Telmisartan why upper respiratory infections. Telmisartan-sz - instructions for use. From the skin

It requires immediate treatment, otherwise its development can cause many, including heart attacks and.

You can find a wide variety of products on the market. One of the effective medications is Telmisartan. Read more about it in the article.

The drug can be purchased at any pharmacy.

The drug Telmisartan is intended for the treatment of hypertension. In addition, it is used in education.

Also, tablets are often used during bodybuilding, when during anabolic cycles the pressure readings exceed the norm.

Moreover, thanks to them, you can not only get rid of, but also generally improve the athlete’s health.

Telmisartan increases the parameters of insulin dependence and endurance indicators. It has a positive effect on the brain, thereby significantly reducing the likelihood of developing atherosclerosis or stroke.

This medication produces a metabolic effect. With its help, in case of insulin resistance and long-term malnutrition, problems of changes in gene expression are solved. In addition, the medicine accelerates fat burning processes, which are especially important for overweight people.

Compound

The drug contains the active substance under the same name telmisartan in a volume of 40 or 80 mg. Additional ingredients here are as follows: sodium hydroxide, mannitol, povidone, hydroxypropyl methylcellulose, magnesium stearate, meglumine, sorbitol.

The drug Telmisartan

Release form and packaging

The medicine is released in the form of tablets. They are white and have a mark on one side. The product is packaged in cardboard and contains 30 tablets. They are in blisters of 10 pieces.

Instructions for use of Telmisartan

The tablets are able to maintain blood pressure levels within . You can take Telmisartan regardless of meals. It should be washed down with water without chewing.

The daily dosage is usually 20-40 mg.

Their effect lasts throughout the day and appears within 3 hours after administration. Regular use contributes to a stable blood pressure level after a month of use of the drug.

If you stop taking the drug, there will be no withdrawal syndrome, but blood pressure readings will return to the previous numbers that were before treatment.

The maximum allowable dose is 80 mg per day. If you have liver problems, you should not take more than 40 mg per day.

Contraindications

The drug has the following contraindications:

• severe liver failure;
• simultaneous use of aliskiren;
• hypersensitivity to components;
• , lactation period;
• obstructive diseases of the biliary tract;
• hereditary fructose intolerance.

In addition, there are a number of cases when this medicine must be taken with caution:

• diarrhea;
• aortic or mitral valve stenosis;
• cardiac ischemia;
• chronic heart failure;
• obstructive hypertrophic cardiomyopathy;
• renal artery stenosis;
• decrease in circulating blood volume;
• admission restrictions;
• primary aldosteronism;
• liver and/or kidney dysfunction;
• conditions after kidney transplantation;
• hyperkalemia;
• hyponatremia;
• peptic ulcer;
• idiopathic hypertrophic subaortic stenosis;
• diseases of the gastrointestinal tract.

It is unacceptable to take the drug not only during pregnancy, but also during pregnancy planning.

Side effects

Any medicine has side effects, Telmisartan has the following:

• effect on the cardiovascular system– thrombocytopenia, chest pain, anemia, orthostatic, eosinophilia, decreased hemoglobin levels;
• effect on the digestive system y – abdominal pain, vomiting, diarrhea, dyspepsia, liver dysfunction, dry mouth, stomach discomfort, liver disease, flatulence;
• effect on the nervous system– , insomnia, depression, vertigo, visual disturbances, ;
• effect on the respiratory system y – flu-like symptoms, upper respiratory tract infections, pharyngitis, shortness of breath, decreased tolerance towards upper respiratory tract infections;
• damage to the genitourinary system– infections, renal dysfunction;
• manifestation of allergic reactions– toxic rash, itching, rash, urticaria, hyperhidrosis, anaphylactic reactions, hypersensitivity, angioedema;
• effect on the musculoskeletal system– pain in the lower extremities, arthralgia, back pain, muscle spasms, myalgia, tendon pain;
• changes in some laboratory parameters– increased concentration of creatinine, creatine phosphokinase, uric acid, activity of “liver” enzymes, decreased hemoglobin content;
• other– sepsis, influenza-like syndrome, chest pain, hyperkalemia, weakness, hypoglycemia.

Price and where to buy

Telmisartan is a fairly expensive drug, so patients often look for more.

On average, the cost for 98 tablets is about 6,000 rubles for a German-made medicine.

At the same time, the product is distributed in all pharmacies, and it is very easy to find.

You just need to remember that this medication can only be purchased with a prescription. The most common and popular analogues are Mikardis, whose average price is 600 rubles, as well as Telmista - at a cost of about 1,200 rubles.

Telmisartan 40 mg price

1 package 80 euros
2 packages 75 euros each
3 packs 70 euros each

Telmisartan 40 mg buy in Moscow

Medicine Telmisartan 40 mg direct deliveries from Germany to Moscow tel +7 926 3666610, payment to the courier upon receipt, delivery to all cities of Russia and CIS countries, all offered drugs have European Union (EU) certificates of conformity

If you want to buy the German drug Telmisartan or check the price, contact our representatives, we provide guarantees of authenticity and attach an original receipt from a German pharmacy

Telmisartan instructions

Drug name
Telmisartan
International name
Telmisartan
Indications
Arterial hypertension.
pharmachologic effect
Antihypertensive agent, angiotensin II receptor antagonist (AT1 type). It has a very high affinity for this receptor subtype. By selectively and long-term binding to receptors, telmisartan displaces angiotensin II from its connection with AT1 receptors. Does not show affinity for other AT receptor subtypes. The functional significance of other receptor subtypes and the effect of increased (as a result of the administration of telmisartan) levels of angiotensin II on them is not known. Telmisartan reduces the level of aldosterone in the blood plasma, does not inhibit plasma renin, does not block ion channels, and does not inhibit ACE (kinase II), which also destroys bradykinin. Therefore, there are no side effects associated with bradykinin.
Telmisartan has a pronounced antihypertensive effect and is widely used to control and maintain blood pressure within acceptable values.
The product is effective throughout the day, the duration of the effect after its use is observed within 48 hours. The drug begins to act within 3 hours after the initial dose, and just a month after the start of treatment with Telmisartan, blood pressure decreases to the maximum level in both the lower and upper values, without affecting the pulse rate.
When the drug is discontinued, the pressure will return to those parameters that were at the beginning of the treatment period, but no withdrawal syndrome is observed.
Telmisartan has a positive effect on the cardiovascular system and reduces the risk of strokes and heart attacks, as well as death in patients with a significant cardiovascular risk who cannot take angiotensin-converting enzyme inhibitors.
Taking Telmisartan in patients with high blood pressure and cardiomyopathy is associated with a decrease in left ventricular mass.
Method of use of the drug
The drug is used regardless of the time of meal, 20-40 mg per day; in some cases, the daily dosage can reach 80 mg.
However, patients with liver problems should not take more than 40 mg per day.
Elderly people or people with renal failure do not need dose adjustment.
The active substance is telmisartan. Other substances included in the drug are the following: povidone, sodium hydroxide, sorbitol, meglumine, hydroxypropyl methylcellulose, magnesium stearate, mannitol.
Interaction with other drugs
The effect of lowering blood pressure is enhanced by simultaneous administration of Telmisartan and thiazide diuretics (for example, hydrochlorothiazide).
The drug can also enhance the effect of other drugs with a hypotension effect.
If you take Telmisartan with medications that increase the concentration of potassium in the blood plasma, the risk of developing hyperkalemia, that is, a pathological condition that appears due to a significant increase in the amount of potassium in the blood, increases significantly.
If you take Telmisartan and Digoxin at the same time, the level of the latter in the blood increases, so in this case it is very important to regularly check and monitor the concentration of the second drug in the blood.
When taking medications containing lithium, there is an increase in the amount of this element in the blood, which can have a toxic effect on the body.
Side effects of the drug
Telmisartan, like any other drug, has its side effects and contraindications. Side effects:
dizziness;
cough;
headache;
nausea;
myalgia;
diarrhea;
flu-like symptoms;
decreased hemoglobin levels;
pain in the abdomen, chest, lower back;
increased uric acid levels.
Drivers of vehicles and people working at complex technical sites should carefully evaluate possible side effects before taking the drug before driving or operating precision machinery, since after taking Telmisartan, dizziness or drowsiness may occur, and attention and concentration may be dulled.
People suffering from hyponatremia or having a reduced circulating blood volume may experience symptomatic arterial hypotension after taking the first tablet of the drug.
The use of Telmisartan by patients suffering from renal artery stenosis significantly increases the risk of developing severe hypotension and renal failure. This category of patients should take Telmisartan carefully.
Contraindications of the drug
The drug should not be taken during pregnancy. Even those who are planning to become a mother should refuse to take it. Breastfeeding women should stop breastfeeding during drug therapy.
The safety of taking the drug for children and adolescents has not yet been determined, therefore, to avoid health problems for children, Telmisartan is contraindicated.
You should also not take the medicine in the following cases:
sensitivity to the components of the drug;
serious diseases and dysfunction of the liver and kidneys;
obstruction of the biliary tract.
How to store
store at a temperature no higher than 25 degrees

