Tilhasan 60 Hasan medicine for hypertension (3 blisters x 10 tablets)

Dosage form Box of 3 blisters x 10 tablets
Specifications Diltiazem

Ingredient

Composition information	Content
Diltiazem	60mg

Uses

indications

Tilhasan 60 drug is indicated in the following cases:

Preventive and long -term treatment for angina. Not only for acute angina. Diltiazem inhibits the calcium line into the cell during the reducing stage, thus reducing the amount of calcium released from the mesh, resulting in reduced oxygen consumption of the heart muscle. This increases exertion and improves all myocardial ischemia in patients with angina patients.

diltiazem relaxes coronary arteries, large and small, prinzmetal angina and reduced response to catecholamine but have little effect on peripheral blood vessels. Therefore, diltiazem does not cause heart reflexes quickly. Diltiazem mitigates heart rate and increases the supply of heart, improves myocardial perfusion and reduces the activity of ventricular.

Pharmacokinetics

absorption

Diltiazem is well absorbed (90%) after drinking. The peak concentration in plasma is achieved after 3-4 hours of using the drug, the bioavailability of the drug 40%.

Distribution

diltiazem is associated with plasma proteins about 80 - 85%.

Metabolism

Strong metabolism in the liver. The main metabolic substance is N-Monodesmethyl Diltiazem accounting for about 35% of the blood diltiazem.

Elimination

Diltiazem waste time in plasma is from 4 to 8 hours. Less than 5% of the non -metabolic diltiazem is excreted in the urine.

Before taking Tilhasan 60 Hasan medicine for hypertension (3 blisters x 10 tablets)

How to use

Take oral use, before eating and at bedtime.

Patients should not stop the drug suddenly because it can cause serious angina.

Dosage

Adults:

The usual dose is 1 tablet (60 mg) x 3 times/day.

However, the response of each patient may vary and the dosage is also significantly different between patients, which can increase to 360 mg/day.

High doses of 480 mg/day shows effective some patients with unstable angina. There is no evidence that the drug is effective at high doses.

Elderly people, patients with liver failure, kidney failure:

The starting dose of 1 tablet (60 mg)/time x 2 lines/day. Measure regular heart rate. Do not increase the dose if the heart rate is less than 50 beats/minute.

Children:

Effective and safe in children has not been set up. Recommendation not to use drugs for children.

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? The conduction disorder can be treated by temporary heart rate. Remedy treatment: Atropin, vasoconstrictor drugs, contraction agents, glucagon and calcium gluconate injected.

What to do when forgetting a dose? If the time of remembering is close to the next dose, skip the forgotten dose and continue taking the next dose as usual. Do not take double dose to compensate for the forgotten dose.

Side Effects

When using Tilhasan 60, you may experience unwanted effects (ADR).

Common, ADR> 1/100

heart: Atrial block (maybe level 1, 2 or 3, Block branch can occur), Brush the chest drum.

nerve: headache, dizziness.

blood vessels: blushing. digestive: constipation, indigestion, stomach pain, nausea.

Skin, subcutaneous tissue: Red rash.

Other: peripheral edema, uncomfortable.

Uncommon, 1/1000

Mental: Stress, insomnia.

heart: Slow heart rate. blood vessel: Hypotenemably posture. digestive: vomiting, diarrhea. liver, bile: increase liver enzymes (AST, ALT, LDH, ALP).

Unknown frequency:

Blood, lymphatic system: platelets.

Mental: Change personality. nerve: Syndrome. Heart: Sinus block, congestive heart failure, loss of sinus rhythm, cardiac arrest. vascular: vasculitis (including vasculitis or vascular inflammation in the skin). digestion: gum hyperplasia.

Metabolism, nutrition: hyperglycemia.

liver, bile: hepatitis.

Skin, subcutaneous tissue: sensitive to light, angioedema, red pot, diverse pink rash, sweating, flaking dermatitis, acne blind acne syndrome, redness or no fever.

Reproduction: Big Breasts in men.

Instructions on how to handle ADR

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

Before using the drug you need to read the instructions carefully and refer to the information below.

Contraindicated

Tilhasan 60 drug contraindicated in the following cases:

Hypersensitivity to diltiazem or any ingredients of the drug.

Sinus -node impairment syndrome, atrioventricular block 2 or degree 3 in patients who do not place ventricular pacemaker.

Slow heart rate (less than 40 beats/minute).

