patients after sympathetic neuralgia.

If renal failure is progressed, it is necessary to consider or continue using diuretics.

Liver function

Telmisartan: Because most of the Telmisartan eliminates the bile, the clearance of the drug will decrease in patients with bile congestion or liver failure. Be careful when taking Cilzec Plus Mega in these patients.

Renal function

Telmisartan: The drug has the effect of inhibiting the Renin - Agiotensin - Aldosterone system so it can change the kidney function in sensitive patients.

Not used long -term telmisartan in patients with kidney stenosis on one side or both sides but the effect is similar to that in patients treated with enzyme inhibitors that can be predicted.

Hydrochlorothiazide: Be careful when using Thiazide in patients with severe renal failure. In patients with renal disease, Thiazide can cause urea accumulation and can cause impaired renal function.

Renin - Agiotensin - Aldosterone system inhibitors

Telmisartan: Because the drug has the effect of inhibiting the Renin - Agiotensin - Aldosterone system, there is a report on cases that change the kidney function (including acute renal failure). Need to be cautious and closely monitor kidney function when inhibiting the Renin - Agiotensin - Aldosterone system.

Cancer, causing mutations and decline in fertility

Telmisartan and Hydrochlorothiazide: There has been no research on the effects of cancer, mutations and fertility.

Telmisartan: There is no evidence that causes cancer for mice and rats to eat a diet that contains Telmisartan for 2 years. Gen poisoning test does not show any effect on genetic and chromosomes.

No drugs have an effect on the fertility of male mice and female mice using Telmisartan at a dose of 100 mg/kg/day (maximum dose), about 13 times MRHD of Telmisartan based on Mg/m2.

Hydrochlorothiazide: There is no evidence of the ability to cause cancer of hydrochlorothiazde on female mice (dose of about 600 mg/kg/day) or on male and female rats (dose of about 100 mg/kg/day).

Hydrochlorothiazide does not cause in vitro gene poisoning on the ames trial causing mutations on the Salmonella Typhimurium strain.

There is no side effects on the fertility of rats and mice in a study where the drug exposure through a diet is 100 and 4 mg/kg, before mating and during pregnancy.

Use in children

Safety and efficiency in children have not been established.

In the elderly

In general, there is no difference in the safety and effectiveness of the drug on the elderly compared to young people. Clinical experience reports show that there is a difference in response to drugs between the elderly and young people, but it should not eliminate the possibility that the elderly may be more sensitive to the drug.

The ability to drive and operate machinery

There has been no research on the effect of the drug on the ability to drive and operate 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

Anti -adjustment for pregnant women in the second and 3rd pregnancy of pregnancy.

The period of breastfeeding

is not sure whether Telmisartan is excreted through breast milk, but Telmisartan is found in breast milk. Thiazide is found in human milk. Due to the risk of side effects for children, they must decide to stop the drug or stop breastfeeding depending on the importance of the drug for the mother.

Drug interaction

Telmisartan

Digoxin: Concentrated 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.

Lithium: Increased lithium concentration in serum recovery and toxicity of lithium in serum has been reported when used simultaneously lithium and enzyme inhibitors.

RamIPril and RamIPrilate salt: When used simultaneously Telmisartan and Ramipril simultaneously, the drug responds may be higher due to the combination of combination and increase in Ramipril and RamIPrilate exposure in Telmisartan. This combination is not recommended.

warfarin: simultaneously used with Telniisartan for 10 days reduces the average base concentration of Warfarin in plasma, but does not change the international standardized ratio (INR).

Other drugs: Telmisartan simultaneous use with acetaminophen, amlodipine, glibenclamide, simvastatin, hydrochlorothiazde or ibutrofen without clinical interactions.

hydrochlorothiazde

Alcohol, barbiturate or sleeping pills: may occur vertical hypotension.

Diabetes (oral and insulin medications): Diabetes should be adjusted.

Other antihypertensive drugs: combined or increased hypotension.

Cholestyramin and Colestipol: Absorbing hydrochlorothiazde decreases in the presence of ion exchange resin.

corticosteroids, ACTH: increase power outages, especially decreased potassium.

Amines hypertension: may reduce the response to hypertension but not enough to prevent use.

Non -reducing muscle relaxants: may increase response to muscle relaxants.

lithium: should not be used with diuretics because of reducing lithium clearance in the kidneys and increasing the toxicity of this drug.

Non -steroids anti -inflammatory drugs: may reduce diuretics, sodium diuretic and hypotension effects of diuretics, potassium -saving diuretic and thiazide diuretics in some patients.