Cozaar XQ 5/100mg Organon Treatment Treatment of Definitely Hypertension (3 blisters x 10 tablets)
Dosage form Box of 3 blisters x 10 tablets
Specifications Amlodipine, Losartan Kali
Ingredient Hanmi Pharm.co., Ltd
Ingredient
| Composition information | Content |
| Amlodipine | 5mg |
| Losartan Kali | 100mg |
Uses
indications
Cozaar XQ 5/100mg drug is indicated for treatment of high blood pressure in adults that do not control well with single therapy with Amlodipine or Losartan.
Pharmacological
Cozaar XQ is effective in lowering blood pressure. Both Losartan and Amlodipine have lowered blood pressure due to reduced peripheral resistance. The closing the calcium line and the reduction of angiotensin II, the reduction of circuit spasms are the basic mechanisms.
losartan
Losartan inhibits systolic and diastolic blood pressure due to Angiotensin II. At the peak, 100 mg of Losartan potassium inhibits about 85% of these response; 24 hours after using a single dose or multiple doses, the inhibition is about 26 - 39%.
After using Losartan, the elimination of Angiotensin II's negative effects on the threadin secretion increases the lyin activity in plasma. Increasing lenin activity in plasma leads to an increase in angiotensin in plasma. While long -term treatment (6 weeks) for patients with hypertension with losartan dose of 100 mg/day, angiotensin II in plasma increased by about 2-3 times at the time of the drug reached the peak concentration in plasma. In some patients, there is more increase, especially during short treatment (2 weeks). However, anti -hypertension and inhibiting aldosteron concentration in plasma has been seen for 2 and 6 weeks, when Angiotensin II receptor is effectively blocked. After stopping Losartan, the renin activity in plasma and angiotensin II concentration returns to untreated level within 3 days.
Because Losartan is an Angiotensin II type antagonistic antagonistic drug, ACE inhibitors (Kininase II), an enzyme that causes Bradykinin degeneration.
In a study comparing the effect of the Losartan doses of 20 mg and 100 mg with a ACE inhibitor in response to Angiotensin I, Angiotensin II and Bradykinin, Losartan sees the response of Angiotensin I and Angiotensin II without affecting Bradykinin's response. This result is consistent with the specific mechanism of action of Losartan. In contrast, the ACE inhibitors of Angiotensin I's response and enhances Bradykinin's response without changing the response of Angiotensin II. That is the difference in pharmacological force between Losartan and ACE inhibitors.
Losartan concentration and metabolites are also active in plasma and anti -hypertension effects of Losartan increases when the dose increases.
Because Losartan and its active metabolites are Angiotensin II receptor antagonists, both contribute to anti -hypertension effects.
In a normal male study, taking a 100 mg of Losartan Kali dose in high salt diet and low salt, does not change the speed of glomerular filtration and flow or plasma filter fraction through the kidneys. Losartan has the effect of sodium, this effect is stronger when eating a diet of less salt and is not related to the inhibition of nodium reabsorption in the nearby tube. Losartan also increases the elimination of urinary uric acid, in patients with hypertension without diabetes but has proteinuria (≥ 2 g/24 hours) treated for 8 weeks, using Losartan Kali 50 mg to 100 mg reduces the meaning of proteinuria about 42%. The excretion of albumin and IgG also significantly decreased, in these patients, Losartan maintains the speed of glomerular filtration and reduces filtration capacity.
In hypertension women after menopause are treated with Losartan Kali 50 mg for 4 weeks, it does not see the effect on prostaglandin content in the kidney or body.
Losartan does not work on automatic reflexes and does not work to maintain norepinephrin in plasma.
Losartan Kali used at doses up to 150 mg high once a day, does not cause clinical changes such as triglycerides at hunger, total cholesterol or HDL - cholesterol in patients with hypertension. Such losartan doses do not work on blood glucose content.
In general, Losartan reduces uric acid in serum (usually In a 12 -week parallel design study in patients with left ventricular failure (degree II - IV according to the functional classification of the New York Heart Association), most patients who have used diuretics and/or digitalis, now use Losartan Kali on the lane of 2.5 doses; 10; 25 and 50 mg compared to plantbo.