Preparations containing Telmisartan (Telmisartan, ATC code C09CA07)

Common release forms
Name, manufacturer	Release form	Pack, pcs.	Price, r
Micardis; Germany, Boehringer Ingelheim; original	table 40mg	14	470-1.280
		28	940-1.300
	table 80mg	28	830-1.380
Telsap; Türkiye, Zentiva	table 40mg	30	260-400
		90	710-920
	table 80mg	30	330-560
		90	860-1.140
Telmista; Slovenia, KRKA	table 40mg	28	250-405
	table 80mg	28	250-550
Rare and discontinued release forms
Telmisartan; India, Dr. Reddis	table 40mg	30	250-350
	table 80mg	30	3000-430
Pritor; Italy, Glaxo	table 40mg	14	No
	table 80mg	14	No

Commercial names abroad (abroad) - Adcom, Arbitel, Astel, Axeten, Cordiax, Cortel, Cresar, Etela, Hytel, Inditel, Kinzal, Lowlip, Macsart, Mitosan, Targit, Telart, Telday, Teli, Teliact, Telista, Telma , Telmore, Telminorm, Telmed, Telpres, Telsite, Telza, Temax, Tisartan, Vasorta, Zitelmi.

Mikardis (Telmisartan) - instructions for use. The drug is a prescription, the information is intended only for healthcare professionals!

Clinical and pharmacological group:

Angiotensin II receptor antagonist

pharmachologic effect

Angiotensin II receptor antagonist.

Telmisartan is a specific angiotensin II receptor antagonist. It has a high affinity for the AT1 receptor subtype of angiotensin II, through which the action of angiotensin II is realized. Telmisartan displaces angiotensin II from binding to the receptor without having an agonist effect on this receptor. Telmisartan binds only to the AT1 receptor subtype of angiotensin II. The binding is long lasting. Telmisartan has no affinity for other receptors (including AT2 receptors) and other, less studied angiotensin receptors. The functional significance of these receptors, as well as the effect of their possible excessive stimulation by angiotensin II, the concentration of which increases with the administration of telmisartan, have not been studied. Reduces the concentration of aldosterone in the blood, does not inhibit renin in the blood plasma and does not block ion channels, does not inhibit ACE (kininase II, an enzyme that also destroys bradykinin). Therefore, an increase in the side effects caused by bradykinin is not expected.

Telmisartan at a dose of 80 mg completely blocks the hypertensive effect of angiotensin II. The onset of the hypotensive effect is observed within 3 hours after the first dose of telmisartan. The effect of the drug lasts for 24 hours and remains significant for up to 48 hours. A pronounced hypotensive effect usually develops 4-8 weeks after regular use.

In patients with arterial hypertension, telmisartan reduces systolic and diastolic blood pressure without affecting heart rate.

In case of abrupt withdrawal of telmisartan, blood pressure gradually returns to its original level without the development of withdrawal syndrome.

Pharmacokinetics

Suction

After oral administration, telmisartan is rapidly absorbed from the gastrointestinal tract. Bioavailability is about 50%.

When taking Micardis simultaneously with food, the reduction in AUC values ​​ranges from 6% (at a dose of 40 mg) to 19% (at a dose of 160 mg). 3 hours after taking the drug, the concentration of telmisartan in the blood plasma levels out regardless of food intake.

Distribution

Binding to blood plasma proteins is more than 99.5%, mainly with albumin and α1-glycoprotein. The average apparent Vd at equilibrium is approximately 500 L.

Metabolism

Telmisartan is metabolized by conjugation with glucuronic acid. The metabolite does not exhibit pharmacological activity.

Removal

T1/2 - more than 20 hours. Telmisartan is mainly excreted in the feces, mainly unchanged, through the kidneys - less than 2%. Total plasma clearance is quite high (approximately 900 ml/min) compared to hepatic blood flow (approximately 1500 ml/min).

Pharmacokinetics in special clinical situations

In women, Cmax and AUC in plasma are 3 and 2 times higher, respectively, than in men (without a significant effect on efficacy).

The pharmacokinetics of telmisartan in elderly patients does not differ from young patients. No dose adjustment is required.

No dose adjustment is required in patients with renal impairment, including patients on hemodialysis.

Telmisartan is not removed by hemodialysis.

Indications for use of the drug MIKARDIS®

• arterial hypertension;
• reducing cardiovascular morbidity and mortality in patients aged 55 years and older with a high risk of cardiovascular disease.

Directions for use and dosage

The drug is prescribed orally, regardless of food intake.

For arterial hypertension, the initial recommended dose of the drug is 1 tablet (40 mg) once a day. In cases where the therapeutic effect is not achieved, the dose is up to 80 mg 1 time per day. When deciding whether to increase the dose, it should be taken into account that the maximum antihypertensive effect is usually achieved within 4-8 weeks after the start of treatment.

To reduce cardiovascular morbidity and mortality, the recommended dose is 1 tablet (80 mg) once a day. During the initial period of treatment, additional blood pressure correction may be required.

Patients with renal failure (including those on hemodialysis) and elderly patients do not require dose adjustment.

In patients with mild to moderate liver dysfunction (class A and B on the Child-Pugh scale), the daily dose of the drug should not exceed 40 mg.

Side effect

The observed incidence of side effects did not correlate with the gender, age or race of the patients.

Infections: sepsis, including fatal sepsis, urinary tract infections (including cystitis), upper respiratory tract infections.

From the hematopoietic system: decreased hemoglobin levels, anemia, eosinophilia, thrombocytopenia.

From the central nervous system: insomnia, anxiety, depression, dizziness.

From the cardiovascular system: marked decrease in blood pressure (including orthostatic hypotension), bradycardia, tachycardia, fainting.

From the respiratory system: shortness of breath.

From the digestive system: dry mouth, flatulence, discomfort in the stomach, vomiting, dyspepsia, diarrhea, abdominal pain, impaired liver function, increased activity of liver transaminases.

From the urinary system: impaired renal function (including acute renal failure), peripheral edema, hypercreatininemia.

From the musculoskeletal system: arthralgia, back pain, muscle spasms (calf muscle cramps), pain in the lower extremities, myalgia, tendon pain (symptoms similar to tendinitis), chest pain.

