Savi Dopril Plus medicine for treatment of arterial hypertension (10 tablets x 3 blisters)
Dosage form Box of 3 blisters x 10 tablets
Specifications Indapamide, perindopril
Ingredient
Thành phần cho 1 viên
| Composition information | Content |
| Indapamide | 1.25mg |
| Perindopril | 4mg |
Uses
indications
Savi Dopril Plus drugs are indicated for treatment of hypertension arterial artery. Use drugs for patients with uncontrolled blood pressure if only perindopril is used.
Pharmacokology
Savidopril Plus is a combination of Perindopril's Tert-butylamin salt (enzyme inhibitors) with indapamid Hemihydrate (chlorosulfamoyl group). The pharmacological essences of the drug are a combination of two ingredients in the formula.
involves Perindopril
Perindopril is an enzyme inhibitor that converts angiotensin, which is applied through Perindoprilat metabolites. Perindopril prevents Angiotensin I into Angiotensin II, a strong vascular shrink and promotes blood vessel and heart muscle cells growth. The drug also reduces serum aldosteron, which also reduces sodium holding in the body, reduces Bradykinin decomposition, a strong vasodilator and can change Prustenoid metabolism and inhibit sympathetic nervous system.
In humans of hypertension, Perindopril reduces blood pressure by reducing the peripheral barrier, accompanied by a slight or no heart rate, center -centered or cardiac flow. The drug often causes arterial dilatation and may have vein. Hypoglycemia and tachycardia rarely occur, but often causes hypocthurizing or hypoglycemia.
blood pressure returns to normal for a month and remains stable when long -term treatment. The effect is maintained for 24 hours when taking 1 single dose. Vasodilation and elastic restoration of arteries have been confirmed with left ventricular hypertrophy.
Using additional diuretics will maximize the lowering effect. In people with congested heart failure, Perindopril reduces left ventricular hypertrophy and excess collagen under endocardium, restoring the ISO enzyme properties of myosin and reducing the appearance of arrhythmia. Perindopril reduces the heart's load (both money and post -load). Perindopril reduces the pressure of pumping blood into the right and left ventricle, reducing the body's boundaries, mitigating the heart frequency, increasing cardiac weight. With the recommended dose, blood pressure does not change clearly when taking the first dose as well as long -term.
Long -term drug treatment does not change kidney function or potassium. The drug does not change glucose tolerance, uric acid concentration or cholesterol in the blood.
related to indapamid hemihydrate
indapamid hemihydrate is a diuretic sulfonamid, with indol nucleus, not belonging to the thiazid group.
Drugs have diuretic and anti -hypertension effects.
diuretic effect
Similar to thiazid diuretics, indapamid hemihydrate increases sodium chloride and water excretion by inhibiting the reabsorption of sodium ions in the distal tube in the kidney shell. Sodium and chloride excretion drugs, potassium and magnesi are less than a level, thus increasing the urethra.
Use indapamid hemihydrate long -term can cause mild alkaline infection, accompanied by reduced potassium and blood chlorine. In patients with hypercalcemia, Hemihydrate indepamid reduces calcium excretion through urine. Hemihydrate indapamid at the dose of treatment, can reduce the secretion of uric acid through the urine. There have been some reports of patients with hyperuricemia when using indapamid hemihydrates.
Anti -blood pressure effect
Anti -hypertension effects of Indapamid Hemihydrate have a major mechanism outside the kidney. This mechanism causes the circuit to return to normal and reduce peripheral artery resistance. The mechanism of blood vessel acting is explained by a decrease in the contraction of blood vessel smooth muscles due to changing the exchange of ions through the membrane, especially calcium ions, vascular dilatation due to the synthesis of prostaglandin, lowering blood pressure such as PGE2, PGI2, eventually enhancing the vascular relaxation effect of Bradykinin.
The anti -hypertension effect of the drug has been shown to have an external mechanism of kidneys due to maintaining anti -hypertension in people with hypertension without kidney function.
Indapamid hemihydrate 2.5 mg daily dose has shown to have long -term anti -hypertension effect and reach the maximum level, and diuretic effects are not available.
Metabolic effect
Indapamid Hemihydrate proved to have little impact on triglycerides, total cholesterol, high density lipoprotein (HDL), lipoprotein very low density (VLDL) and low density lipoprotein (LDL) in serum, although the data when long -term treatment is limited. Hemorrhage glucose usually does not change, although increased blood glucose in some patients.
