Troysar am troikaa treatment for hypertension, angina (10 blisters x 10 tablets)
Dosage form Box of 10 blisters x 10 tablets
Specifications Losartan Potassium, Amlodipine
Ingredient
| Composition information | Content |
| Losartan Potassium | 50mg |
| Amlodipine | 5mg |
Uses
indications
Troysar AM are indicated in the following cases:
Angiotensin II [formed from Angiotensin I in a catalytic reaction by Angiotensin conversion enzyme (ACE, Kininase II), is a strong vascular contraction agent, blood vessel hormone of the renin angiotensin systems and an important component in hypertension disease. It also stimulates the adrenal shells of Aldosterone.
Losartan and metabolites operate mainly to prevent vascular contraction and aldosterone secretion of angiotensin II by preventing the cohesion of Angiotensin II with AT1 receptors at multiple tissues, (for example, smooth muscle vessels, adrenal glands). There is also an AT2 receptor at multiple tissues but does not affect the cardiovascular balance.
Losartan as well as an ACE -inhibited active metabolites (Kininase II, Angiotensin I conversion enzymes into angiotensin II and Bradykinin degenerate); Nor do not bind or prevent other hormonal receptors or ion channels. Losartan inhibit the hypertension of angiotensin II (as well as angiotensin I) injected form. A dose of 100 mg inhibited inhibitor is about 85% peak and continues to inhibit 25-40% in 24 hours.
eliminates the negative feedback of angiotensin II increases 2-3 times of plasma renin activity and the results increase the plasma angiotensin II concentration in patients with hypertension. Losartan does not affect Bradykinin reactions, while ACE inhibitors increase Bradykinin reaction. Aldosterone concentration decreases when using Losartan. Despite the influence of Losartan on the secretion of Aldosterone, observing very little effect on serum potassium.
There is a slight increase in urinary uric acid, which leads to a minimum reduction in uric acid in serum (which means a decrease in
amlodipin
Amlodipin is a calcium dihydropyridine antagonist (calcium ion antagonist or slow channel blocker) that inhibits the metabolism of calcium ions into the blood vessel and heart muscle. Amlodipine is linked to both dihydropyridin Nondihydropyridine. Amlodipine inhibits the selective calcium ions through the selective cell membrane, with a stronger impact on the smooth muscle cells of the blood vessels into the heart cell.
Serum calcium concentration is not affected by amlodipine. Amlodipine is a peripheral artery dilatation that affects blood vessel smooth muscles, reducing peripheral blood vessels and reducing blood pressure. Amlodipine angina mechanisms include:
Hemodynamics:
Amlodipin relaxes, leading to reducing activity and maintaining blood pressure. A decrease in blood pressure does not accompany a significant change in heart rate or plasma catecholamine levels at chronic treatment dose. With daily chronic treatment, hypotension effect is maintained for at least 24 hours. Serum concentration corresponds to effective and old patients.
In patients with hypertension with normal kidney function, amlodipine treatment dose reduces the resistance of the kidney and increases the ratio of glomerular filtration and acts on serum kidney flow without changing the ratio of filtration or proteinuria.
Like other calcium channel blockers, measuring cardius with cardiovascular function when resting and during exercise (or evenly) in patients with normal ventricular function using amlodipin often proves to have a slight increase in cardiovascular parameters without significantly affecting DP/DT or pressure on the left ventricular or flow. In hemodynamic studies.
Amlodipin does not cause cardiova Contract when using the dosage for animals and humans. Similar results, however, observed normal patients or patients with heart failure accompanied by heart spasms.
Biological effects:
Amlodipine does not change the function of atrial sinus button or atrial transmission, does not significantly change A-H and H-V and the recovery time of the sinus button after the rhythm and does not change the electrocardiogram intervals or the higher production of the AV block.
Pharmacokinetics
absorption
After drinking, Losartan is well absorbed and experienced the first metabolism; Losartan's bioavailability system is approximately 33%. About 14% of oral dose converts into active metabolites.
The peak concentration of Losartan reaches for 1 hour and the metabolites are operating in 3-4 hours.
While Losartan's maximum concentration and plasma metabolites are approximately equal, the AUC of Losartan's 4 times the metabolites. Food will slow down the absorption of Losartan and reduce its CMAX but only has a small effect on the AUC of Losartan or on the AUC of the metabolites (decreased to about 10%).
After taking amlodipine, the high concentration reaches after 6 to 12 hours. Absolute bioavailability has been estimated at 64% and 90%. Amlodipine's bioavailability is not changed by food.
Distribution
Both Losartan and metabolites are attached to plasma proteins mainly albumin, with the corresponding ratio of 1.3% and 0.2%.
Amlodipine content in plasma in a stable state is achieved after 7-8 days of medication.