Allergic reactions: anaphylactic reactions, hypersensitivity reactions to the active substance or auxiliary components of the drug, angioedema, eczema, erythema, itching, rash (including drug rash), urticaria, toxic rash.

Laboratory indicators: hyperuricemia, increased blood CPK levels, hyperkalemia.

Other: hyperhidrosis, flu-like syndrome, visual impairment, asthenia (weakness).

Contraindications to the use of the drug MIKARDIS®

• pregnancy;
• lactation period;
• obstructive diseases of the biliary tract;
• severe liver dysfunction (class C on the Child-Pugh scale);
• fructose intolerance and glucose/galactose malabsorption syndrome or sucrase/isomaltase deficiency;
• age under 18 years (efficacy and safety have not been established);
• hypersensitivity to telmisartan and other components of the drug.

Carefully

• bilateral renal artery stenosis or stenosis of the artery of a single kidney;
• liver and/or kidney dysfunction;
• decrease in blood volume due to previous diuretic therapy, restriction of salt intake, diarrhea or vomiting;
• hyponatremia;
• hyperkalemia;
• conditions after kidney transplantation (no experience of use);
• chronic heart failure;
• stenosis of the aortic and mitral valve;
• idiopathic hypertrophic subaortic stenosis;
• primary aldosteronism (efficacy and safety have not been established).

The drug is not indicated for use in children and adolescents, because There are no data on efficacy and safety in this category of patients.

Use of the drug MIKARDIS® during pregnancy and breastfeeding

Micardis® is contraindicated for use during pregnancy and lactation.

If pregnancy is planned, Micardis should be replaced with another antihypertensive drug. If pregnancy is established, use of Micardis should be discontinued as soon as possible.

Preclinical studies did not reveal a teratogenic effect of the drug, but a fetotoxic effect was noted.

Use for liver dysfunction

The use of the drug is contraindicated in cases of obstruction of the biliary tract or severe liver dysfunction.

With caution: liver dysfunction

Use for renal impairment

With caution: renal dysfunction.

special instructions

In some patients, due to suppression of the RAAS, especially when using a combination of drugs acting on this system, renal function is impaired (including acute renal failure). Therefore, therapy accompanied by such a double blockade of the RAAS should be carried out strictly individually and with careful monitoring of renal function (including periodic monitoring of serum potassium and creatinine concentrations).

In cases where vascular tone and renal function depend primarily on the activity of the RAAS (for example, in patients with chronic heart failure or kidney disease, including renal artery stenosis or stenosis of the artery of a single kidney), prescribing drugs that affect this system, may be accompanied by the development of acute arterial hypotension, hyperazotemia, oliguria, and, in rare cases, acute renal failure.

Based on the experience of using other drugs that affect the RAAS, when Micardis® is co-administered with potassium-sparing diuretics, potassium-containing supplements, potassium-containing table salt, and other drugs that increase the concentration of potassium in the blood (for example, heparin), this indicator should be monitored in patients.

Alternatively, Micardis® can be used in combination with thiazide diuretics, such as hydrochlorothiazide, which additionally have a hypotensive effect (for example, MicardisPlus® 40 mg/12.5 mg, 80 mg/12.5 mg).

In patients with severe arterial hypertension, a dose of telmisartan 160 mg per day in combination with hydrochlorothiazide 12.5-25 mg was well tolerated and effective.

Micardis® is less effective in black patients.

Impact on the ability to drive vehicles and operate machinery

No special clinical studies have been conducted on the effect of the drug on the ability to drive a car or use machinery. However, when driving and operating machinery, the possibility of dizziness and drowsiness should be taken into account, which requires caution.

Overdose

Cases of drug overdose in humans have not been identified.

Symptoms: marked decrease in blood pressure, tachycardia, bradycardia.

Treatment: for arterial hypotension, symptomatic therapy is prescribed. Hemodialysis is ineffective.

Drug interactions

Telmisartan may increase the hypotensive effect of other antihypertensive agents. Other types of interactions of clinical significance have not been identified.

Combination use with digoxin, warfarin, hydrochlorothiazide, glibenclamide, ibuprofen, paracetamol, simvastatin and amlodipine does not lead to clinically significant interactions. There was an increase in the average concentration of digoxin in the blood plasma by an average of 20% (in one case by 39%). When telmisartan and digoxin are prescribed simultaneously, it is advisable to periodically determine the concentration of digoxin in the blood.

With simultaneous use of telmisartan and ramipril, an increase in AUC0-24 and Cmax of ramipril and ramiprilat was observed by 2.5 times. The clinical significance of this phenomenon has not been established.

With the simultaneous administration of ACE inhibitors and lithium preparations, a reversible increase in the concentration of lithium in the blood was observed, accompanied by a toxic effect. In rare cases, such changes have been reported with the administration of angiotensin II receptor antagonists. When prescribing lithium and angiotensin II receptor antagonists simultaneously, it is recommended to determine the concentration of lithium in the blood.

Treatment with NSAIDs, including acetylsalicylic acid, COX-2 inhibitors and non-selective NSAIDs, may cause the development of acute renal failure in dehydrated patients. Drugs acting on the renin-angiotensin-aldosterone system (RAAS) may have a synergistic effect. In patients receiving NSAIDs and telmisartan, blood volume should be compensated and renal function monitored at the beginning of treatment.

A decrease in the effect of antihypertensive agents, such as telmisartan, through inhibition of the vasodilatory effect of prostaglandins has been observed when combined with NSAIDs.

Conditions for dispensing from pharmacies

The drug is available with a prescription.

Storage conditions and periods

List B. The drug should be stored out of the reach of children, protected from moisture at a temperature not exceeding 30°C. Shelf life - 4 years.

High blood pressure is one of the most common diseases of the cardiovascular system. Every year, patients of all ages are increasingly diagnosed with high blood pressure. There are a lot of medications that reduce intracranial and blood pressure, but many of them have a large number of side effects. Micardis has a minimum of side effects; it is an excellent alternative to the more expensive Telmisartan. Produced in the form of tablets in blisters. Each tablet contains 20, 40 or 80 mg of telmisartan (active substance).

Indicated also for patients suffering from renal failure. According to the instructions for use, Micardis is not prescribed to patients with a diseased liver and imperfect biliary tract. For those with moderate renal failure, no more than 40 mg of Micardis per day is prescribed.

The effect of Micardis

The effectiveness of taking Micardis depends on the dose. If you increase the daily dose from 20 to 80 mg, this will mean that blood pressure will drop twice. It is not worth increasing the dose of Micardis above 80 mg - this will not reduce blood pressure even more. The maintenance dose of the drug is 40 mg per day. After a month of taking Mikardis, blood pressure returns to normal. If you have the initial stage of hypertension, it is more prudent to buy Micardis 40 mg and take half a tablet per day (20 mg), if the chronic form is 40 and 80 mg.

What does Mikardisa consist of:

• Telmisartan is the active substance;
• Hydrochlorothiazide (diuretic);
• Polividone;
• Sodium hydroxide;
• Meglumin;
• Magnesium stearate;
• Sorbitol (fructose).

The last six are excipients.

Micardis as a drug that prolongs life

Mikardis in its medicinal essence is sartan or angiotensin receptor blocker. This is a medicine used to treat high blood pressure. The principle of their action is that the kidneys, after taking sartans, produce renin, which converts inactive angiotensinogen into angiotensin 1, which dilates blood vessels and is a diuretic. Next comes a whole chain of reactions in the body that prevents hypertension. This is how blood pressure returns to normal if it is elevated. And this is how the life of a patient suffering from hypertension and cardiovascular diseases is prolonged.