Doses of 25 mg and 50 mg increases hemodynamic effects and nerves; These effects are maintained during the research period. The hemodynamic response is characterized by increasing the heart index and reducing: the pressure of the pulmonary capillary seasoning, the body's pulse resistance, the average body blood pressure and the heart rate. Hemorrhage drops are related to dosage in patients with heart failure. The nerve effect is characterized by reducing the content of aldosteron and norepinephrin in the circulation.
amlodipine
Hemodynamics: After taking the treatment dose for patients with hypertension, amlodipine causes vasodilation, leading to lowering blood pressure on their backs and standing posture. This reduced blood pressure is not accompanied by a significant change in heart rate or catecholamine level in general blood when used for a long time. Although Amlodipine acute intravenous injection reduces arterial blood pressure and increases heart rate in the studies of hemodynamics of patients with chronic myocardial anemia. Amlodipine for long -term use in clinical trials does not change clinical significance of heart rate or blood pressure in patients with myocardial anemia with normal blood pressure. With the way to take the drug once a day lasts for many days, the anti -hypertension effect remains at least 24 hours. The concentration of plasma drugs is associated with the effects of both the elderly. A amlodipine blood pressure amplitude is also associated with hypertension before treatment; For example, moderate hypertension people (diastolic blood pressure 105 - 114 mmHg) have a response of about 50% larger than patients with mild hypertension (diastolic blood pressure 90 - 104 mmHg). Normal blood pressure people do not change clinical blood pressure (+1 to -2 mmHg).
In people with normal hypertension with normal renal function, amlodipine treatment dose do reduces the kidney resistance and increases the speed of glomerular filtration and blood flow effectively through the kidneys without changing filter or proteinuria.
As with other calcium channel blockers, the hemodynamic values of the heart function at the time of rest and during exertion (or pacemaker) in patients have a normal ventricular function using amlodipine, increasing little heart index without meaning to DP/DT, or on blood pressure or left -end volume of left ventricle. In hemodynamic studies, Amlodipine does not have the effect of reducing contractions when used within the dosage treatment for intact animals and humans, even when used with beta blockers for humans. However, similar results are found in patients with normal heart failure or heart failure is good for drugs that reduce the meaning of heart contractions.
Effects on physiological electrophysiology: Amlodipine does not change the function of the atrial sinus button or atrial transmission in intact animals or humans, in patients with stable chronic myocardial anemia, 10 mg intravenous injection, which has a change of A-H transmission (from the atrial to HIS) and H-V (from His to the center of ventricular) and the recovery time after transplanting the rhythm machine. Similar results are obtained in patients with amlodipine and beta blockers simultaneously. In clinical studies using amlodipine in combination with beta blockers for patients or hypertension or angina, there is no complications on the electrocardiogram. In clinical trials in patients only suffering from angina, Amlodipine does not change the amount of on the center of the center or causes a higher level of atrial block.
pharmacokinetics
In studies to evaluate the pharmacokinetics of the combined product, monomers on mice and dogs shows no significant differences in Amlodipine pharmacokinetics and metabolites or Losartan and metabolites with Exp3174 activity, when using Amlodipine Camsylate and Losartan or drugs. There is no impact on pharmacokinetics when using products combining Amlodipine Camsylate and Losartan in mice and dogs. A study on healthy people also confirmed that there was no interaction between Amlodipine Camsylate and Losartan.
absorption
losartan
After drinking, Losartan absorbs well and is initially metabolized in the liver, forming a carboxylic acid metabolite that is active and other metabolites are no longer active. The whole body of Losartan tablets is about 33%. The average peak concentration of Losartan and metabolites is still active in the order of 1 hour and 3-4 hours. There is no clinical effect of Losartan's concentration in plasma when the drug is used with a standard meal.
amlodipine
After taking amlodipine the dose of treatment, the absorption causes peak concentration in the plasma between 6 and 12 hours. Absolute bioavailability is 64 - 90%. Amlodipine's bioavailability does not change when there is food.
distribution
losartan
Both Losartan and metabolites are also associated with plasma proteins ≥99%, mainly with albumin. The distribution of Losartan is 34 liters. The studies in white rats show that Losartan passes through the brain barrier very poorly, if not absolutely not.
amlodipine
EX Vivo studies are only about 93% of drugs during circulation associated with plasma proteins of hypertension.
transformation
losartan
About 14% of the dose of Losartan oral or intravenously converts into an active metabolic substance. After taking or intravenously Losartan Kali marks 14C, radioactive activity in plasma is mainly of Losartan and its active metabolites. The metabolism of Losartan into its active metabolites is only about 1% of the researchers.
