Levistel 40 Tada Pharma tablets treated with idiopathic hypertension (4 blisters x 7 tablets)

Precautions for use

There is a risk of strong hypotension and renal failure when the patient has narrowed kidney stenosis on both sides or one side treated with drugs that influenced on the Rennin-Antotensin-ALDosteron system.

kidney failure and kidney transplant

Periodically monitor potassium and blood creatinine concentrations when Telmisartan is used in patients with renal failure. There is no experience using Telmisartan in the new kidney transplant patient.

Intravascular volume exhaustion

Symptomatic hypotension may occur, especially after the first dosage in patients with a decrease in intravascular volume or sodium reduction due to treatment with strong diuretics, a diet that limits salt, diarrhea or vomiting. It is necessary to treat the patient before using Telmisartan.

Những bệnh lý khác làm kích thích hệ thống Renin - Angiotensin - Aldosteron ở bệnh nhân có chức năng thận và trương lực mạch ưu tiên phụ thuộc vào hoạt động của hệ thống Renin - Angiotensin - Aldosterone (ví dụ: Bệnh nhân bị suy tim sung huyết nặng hoặc bệnh thận bao gồm hẹp động mạch thận), việc điều trị phối hợp với các thuốc khác có ảnh hưởng đến hệ thống Renin - Angiotensin - Aldosteron sẽ gây hạ huyết áp cấp, tăng Blood nitrogen, urinary or acute renal failure (rare).

Increasing primary aldosteron

In general, patients with primary aldosterone increases will not respond to antihypertensive drugs that act on the inhibition of the Renin - Angiotensin system. Therefore, Telmisartan should not be used in these patients.

Security of mitral valve and aortic valve, hypertrophic heart muscle disease

As other vasodilators, special attention should be paid to patients with aortic valve stenosis or mitral valve or congested heart muscle.

Hemorrhage

When treated with drugs that affect the Renin - Angiotensin - Aldosteron system can cause hyperkalemia, especially in patients with renal failure or heart failure. Monitoring the amount of blood potassium in patients is at risk of recommended.

The use in combination with the benefits to keep potassium/potassium supplements, replacement salts containing potassium or other drugs may increase blood potassium concentration (e.

Hepatic failure

Telmisartan is excreted mainly through bile. The removal is impaired in patients with biliary or liver failure, which should be used cautiously in these patients.

Other notes

Through studies on angiotensin enamel inhibitors show that Tehnisartan and other Angiotensin antagonists have a significant lower pressure effect in darker people in other colored people. Maybe because the body of the black high blood pressure has a lower amount of renin.

Like all antihypertensive drugs, excessive decrease in blood pressure in patients with cardiovascular disease due to ischemia can lead to myocardial infarction or stroke.

The ability to drive and operate machinery

There is no research on the effects of the drug on the ability to drive and control machines. However, when driving or operating machinery, it is important to pay attention to the feeling of dizziness or drowsiness can sometimes occur during the treatment of high blood pressure.

Pregnancy

do not recommend the use of Angiotensin II receptor drugs in the first 3 months of pregnancy. Contraindicated using Angiotensin II receptor drugs in 3 months between and at the end of pregnancy.

Breastfeeding period

Because there is no information on using Telmisartan during breastfeeding, it is not recommended to use Telmisartan and should prioritize replacement drugs with safety data that have been determined in this period, especially for infants and children with shortage.

Medicinal interaction

Telmisartan may increase the effect of other hypotension drugs. Other interactions are not significant clinical significance.

There is no clinical significant interaction when using Telmisartan simultaneously with digoxin, warfarin, hydrochlorothiazid, glibenclamid, ibuprofen, paracetamol, simvastatin and amlodipine. Digoxin bottom concentration is found to increase by 20% (in a single meeting of 39%) should consider monitoring the concentration of digoxin in plasma.

Increased plasma and recovery lithium concentration has been recorded when shared with lithium with angiotensin transfer enzymes inhibitors. In some cases, it has also been reported when used with Angiotensin II receptor antagonist. Therefore, lithium concentration should be monitored when using two drugs.

Diuretics keep potassium or potassium supplements

Angiotensin II receptor antagonists like Telmisartan, reduced to cause potassium loss of diuretics. Diuretics hold for example Spirinolacton, Eplerenon, Triamteren or Amilorid, supplementing potassium, or salt containing potassium can lead to significant increase in blood potassium. If used simultaneously due to hypokalemia has been determined, the pharmacy should be used carefully and often monitor blood potassium.

Non -steroid anti -inflammatory drugs (NSAID)

Simultaneously used with NSAID drugs (such as acetylsalicylic acid at doses for anti-inflammatory effects, COX-2 inhibitors and non-selective NSAID drugs) can reduce the effect of lowering the blood pressure of Angiotension II receptor anti-receptor drugs. In some patients with reduced renal function (patients with dehydration or elderly people reduce renal function), the coherent effect of Angiotension II receptor antagonists and cyclo-oxygenase inhibitors can lead to more renal failure including acute renal failure, often recovered. Therefore, this combination should be careful, especially in the elderly. The patient should be fully rehydrated and monitor the kidney function from the beginning of the combination and periodic treatment.

The anti -hypertension effect of Telmisartan drugs is reduced by the inhibition of vasodilic prostaglandin that has been reported during treatment in combination with nonsteroidal anti -inflammatory drugs.

In a combination of Telmisartan and Ramipril, it led to an increase of 2.5 times ACO24 and CMAX of Ramipril and Ramiprilat. Unknown clinical involvement of this observation.

corticosteroids (using the whole body)

Reducing the hypotension effect of Temisartan.