Coveram medicine 10mg/5mg Servier treat hypertension (30 tablets)
Dosage form Box of 30 tablets
Specifications Perindopril arginine, amlodipine
Ingredient Coronary artery disease, high blood pressure
Ingredient
| Composition information | Content |
| Perindopril Arginine | 10mg |
| Amlodipine | 5mg |
Uses
Indications
Coveram 10mg/5mg indicated in the treatment of hypertension and/or stable coronary artery disease in patients who have used Perindopril and Amlodipine in the form of separate tablets of the same dose.
Pharmacokic
Perindopril: is an enzyme inhibitor that converts angiotensin I into angiotensin II (ACE), reduces angiotensin II in plasma plasma activity in plasma (due to inhibition of the negative response of the renin secretion) and reduces Aldosterone secretion. In addition, ACE also manifests Brandykinin, so when using Perindopril can cause dry cough side effects.
The effects of Perindopril: Hypotension at all levels (mild, medium, heavy); Reducing systolic and diastolic blood pressure in both positions lying on their backs and standing. Reducing peripheral resistance, increasing peripheral blood without effect on the heart frequency, reducing left ventricular hypertrophy, increasing blood flow through the kidneys but not changing the speed of glomerular filtration (GFR); Improve the elasticity of a large artery and reduce the middle layer ratio of the vascular wall/heart in small arteries.
Stop using drugs leads to reBound Effect.
amlodipin: is an inhibitor of calcium ions that enter the heart muscle and smooth muscle of the blood vessels, belonging to the dihydropyridine group (slow channel blockers or calcium ion antagonism). Amlodipine's anti -hypertension mechanism is due to the relaxation of peripheral arteries and thus reduces the entire peripheral resistance against the contraction of the heart (posterior). In addition, Amlodipin also relaxes large coronary arteries and coronary arteries, both in normal areas and ischemic areas. Vascular dilatation will increase oxygen supply in the heart of a patient with coronary artery spasm (Prinzmental angina or angina variant).
pharmacokinetics
perindopril:
absorption: Perindopril absorbs quickly after drinking. Perindopril's peak concentration and Perindoprilat metabolites are achieved after 1 hour and 3-4 hours respectively.
Distribution: Perindoprilate bonding protein accounts for 20% of plasma proteins, mainly attached to ACE enzymes and dosage depends on dosage. The distribution volume (VD) is about 0.2 liters/kg with non -cohesive perindoprilat.
Metabolism: Foods that limit metabolism to Perindoprilat. Perindopril metabolizes into Perindoprilat activity and 5 other non -active substances.
Elimination: Perindopril's waste sale time in plasma is 1 hour. Perindoprilat is discharged through the urine and the semi -discharged time of the non -linked part is about 17 hours, reaching a stable state within 4 days.
amlodipin:
Absorption: Amlodipin absorbs well after drinking, reaching the peak concentration in the blood after 6 - 12 hours. Absolute bioavailability is 64 - 80% and is not affected by food.
Distribution: The distribution volume (VD) is about 21 liters/kg. About 97.5% amlodipine bonding plasma protein.
Metabolism: Amlodipine metabolism is mostly in the liver so that the metabolites are inactive.
Elimination: The last waste sale time is about 35 - 50 hours. About 60% of the dose will be discharged through the urine, of which 10% is non -metabolized amlodipine.
Before taking Coveram medicine 10mg/5mg Servier treat hypertension (30 tablets)
How to use
use medicine with a cup of water, it is best to take at the right time in the morning before meals.
Fixed combination drugs are not suitable for arising.
If you need to change the dose, you can adjust the dose of coveram or adjust each component in the form of free coordination that may be considered.
Dosage
Take 1 tablet/day.
Special subjects
Patients with kidney and elderly:
Perindoprilat's elimination is reduced in older patients and patients with renal failure. Therefore, regular medical monitoring will include exam testing and potassium.Can use coveram in patients with creatinine clearance ≥ 60 ml/min, and not for patients with clearance
Amlodipin is used the same dose in the elderly or young people with equivalent tolerance. The normal dose is recommended in older patients, but should be cautious when increasing the dose. Change plasma amlodipine concentration is not related to the level of renal failure. Amlodipine is not filtered.