Along with the active metabolites, the no longer active metabolites are also formed, including 2 main metabolites due to the hydroxylation of the butyl side circuit, and a metabolic substance in low amount in the form N - 2 tetrazol glucuronid.
amlodipine
Amlodipine is very strongly metabolized (about 90%) into metabolites that are no longer active through the metabolism in the liver. About 10% of the mother and 60% of the metabolites except for urine.
Elimination
losartan
Losartan's plasma clearance and metabolites are also active in the order of about 600 ml/min and 50 ml/minute. The kidney clearance of Losartan and metabolites is also active in the order of about 74 ml/min and 26 ml/min. When taking Losartan, about 4% of the dose is eliminated in the form of unchanged urine, and about 6% of the dosage is eliminated in the urine in the form of metabolites. The pharmacokinetics of Losartan and metabolites are also active in proportion to the oral dosage of Losartan Kali to the dose of 200 mg.
After drinking, Losartan's plasma concentrations and its metabolites decrease in the exponential function with half -life except for the last elimination in the order of about 2 hours and 6 - 9 hours. While using a 100 mg dose once a day, both Losartan and the metabolites and its active active are not meaningful in plasma.
Losartan and its metabolites are excreted both through the bile and through the urine. After taking a losartan dose marked 14C in humans, about 35% of radioactive activity found in urine and 58% in feces. After intravenous injection, a losartan dose marks a person, about 43% of radioactive activity is seen in urine and 50% in feces.
amlodipine
The excretion of serum in two phases with half -life eliminates the last phase about 30-50 hours. Amlodipine concentration in plasma in kinetic balance state is achieved after 7 to 8 days when used continuously once a day.
Patient characteristics
cozaar xq
Cozaar XQ has not been studied in a special patient population, because the nature of Losartan and Amlodipine has been known very well.
Be careful when using Losartan for people with kidney failure and liver failure, and contraindicated for breastfeeding women. The official research has not been conducted in the elderly and children. For amlodipine, caution should be cautious in people with liver failure, and contraindicated in people with unstable cardiovascular disease and pregnant or breastfeeding women.
losartan
Losartan concentration and metabolites are also active in elderly men with hypertension are not different from young men with hypertension.
Losartan concentration in plasma in hypertension women is 2 times higher than men hypertension. The concentration of metabolites is still active, not different between men and women. The difference in pharmacokinetics has been evaluated and found that there is no clinical significance.
After drinking in patients with mild and medium alcoholic cirrhosis, Losartan's plasma concentrations and its metabolic substance in order are 5 times larger and 1.7 times compared to young men.
Losartan concentration in plasma does not change in patients with renal clearance of over 10 ml/min. Compared to patients with normal AUC kidney function of Losartan about 2 times larger than patients with dialysis. The plasma concentration of metabolites is still active in patients with kidney failure or dialysis. Both Losartan and its metabolites are not removed when dialysis.
amlodipine
The pharmacokinetics of Amlodipine are not affected by the kidney failure. Therefore, patients with renal failure may use the starting dose as usual.Elderly patients and patients with hepatic impairment have decreased amlodipine clearance, so AUC increases by 40-60% and requires a lower starting dose. AUC increases similarly in patients with medium to severe heart failure.
62 patients with hypertension aged 6 to 17 have taken the dose of amlodipine from 1.25 to 20 mg. If calculating the weight, the clearance and distribution of the distribution are similar to adults.