Metabolism
Losartan is an active and first metabolic agent with Cytochrome P450 enzyme. Convert partially converted into active carboxylic acid metabolites that are responsible for Angiotensin II receptor resistance. The metabolic substance of Losartan has been found in human plasma and urine.
In addition to active carboxylic acid metabolites, some inactive are also formed. The sale time of Losartan is about 2 hours and of the metabolite is about 6-9 hours. Losartan and its metabolites are also not accumulated in plasma when taking a daily dose daily.
amlodipine converts (about 90%) into inactivated metabolites through the metabolism in the liver, with 10% of unprocessed drugs and 60% of the metabolites excreted in urine.
Elimination
After taking the only dose of Losartan, about 4% of the dose is excreted without changing in the urine and about 6% is excreted in the urine is the metabolic active substance. Contribute to the excretion of Losartan and its metabolites.
Amlodipine elimination in 2 phases, the last elimination time is about 30-50 hours. Amlodipine and metabolites are mainly eliminated through urine.
Before taking Troysar am troikaa treatment for hypertension, angina (10 blisters x 10 tablets)
How to use
oral medication.
Dosage1 tablet per day or as directed by the physician.
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?
losartan
The manifestations of overdose are most likely to lower blood pressure and tachycardia; Slow heart rate may be due to the stimulation of the sympathetic nervous system. If symptoms of hypotension occur, it is necessary to conduct supportive treatment.
Losartan and metabolism cannot be removed by dialysis.
amlodipin
Overdose will cause excessive peripheral vessels leading to hypotension and can cause reflexes of tachycardia. In humans, intentionally using amlodipine overdose is very limited. If overdose is used, it is necessary to support the activity of the heart and the respiratory system.
Regular blood pressure is essential. Hypotension should occur, patients need to be supported cardiovascular, including starting dose and infusion. If hypotension still does not respond to measures to protect and use hypertension (such as phenylephrine), it is necessary to pay attention to circulating flow and excreted urine.
Intravenous calcium gluconate can be beneficial in restoring the impact of calcium canal. Because amlodipine is strongly linked to protein, the divergence has no results.
In an emergency, call the 115 emergency center immediately or go to the nearest local health station.
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 Troysar AM , you may experience unwanted effects (ADR).
Common, ADR> 1/100
Testing: Increasing liver enzymes and/or serum bilirubin, increasing blood urea nitrogen urea (bun) or serum creatinine, less hemoglobin and hematocrit, hyperkalemia and hypoglyc sodium.
Uncommon, 1/1000 Rare, ADR Hepatitis: Hepatitis. Anaphylaxis reaction: Evana, including laryngeal swelling and subjects, causing obstruction of airway and/or swelling of the face, lips, throat, and/or tongue. Not determined frequency ears: tinnitus. Hematology: leukopenia, rash, platelet reduction. 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
Troysar AM drugs contraindicated in the following cases:
Caution when using
general
losartan
Fetal/ infant's death and death: The drug directly acts on the Renin Angiotensin system, which can cause disease and death in the fetus and infants when used for pregnant women. When detecting pregnancy, Losartan should stop using as soon as possible.
Should notify the woman exposed to Angiotensin II receptor drug during the first quarter of pregnancy. However, when the patient is pregnant, the physician should stop using Losartan as soon as possible.
Monitoring children with a history of exposure to Angiotensin II receptor antagonists such as low blood pressure, minimum, and hypokalemia. If the urinary minority occurs, pay attention to the blood pressure and the infusion of the kidneys. Translation or interpretation is required as a means of reversing low blood pressure and/or replacing kidney dysfunction.
Patients with low blood pressure:
In patients with low vessel walls (using diuretics), symptoms of hypotension occur after the first treatment. In the above cases, it should start therapy with low doses Losartan.
amlodipine
Increase the rate of angina and/or coronary artery:
Rare, especially in patients with chronic coronary artery structure, increases frequency, prolongs the time and/or severity of angina or myocardial infarction when starting to use calcium blockers or at the time of increasing the dose of drug use. The mechanism of this impact has not been clarified.
Preventive
losartan
Hypersensitivity: eagle.
Liver failure: Based on the pharmacokinetic data, it has shown a significant increase in Losartan levels in plasma in patients with cirrhosis, reducing the dose for patients with liver function.
Kidney failure: The consequences of preventing the renin-angiotensin-aldosteron system, changing the kidney function in sensitive patients when treated with Losartan, in patients with changes in renal function to stop treatment. In patients with renal function, depending on the activity of the renin-angiotensin-aldosterone system (for example, patients with chronic congested heart failure), treatment with enzyme inhibitors that transform Angiotensin will be accompanied by symptoms of urinary tract and/or hyper urea and (rare) acute renal failure and/or death. The report results are similar to Losartan.
