Viacoram medicine 7mg/5mg Servier Treatment of hypertension (30 tablets)

Caution when using

Hypersensitivity, eagown

Fantasia on the face, limb, lips, mucosa, tongue, bar, larynx rarely appear in patients using Perindopril. If this phenomenon occurs, Viacoram should be stopped immediately and takes appropriate and continuous monitoring measures until these symptoms are completely over. In general, the phenomenon of local and lips swelling is often cured without treatment, although antihistamine drugs can reduce symptoms.

Laryngeal -related angioema can be fatal. When the tongue, the subject or the larynx can cause obstruction of the respiratory tract, emergency should be immediately rescued (using adrenaline with or not accompanied by measures to ventilate the airway). Monitor the patient closely until the symptoms of recitation.

Patients with a history of angioedema because ACEI drugs may increase the risk of angioed with vascular use when using viacoram.

Evaluation in the intestinal tract rarely appear in patients with ACEI drugs. Manifestations: abdominal pain (with or without nausea, vomiting); In some cases, there is no previous edema and C - 1 esterase concentration is normal. Evaluation is diagnosed with abdominal CT scan, or ultrasound or during surgery and regression of symptoms after stopping ACEI. The intestinal angioedema should be considered in distinguished diagnosis in patients with ACEI drugs with abdominal pain.

Anaphylactic reactions during the sensitivity process

Patients taking Acei drugs during the treatment of sensitivity (membrane venom) have encountered anaphylactic reactions.

leukopenia, grain leukemia, thrombocytopenia, anemia

The above manifestations have been recorded in patients with ACEI drugs. Rarely reduced leukopenia in patients with normal renal function and no other complex factors. Especially cautious when using Viacoram for patients with collagen vascular disease, patients are treating immunosuppressive, treatment with allopurinol or process, or combining these risk factors, especially if the patient has previously impaired renal function. Some patients have severe infections, sometimes not responding to the treatment of positive antibiotics. Periodic monitoring of leukocytes and patients should notify any signs of infection (sore throat, fever).

Double blockade of Renin - Angiotensin - Aldosteron (RAAS)

Simultaneous use of Acei, Angiotensin II or Aliskiren receptor inhibitors increases the risk of hypotension, hyperkalemia and impaired renal function (including acute renal failure). It is not recommended to combine these drugs due to the dual blockade of the RAAS system.

If the dual blockade therapy is needed, only under the supervision of the expert and need to closely monitor regular kidney, electrolyte and blood pressure.

Acei drugs and Angiotensin II receptor inhibitors should not be used simultaneously in patients with diabetes.

Patient with primary Aldosteron

It is not recommended to use Viacoram in primary Aldosteron patients due to non -response to anti -hypertension drugs that operate through inhibition of the Renin - Angiotensin system.

Patients with renal impairment - Hypertension of kidney

Contraindicated in patients with severe renal failure (CLCR

In some patients with nephrotic stenosis on both sides or one side treated with ACEI drugs, there has been a phenomenon of increased blood urea and serum creatinine, often recovered after stopping the drug. This is easy to happen in patients with renal failure. The risk of severe hypotension and renal failure increases if there is signs of hypertension - renal vessels. Some patients with hypertension do not show signs of previous kidney disease, which have increased blood urea and creatinine, often mild and transient, especially when concurrent Perindopril and diuretics. This is more likely to happen in patients with impaired renal function.

Amlodipin may be used for patients with renal impairment at normal doses. Amlodipine cannot be removed by dialysis.

Do not recommend using Viacoram in patients with kidney transplant.

Increased risk of hypotension and renal failure in patients with narrowed kidney stenosis or artery stenosis in one kidney undertake the remaining function when treated with Acei. Treatment with diuretics may be a combination agent. The impaired renal function may occur with only a small change in serum creatinine even in patients with kidney stenosis on the one hand.

Patients with impaired liver function

Acei drugs are rarely related to the syndrome that starts with cholestasis and progress to serious liver necrosis and (sometimes) death. The mechanism of this syndrome is unclear. Patients with jaundice and significant liver enzymes should stop using Viacoram and appropriate medical monitoring.

In patients with impaired liver function, Amlodipine's exhaust time is prolonged and higher AUC.

Hypertension

Safety and effectiveness of amlodipine on unknown hypertension.

Patients with heart failure

Be cautious when using viacoram for patients with congestion heart failure, as amlodipine can increase the risk of cardiovascular and death.

Hypotension

Acei drugs can cause hypotension. This symptom is rare in patients with non -complicated hypertension and is likely to appear more in patients with reduced circulatory volume or serious hypertension patients dependent on renin. Closely monitor kidney function and serum potassium concentration in patients with high risk of lowering blood pressure during Viacoram treatment.

Similar consideration for patients with myocardial oral disease, excessive hypotension can lead to myocardial infarction or stroke.

If hypotension, the patient is on the back and if necessary, NaCl 9 mg/ml (0.9%) should be transmitted. Hypotension is not contraindicated for the next dose, the next dose can be used normally when the blood pressure has increased after the collection of circulating mass.

Patient with mitral stenosis and output clogged of left ventricle

Be cautious when taking Acei medication for patients with mitral stenosis and congestion of left ventricular (aortic stenosis or hypertrophic cardiomyopathy).