Dynamic pharmacokinetics
Regarding the combination of "perindopril + indapamid hemihydrate"
The combination of Perindopril and Indopamid Hemihydrate does not change the pharmacokinetic properties of both active ingredients compared to separate use.
Related to Perindopril
After drinking, Perindopril is quickly absorbed (reaching the peak concentration in 1 hour) and strongly metabolized mainly in the liver into Perindoprilat that is active and some other non -active metabolites include glucuronids (bio -used: 65 - 70%). Perindopril's waste sale time in plasma is 1 hour.
About 20% is transformed into Perindoprilat. Perindoprilat peak concentration in plasma is achieved after 3-4 hours. Food reduces the transformation into Perindoprilate and thus reduces bioavailability. Perindoprilai distribution volume is approximately 0.2 liters/kg. The drug is less attached to protein, less than 30%, but depends on concentration.
Perindoprilat is eliminated in urine and the sale time is about 3 to 5 hours. Perindoprilat separation associated with Angiotensin conversion enzyme creates a "effective" sale time of 25 hours. No Perindoprilat accumulation phenomenon after repeated dose and stable concentration for 4 days. In the elderly, people with congestive heart failure and patients with renal insufficiency, Perindopril eliminated slower. The dose adjustment should be based on creatinine clearance. The clearance of Perindopril is 70 ml/min.
Related to indapamid hemihydrate
Indapamid Hemihydrate is absorbed quickly and completely through the stomach - intestines. Food or antacids almost does not affect the absorption of the drug. After drinking, the peak concentration in the blood is reached for about 2 to 2.5 hours. Indomamid Hemihydrate prefers lipids and is widely distributed in the body. About 71% - 79% of the drug associated with plasma proteins. The drug is also associated with the carbon dioxide in erythrocytes.
The sale time of indapamid Hemihydrate is about 14 - 18 hours in adults with normal kidney function. In people with impaired renal function, the sale time of the drug does not last long. Indomamid Hemihydrate is strongly metabolized in the liver, mainly into glucuronid and sulfate complexes.
About 60% of the drug excreted through the urine within 48 hours, only 7% of the drug excreted in the form of the body. About 16% - 23% of the drug excreted into the feces, via bile. Hematopathy does not eliminate Indapamid Hemihydrate.
Before taking Savi Dopril Plus medicine for treatment of arterial hypertension (10 tablets x 3 blisters)
How to use
Savidopril Plus preparations are taken once in the morning, before meals.
It is recommended that the dosage for each patient. In each case, it is possible to consider direct replacement from Perindopril (Savidopril) to Perindopril + Indapamid Hemihydrate (Savidopril Plus).
Dosage
Adults
Initial dose: 2 mg Perindopril/0.625 mg indapamid (need to choose the appropriate dosage format). The dose can be increased to 4 mg Perindopril/1.25 mg indapamide/day.
kidney failure
Need to adjust the dose depending on the clearinine clearance:
Children
Do not use drugs for children because of the efficiency and safety of Perindopril, whether used separately or in combination drugs.
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? Salt and water disorders (low potassium and sodium concentrations).
The first measures are to quickly emit the components of the eagle to wash the stomach and/or take activated carbon, then balance the fluid and electrolytes at the specialist, until returning to normal. If you experience obvious hypotension, treatment should be treated by letting the patient lies on his back, lowering his head. If necessary, intravenously with isothermal NaCl solution or use other methods to compensate for the volume.
perindopril can be fertilized (70 ml/min).
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 Savi Dopril Plus , you may experience unwanted effects (ADR).
Regarding the combination of Perindopril + Indapamid Hemihydrate (Savidopril Plus)
Stop Perindopril will inhibit the renin-analiotensin-aldosteron and tend to reduce the loss of potassium caused by Indapamid Hemihydrate.