Severe left ventricular failure with pulmonary congestion.

Simultaneously used with infusion dantrolen or in combination with Ivabradin.

Lactating women.

Pregnant or pregnant women. Server congestive heart failure.

Porphyria.

Cardiococci.

Hypotension (systolic blood pressure

Heavy aortic stenosis.

Be cautious when using

Need to monitor closely in patients with left ventricular failure, slow heart rate, atrial atrial block of degree 1 or extend the PR about the electrocardiogram.

In plasma diltiazem concentrations may increase in the elderly and patients with liver or kidney failure.

Reduces the ability to contract the heart, transmission and automatic properties, blood vessels associated with anesthetic may occur when using calcium channel blockers. Therefore, anesthetic doctor should be notified that the patient is using diltiazem.

Diltiazem treatment may cause mood change, including depression. In this case, it is necessary to consider stopping the drug.

diltiazem inhibits intestinal motility. Therefore, caution should be used in patients at risk of intestinal obstruction.

Need to monitor carefully in patients with potential diabetes or diabetes, due to the risk of hyperglycemia.

Preparations contain lactose. Patients with rare genetic problems with galactose, patients with lactase enamel deficiency or less absorbent lactose-galactose should not use this drug.

The ability to drive and operate machinery

should be cautious because the drug can cause headaches, dizziness and discomfort, affecting the ability to drive and operate machinery. However, no research has been conducted.

Pregnancy

diltiazem is contraindicated for pregnant women or possibly pregnant but does not use effective contraception.

Lactation period

Contraindicated use of diltiazem in nursing women. If it is necessary to treat with diltiazem, it is necessary to replace it with other breastfeeding methods.

Interactive drugs

Dantrolen (infusion): Combining Calcium channel blockers with dantrolen can be dangerous.

Ivabradin: Increased risk of heart rate.

Caution should be careful:

Alpha blockers: Increase anti -hypertension effect. Treatment in combination with alpha blockers can cause hypotension or aggravation of disease.

Beta blockers: can cause arrhythmia (heart rate, sinus rhythm), atrial and atrial sinus transmission disorders, heart failure (combined effect). This combination is only used when clinically and electrocardive monitoring, especially at the beginning of treatment.

Amiodaron, Digoxin: Increased risk of heart rate, need to be cautious when combined with diltiazem.

anti -arrhythmia: Because diltiazem has anti -arrhythmia, it is not recommended to use diltiazem with other anti -arrhythmic drugs due to the risk of increased side effects on the heart.

Nitrate derivatives: increase the effect of lowering blood pressure and fainting. In patients using calcium channel blockers, nitrate derivatives should be adjusted gradually.

cyclosporin: Increased blood cyclosporin levels, cyclosporin should be reduced, monitoring kidney function and blood cyclosporin levels. Adjust the dose during coordination and after stopping.

Phenytoin: Diltiazem may increase the level of phenytoin when shared.

Acetyl Salicylate (ASA/LAS): Increasing the risk of bleeding due to the impact of synergies to platelet aggregation.

X -ray contrast substance: Increased risk of hypotension when rapid intravenous injection of X -ray contrast in patients being treated with diltiazem.

carbamazepin: used with diltiazem increases carbamazepin levels in the blood.

Theophylllin: Increases the concentration of theophyllin in the blood.

H2 anti -H2 (cimetidine and ranitidine): Increases plasma diltiazem concentrations.

Rifampicin: There is a risk of reducing the concentration of diltiazem in plasma after the dose of rifampicin pain.

Lithi: Increased risk of nervous toxicity.

MEDICINE MEDICINE NOTE NOTE:

Sharing Diltiazem with strong CYP3 A4 inhibitors increases medium (

Grapefruit juice can increase the concentration of diltiazem (about 1.2 times. Avoid using grapefruit juice if suspected of interacting.

Statin: Diltiazem is a CYP3A4 inhibitor, significantly increasing the AUC of some statins. Diliazem combination with metabolic statins through CYP3A4 (Atorvastatin, Fluvastatin and Simvastatin) increases the risk of muscle and muscle diseases.

benzodiazepin (Midazolam, Triazolam): significantly increased the concentration of Midazolam and Triazolam in plasma and extended the sale time of these drugs.

corticosteroid (methylprednisoion): diltiazem may increase methylprednisolon levels. Patients need to be monitored at the beginning of treatment.

Storage

Where dry, less than 30 ° C. Avoid light.

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