Patients with liver failure:
Recommendations have not been set in mild to medium liver failure patients; Therefore, choosing the dose should be cautious and should start at the lowest dose of the dose. To find the optimal starting dose and maintain the dose for patients with liver failure, patients should be adjusted in the form of free coordination of Perindopril and Amlodipin. Amlodipin's pharmacokinetics have not been studied in patients with severe liver failure. Amlodipine should be started at the lowest dose and slowly adjust the dose in patients with severe liver failure.
Children's subjects:
Do not use coveram for children and minors due to the efficiency and intake of Perindopril and Amlodipin, in the form of coordination, have not been established on this object.
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
The serious overdose can lead to excessive peripheral vasodilation and may experience reflective tachycardia. Hypotension is noticeable and may extend to the shock level and including shock leading to the death of death.Handling
Clinical hypotension clinically due to amlodipin overdose requires supportive activities for the heart including regular heart monitoring and respiratory function, edema of the limbs and paying attention to the volume of circulatory and urine.
Using a vasoconstrictor may be useful in restoring blood vessels and blood pressure in the absence of contraindications. Venous calcium gluconate can be effective against the effect of calcium channel blockers.
Gastric lavage may be valid in some cases. Using activated carbon until 2 hours after using amlodipine 10 mg reduces the absorption rate of amlodipine. Dialysis is not effective because amlodipine is closely attached to plasma proteins.
For Perindopril, data overdose is limited. Symptoms related to the overdose of enzyme inhibitors may include hypotension, circulatory shock, electrolyte disorders, kidney failure, respiratory increase, tachycardia, chest drum, slow rhythm, dizziness, anxiety and cough.
Extremely recommended treatment is the isometric salt vein intravenous. If hypotension appears, patients should be in a shockproof position. If possible, consider Angiotensin II transmission and/or intravenous catecholamine. Perindopril can be removed from the circulatory system through dialysis. The span is indicated in the case of a slow heart rate that does not respond to treatment. Should continue monitoring the signs of survival, concentration of electrolytes and creatinine in serum.
What to do when you forget 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 Coveram 5 mg/10 mg, you may experience unwanted effects (ADR).
Common, ADR> 1/100
When experiencing side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.
Warnings
Contraindicated
related to Perindopril
Related to coveram
Precautions when using
related to Perindopril
Hypersensitivity/eagles
Facility on the face, limb, lips, mucosa, tongue, subjects and/or larynx are rarely recorded in patients treated with enzyme inhibitors, including Perindopril. This phenomenon may appear at any time during treatment. If this phenomenon occurs, stop immediately coveram and take appropriate and continuous monitoring measures until these symptoms are completely gone. In general, the phenomenon of local and lips swelling is usually cured without treatment, although antihistamine drugs may have the effect of reducing symptoms.
Evaluation related to laryngeal edema can be fatal. When tongue edema, subject or larynx can cause respiratory obstruction, immediately use emergency measures. This measure includes the use of Adrenalin with or not accompanied by ventilation measures. Patients should be closely monitored until the symptoms of complete retreat.
Patients with a history of angioedema are not related to the treatment of transferred enzyme inhibitors that can increase the risk of angioedema when using enzyme inhibitors.
Evaluation in the intestinal tract is rarely recorded in patients treated with transferred enzyme inhibitors. These patients show signs of abdominal pain (with or without nausea or vomiting); In some cases, there is no previous edema and the C-1 esterase concentration is normal. Evaluation is diagnosed with abdominal CT scan, or ultrasound or during surgery and the regression of symptoms after stopping the enzyme inhibitor. The intestinal angioedema should be considered in distinguished diagnosis in patients using enzyme inhibitors with abdominal pain.
Combining Perindopril with Sacubitril/Valsartan is contraindicated due to increased risk of angioedema. Sacubitril/Valsartan is only started to take 36 hours after the end of Perindopril's final dose. If treated with Sacubitril/Valsartan, Perindopril therapy is only started 36 hours after the last dose of Sacubitril/Valsartan. The simultaneous use of NEP inhibitors (such as racecadotril) and enzyme inhibitors may also increase the risk of angioedema. Therefore, it is necessary to evaluate benefits - risks carefully before starting treatment with NEP inhibitors (such as racecadotril) on patients taking Perindopril.