There are 4% of patients taking this drug with hypokalemia (potassium level
gastrointestinal tract
Meet, ADR> 1/100 and
Respiratory system
Meet, ADR> 1/100 and
cardiovascular system
Uncommon, 1/1000 DA Uncommon, 1/1000 Uncommon, 1/1000 Hematology system Very rare, ADR Related to indapamid hemihydrate: Indapamid Hemihydrate, with treatment dose, is often well tolerated and has little unwanted effects. The dose reduction can sometimes reduce the rate of appearance and the severity of unwanted effects. About 2 - 10% of patients using Indapamid Hemihydrate must stop using the drug due to unwanted reactions. Because Indapamid Hemihydrate can cause electrolytes, it is necessary to periodically determine the concentration of electrolytes in serum, especially for sodium ions, potassium, chloride and bicarbonate, for those who are taking the drug. To prevent or treat hypokalemia, it is necessary to take measures to maintain normal serum concentrations and supplement potassium if necessary. Rooming hypotension is especially important when using indapamid hemihydrates with high doses (> 5 mg/day) simultaneously with cardiac glycosides or potassium loss drugs such as corticosteroids, corticotropine, or for patients with cirrhosis or hyperloston and for cases where hypotension is considered to be a risk, such as a history of ventricles. Periodically determine the concentration of electrolytes in serum is especially important for patients with vomiting, diarrhea, patients who are infusing, people who are sick can cause disorders of electrolytes such as heart failure, kidney disease and patients to eat lightly. People with edema may increase the risk of hypoglycemia due to thin blood. Often treated with restrictions on the body (500 ml/day) and stop using the drug. In case of hyperuricemia and gout, it is recommended to use hyperuric waste.
Warnings
Before using the drug you need to read the instructions carefully and refer to the information below.
contraindicated
Savi Dopril Plus contraindicated in the following cases:
Children.
Related to Perindopril
Uncounty heart failure.
Related to indapamid hemihydrate
Be cautious when using
related to perindopril
general
In case of heart failure, salt loss, dehydration ... The risk of hypotension and/or kidney failure: loss of salt and water (completely faded and/or treatment of diuretic) or kidney artery stenosis leads to stimulation of the renin -angiotensin system. Therefore, when using an enzyme inhibitor can cause hypotension, especially the first dose and for 2 weeks of treatment, and/or renal function, sometimes acute, although rarely and take place in a non -fixed time. Therefore, when starting treatment, it is necessary to comply with some special recommendations as follows:
In case of hypertension that has been treated for diuretic from before, it is necessary to:
In kidney hypertension, it is advisable to start treating at a low dose of 2 mg (see hypertension due to kidney blood vessels).
CREATININ CREATIIN ATTRACTIVE ATTRACTIVE ATTERS AND INTERESTING AND IN THE FIRST MONTH.
In congestive heart failure with diuretics, if possible, diuretics should be reduced a few days before starting Perindopril.
On risk groups, especially people with severe congestion heart failure (degree IV), the elderly, the initial patient has too low blood pressure or renal function, or patients who are taking high doses of dosage, must start using low doses of 1 mg, under medical monitoring.
Thincon edema
Facility on the face, limbs, lips, tongue, subjects and/or larynx have been reported rarely in patients treated with enzyme inhibitors, including Perindopril. In this case, treatment with Perindopril should stop immediately and the patient must be monitored until the edema disappears.
When edema only affects the face and lips, this effect is often relieved without treatment, although anti -allergic drugs can be used to reduce symptoms. The veins combined with laryngeal edema can be fatal. With the participation of edema of the tongue, bar or larynx can lead to respiratory obstruction.
Should quickly get subcutaneously subcutaneously adrenalin solution 1: 1000 (0.3 ml to 0.5 ml) and apply other appropriate measures. The prescription of an angiotensin transferred enzyme inhibitors can then be contraindicated in these patients.
Patients with a history of Quincke edema are not related to Angiotensin transferred enzyme inhibitors, which will be at higher risk of quincke edema when using angiotensin transfer enzyme inhibitors.
Hematology effect
The risk of leukopenia/loss of granulocytes in patients with inhibited immune systems.
The risk of neutropenia seems to be related to the dosage and depends on the patient's clinical condition. Although rare in patients with no complications, it can occur in patients with a degree of renal failure, especially when combined with blood vessel collagen disease, such as lupus erythema, hardening and treatment with immunosuppressive drugs.
This symptom can recover after stopping the enzyme inhibitors transferring angiotensin (ACE). Strictly adherence to predetermined dose seems to be the best way to prevent the attack of these symptoms. However, if an angiotensin transfer enzyme inhibitor has been used for this type of patient, the risk/benefit ratio needs to be carefully evaluated.
Hematopalyst
Anaphylactic reactions (lip edema and tongue with shortness of breath and hypotension) have been recorded while hemolysis with high absorbent membranes (polyacrylonitril) on patients treated with enzyme inhibitors. This coordination should be avoided.
In case of renal failure
Need to adjust the dose of Perindopril according to the degree of renal failure. In these patients, they must periodically check potassium and creatinin.