Manufacturer, cost, Russian analogues

Mikardis tablets are made in Austria, so the price of Mikardis reaches 1000 rubles for a package of 28 pieces. But there are cheaper Russian-made analogues of Mikardis:

• Angiakand;
• Blocktran;
• Aprovel;
• Candesartan;
• Atakand;
• Losartan;
• Kozaar;
• Lozap;
• Teveten;
• Cardosal;
• Diovan;
• Walz;
• Valsartan.

Imported analogues of Mikardis:

• Telmista (Poland/Slovenia);
• Teseo (Poland);
• Praytor (Germany);
• Twinsta (Slovenia);
• Telmisartan-Teva (Hungary);
• Telpres (Spain);
• Telsartan (India);
• Tsart (India);
• Hypotel (Ukraine).

The price of German-made Micardis will a priori be higher than the price of drugs with the same therapeutic effect, but with different components. The price of drugs similar to Mikardis, produced in Hungary and Poland, is approximately the same as Mikardis, produced in Germany. There are no Russian medicines containing the active ingredient telmisartan.

Micardis: when to use

According to the instructions for use, Micardis is taken to:

• Cure high blood pressure;
• For the prevention of cardiovascular diseases.

When not to take

Based on the instructions for use, Micardis 80 mg, 40 mg should not be taken by those who:

• Expecting a child;
• Breastfeeds the baby;
• Suffers from bile duct obstruction;
• Has severe disturbances in the functioning of the liver and kidneys;
• Has an allergy to the components of the drug (contains fructose);
• Has an intolerance to the substance telmisartan;
• Children under eighteen years of age.

Drink with caution

In accordance with the instructions for use, Micardis should be taken carefully, under the supervision of a doctor, by those who suffer from:

• Coronary heart disease;
• Stenosis of both renal arteries;
• Chronic heart failure;
• Valve stenosis;
• Cardiomyopathy;
• Renal hypertension;
• Hyperkalemia;
• Renal dysfunction as part of a kidney transplant;
• In case of violations of the outflow of bile;
• Liver dysfunction;
• Diabetes mellitus;
• Dehydration of the body as part of food poisoning (sweating fluids must be restored before taking Micardis).

Side effect

The drug Mikardis, as indicated in the instructions for use, has a number of side effects, which, however, do not occur often:

• Myalgia;
• Dizziness;
• Depression;
• Increased anxiety;
• Chest pain;
• Nonproductive cough;
• Swelling of the mucous membranes;
• Anemia;
• Hives;
• Skin itching.

Micardis and alcohol

While taking Mikardis, you should absolutely not drink alcohol or take medications that contain ethanol.

Micardis and other medicines

Some patients wonder what is better to take, Micardis or Lorista? Both of these drugs lower blood pressure, but the active ingredient in them is different. The price is also different. Lorista costs about 300 rubles, while Mikardis costs about 1000.

Reviews

Reviews from cardiologists

Reviews from cardiologists about Mikardis are mostly positive. If you do not violate the dosage and before use you are examined for the presence of diseases that are contraindications to the use of Micardis 40 mg, then the effect will be. Moreover, without any special side effects. Cardiologists note the minimal impact of this drug on heart rhythm, the effectiveness of the drug even in cases of chronic hypertension, and the rarity of side effects. And if they do appear, then they are of a small intensity. The effect is prolonged - lasts 48 hours.

Patient reviews

Patient reviews of the drug Micardis are good. The only drawback of this German medicine, according to patients, is the cost. Approximately 1000 rubles, plus or minus 100 rubles - this price will not suit everyone. One of the positive qualities is a comfortable welcome. It is enough to take a tablet once a day and you will walk with normal blood pressure all day. Side effects are rare.

Semyon. B., 54 years old, Novosibirsk: After a heart attack, I suffered from dizziness and pressure surges, the cardiologist prescribed this drug. I've been drinking for a year now. A month after taking it, the pressure stopped jumping and became normal - 120/70. Now my wife and sister drink Mikardis.

Oleg P. 45 years old. Tomsk: The doctor prescribed Mikardis for me when I asked to replace Aprovel with something too expensive. It helps me very well in lowering blood pressure without affecting my heart rate.

Angela P., 56 years old: I take Micardis in symbiosis with other drugs to lower blood pressure, because I suffer from a chronic form of hypertension. It helps well and there are few side effects, only sometimes the skin on the palms itches.

Twinsta: instructions for use, price, reviews, analogues of tablets

Twynsta tablets (sometimes misspelled as Twista) are a combination of two antihypertensive substances, the actions of which complement each other, and help control blood pressure in those patients who suffer from essential arterial hypertension.

This combination of telmisartan and amlodipine provides a higher level of antihypertensive effect than the use of each component separately.

The instructions for use will tell you in more detail.

Adult patients should take tablets once a day. If a person needs a significant reduction in blood pressure, the initial dosage for him will be 80/5 mg once a day.

If additional reduction in blood pressure is necessary, already 2 weeks after the start of therapy, the volume of the drug can be gradually increased to reach 80/10 mg per day. The drug can be taken together with other antihypertensive drugs.

For patients with mild to moderate liver dysfunction, tablets are prescribed with caution. The dosage of telmisartan should not exceed 40 mg per day. After taking the first dose of the drug, the hypotensive effect:

• develops smoothly, usually within the first 3-4 hours;
• lasts 24 hours;
• remains significant for up to 48 hours.

If it is necessary to abruptly stop taking the pills, blood pressure will return to its original level gradually, without the so-called withdrawal syndrome.

If the patient has impaired renal function and is on hemodialysis, there is no need to change the dosage of the drug, since the active ingredients of the drug are not dialyzed. Due to the lack of data on the use of Twynsta in patients under the age of 18, the tablets are not prescribed to them. For the treatment of elderly people, no dosage changes are required.

Blood pressure pills can be purchased at any pharmacy, but only with a prescription from a doctor.

Drug interactions

According to the instructions for use, there is no interaction between the substances that make up the drug. When treated in parallel with other antihypertensive pills, their effect may be significantly enhanced (the blood pressure will drop too quickly).

Medicines for normalizing blood pressure Amifostine and Baclofen, due to their pharmacological properties, can enhance the hypotensive effect of almost all antihypertensive drugs, including Twynsta tablets. In addition, orthostatic hypotension may be exacerbated by:

1. alcoholic drinks;
2. narcotic drugs;
3. antidepressants.

Systemic use of corticosteroids can reduce the antihypertensive effect. Telmisartan may increase the hypotensive effect of other drugs against high blood pressure, but other interactions that will have clinical significance have not been established.

The use of Telmisartan does not lead to a strong interaction with Warfarin, Digoxin, Ibuprofen, Hydrochlorothiazide, Glibenclamide, Amlodipine, Paracetamol and Simvastatin. Since there is a possibility of an increase in the level of Digoxin in the blood plasma, the advisability of monitoring the level of this substance should always be taken into account.

Medical studies have established that parallel treatment with lithium preparations results in a reversible increase in the concentration of lithium in the blood and the development of toxicity. Similar situations, according to patient reviews, were observed during simultaneous treatment with angiotensin II receptor antagonists. For this reason, there are indications to monitor the level of lithium in the blood plasma.

If the body is dehydrated, treatment with non-steroidal anti-inflammatory drugs and cyclooxygenase II inhibitors can lead to the onset of acute renal failure.

Tablets that affect renin-angiotensin activity may have a synergistic effect in this regard. In patients receiving non-steroidal anti-inflammatory drugs and Telmisartan:

• Normal water regime must be maintained;
• At the beginning of therapy, renal function should be monitored.

With simultaneous treatment with non-steroidal anti-inflammatory drugs and anti-hypertensive drugs, the hypotensive effect may be reduced due to inhibition of prostaglandins.