Simultaneously used with MTor inhibitors (such as syrolimus, Everolimus, Temsirolimus)
Patients with simultaneous use with MTor inhibitors (such as syrolimus, Everolimus, temsirolimus) may increase the risk of angioedema (such as respiratory or tongue, with or without respiratory decline).
Hypersensitivity reactions during filtering low density lipoprotein (LDL)
Rarely experiencing life -threatening response in patients using enzyme inhibitors transferred during filtering low density lipoprotein type as dextran sulphat. Anaphylactic reactions can be avoided by temporarily stop taking enzyme inhibitors before each filter.
Anaphylactic reactions during the sensitivity process
Patients taking enzyme inhibitors during the treatment of sensitivity (such as membrane insect venom) have encountered anaphylactic reactions. Anaphylactic reactions may be avoided in these patients when temporarily stopped the enzyme inhibitors, but these reactions may reappear if unintentionally exposed to allergens.
leukopenia/grain leukemia/thrombocytopenia/anemia
leukopenia/granulocytosis, thrombocytopenia and anemia have been recorded in patients using enzyme inhibitors. Rarely appear leukopenia in patients with normal renal function and no other complex factors. Should be especially cautious when taking Perindopril for patients with blood vessels to create glue, patients are treating immunosuppressive, treatment with Allopurinol or Procainamid, or combining these risk factors, especially if the patient has impaired renal function before. Some patients in these patients have severe infections, sometimes not responding to positive antibiotic treatment. If Perindopril is used for these patients, periodic monitoring of the number of white blood cells should be monitored and the patient should be instructed to notify any signs of infection (such as sore throat, fever).
Aortic hypertension
There is the ability to increase the risk of hypotension and renal failure when the patient has narrowing of the kidney artery on both sides or the kidney artery stenosis leads to the kidney function on the one hand is treated with the inhibition of the enzyme. Treatment with diuretics may be a contributing factor. Kidney failure may even appear with slight changes in serum creatinine in patients with kidney stenosis on one side.
Double blockade of the renin-Anotensin-aldosteron (RAAS)
There is evidence that the simultaneous use of enzyme inhibitors, Angiotensin II or Aliskiren receptor inhibitors increases the risk of hypotension, hyperkalemia and impaired renal function (including acute renal failure). Dual blockade of RAAS systems using a combination of enzyme inhibitors, Angiotensin II receptor inhibitors or Aliskiren therefore is not recommended.
If the dual blockade therapy is certainly considered necessary, this use is only performed under the supervision of the expert and should be closely monitored regularly for kidney, electrolyte and blood pressure.
Enzyme inhibitors and Angiotensin II receptor inhibitors should not be used simultaneously in patients with diabetic kidney disease.
Increase Aldosterone Tien Phat
Patients with hypertrophy of primary aldosterone are generally not responding to anti-hypertension drugs that operate through inhibition of the renin-angiotensin system. Therefore the use of this drug is not recommended.
Hypotension
Enzyme inhibitors can cause hypotension. Symptoms of hypotension are recognized as rare in patients with no complications of hypertension and is more likely to appear in patients with reduced circulatory volume such as treatment with diuretics, salt -limiting diet, hemolysis, diarrhea or vomiting or in serious hypertension patients dependent on renin. In patients with high risk of hypotension with symptoms, it is advisable to closely monitor blood pressure, kidney function and serum potassium concentration during Coveram treatment.
Similar considerations are applied to patients with myocardial oral disease, excessive hypotension can lead to myocardial infarction or stroke.
If the blood pressure appears, the patient should be on the back and if necessary, the veins of the sodium chloride solution should be inferior to 9 mg/ml (0.9%). Hypoglycemia is not contraindicated for the next dose, the next dose can often be used without fear when blood pressure has increased after the collection of circulating mass.