Hypertension due to kidney vessels
Hypertension due to kidney vessels must be treated by regenerating blood vessels. However, Perindopril may be helpful for patients with hypertension due to kidney blood vessels waiting for orthopedic surgery or when surgery is not available. At that time, you must start treatment carefully and monitor kidney function.
Children
Because there is no research in children, in the current state of knowledge, Perindopril is contraindicated for children.
On the elderly
Should start treatment at a dose of 2 mg daily, disposable, and must assess the kidney function before starting treatment.
surgical intervention
In case of great surgery, or medication can cause lower pressure, Perindopril may cause hypotension, which must be cured by increasing blood volume.
SECRETING HEART
On patients with mild to medium congestive heart failure, there is no change in blood pressure when the starting dose of 2 mg.
However, on patients with severe congestion and patients at risk, should start using low doses.
related to indapamid hemihydrate
Patients with severe renal impairment, because plasma volume decreases, accompanied by a reduced glomerular filtration rate may promote hypoglycemia. If the kidney damage progresses, the drug must be stopped.
Patients with impaired liver function or liver disease are progressing, especially when the serum potassium appears, because of the imbalance of water and electrolytes because the drug can cause liver coma.
Patients with hyperthyroidism or thyroid diseases. If there is a hypercalcemia and hypoglycemia, it is necessary to stop the drug before testing the thyroid function.
People with lupus erythematosus, because the drug can make the disease worse.
Patients with surgery to remove sympathetic neuropathy, because the hypotension effect of the drug can increase in these patients.
The ability to drive and operate machinery
Both active ingredients in the combined tablet do not affect alertness. However, the reaction is related to low blood pressure such as dizziness or body weakness that can occur in some patients, especially at the beginning of treatment or at the time of combined with another anti -blood pressure drug. This leads to the ability to drive or operate machinery may be impaired, so it is necessary to be cautious when driving or operating machinery.
Pregnancy
Because the combination drug contains medication inhibitors, it is contraindicated to use this drug during pregnancy.
Related to Perindopril
High doses on mice and rabbits have toxicity for pregnancy and mother when taking the highest doses. So far, there is no data on Perindopril.
On patients treated with enzyme inhibitors:
Do not use medication for pregnant people.
Related to indapamid hemihydrate
Animal research shows that the drug is not toxic to the development of the fetus. However, there is no complete and complete research on pregnant women. Therefore, do not use indapamid hemihydrates for pregnant women, unless the benefits of using drugs are greater than any potential risk.
The period of breastfeeding
Because the form of combination drug contains enzyme inhibitors, it is contraindicated to use this medication during the breastfeeding period.
Related to Perindopril
In animals, a small amount of Perindopril is secreted into breast milk. There is no figure on humans.
Do not use for breastfeeding.
Related to indapamid hemihydrate
It is unknown whether indapamid is distributed in milk or not. If it is necessary to use medication for breastfeeding, you must stop breastfeeding.
Drug interaction
related to perindopril
The agent reduces the effect
Non -steroid anti -inflammatory drugs, corticosteroids, tetracosactids.
Agents increase the effect
Some patients have used diuretics before, especially when newly treated. The lowering effect may be over -starting to use Perindopril.
Collaborate with sedative and anti -depression drugs Imipramin will increase the risk of hypotension.
Diabetes treatment (insulin, hypoglycemic sulfamid)
As well as other angiotensin transferring inhibitors, Perindopril increases the hypotension effect of these drugs.
Agents increase toxicity
Combining Perindopril with potassium salts and with potassium -keeping diuretics at risk of hyperkalemia and kidney failure. Do not coordinate drugs that cause hyperkalemia with enzyme inhibitors, except for hypokalemia. However, if this combination is necessary, it should be used carefully and must regularly evaluate potassium.
lithium
Hyperbonemia.
There is no pharmacokinetic interaction when shared Perindopril with digoxin. There is no need to change the dose of digoxin in case of common use on congestive heart failure.
related to indapamid hemihydrate
Do not use Indapamid Hemihydrate in combination with other diuretics because it can cause hypokalemia and hyperuricemia. Like thiazid diuretics, do not use indapamid hemihydrates simultaneously with lithium because diuretics reduce the removal of the kidneys for lithium, thus risk lithium poisoning.
Indapamid Hemihydrate reduces the artery response to vasoconstrictors such as noradrenalin, but the decrease is not enough to prevent the treatment effect of noradrenalin.
Storage
Store in dry places, the temperature does not exceed 30 ° C. Avoid light.
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