Before taking Cozaar XQ 5/100mg Organon Treatment Treatment of Definitely Hypertension (3 blisters x 10 tablets)
How to use
Cozaar XQ can be used during or outside meals. Cozaar XQ should be taken with water.
Dosage
The recommended dose of Cozaar XQ is a tablet.
Cozaar XQ can be used with other anti -hypertension drugs.
Losartan is an effective medication to treat hypertension, the dose once a day 50 mg to 100 mg, and Amlodipine is effective at the dose of 5 mg to 10 mg when used for monomers. The maximum dose recommended by Cozaar XQ is 100 mg/5 mg.
Patients with non -controlled blood pressure with single Losartan or single amlodipine can be transferred to coordinate treatment with Cozaar XQ.
Cozaar XQ 50 mg/5 mg is used for patients with unprover blood pressure with Losartan 50 mg or Amlodipine 5 mg alone.
Cozaar XQ 100 mg/5 mg is used for patients with unprover blood pressure with Losartan 100 mg or Cozaar XQ 50 mg/5 mg.
Patients who are taking both Losartan and Amlodipine may switch to Cozaar XQ (a fixed dosage combination form of each drug) for convenience) for convenience.
Used for patients with renal failure
No dose adjustment in patients with mild renal impairment (creatinine clearance 20 - 50 ml/minute). For patients with medium to severe renal failure (Creatinine clearance
Used for patients with dehydration in the circuit
For patients with dehydration in the vessel (such as patients with high doses of dosage), the starting dose of 25 mg Losartan should be used once a day. Because there is no 25 mg of Losartan in Cozaar XQ drug, this dose is needed with a single therapy Losartan.
Used for patients with liver failure
In cases where low -dose Losartan is required (25 mg once a day) for patients with a history of liver failure, it is not recommended to use Cozaar XQ.
Used for the elderly
Elderly people have decreased clearance, so the treatment of amlodipine should start at a dose of 2.5 mg daily. But there is no 2.5 mg of amlodipine in Cozaar XQ drug, so this dose is needed with a single amlodipine.
Used for minors and children
Because the safety and effectiveness of Cozaar XQ has not been identified in children ≤ 18 years old, it is not recommended to use Cozaar XQ.
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? Overdose of each component Amlodipine and Losartan is described as follows:
losartan
The existing figures of overdose in people are limited. The most common manifestation is hypotension and tachycardia; Slow heart rate can occur due to sympathetic nerve stimulation (vagus nerve). If symptoms of hypotension occur, supportive treatment.
Both Losartan and metabolites are also active, they cannot be removed by blood decay.
amlodipine
Overdose can cause excessive peripheral vasodilation leading to strong hypotension and can lead to reflected tachycardia. In humans, amlodipine overdose experience is limited.
The only dose of amlodipine maleat is equivalent to 40 mg of amlodipine/kg and 100 mg of amlodipine/kg causes death in the order in white rats and white rats. The single doses of amlodipine maleat are equivalent to 4 mg/kg or more or higher in dogs (11 times or more to the maximum recommendations for people on the basis of the dose calculated by mg/m2), causing very strong peripheral vasodilation and hypotension.
If overdose occurs, actively monitor the heart and respiration. Regular blood pressure measurement. If there is a drop in blood pressure, cardiovascular support is required, including lifting limbs and using fluid properly. If hypotension remains not responding to these mild measures, hypertension may be used (such as phenylephrin) but should pay attention to the volume of circulation and urinary efficiency. Because Amlodipine is bound to protein, bloody decentralization does not seem useful.
In an emergency, call the 115 emergency center immediately or go to the nearest local health station.
What to do when you forget 1 dose? However, if the time to relax with the next dose is too short, skip the dose and continue the calendar of the drug. Do not use double dose to compensate for missed dose.
Side Effects
The safety of Cozaar XQ has been assessed in 325 patients with Losartan/Amlodipine Camsylate combination therapy among 646 patients with idiopathic hypertension in three clinical trials (studies of 201.31 and 302) for 8 weeks. The adverse reactions have been reported:
Common (≥ 1/100,
The following adverse reactions have been reported to the components of Cozaar XQ:
losartan
Because clinical trials are conducted under very different conditions, the adverse reaction rate observed in the clinical trials of a drug cannot be compared directly in other drug clinical trials and may not reflect the adverse reaction rate observed in practice.