Skin color

Acei drug increases the angioed and less voltage effect in black skin patients than other skin -colored patients.

dry cough

may have persistent dry cough but will end when stopping using viacoram.

Patients with surgery/anesthesia

In patients undergoing major surgery or when anesthesia uses drugs that cause hypotension, Perindopril may inhibit the formation of secondary angiotensin II to compensate for released Renin. Should stop the medicine before surgery 1 day. If hypotension is caused by this mechanism, it is necessary to adjust by increasing the volume of circulation.

Hemorrhage

Acei medicine can cause hyperkalemia. Risk factors include: renal failure, impaired renal function, over 70 years old, diabetes, events that occur simultaneously, especially dehydration, acute heart loss, metabolic acidosis and simultaneous use with potassium -keeping diuretics, potassium -containing products or replacement salts containing potassium; Or patients taking drugs that increase blood potassium (heparin, other ACEI drugs, Angiotensin II antagonists, acetylsalicyclic acid> 3 g/day, COX - 2 inhibitors, non -selective NSAID drugs, immunosuppressants such as ciclosporin or tacrolimus, trimethoprim).

Using these drugs, especially in patients with impaired renal function, can significantly increase serum potassium. Hyperboly hyperpass can cause serious arrhythmia, sometimes leading to death. If the coordination of Viacoram with any of the above drugs is really necessary, should be cautious and regularly monitor blood potassium concentration.

Patients with diabetes

In patients with diabetes treated with oral or insulin anti -diabetes, strictly controlling blood glucose during the first month of treatment with viacoram.

The ability to drive and operate machinery

has not been studied by the effect of Viacoram on driving and operating machinery.

Perindopril and Amlodipin may have a slightly affected on average on the ability to drive and operate machinery. If the patient has dizziness, headache, fatigue, exhaustion or nausea, the ability to react may be impaired.

Caution recommendations when using viacoram, especially when starting treatment.

pregnancy

do not recommend using viacoram for the first 3 months of pregnancy. Contraindications for use in the middle 3 months and the last 3 months of pregnancy.

Do not start using viacoram during pregnancy. Unless the continued use of Viacoram is considered necessary, the patient is planning to get pregnant, so he switched to another medication to treat hypertension, which had safe data set in pregnant women. When a patient is diagnosed with pregnancy, he should stop immediately treated with Viacoram and should apply another alternative treatment.

The period of breastfeeding

is not recommended to use Viacoram during breastfeeding. Therefore, the decision to stop breastfeeding or stop taking the drug is based on the importance of this therapy on the mother.

Drug interaction

Increased risk of hyperkalemia when coordinating with viacoram with drugs: Aliskiren, potassium salt, potassium diuretics, Acei drugs, Angiotensin II, NSAIDs, Heparin, immunosuppressants (cyclosporin, tacrolimus, trimethoprim ...).

Contraindicated to use Viacoram and Aliskiren in patients with diabetes or impaired renal function, the risk of hyperkalemia, worsening kidney function and the incidence of cardiovascular diseases and death due to increased vascular diseases.

Do not recommend coordination of viacoram and estramutine due to increased risk of adverse effects such as nerveema.

It is not recommended to use viacoram and lithium due to increased lithes that recover toxic lithium concentrations, but if it is necessary to coordinate, closely monitor serum lithium concentration.

Due to the risk of hyperkalemia, it is not recommended to coordinate viacoram (containing amlodipine) with intravenous dantrolen in patients who have the ability to increase malignant body temperature and in the treatment of malignant body temperature.

Combining Acei and diabetes medications can cause blood glucose due to increasing the effect of lowering the glucose effect of the drug. This phenomenon is more common in the first week when combining drugs and on patients with renal failure.

Combining viacoram with Baclofen increases the effect of lowering blood pressure. Monitoring blood pressure and adjusting the dose of hypotension if necessary.

Shared Viacoram and diuretics do not hold potassium, especially in patients with reduced volume of circulatory and/or salt loss, which can cause excessive reduction in blood pressure.

Combining Viacoram and NSAIDS drugs (including aspirin dose ≥ 3G/day) may reduce the effect of lowering blood pressure and increased the risk of impaired kidney function.

Concomitance use Viacoram with CYP3A4 induction drugs can reduce plasma amlodipine levels; Simultaneous use of viacoram with CYP3A4 inhibitors increases plasma amlodipine levels.

It is not recommended to use viacoram and grapefruit due to increased bioavailability of amlodipine, increasing the effect of lowering blood pressure.

Combining viacoram with anesthetic, three -ring antidepressants, anti -psychotic drugs, anti -hypertension drugs and vasodilators (especially with nitroglycerin and nitrate) can cause excessive blood pressure.

Increased risk of angioedema due to gliptin reduces the effect of dipeptidyl peptidase IV (DPP - IV) in patients using ACEI drugs.

Sympathetic medications can reduce the hypotension effect of Viacoram.

α, amifostin blockers combine viacoram increases the effect of lowering blood pressure and increases the risk of hypotension.

Corticosteroids, tetracosactids reduce the hypotension effect of Viacoram.