During treatment with Twynsta, grapefruit juice and grapefruit should not be consumed, as there is a possibility of increased bioavailability, leading to a rapid increase in blood pressure. Combined use with certain anticonvulsants may result in a decrease in the concentration of amlodipine in the blood serum, such drugs include: Phenytoin, Primidone, Phenobarbital, Carbamazepine, Rifampicin. Parallel treatment with Twinsta and St. John's wort has similar properties.

The combined use of large doses of amlodipine with Simvastatin will immediately increase the effect of the former by 77%, when compared with isolated administration of the drug. Therefore, the daily dosage of simvastatin for people taking amlodipine should always be limited to 20 mg per day.

In monotherapy, the safety of combined use of the drug with medications has been confirmed:

1. diuretics;
2. beta-blockers;
3. ACE inhibitors;
4. Nitroglycerin (under the tongue);
5. oral hypoglycemic agents;
6. long-acting nitrates;
7. antibiotics;
8. non-steroidal anti-inflammatory drugs.

With simultaneous treatment with amlodipine and Sildenafil, each substance will exhibit an independent hypotensive effect.

It should also be taken into account that the pharmacokinetics and pharmacodynamics will not be affected by parallel treatment with Twynsta tablets and Cimetidine, Warfarin, Digoxin, Atorvastatin.

Significant negative effects and a decrease in the effectiveness of treatment will not occur if you take 10 mg of amlodipine and no more than 240 ml of grapefruit juice on the same day.

The active ingredients of the drug are excreted primarily in bile. With obstruction of the biliary tract, liver failure, in some cases, reduced clearance is observed.

The half-life of Twynsta tablets, similar to calcium supplements, may increase if there are liver problems. In such cases, the drug at a dosage of 80/5, 80/10 mg is contraindicated for use.

If a person suffers from bilateral renal artery stenosis, stenosis of the artery of a single kidney, or takes medications that affect the renin-aldosterone system, his likelihood of developing severe:

• renal failure;
• hypotension.

When there is a need to prescribe Twynsta tablets to a patient who has undergone a kidney transplant, constant monitoring of the level of creatinine and potassium in the blood plasma should be ensured. However, to date there is no experience with the use of the drug in such patients.

In people with hyponatremia or reduced circulating blood volume, for example, against the background of intensive diuretic therapy, vomiting, diarrhea, dietary restrictions on the consumption of table salt, symptomatic hypotension may occur. This problem is especially relevant when taking the first dose of the drug. For successful treatment, these conditions must be eliminated, and only then it is necessary to take Twynsta tablets.

During inhibition of the renin-angiotensin-aldosterone system, especially when using several medications that affect this system, in patients with a predisposition, some renal dysfunction may occur, up to the onset of acute renal failure.

Twynsta tablets can be used along with other drugs against high blood pressure, but double blockade of renin-angiotensin-aldosterone is undesirable, as it can provoke negative reactions in the body. A similar treatment regimen can be used:

1. only for individual indications;
2. against the background of constant monitoring of kidney function.

Main contraindications

Contraindications to the use of tablets will be increased sensitivity to the main active ingredients of the drug, to dihydropyridine derivatives, other excipients, the second and third trimester of pregnancy, shock conditions (including cardiogenic shock), obstructive biliary disorders, severe liver failure.

Treatment should not be prescribed for:

• severe arterial hypotension;
• obstruction of the left ventricular outflow tract;
• hemodynamically unstable heart failure.

In addition, parallel treatment with Aliskiren and Telmisartan is contraindicated for patients who suffer from renal impairment, type 1 and type 2 diabetes mellitus.

It is not recommended to use Twynsta for primary hyperaldosteronism. Such patients should not be treated with other antihypertensive drugs that act by inhibiting the renin-angiotensin-aldosterone system.

As for sick people with aortic and mitral valve stenosis, obstructive hypertrophic cardiomyopathy, the use of Twynsta does not require special caution. There is no information justifying the need for treatment with Twynsta in patients with myocardial infarction or unstable angina pectoris.

In a long-term placebo-controlled study of the drug in people with heart failure of non-ischemic etiology of classes 3 and 4, it was found that the use of amlodipine is accompanied by the frequent development of pulmonary edema.

In diabetes mellitus, which is burdened by the risk of cardiovascular diseases, for example, coronary heart disease, the use of antihypertensive drugs may be accompanied by a high risk of:

1. myocardial infarction;
2. sudden death.

Coronary heart disease in a diabetic may occur without any symptoms and, therefore, can be quite difficult to diagnose. Such patients must undergo appropriate examinations to establish and further treat the disease even before starting to take Twynsta.

Use during pregnancy, lactation, children

Today there is no exact data on the effect of the drug on pregnancy and breastfeeding, however, there is information on the effects of individual components of the drug.

Angiotensin II receptor antagonists are not used during pregnancy. Women who are planning a pregnancy should replace Twynsta with other antihypertensive drugs that have an established safety profile in advance. If pregnancy is established during therapy with angiotensin II antagonists, treatment is stopped immediately, or the doctor will decide on an alternative treatment regimen.

Preclinical studies of telmisartan will not indicate its teratogenicity, but will show the phytotoxicity of the substance. The use of angiotensin II receptor antagonists during the second and third trimester of pregnancy will cause:

1. decreased kidney activity;
2. oligohydramnios;
3. delayed ossification of the skull;
4. renal failure;
5. hyperkalemia;
6. arterial hypotension.

When treating with angiotensin II antagonists from the second trimester, it is necessary to conduct regular examination of the fetal skull and kidneys. Infants whose mothers took Twynsta during pregnancy should be monitored for hypotension.

Data obtained from the use of amlodipine or other calcium receptor antagonists indicate no negative effects on the unborn child. However, there is a possibility of prolonged action of the medication.

To date, there is no reliable information about the effects of amlodipine excreted in mother's milk. During clinical studies, the presence of telmisartan in breast milk was proven. Given the potential for adverse reactions in nursing infants, the importance of such treatment for both mother and baby will need to be considered. Most likely, the doctor will decide to stop lactation or suspend therapy.

The instructions for use state that separate studies on the toxicity of the combination of amlodipine and telmisartan, individual components, have not been conducted. Preclinical tests have shown that these substances are not capable of adversely affecting female and male fertility.

There is also no information about whether the drug affects the ability to manage:

• potentially dangerous mechanisms;
• automobile and other transport.

Some patients report that during therapy, negative effects are sometimes observed, for example, fainting, dizziness, drowsiness, vertigo. For this reason, extreme caution must always be used when operating vehicles and machinery.

Cases of overdose

It is expected that the symptoms and manifestations of overdose will respond with potent pharmacological effects. Expressive symptoms of excessive use of the drug will be:

1. arterial hypotension.

In addition, there is information about attacks of bradycardia, increased levels of creatinine in the blood, as well as increased blood pressure, nausea and dizziness.

An overdose can cause excessive expansion of peripheral vessels and reflex tachycardia. There is information about the development of prolonged systemic hypotension, including a state of shock with a fatal outcome.

Treatment in such cases requires symptomatic and supportive treatment. All therapeutic measures will depend on the severity of symptoms and time of administration. The proposed measures include gastric lavage and induction of vomiting. In such situations, activated carbon or similar sorbents may be useful.

To improve the patient's condition, the level of creatinine and electrolytes in the blood should be systematically monitored. If arterial hypotension occurs, the patient needs to lie down with his legs slightly elevated. It is recommended to ensure adjustment of salt balance and blood volume and supportive therapy. Calcium gluconate may be required to reverse calcium channel blockade.

Each package of the drug contains instructions from which you can find out more information about the features of treatment and the effectiveness of blood pressure reduction. The video in this article offers some advice from a cardiologist.