Losartan generally tolerates well in clinical trials that treat high blood pressure with tests, mild and transient side effects, and no need to stop the drug. The general ratio of the side effects of Losartan is equivalent to the placebo.
In clinical trials that have been tested when treating blood pressure, dizziness is the only side effect that occurs with drugs larger than Placebo in more than 1 % of patients using Losartan. In addition, the hypotension effect of standing posture is associated with the dose occurring in less than 1 % of the patient. The skin rare is very rare, even in clinical trials, the ratio of skin rash is less than Placebo.
In double blind clinical trials for treatment of idiopathic hypertension, the following adverse reactions have been reported in the Losartan group ≥ 1% of patients, regardless of whether it is related to drugs:
losartan
(n = 2085)
Placebo
(n = 535)
body breasts
3,1
Also in the above study, patients who have never had diabetes have a new rate of diabetes due to lowering Losartan than atenolol (in order of 242 compared to 320 with p
Losartan generally tolerates well in a clinical trial tested in patients with type 2 diabetes with proteinuria. The most common side effects related to drugs are weakness/fatigue, dizziness, hypotension and hyperkalemia.
There are more adverse reactions that have been reported during marketing:
Hypersensitivity: Anaphylactic reactions, angels including laryngeal swelling and subjects causing respiratory traces and/or swelling of the face, lips, throat and/tongue have been reported, though rare in patients using Losartan; Some of these patients have had angels in advance due to other drugs including ACE inhibitors. Vascular inflammation, including Henoch-Schoenlein hemorrhage, has a rare report.
Because clinical trials are conducted under very different conditions, the adverse reaction rate observed in the clinical trials of a drug cannot be compared directly in other drug clinical trials and may not reflect the adverse reaction rate observed in practice.
Amlodipine Besylat has been assessed for safety in 11,000 patients in tests worldwide. In general, amlodipine besylat treatment is well tolerated at daily dose to 10 mg. The most adverse reaction in the treatment with Amlodipine Besylat is only mild or moderate. In clinical trials with direct comparison of Amlodipine Besylat (n = 1,730) at a dose of up to 10 mg with Placebo (n = 1,250), it is necessary to stop treating amlodipine besylate due to a stroke because of only about 1.5 % of patients and not different from Placebo (about 1 %). The most common side effect is headache and edema. The ratio (%) of side effects occurs according to the dose as follows:
Warnings
Before using the drug you need to read the instructions carefully and refer to the information below.
contraindicated
Cozaar XQ 5/100mg contraindicated drug in the following cases:
Caution when using
cozaar xq
Patients with volume reduced (for example, people treated with diuretics).
Patients with strict salt restrictions.
Patients with average to severe to severe renal impairment (creatinine clearance
Patients with hyperkalemia.
Hemorrhage lag
Patients with a decreased blood vol Reducing blood volume in the vessel should be adjusted before using Cozaar XQ, or a low starting dose. Because the beginning of the effect gradually, the hypotension often does not occur.
Hepatic failure
Based on the results of pharmacokinetics research, the Losartan concentration in plasma is significant in cirrhosis patients, therefore, lower losartan dose is needed for patients with liver failure.
Because amlodipine is strongly metabolized in the liver and half -life eliminates from plasma (T1/2) is 56 hours in patients with liver failure, increasing or decreasing slow doses when taking amlodipine for patients with severe liver failure.
losartan
Toxicity for pregnancy:
The use of drugs on the Renin - Angiotensin system in the middle and the last three months of pregnancy reduces the kidney function of the fetus, increases disease and death in the fetus and babies. The amniotic fluid results may be associated with reduced lung production and skeletal deformation in fetuses. The possible side effects in newborns include reducing skull production, anuria, hypotension, renal failure and death. When detecting pregnancy, it is necessary to stop Cozaar XQ as soon as possible.
Hypersensitivity: eagle.
