Active substanceAmlodipineAmlodipine
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  • Dosage form: & nbsppills
    Composition:

    Each tablet contains active substance: amlodipine besylate in a dose equivalent to 5 or 10 mg of amlodipine.

    Excipients: calcium hydrophosphate, anhydrous 46.19 / 47.14 mg, sodium carboxymethyl starch 3/6 mg, magnesium stearate 1.5 / 3 mg, microcrystalline cellulose 92.38 / 100 mg.

    Description:

    White or almost white, round, flat pills.

    Pharmacotherapeutic group:The blocker of "slow" calcium channels
    ATX: & nbsp

    C.08.C.A.01   Amlodipine

    Pharmacodynamics:

    The dihydropyridine derivative blocking the "slow" calcium channels of the second generation, has an antianginal and hypotensive effect. Linking with dihydropyridine receptors, blocks calcium channels, reduces the transmembrane transition of calcium ions into the cell (mostly in smooth muscle cells of blood vessels, rather than in cardiomyocytes).

    Antianginal effect is due to the expansion of coronary and peripheral arteries and arterioles: with angina decreases the severity of myocardial ischemia; expanding peripheral arterioles, reduces the overall peripheral vascular resistance, reduces afterload on the heart, reduces the need for myocardium in oxygen. Expanding the main coronary arteries and arterioles in unchanged and ischemic zones of the myocardium, increases the flow of oxygen into the myocardium (especially with vasospastic angina); prevents the development of constriction of the coronary arteries (including caused by smoking). In patients with angina, a single daily dose increases the time of exercise, slows the development of angina pectoris and the "ischemic" depression of the segment ST, reduces the incidence of angina attacks and consumption of nitroglycerin tablets.

    Has a long-term dose-dependent hypotensive effect. The hypotensive effect is due to a direct vasodilating effect on smooth muscle vessels. With arterial hypertension, a single dose provides a clinically significant decrease in blood pressure (BP) for 24 hours (in the patient's position "lying" and "standing").Does not cause a sharp decrease in blood pressure, a decrease in exercise tolerance, a fraction of the outflow of the left ventricle. Reduces the degree of myocardial hypertrophy of the left ventricle, has antiatherosclerotic and cardioprotective action in ischemic heart disease (CHD). Does not affect the contractility and conductance of the myocardium, does not cause a reflex increase in the heart rate (HR), inhibits platelet aggregation, increases the rate of glomerular filtration, has a weak natriuretic effect. When diabetic nephropathy does not increase the severity of microalbuminuria. The time of onset of the effect is 2-4 hours, the duration of the effect is 24 hours.

    Does not have any adverse effect on the metabolism and concentration of plasma lipids and can be used in the treatment of patients with bronchial asthma, diabetes and gout.

    Pharmacokinetics:

    Suction: after oral administration amlodipine slowly absorbed from the gastrointestinal tract (GIT). The average absolute bioavailability is 64%, the maximum concentration (Cmah) in the serum is observed after 6-9 hours. Equilibrium serum concentrations (Css) are achieved after 7-8 days of therapy. Food intake does not affect the absorption of amlodipine.

    Distribution: the average volume of distribution is 21 l / kg body weight, indicating that most of the drug is in the tissues, and relatively less in the blood. Most of the drug in the blood (95%), binds to blood plasma proteins.

    Metabolism and excretion: Amlodipine undergoes a slow, but extensive metabolism (90%) in the liver with the formation of inactive metabolites. Metabolites do not have significant pharmacological activity.

    After a single oral intake, the half-life period (T1/2) varies from 31 to 48 hours, with a reappointment T1/2 is approximately 45 hours. About 60% of the dose taken internally is excreted by the kidneys mainly in the form of metabolites, 10% in the unchanged form, and 20-25% in the intestine, as well as in breast milk. The total clearance of amlodipine is 0.116 ml / s / kg (7 ml / min / kg, 0.42 l / h / kg).

    In elderly patients (over 65 years of age), the excretion of amlodipine is slowed (T1/2- 65 hours) compared with young patients, but this difference has no clinical significance. Elongation T1/2 in patients with hepatic insufficiency suggests that with prolonged administration, the cumulation of the drug in the body will be higher (T1/2 up to 60 hours).Renal failure does not significantly affect the kinetics of amlodipine. The drug penetrates the blood-brain barrier. When hemodialysis is not removed.

    Indications:

    - Arterial hypertension (monotherapy or in combination with other antihypertensive agents).

    - Stable exertional angina, vasospastic angina (prinzmetal angina) (monotherapy or in combination with other antianginal agents)

    Contraindications:

    - Hypersensitivity to amlodipine and other dihydropyridine derivatives, as well as to other components of the drug.

    - Unstable angina (with the exception of Prinzmetal angina).

    - Cardiogenic shock, collapse.

    - Severe arterial hypotension (systolic blood pressure less than 90 mm Hg).

    - Clinically significant stenosis of the aorta.

    - Pregnancy and lactation.

    - Age to 18 years (effectiveness and safety not established).

    Carefully:

    Dysfunction of the liver, arterial hypotension, chronic heart failure of non-ischemic etiology (III-IV functional class by classification NYHA), acute myocardial infarction (and within 1 month after myocardial infarction), hypertrophic obstructive cardiomyopathy, weakness syndrome of the sinus node (pronounced bradycardia, tachycardia), elderly age, aortic stenosis, mitral stenosis.

    Pregnancy and lactation:

    The safety of the drug during pregnancy and during lactation is not established, therefore, use during pregnancy is only possible in cases when the benefit to the mother exceeds the risk for the fetus and the newborn. For the period of breastfeeding it is recommended to stop or take the drug, or stop breastfeeding (there is no data on excretion of amlodipine with breast milk).