Aortic stenosis and hypertrophic cardiac/myocardial valve
Be cautious when taking enzyme inhibitors transferred to patients with mitral stenosis and clogged output of the left ventricle such as aortic stenosis or hypertrophic cardiomyopathy.
kidney failure
In the case of renal failure (Creatinine clearance
Potassium and creatinine control is regularly part of medical practice for patients with impaired renal function.
In some patients on both sides of the renal artery or one side of the kidney stenosis, which has been treated with transferred enzyme inhibitors, the phenomenon of increased blood urea and serum creatinine, often recovered after stopping treatment. This is especially likely to occur in patients with renal impairment. The risk of severe hypotension and renal failure increases if there is a manifestation of kidney hypertension. Some patients with hypertension do not show signs of previous kidney disease, which have increased blood urea and creatinine, usually mild and transient, especially when used simultaneously Perindopril and diuretics. This is more likely to occur in patients who have impaired renal function before.
Hepatic failure
Enzyme inhibitors are rarely related to the syndrome that starts with cholestasis jaundice and progresses into serious liver necrosis and (sometimes) death. The mechanism of this syndrome is not well known. Patients using enzyme inhibitors with jaundice and significant liver enzymes should stop using inhibitors of enzymes and appropriate medical monitoring.
Race
Enzyme inhibitors increases the rate of angioedema in black skin patients in other skin -colored patients.
The transferred enzyme inhibitors may be less effective in lowering blood pressure on black people than other skin -colored people, which may be due to the more commonly common plasma renin activity in the population of hypertension patients with hypertension.
ho
cough has been recorded when using the transferred enzyme inhibitor. Cough is characterized by dry, persistent and out of treatment. Coughing caused by transferred enzyme inhibitors should be considered as part of cough diagnosis.
surgery/anesthesia
In patients undergoing major surgery or during anesthesia, using drugs that can cause hypotension, coveram can inhibit the formation of secondary angiotensin II to compensate for released. Coveram should be stopped one day before surgery. If hypotension appears and hypotension is considered to be due to this mechanism, it is necessary to adjust by increasing the volume of circulation.
Hemorrhage
Serum hyperpass has been recorded in some patients treated with enzyme inhibitors, including Perindopril. Factors that increase blood potassium include renal failure, worsening renal function, age (> 70 years old), diabetes, events that occur, especially dehydration, acute cardiomemia loss, metabolic acidosis and simultaneous use with potassium diuretics (such as Spironolacton, Eplerenon, Triamteren or Amilorid, Solo or combination), supplements of potassium or replacement salts; Or patients taking other drugs that increase serum potassium (such as heparin, co-trimoxazole known as trimethoprim/sulfamethoxazole).
Use potassium supplements, potassium diuretic or alternative salts containing special potassium in patients with impaired renal function can significantly increase serum potassium. Hyperboly hyperpass can cause serious arrhythmia, sometimes leading to death. If the simultaneous use of Perindopril with any of the above drugs is really necessary, should be used carefully and regularly monitor blood potassium concentration.
Patients with diabetes
In patients with diabetes treated with oral diabetes or insulin drugs, it is advisable to strictly control blood glucose in the first month of treatment with enzyme inhibitors.
Related to amlodipine
Safety and effectiveness of amlodipine in the hypertension has not been established.
heart failure
Should be careful treatment for patients with heart failure.
In a long-term study, compared to the place of placebo, patients with severe heart failure (NYHA III-IV), pulmonary edema events have been reported higher in the treatment group with amlodipine compared to the placebo group. Calcium channel blockers, including amlodipine, should be used carefully in patients with congestive heart failure because they can increase the risk of cardiovascular events and deaths later.
Hepatic failure
In patients with impaired liver function, Amlodipine's exhaust time and prolonged area of the curve (AUC) are higher; The dose recommendations have not been set. Therefore, it is recommended to start treating amlodipine with low doses and cautiousness when starting and increasing the dose. Requires a slow dosage increase and strict control in patients with severe liver failure.
Elderly
Need to increase the dose with caution in elderly patients.
kidney failure
Amlodipin may be used for patients with renal impairment at normal doses. Change plasma amlodipine concentration is not related to the level of renal failure. Amlodipine cannot be removed by dialysis.