Electrolyte imbalance:
Electrolyte imbalance is common in patients with renal failure, having or without diabetes and should be concerned. In a clinical study conducted in patients with type 2 diabetes with proteinuria, the rate of hyperkalemia in Losartan treatment group is higher than the Placebo group, however, few patients have to stop treatment due to hyperkalemia (see side effects and test results).
kidney failure
As a result of the inhibition of the Renin - Angiotensin system, renal function changes including renal failure have been reported in sensitive individuals; These renal function changes can recover when stopping treatment.
Other drugs that affect the Renin - Angiotensin system may increase serum blood and creatinine urea in patients with patients on both sides of the kidneys or the kidney stenosis of the human kidney. The same effect has been reported to Losartan; These changes of kidney function can recover when stopped treatment.
amlodipine
Increased angina or myocardial infarction:
Acute angina and myocardial infarction may develop after the beginning or increase of amlodipine dose, especially in patients with severe coronary artery disease.
Use in children
Because the safety and effectiveness of Cozaar XQ for children ≤ 18 years old has not been determined, it is not recommended to use Cozaar XQ.
Babies have a history of cozmr xq exposure in the uterus:
If the urinary or hypotension occurs, pay attention directly to the support of blood pressure and kidney perfusion. It may be necessary to transmit blood or fertilizer as a measure to reverse hypotension and/or instead of kidney function.
Used in older people
In clinical studies, it is not relevant to the age to effectively or the safety of Losartan.
Because the clearance of amlodipine decreases in the elderly and as a result, AUC increases by 40 - 60%, Amlodipine therapy needs to start with a daily dose of 2.5 mg daily. Because the amlodipine 2.5 mg dose is not found in Cozaar XQ drug, this dose is needed with a single amlodipine.
Use drugs for women during pregnancy and lactation
used in pregnant women
Medicines directly acting on the Renin - Angiotensin system can cause damage and developing pregnancy. When detecting pregnancy, it is necessary to stop Cozaar XQ as soon as possible.
Although there is no experience in using cozaar XQ for pregnant women, the Losartan Kali studies on animals prove fetus or newborn child is damaged or died, the mechanism is thought to be pharmacological effects on the renin -angiotensin system. In humans, the renal formation process of pregnancy, although depends on the development of the Renin - Angiotensin system, usually starts in the second three months; Therefore, the risk for pregnancy increases, if Cozaar XQ is used in the second or third month of pregnancy.
The use of drugs on the Renin - Angiotensin system in the middle and the last three months of pregnancy reduces the kidney function of the fetus, increases disease and death in the fetus and babies. The amniotic fluid results may be associated with reduced lung production and skeletal deformation in fetuses. The possible side effects in newborns include reducing skull production, anuria, hypotension, renal failure and death. When detecting pregnancy, it is necessary to stop Cozaar XQ as soon as possible.
These harmful results are often associated with the use of these drugs in the middle and the last three months of pregnancy. Most epidemiological studies survey abnormalities in fetuses after exposure to anti -hypertension drugs used in the first three months of pregnancy, regardless of drugs that affect the Renin - Angiotensin system with other anti -hypertension drugs. The appropriate management of hypertension in the mother during pregnancy is important to optimize the results for both mother and pregnancy.
In special cases, when there is no appropriate replacement treatment for drug treatments that affect the Renin - Angiotensin system for a separate patient, must notify the mother about the risk that may occur for the fetus, need to conduct ultrasound tests to assess the environment in the amniotic fluid. Stop using cozaar XQ if observed with amniotic fluid unless this drug is considered a drug to save life for the mother. The pregnancy test may be suitable based on the week of gestational age. However, doctors and patients should know that amniotic fluid may not show until after the fetus has been injured for a long time, it is necessary to closely monitor babies with a history of cozaar XQ exposure in the uterus on manifestations
There are no appropriate studies and good test amlodipine in pregnant women.
Used in breastfeeding women
It is not known whether Losartan or Amlodipine will be secreted into breast milk. Because many drugs are given to breast milk and because of the ability to cause damage to breastfeeding, it is necessary to consider whether to stop breastfeeding or stop taking the drug, depending on the importance of the drug for the mother.