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Heart medications: review of basic medications, indications, treatment examples

Currently, in the arsenal of cardiologists there is a fairly large volume of medications that can eliminate a life-threatening situation in patients with cardiovascular pathology, as well as reduce unpleasant symptoms, improve the quality of life and significantly prolong the patient’s life. The following is an overview of the most commonly prescribed medications in cardiology.

Attention! The material is provided for informational purposes only. Self-prescription of most drugs can be life-threatening!

Nitrates

Nitroglycerin preparations, or nitrates, are drugs whose main property is to provide a vasodilating, that is, vasodilating, effect. These drugs are taken (nitroglycerin tablets, nitromint, nitrospray), as a rule, sublingually (under the tongue), which is especially important when quickly providing assistance to a patient with an attack of angina. Long-acting drugs are also used - monocinque, pectrol, cardiquet and nitrosorbide.

Nitrates dilate not only peripheral arteries and veins, but also arteries supplying the heart, thus providing blood flow to the myocardium, which is in a state of ischemia. Thanks to this, the use of nitrates during attacks of angina pain helps prevent the development of myocardial infarction.

Indications: in persons with acute myocardial infarction, with stable angina, progressive angina, with acute coronary syndrome, during a hypertensive crisis, pulmonary edema, with the development of acute and chronic heart failure.

Contraindications: collapse (sharp decrease in blood pressure with loss of consciousness), shock, hemorrhagic stroke in the acute period, glaucoma with high intraocular pressure.

Of the side effects, intense headache caused by dilation of intracranial vessels deserves special attention. Sometimes the pain is so severe that it forces patients to stop using nitroglycerin. Such pain is not relieved by conventional analgesics, but relief can occur if the patient immediately after taking nitrates dissolves a mint candy or a validol tablet.

Other side effects include increased heart rate, dizziness, nausea, a sharp decrease in blood pressure, and redness of the facial skin.

This is perhaps the most frequently prescribed group of drugs for the heart and blood vessels in young people (under 50 years of age) and in patients at the initial stage of coronary heart disease. At the same time, good effectiveness of the drugs is also observed in elderly patients with severe myocardial ischemia, as well as after heart attacks.

This group includes a large number of drugs that differ in their mechanism of action, but the effect is the same for all - this is the elimination of the processes of lipid peroxidation (LPO), which is the basis of cell damage during hypoxia, as well as increasing the resistance of cells to hypoxia (acute lack of oxygen) and strengthening the heart.

In cardiology, various vitamins are most often prescribed, as well as preductal, mexidol, actovegin and mildronate, and the intramuscular and intravenous route of drug administration is preferable, although tablet forms are also quite effective.

Indications:

• Long-term therapy of coronary disease, for the prevention of acute myocardial infarction, strengthening of the myocardium in chronic heart failure - for all drugs in this group,
• Consequences of acute strokes in the subacute period (for preductal and mildronate),
• Ischemic stroke in the acute period (for Actovegin),
• Microcirculation disorders in pathology of arteries and veins, as well as in diabetic neuropathy (for Actovegin),
• Dyshormonal cardiomyopathy (for mildronate).

Contraindications:

1. Pulmonary edema,
2. Acute renal or liver failure,
3. Children's age, pregnancy and lactation (for Mildronate, Preductal and Mexidol).

Allergic reactions are rarely observed as side effects.

Potassium and magnesium supplements

Of the drugs in this group, the most commonly prescribed are panangin and asparkam, which are recognized by doctors as the best drugs that affect cell metabolism. Doctors often call them a “vitamin” for the heart. In fact, this is true - potassium in combination with magnesium are microelements, the normal content of which inside cells, including myocardial cells, contributes to good intracellular metabolism. Thus, being involved in intracellular metabolism, potassium and magnesium play an important role in regulating contractions of the heart muscle. In addition, when administered intravenously, potassium can slow down the heart rate during tachycardia or restore it during arrhythmia.

Indications:

• Atrial fibrillation,
• Treatment of tachycardia,
• Taking cardiac glycosides (digoxin),
• With low levels of potassium and magnesium intake from food in order to strengthen the heart muscle.

Contraindications: acute and chronic renal failure, increased potassium levels in the blood (hyperkalemia), atrioventricular block II-III degree, Addison's disease (adrenal insufficiency accompanied by hyperkalemia), cardiogenic shock.

Side effects: allergic reactions, nausea, epigastric burning, fatigue, muscle weakness, atrioventricular block.

Video: coronary heart disease and drugs for its treatment in the “Tablet” program

ACE inhibitors

This is a group of heart medications that have an inhibitory effect (preventing the function) of the angiotensin-converting enzyme (ACE). This enzyme is one of the most important links in the chain that regulates vascular tone and the associated level of blood pressure in the body. Thus, by inhibiting the enzyme, these drugs help lower blood pressure.

In addition, ACE inhibitors have proven organoprotective properties, that is, they have a protective effect on the inner lining of blood vessels, the heart, kidneys and brain, eliminating the damaging effects of high blood pressure in hypertension.

The most commonly prescribed drugs are enalapril, lisinopril, captopril and perindopril. Captopril is used only as an emergency drug for high blood pressure.

Indications for use are arterial hypertension and chronic heart failure, especially if they are observed in persons with the following diseases:

• Diabetes,
• Left ventricular myocardial hypertrophy,
• Systolic or diastolic asymptomatic left ventricular dysfunction (according to echocardioscopy),
• Post-infarction cardiosclerosis (PICS),
• Atherosclerosis of the aorta and carotid arteries,
• Kidney damage due to hypertension (nephropathy), manifested by the presence of protein in the urine - proteinuria.

Contraindications include the presence of allergic reactions to drugs of this group in the past (rash, swelling, anaphylactic shock). The drugs are contraindicated for pregnant and lactating women.

Drugs in this group are usually well tolerated by patients, but a small group of patients (less than 20%) experience side effects such as dry cough, hoarseness, and allergic reactions (extremely rare), manifested by rash, swelling and redness of the facial skin.

With daily, long-term use of drugs of this group, as required by the therapy of many cardiovascular diseases, there is no danger from taking the tablets, since they do not have a negative effect on the liver, do not increase blood sugar and cholesterol levels, and do not remove potassium from the body. But refusal of such therapy is fraught with a high risk of developing chronic heart failure and even sudden cardiac death.

Angiotensin II receptor antagonists (ARA II)

Heart medications in this group are called sartans. The mechanism of their action is similar to the action of the previous group, only it is not the enzyme that converts angiotensin I into angiotensin II that is blocked, but the receptors for angiotensin II. As a result, angiotensin does not influence vascular tone - the latter remains normal or decreases, as a result of which blood pressure normalizes.

Indications and contraindications for use are the same as for ACE inhibitors.

Just like the previous group, sartans are well tolerated. Their undoubted advantage is the absence of dry cough as a side effect, due to which they can be taken by patients with intolerance to ACE inhibitors. Other side effects rarely include allergic reactions, swelling, weakness, muscle aches and pain, nausea, abdominal pain, etc.

Beta blockers

The functional activity of beta blockers is due to their blocking effect on adrenaline receptors located in the heart muscle and in the vascular wall. Adrenaline stimulates the myocardium, increasing the frequency and strength of contractions, and increases vascular tone.

All of these effects of adrenaline on the cardiovascular system contribute to increased heart rate and increased blood pressure. This action has an adverse effect on the heart, especially if the patient has coronary artery disease, since rapid heartbeat leads to an increase in myocardial oxygen demand, and the lack of oxygen in the heart muscle is the pathophysiological basis of ischemia.