Related to coveram
All warnings related to each component, as listed above, are applied to Coveram fixed tablets.
excipients
Due to the presence of lactose, patients with rare genetic diseases such as galactose tolerance, glucose-galactose malabsorption, or a shortage of lactase enamel should not use this drug.
The ability to drive and operate machinery
Amlodipine can affect the ability to drive and operate machinery mild - medium, because it is likely to cause dizziness, fatigue, exhaustion, nausea or impaired reaction. Be cautious when starting treatment with coveram.
Pregnancy
In relation to Perindopril
It is not recommended to use enzyme inhibitors in the first three months of pregnancy. Contraindicated use of enzyme inhibitors transferred in the middle and last three months of pregnancy.
Except for the need to continue treating with enzyme inhibitors, patients planning to get pregnant should turn to other antihypertensive drugs that are considered safe during pregnancy. When a patient is diagnosed with pregnancy, it is advisable to stop treating with enzyme inhibitors immediately and if possible, you should start an alternative treatment.
The use of enzyme inhibitors transferred in the three months and the last three months of pregnancy is known to be toxic to the fetus (reduced kidney function, amniotic fluid, skull slowly) and toxicity in infants (kidney failure, hypotension, hyperkalemia).
If the patient uses an enzyme inhibitor in three months between pregnancy, it is recommended that the ultrasound should be taken to check the kidney function and the fetal skull.
Infants whose mothers use enzyme inhibitors, they should be closely monitored by the risk of hypotension.
Related to amlodipine
The safety of amlodipine in pregnant women has not been established.
Only recommend used in pregnant women when there is no safer alternative measure and when the risk is due to the disease is greater than the mother and the fetus.
Breastfeeding period
Related to Perindopril
Due to the lack of information related to the use of Perindopril during breastfeeding, it is not recommended to use Perindopril and should be replaced by other treatments that have been better known for safety during breastfeeding, especially when raising infants or premature babies.
Related to amlodipine
Amlodipine is excreted through breast milk. It is currently unknown the effect of amlodipin on breastfeeding. The decision to continue/stop breastfeeding or continue/stop treatment with amlodipine should be considered based on the benefits of breastfed babies and amlodipine treatment benefits on the mother.
Drug interaction
related to Perindopril
Renin-Anotensin-Aldosteron (RAAS) dual blockbounds by using a combination of enzyme inhibitors, Angiotensin II or Aliskiren receptor inhibitors are more frequency of adverse frequency such as hypotension, hyperkalemia and impaired renal function (including acute renal failure) when compared with the use of remedy for drug-impact drugs on the system.
Medications that cause hyperkalemia: Some drugs or therapy may increase the likelihood of hyperkalemia: Aliskiren, potassium salts, potassium diuretics, enzyme inhibitors, angiotensin-II antagonists, nsAID drugs, heparin drugs, immunosuppressants such as ciclosporin or tacrolimus, trimethrim and dose in combination with dose in combination with dose in combination with dose in combination with dose in combination with dose combination with dose in combination with dosage sulfamethoxazol (co-trimoxazole). The combination of these drugs increases the risk of hyperkalemia.
Combining coordination:
Aliskiren: In patients with diabetes or renal failure, the risk of hyperkalemia, worsens the kidney function and the rate of disease and cardiovascular death increases.
Extracent body treatment: The body's treatment leads to blood exposure to negative charged surfaces such as a juris or dialysis with certain high -speed filters (such as polyacrylonitril film) and removal of low density lipoprotein with dextran sulphate due to increased risk of sensitivity. If this treatment is required, it is necessary to consider using another type of filter or another anti -hypertension drug.
Sacubitril/Valsartan: Concomitant use of Perindopril with Sacubitril/Valsartan is contraindicated due to the coordination of neprilysin inhibitors and transferred enzyme inhibitors that can increase the risk of angioedema. Sacubitril/Valsartan is only started to use 36 hours after Perindopril's last dose. Perindopril therapy only starts 36 hours after the last dose of Sacubitri/Valsartan.