The effect of drugs on driving and operating machinery
has not conducted any research of Cozaar XQ on the influence of driving and operating machinery. However, some of the adverse effects of Cozaar XQ have been reported may affect the ability of patients to drive and operate machinery. The response of each individual with Cozaar XQ is different.
Drug interaction
has not conducted research on drug interactions of Cozaar XQ and other drugs, but each Losartan and Amlodipine drugs have been studied as described below.
losartan
There is no drug -and -pharmacokinetical drug interaction with clinical significance found in studies on interactive with hydrochlorothiazide, digoxin, warfarin, cimetidine and phenobarbital. Rifampin is a substance that induces drug metabolism, reducing the concentration of active, human metabolites, and two 3A4 inhibitors have been studied. Ketoconazole does not affect the conversion of Losartan into active metabolites after losartan intravenous injection, and erythromycin have no clinical significance after oral losartan. Fluconazole is a P450 2C9 inhibitor, reducing the concentration of active metabolites. The consequences of simultaneous use Losartan and inhibitors
P450 2C9 has not been seen. The non -metabolic objects of Losartan into active metabolites have been shown to have specific and rare defects about Cytochrome P450 2C9. But this data shows that the conversion of Losartan into metabolites has the main activity of P450 2C9 intermediaries and not P450 3A4.
As well as other Angiotensin II blockers, simultaneous use of potassium -keeping pills (such as spironolacton, triamteren, amilorid), potassium supplements, or salt -containing substances containing potassium can increase potassium in serum.
As well as other drugs that affect sodium elimination, liti elimination may decrease. Therefore, the lithium content in serum should be carefully monitored if the liti salts are used with Angiotensin II receptor antagonistic drugs.
Non-steroid anti-inflammatory drugs (NSAID) including cyclooxygenase-2 inhibitors (COX-2), which can reduce the effects of ureter and other anti-hypertension drugs. Therefore, the anti-hypertension effect of Angiotensin II receptor drugs or ACE inhibitors can be reduced by NSAIDs including selective COX-2 inhibitors.
In some patients with impaired renal function (such as elderly patients or patients with a decreased blood vol These effects often recover. Therefore, the coordination should be very careful in patients with impaired renal function.
amlodipine
In vitro results
In vitro research results show that Amlodipine does not work on the link with Digoxin, Phenytoin, Warfarin and Indomethacin.
cimetidine
Use amlodipine along with cimetidine does not affect the pharmacokinetics of amlodipine.
Squeezing grapefruit juice
Use a combination of 240 ml of grapefruit juice with a single dose of amlodipine 10 mg for 20 healthy volunteers, not meaningful effect on amlodipine pharmacokinetics.
anti -acid Magnesi and aluminum hydroxyd
Use combination of anti -acid drugs such as magnesi and aluminum hydroxyd with a single dose of amlodipine does not have a significant effect on pharmacokinetics of amlodipine.
Sildenafil
A single dose of 100 mg of Sildenafil for people with idiopathic hypertension does not work on amlodipine pharmacokinetics parameters. When Amlodipine and Sildenafil are used in combination, each drug has its own independent hypotension.
Atorvastatin
Use a combination of 10 mg of amlodipine with 80 mg atorvastatin does not change the dynamic balance of the pharmacokinetics parameters of Atorvastatin.
Simvastatin
Use a combination of many doses of amlodipine 10 mg with simvastatin 80 mg resulting in an increase of 77% in contact with simvastatin compared to when using Simvastatin alone. Limit the dose of simvastatin in patients who are taking amlodipine to 20 mg/day.
digoxin
Use amlodipine combination with digoxin does not change the concentration of Digoxin in the serum, nor does it change the kidney clearance of Digoxin in normal volunteers.
Ethanol (alcohol)
single dose or multiple 10 mg doses of amlodipine does not have significant effects on pharmacokinetics of ethanol.
warfarin
Use amlodipine combination with warfarin does not change the time to respond to prothrombin of warfarin.
Interaction with test parameters
Unknown.
Storage
Store at temperatures below 30 ° C (86 ° F). Store in the original packaging. Avoid moisture.
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