Thanks to beta blockers, it has become possible to slow down the heart rate and lower blood pressure, which significantly reduces the risk of myocardial infarction and improves the prognosis in people with coronary heart disease. At the same time, the isolated prescription of beta blockers to persons with only hypertension, without ischemia, is unjustified, since they have more side effects than the first two groups of drugs.

Thus, the main indications for prescribing beta blockers are myocardial ischemia, previous infarction, abnormal heart rhythm with increased heart rate (tachyarrhythmias), post-infarction cardiosclerosis, the development of chronic heart failure, hypertension in persons who have suffered a stroke.

Beta blockers are contraindicated in case of individual intolerance and allergic reactions to the drug in the past, in patients with bronchial asthma (with chronic obstructive bronchitis prescribed with caution), as well as in case of conduction disorders (atrioventricular block, sick sinus syndrome), with bradycardia (rare pulse less than 55 per minute), with cardiogenic shock and low blood pressure (below 100/60 mm Hg).

Side effects include:

1. Conduction disturbances (blockades) and bradycardia,
2. Poor exercise tolerance - general weakness, fatigue,
3. Nausea, dizziness,
4. The use of outdated drugs (propranolol (Anaprilin), atenolol) in young and middle-aged men leads to the development of erectile dysfunction (impaired potency), drugs of the latest generations do not affect potency,
5. Drugs such as propranolol (Anaprilin) ​​and atenolol are not recommended due to the presence of side effects, in particular, increased insulin resistance of body tissues - a condition in which the receptors of internal organs are not sensitive to insulin, which causes an increase in blood glucose levels , which is unfavorable for patients with concomitant diabetes mellitus.

More modern drugs of the latest generations do not affect carbohydrate metabolism and can be used for a long time, especially in patients with diabetes.

The effect of the following cardiovascular drugs - calcium antagonists is due to a block of channels through which calcium ions enter the cells - the main substance that stimulates muscle cells to contract, which causes a decrease in vascular tone and normalizes blood pressure. Calcium antagonists also have an effect on the heart muscle, but the effect depends on the type of drug. Thus, nifedipine and felodipine cause tachycardia, and verapamil and diltiazem, on the contrary, slow down the heart rate.

The main indications are hypertension, angina pectoris and rhythm disturbances such as tachycardia in persons for whom the use of beta blockers is contraindicated. For other patients, it is preferable to prescribe the previous groups of drugs.

Contraindications include low blood pressure, left ventricular systolic dysfunction (according to echocardioscopy), bradycardia and conduction disorders (atrioventricular block), sick sinus syndrome.

Side effects develop infrequently and include reflex tachycardia and facial flushing associated with vasodilation (for nifedipine), bradycardia (for other drugs), and constipation (for verapamil).

Diuretics

Diuretics, or diuretics, act on the kidney tubules, helping to remove excess fluid from the body. This helps not only to lower blood pressure levels, but also to “unload” blood vessels in the lungs, liver and lower extremity vessels, which is important for eliminating symptoms of chronic heart failure such as shortness of breath and edema.

There are three groups of drugs - thiazide (chlorothiazide, indapamide), loop (torasemide (Trigrim, Diuver) and furosemide (Lasix) and potassium-sparing diuretics (veroshpiron (spironolactone).

Indications: arterial hypertension, initial (for thiazide) and severe (for loop and potassium-sparing) stages of chronic heart failure, emergency relief of a hypertensive crisis (furosemide intravenously or intramuscularly).

Contraindications: severe renal failure, high levels of potassium in the blood (for veroshpiron), low levels of potassium in the blood (for furosemide), acute glomerulonephritis, severe liver failure, pregnancy and lactation.

Side effects include increased blood glucose levels and an increased risk of developing diabetes with long-term use. Drugs that do not have this effect are dichlorothiazide and indapamide, which can be used long-term, including in patients with diabetes.

In addition, loop diuretics remove potassium from the body, which has an adverse effect on the heart, so loop diuretics are prescribed together with potassium-sparing ones. The latter, in turn, also have an antiandrogenic effect, which causes a decrease in potency and growth of the mammary glands in men.

Combination drugs

Due to the fact that diseases of the cardiovascular system are becoming younger and occur in people of working age, working patients cannot always remember that they need to take several tablets, and even at different times of the day. The same applies to older people - often such patients do not remember whether they took the medicine. Therefore, to improve compliance, or adherence to treatment, combination drugs were created that combine active substances from different groups. They not only make it possible to take one tablet per day instead of two or three, but also help to enhance the effects of the active ingredients, which often makes it possible to reduce the dosage of the drug.

In addition, the advantage of such drugs is that they are not prescribed by prescription, and you can buy them yourself, but only on the recommendation of your doctor.

Below are the names of the best drug combinations:

1. Valz N - valsartan + hydrochlorothiazide (80 mg + 12.5 mg, 160 mg + 12.5 mg, 160 mg + 25 mg).
2. Noliprel - perindopril 2.5 mg + indapamide 0.625 mg.
3. Noliprel A Bi-forte - perindopril 10 mg + indapamide 2.5 mg.
4. Duplekor - amlodipine 5 mg + atorvastatin 10 mg.
5. Lorista N - losartan 50 mg + hydrochlorothiazide 12.5 mg.
6. Exforge – amlodipine 5 or 10 mg, valsartan 160 mg.
7. Co-Exforge - amlodipine 5 mg or 10 mg + valsartan 40, 80 or 160 mg + hydrochlorothiazide 12.5 mg.
8. Nebilong AM - nebivalol 5 mg + amlodipine 5 mg.
9. Prestance - perindopril + amlodipine (5 mg + 5 mg, 10 mg + 10 mg, 5 mg + 10 mg, 10 mg + 5 mg).

Examples of treatment regimens

We remind you: self-prescription of any medicines from this review is unacceptable!

Long-term, continuous, lifelong therapy, dose adjustment and drug replacement possible:

• Treatment of chronic heart failure - Concor 5 mg in the morning, Prestarium 5 mg in the morning, indapamide 2.5 mg in the morning, ThromboAss 100 mg lunch (a drug to “thin” the blood), atorvastatin 20 mg at night (a drug that lowers cholesterol in the blood).
• Treatment of angina pectoris, ischemic heart disease, after myocardial infarction - nitrospray under the tongue situationally (for pain in the heart), monocinque 40 mg x 2 times a day, indapamide 2.5 mg in the morning, perineva 4 mg in the morning, thromboAss 100 mg lunch, Nebilet 5 mg evening, atorvastatin 20 mg at night.
• Treatment of arterial hypertension - Lorista 25 mg in the morning, amlodipine 5 mg in the evening or Exforge 1 tablet in the morning.

If you see the same or an approximate treatment regimen in your doctor’s prescriptions, do not doubt that the choice and combination of drugs was carried out in the most successful and safest way for your heart.