Uncountable coordination:
Aliskiren: In patients without diabetes or renal failure, the risk of hyperkalemia, worsening kidney function and increased rate of disease and cardiovascular death.
Inhibiting the enzyme inhibitors and Angiotensin receptor blockers: In patients with atherosclerosis, heart failure or diabetes with organs damage, enzyme inhibitors and Angiotensin receptor blockers are related to the frequency of reducing blood pressure, fainting, hyperboly blood, and worse renal function (including renal insufficiency) Renin-Anotesin-Aldosterone. Dual inhibitors (for example, a combination of an enzyme inhibitor with an Angiotensin II receptor antagonist) should be restricted in specific cases with strict monitoring of kidney function, potassium and blood pressure levels.
estramustine: The risk of increasing unwanted effects such as nerveema (angioedema).
co-trimoxazole (trimethoprim/sulfamethoxazole): patients use co-trimoxazole simultaneously ( trimethoprim /sulfamethoxazole) may increase the risk of hyperchemical potassium.
Potassium diuretics (such as triamterene , amiloride ...), potassium salts: hyperkalemia (can be fatal), especially in the case of kidney failure (hyperkalemia effects).
Perindopril combination with the above drugs is not recommended. If this combination is indicated, be careful and regularly check serum potassium. To use Spironolactone in case of heart failure, see below.
Lithi: Increased litheful and toxic lithium recovery has been recorded when used simultaneously with lithiums with enzyme inhibitors. It is not recommended to use Perindopril with Lithi. If necessary, it is necessary to coordinate, recommend should closely monitor serum lithium concentration.
Caution should be particularly cautious:
Anti -diabetic drugs (insulin, oral hypoglycemic drugs): Concentrated use of enzyme inhibitors and anti -diabetic drugs (insulin, oral hypoglycemic drugs) may increase hypoglycemic effects that risk hypoglycemia. This phenomenon seems to occur more in the first weeks of combined treatment and in patients with renal failure.
Diuretics do not keep potassium: Patients who use diuretics, and especially in patients with volume and/or salt, may be excessive blood pressure after starting treatment with enzyme inhibitors. The likelihood of hypotension can decrease by stopping diuretics, increasing volume or amount of salt put into the body before starting treatment in low amounts and increasing the dose of Perindopril slowly.
In arterial hypertension, when the previous diuretic use may cause a decrease in volume/salt, or to stop diuretics before starting treatment with an enzyme inhibitor, in this case, a potassium -free diuretic can be used later or must start using the enzyme inhibitor in low doses and increase the dose of slowly.
In congestive heart failure treated with diuretics, the enzyme inhibitor should be started at a very low dose, maybe after reducing the diuretic dose does not hold potassium.
In all cases, renal function (creatinine concentration) needs to be monitored in the first few weeks using enzyme inhibitors.
Potassium diuretics (Eplerenon, Spironolactone): With Epleron or Spironolactone dose from 12.5 mg to 50 mg daily and with low doses of transferred enzyme inhibitors:
MTOR inhibitors (such as syrolimus, Everolimus, templeimus): patients treated in combination with MTOR inhibitors may increase the risk of angioed.
Non-steroid anti-inflammatory drugs (NSAID) include aspirin dose ≥ 3 g/day: When using concomitant adenodes inhibitors and non-steroid anti-inflammatory drugs (such as acetylsalicylic acid at anti-inflammatory doses, COX-2 inhibitors and non-selective non-selective steroid anti-inflammatory drugs), anti-hypertension effects may be impaired. Simultaneous use of transferred enzyme inhibitors and non -steroid anti -inflammatory drugs may increase the risk of worsening renal function, including the possibility of acute renal impairment and increased serum potassium concentration, especially in patients with poor kidney function before. Should be cautious when combined, especially in elderly patients. Patients should be fully rehydrated and consider monitoring of kidney function after starting treatment and periodic treatment.
Careful coordination:
Gliptine (linagliptine, saxagliptine, sitagliptine, vildagliptine): increased the risk of angioedema, due to dipeptidyl peptidase IV (DPP-IV) reduced activity by gliptine, in patients treated simultaneously with an enzyme inhibitor.