Increases creatinine in plasma and nitrogen urea in the blood when taking losartan for some patients narrowing one or two kidney arteries. These effects will disappear when stopping the drug.
Electrolyte imbalance: Electrolyte imbalance usually occurs in patients with kidney failure at the same time or not at the same time diabetes, and should be resolved. The rate of hyperkalemia is higher in type 2 diabetes patients with proteinuria when treated with Losartan.
Information for patients:
Potassium supplements: Patients who are using Losartan should not supplement potassium or replacement salt containing potassium without a physician's instructions.
Use in the elderly: There is no overall difference and safety between older and young patients, unable to attribute the sensitivity of older patients.
amlodipine
Use amlodipine onset causes slow vasodilation and cause acute hypotension after taking the medication. However, be careful with peripheral vasodilators, should monitor when taking amlodipine, especially in patients with aortic stenosis.
Used in patients with congested heart failure: Normally, caution must be used with calcium blockers in patients with heart failure.
Stop using beta inhibitors: Amlodipine is not a beta inhibitors so it does not protect against the danger when stopping using beta inhibitors suddenly; Any stops should reduce the dose slowly Beta inhibitors.
Patients with hepatic impairment: due to amlodipine metabolic in the liver and the sale time (t1/2) in serum is 56 hours in patients with liver function, cautious when using amlodipine in patients with liver failure.
Used in pediatric: It is unknown amlodipine that acts on blood pressure in patients under 6 years old.
Used in the elderly: Normally, be careful when choosing the dose for adult patients, usually starting low doses will reduce the impact on liver, kidney or heart function and simultaneous diseases or other drugs. Elderly patients with reduced amlodipine clearance lead to an increase in AUC by 40-60%, and it is necessary to start from low doses.
The ability to drive and operate machinery
does not affect the ability to drive and operate machinery.
Pregnancy
Patients who are pregnant must be notified of the consequences of the use of drugs in the second quarter and the third quarter of pregnancy will affect the renin-angiotensin system and they will also be reported not to appear in the uterus when restricting the use of drugs in the first quarter of pregnancy. These patients should inform the physician when pregnant as soon as possible.
Amlodipine should only be used for pregnant women when the benefit is more than the risk of impact on the fetus.
The period of breastfeeding
It is not known whether Losartan is excreted through breast milk or not. Because the harmful effects on breastfeeding, it is necessary to decide whether to stop breastfeeding or stop the drug, depending on the importance of the drug for the mother.
Do not know if Amlodipine is excreted through breast milk or not, but should stop the medicine while breastfeeding.
Drug interaction
losartan:
Losartan does not affect the pharmacokinetics and pharmacological force of single -dose warfarin. Losartan does not affect the pharmacokinetics of oral digoxin or infusion. There is no pharmacokinetic interaction between Losartan and Hydrochlorothiazide, using Losartan and Cimetidine to increase the AUC of Losartan to 18% but does not affect the pharmacokinetics of the metabolitus activity of Losartan. Sharing Losartan and Phenobarbital reduces Losartan's AUC to 20% and the metabolites of Losartan. There is a great interaction with rifampicin (down about 40% of AUC of metabolites and about 30% of Losartan's AUC).
Fluconazole is a cytochrome P450 2C9 inhibitor, reducing the AUC of 40% metabolites, but increases the AUC of Losartan by about 70% after doses.
When using Erythromycin and P450 3A4 inhibitors with oral losartan does not affect the AUC of metabolites but increases the AUC of Losartan 30%.
amlodipine:
Amlodipne does not affect protein cohesion with digoxin, phenytoin, warfarin and indomethacin in human serum.
The effect of other agents on amlodipine.
cimetidine: Using amlodipine with cimetidine does not change the pharmacokinetics of amlodipine.
Grapefruit juice: does not affect the pharmacokinetics of amlodipine.
Anti -acid agent: Shared anti -acid, Maalox with single -dose amlodipine does not affect the pharmacokinetics of amlodipine.
Sildenafil: Sildenafil 100 mg without affecting amlodipine pharmacokinetics.
The effect of amlodipine on other agents:
Atorvastatin: Sharing 10 mg of amlodipine with 80 mg Atorvastatin does not change the stability of the pharmacokinetics parameters of Atovastatin.
Digoxin: Sharing amlodipine with digoxin does not change the concentration of Digoxin in serum or clearing of digoxin in volunteers.
Ethanol (alcohol): Single dose or multiple dose of 10 mg amlodipine does not affect the pharmacokinetics of ethanol.
Warfarin: Sharing amlodipne with warfarin does not change the time to respond to Warfarin prothrombin.
Storage
Temperature does not exceed 30 ° C.
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