Summary table of major cardiac drugs

Active substance

Trade name, content of active substance

Manufacturer country

Price, rubles, depending on dosage and quantity per package

ACE inhibitors
Enalapril	Enam 2.5, 5, 10 and 20 mg Enap 2.5, 10 and 20 mg	India Slovenia	60-100
Lisinopril	Diroton 2.5, 5, 10 and 20 mg Lisinotone 5, 10 and 20 mg	Hungary Iceland	100-400
Perindopril	Prestarium 5 and 10 mg Perineva 4 and 8 mg	France	455-621
Beta blockers
Nebivalol	Nebilet 5 mg Nebilong 2.5 and 5 mg	Germany	495-955
Metoprolol	Betaloc ZOK 25, 50 and 100 mg Egilok 25, 50 and 100 mg	Sweden, Hungary, Türkiye Russia, Hungary	149-417
Bisoprolol	Concor 5 and 10 mg Coronal 5 and 10 mg	Russia, Germany The Slovak Republic	217-326
Calcium channel antagonists
Nifedipine	Cordaflex 10, 20 and 40 mg Corinfar 10, 20 and Nifedipine 10 mg	Germany, Hungary Germany Russia, Bulgaria, Croatia	91-227
	Amlodipine 5, 10 mg Normodipine 5, 10 mg	Russia	121-153
Verapamil	Isoptin 40 and 80 mg Verapamil 40 mg	Germany, Hungary, Slovenia Russia, Macedonia	380
Diltiazem	Cardil 60 and 120 mg Diltiazem 60 and 90 mg	Finland Russia, Macedonia, Croatia	112-265
Diuretics
Furosemide	Lasix 40 mg Furosemide 20 and 40 mg	India, Türkiye, USA, Germany	50
Torasemide	Diuver 5 and 10 mg	Croatia	283-410
Indapamide Hydrochlorothiazide	Arifon 1.5 and 2.5 mg Ravel 1.5 mg Indapamide 1.5 and 2.5 mg Hypothiazide 25 and 100 mg	France Russia, Canada Hungary, Russia	347-377
Spironolactone	Veroshpiron 25, 50 and 100 mg Spironolactone 25, 50 and 100 mg	Hungary	189-264
Nitrates
Nitroglycerine Isosorbide mononitrate Isosorbide dinitrate	Nitroglycerin tablets 0.5 mg Nitrospray 0.4 mg in one dose Monocinque 40 and 50 mg Pectrol 40 and 60 mg Cardiket 20 and 40 mg Nitrosorbide 10 mg	Russia Germany, Italy Slovenia Germany	47-50
Antioxidants and antihypoxants
Hemoderative of calf blood Meldonium dihydrate Ethylmethylhydroxy pyridine succinate Trimetazidine dihydrochloride	Actovegin 40 mg/ml ampoules of 5 ml No. 5 200 mg in tablet No. 50 Mildronate 100 mg/ml 5 ml in ampoule No. 10 250 and 500 mg in tablet No. 60 Mexidol 50 mg/ml 5 ml in ampoule No. 20 50 mg/ml 2 ml in ampoule No. 10 Preductal 35 mg in tablet No. 60	Slovenia, Austria, India Latvia, Republic of Lithuania	589
Potassium and magnesium supplements
Potassium aspartate + magnesium aspartate	Panangin 158 mg + 140 mg in tablet No. 50 45.2 mg/ml + 40 mg/ml 10 ml in ampoule No. 5 Asparkam 175 mg + 175 mg No. 56 10 ml in ampoule No. 10	Hungary	137
Magnesium orotate dihydrate	Magnerot 500 mg No. 50	Germany	594

film-coated tablets

Owner/Registrar

NORTH STAR, JSC

International Classification of Diseases (ICD-10)

I10 Essential [primary] hypertension

Pharmacological group

Angiotensin II receptor antagonist

pharmachologic effect

Antihypertensive agent, angiotensin II receptor antagonist (AT1 type). It has a very high affinity for this receptor subtype. By selectively and long-term binding to receptors, telmisartan displaces angiotensin II from its connection with AT1 receptors. Does not show affinity for other AT receptor subtypes. The functional significance of other receptor subtypes and the effect of increased (as a result of the administration of telmisartan) levels of angiotensin II on them is not known. Telmisartan reduces the level of aldosterone in the blood plasma, does not inhibit plasma renin, does not block ion channels, and does not inhibit ACE (kinase II), which also destroys bradykinin. Therefore, there are no side effects associated with bradykinin.

Pharmacokinetics

When taken orally, it is quickly absorbed from the gastrointestinal tract. Bioavailability is 50%. When taken simultaneously with food, the reduction in AUC ranges from 6% (at a dose of 40 mg) to 19% (at a dose of 160 mg). 3 hours after administration, the plasma concentration levels off, regardless of whether it is taken with food or on an empty stomach. Plasma protein binding is 99.5%. The average values ​​of apparent Vd at the equilibrium stage are 500 l. Metabolized by conjugation with glucuronic acid. Metabolites are pharmacologically inactive.

T1/2 – more than 20 hours. Excreted through the intestines unchanged. Cumulative renal excretion is less than 1%. Total plasma clearance is 1000 ml/min (renal blood flow is 1500 ml/min).

Arterial hypertension.

Obstruction of the biliary tract, severe dysfunction of the liver and kidneys, pregnancy, lactation (breastfeeding), hypersensitivity to telmisartan.

From the side of the central nervous system: headache, dizziness, fatigue, insomnia, anxiety, depression, convulsions.

From the digestive system: abdominal pain, dyspepsia, nausea, diarrhea, increased activity of liver transaminases.

From the respiratory system: cough, pharyngitis, upper respiratory tract infections.

From the hematopoietic system: decrease in hemoglobin level.

Allergic reactions: rash; in a single case - angioedema.

From the urinary system: peripheral edema, urinary tract infections, increased uric acid levels, hypercreatininemia.

From the cardiovascular system: marked decrease in blood pressure, palpitations, chest pain.

From the musculoskeletal system: lower back pain, myalgia, arthralgia.

From the laboratory parameters: hyperkalemia, anemia, hyperuricemia.

Others: flu-like syndrome.

special instructions

Telmisartan is used with caution in cases of liver dysfunction, gastric and duodenal ulcers in the acute stage, other gastrointestinal diseases, aortic and mitral valve stenosis, obstructive hypertrophic cardiomyopathy, coronary artery disease, and heart failure.

In patients with bilateral renal artery stenosis or renal artery stenosis of a single functioning kidney, the use of telmisartan increases the risk of severe arterial hypotension and renal failure. Therefore, telmisartan should be used with caution in this category of patients.

During the period of use of telmisartan in patients with impaired renal function, it is necessary to monitor the content of potassium and creatinine in the blood plasma.

There are currently no data on the use of telmisartan in patients with recent kidney transplantation.

In patients with reduced blood volume and/or hyponatremia, symptomatic arterial hypotension may occur, especially after taking the first dose of telmisartan. Therefore, before carrying out therapy, correction of such conditions is necessary.

The use of telmisartan is possible in combination with thiazide diuretics, because This combination provides an additional reduction in blood pressure.

When considering the possibility of increasing the dose of telmisartan, it should be remembered that the maximum hypotensive effect is usually achieved 4-8 weeks after the start of treatment.

Use in pediatrics

There are no data on the safety and effectiveness of telmisartan in children and adolescents.

Impact on the ability to drive vehicles and operate machinery

The question of the possibility of engaging in potentially hazardous activities that require increased attention and rapid psychomotor reactions should be decided only after assessing the individual response to telmisartan.

For renal failure

Contraindicated in severe renal impairment.

In case of liver dysfunction

Contraindicated in severe liver dysfunction.

Elderly

Elderly patients do not require dose adjustment.

Use during pregnancy and breastfeeding

Telmisartan is contraindicated for use during pregnancy and lactation (breastfeeding).

Drug interactions

When used simultaneously with antihypertensive drugs, the antihypertensive effect may be enhanced.

When used simultaneously with potassium-sparing diuretics, heparin, dietary supplements, salt substitutes containing potassium, hyperkalemia may develop.

When used simultaneously with lithium preparations, an increase in the concentration of lithium in the blood plasma is possible.

With simultaneous use, it is possible to increase the concentration of digoxin in the blood plasma.

For adults, the daily dose is 20-40 mg (1 time/day). In some patients, a hypotensive effect can be achieved with a dose of 20 mg/day. If necessary, the dose can be increased to 80 mg/day.

Patients with impaired renal function, as well as elderly patients, do not require dose adjustment.

For patients with impaired liver function, the daily dose is 40 mg.