Sympathetic medications: Sympathetic medications can reduce the anti -hypertension effect of enzyme inhibitors.
Gold: Nitritoid reactions (symptoms including blushing, nausea, vomiting and hypotension) are rarely recorded in patients being treated with injected gold (sodium aurothiomalate) and simultaneous use with enzyme inhibitors including perindopril.
Related to amlodipine
Uncountable coordination:
Dantrolen (intravenous): Due to the risk of hyperkalemia, it is recommended not to simultaneously use a calcium channel blockers such as amlodipine with dantrolen in patients with the ability to increase malignant body temperature and in the treatment of malignant body temperature.
Caution should be particularly cautious:
CYP3A4 induction drugs: When combined with known CYP3A4 induction drugs, the amlodipine concentration in plasma may change. Therefore, it is necessary to control blood pressure and consider adjusting the dose during and after the combination of drugs, especially with strong induction drugs CYP3A4 (for example, Rifampicin, Hypericum Perforatum).
CYP3A4 inhibitors: simultaneous use of amlodipine with strong and average inhibitors CYP3A4 (protease inhibitors, antifungal drugs Azol, macrolids such as erythromycin and clarithromycin, verapamil or diltiazem) can significantly increase Amlodipine levels. Clinical manifestations corresponding to this pharmacokinetic change of the drug can be more clear in elderly patients. Therefore, clinical monitoring and dose adjustment.
There is an increase in the risk of hypotension in patients using clarithromycin with amlodipine. It is recommended to closely monitor patients when using simultaneously amlodipine with clarithromycin.
Coordination needs to consider:
Amlodipine's hypotension effect plus the hypotension effect of other anti -hypertension drugs.
tacrolimus: There is a risk of increased blood concentration of tacrolimus when combined with amlodipine. To avoid the toxicity of Tacrolimus, blood concentration should be monitored and adjust the appropriate tacrolimus dose when taking amlodipine in patients treated with tacrolimus.
MTor inhibitors: MTor inhibitors such as syrolimus, temsirolimus and Everolimus are substrates of CYP3A. Amlodipine is a weak CYP3A inhibitor. When combined with mtor inhibitors, Amlodipine can increase the concentration of MTor inhibitors.
Ciclosporine: There are no drug interactive studies between ciclosporine and amlodipin controlled in healthy volunteers or other populations except for kidney transplant patients, when they notice that the bottom level changes (average is 0% - 40%) of Ciclosporine. Ciclosporine concentration should be considered in kidney transplant patients using amlodipine, and reducing ciclosporine dose if necessary.
Simvastatin: A Amlodipin 10 mg multi -dose combination treatment with simvastatin 80 mg increases 77% of simvastatin concentration compared to simvastatin treatment. Limit the dose of simvastatin in patients using Amlodipin 20 mg daily.
Other coordinates:
Use amlodipine with grapefruit or grapefruit juice is not recommended due to amlodipine bioavailability may increase above some patients leading to increased hypotension effect of the drug.
Related to coveram
Caution should be particularly cautious:
baclofen: Increased anti -hypertension effect. Control blood pressure and adjust the dose of anti -hypertension drugs if necessary.
Coordination needs to consider:
Anticboo -pressure drugs (such as beta blockers) and vasodilators: simultaneous use of these drugs may increase the hypotension effect of Perindopril and Amlodipine. Using the drug simultaneously with nitroglycerin and other nitrates or other vasodilators may cause more severe hypotension, so it is advisable to be carefully considered.
Corticosteroids, tetracosactid: reduce anti -hypertension effect (due to the effect of holding water and salt of corticosteroids).
Alpha blockers (prazosin, alfuzosin, doxazosin, tamsulosin, terazosin ): Increased anti -hypertension and increased risk of vertical hypotension.
Amifostin: can increase the effectiveness of anti -hypertension of amlodipine.
Three -round antidepressants/psychotic/anesthetic drugs: Increasing anti -hypertension effects and increasing the risk of hypotension.
Storage
Store at temperatures below 30 ° C.
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