    Dosing and Administration:

    Inside, the initial dose for treatment arterial hypertension and angina pectoris is 5 mg once a day. The maximum daily dose is 10 mg once.

    With arterial hypertension, the maintenance dose may be 2.5 to 5 mg (it is possible to use amlodipine in another dosage form: tablets of 5 mg with a risk) per day.

    With angina pectoris and vasospastic angina pectoris, 5-10 mg per day, once. In order to prevent attacks of angina pectoris - 10 mg / day.

    Patients with impaired hepatic function as an antihypertensive agent Amlonorm appoint with caution, at an initial dose of 2.5 mg (possible use of amlodipine in another dosage form: tablets of 5 mg with a risk), as an antianginal agent - 5 mg.

    In elderly patients may increase T1/2 and a decrease in the clearance of creatinine (CC). Dose changes are not required, but more careful monitoring of patients is necessary.

    There is no need for dose changes with simultaneous administration with thiazide diuretics, beta-blockers and angiotensin-converting enzyme (ACE) inhibitors.

    Do not require dose changes in patients with renal insufficiency.

    Side effects:

    Side effects on the frequency of occurrence are distributed as follows: very often (10%), often (≥ 1% and <10%), sometimes (≥ 0.1% and <1%), rarely (≥ 0.01% and <0.1%), very rarely, including individual reports (<0.01%).

    From the cardiovascular system: often - peripheral edema (swelling of the ankles and feet), palpitations, "hot flashes" of blood to the skin of the face, marked decrease in blood pressure; very rarely - syncope, dyspnea, vasculitis. Some adverse effects noted in individual patients can not be differentiated from the symptoms of the natural course of the underlying disease: myocardial infarction, arrhythmias (including ventricular tachycardia and atrial fibrillation), chest pain.

    From the musculoskeletal system: sometimes - arthralgia, muscle cramps, myalgia, back pain, arthrosis; rarely - myasthenia gravis.

    From the central and peripheral nervous system: often - increased fatigue, dizziness, headache, drowsiness; sometimes - general malaise, fainting, increased sweating, asthenia, hypoesthesia, paresthesia, peripheral neuropathy, tremor, insomnia, mood lability, unusual dreams, nervousness, depression, anxiety; rarely - cramps, apathy, agitation; very rarely - ataxia, amnesia, migraine.

    From the digestive system: often - abdominal pain, nausea; sometimes - vomiting, constipation, flatulence, dyspepsia, diarrhea, anorexia, dry mouth, thirst; rarely - gingival hyperplasia, increased appetite; very rarely - gastritis, pancreatitis, hyperbilirubinemia, jaundice (usually cholestatic), increased activity of "hepatic" transaminases, hepatitis.

    On the part of the hematopoiesis system: very rarely - thrombocytopenic purpura, leukopenia, thrombocytopenia.

    From the side metabolism: very rarely - hyperglycemia.

    On the part of the respiratory system: sometimes shortness of breath, rhinitis; very rarely - cough.

    From the urinary system: sometimes - frequent urination, painful urination, nocturia, impotence; very rarely - dysuria, polyuria.

    Allergic reactions: pruritus, rash (including erythematous, maculopapular rash, urticaria), angioedema, erythema multiforme.

    Other: sometimes - alopecia, ringing in the ears, gynecomastia, weight gain / increase, vision impairment, diplopia, accommodation disorder, xerophthalmia, conjunctivitis, eye pain, taste distortion, chills, nosebleeds; rarely - dermatitis; very rarely - parosmia, xeroderma, a violation of pigmentation, increased sweating.

    Overdose:

    Symptoms: excessive peripheral vasodilation with a prolonged and possibly long-term decline in blood pressure and with the possible development of reflex tachycardia, including - with the development of shock and death.

    As a result of an overdose, chronic heart failure, slowing down of impulses in the conduction system of the heart (at the level of the atrioventricular node) and bradyarrhythmia can occur.

    Treatment: gastric lavage and the appointment of activated charcoal, maintenance of cardiovascular function, monitoring of heart and lung function.It is possible to give an elevated position to the lower extremities above the level of the head, the use of parenteral solutions to control the volume of circulating blood and blood pressure, diuresis and the appointment of vasoconstrictors (in the absence of contraindications to their use).

    To eliminate the effects of calcium channel blockade - intravenous calcium gluconate. Because the amlodipine is largely associated with blood serum proteins - hemodialysis is not effective.

    Interaction:

    Amlodipine can be used simultaneously with non-steroidal anti-inflammatory drugs (NSAIDs) (especially indomethacin). It is possible to strengthen the anti-anginal and hypotensive action of BCCC when combined with thiazide and loop diuretics, verapamil, angiotensin-converting enzyme (ACE) inhibitors, beta-blockers and nitrates, as well as enhance their hypotensive effect when combined with alpha1-blockers, antipsychotics.

    Although no negative inotropic effects were usually observed in the study of amlodipine, nevertheless, some BCCCs can enhance the expression of negative inotropic actionantiarrhythmic agents that cause lengthening of the interval QT (eg, amiodarone and quinidine).

    A single dose of 100 mg of sildenafil in patients with essential hypertension does not affect the pharmacokinetics of amlodipine.

    The repeated use of amlodipine in a dose of 10 mg and atorvastatin at a dose of 80 mg is not accompanied by significant changes in the pharmacokinetics of atorvastatin.

    Ethanol (alcoholic beverages): amlodipine at a single and repeated application in a dose of 10 mg does not affect the pharmacokinetics of ethanol.

    Antiviral drugs (ritonavir) increases the plasma concentrations of BCCI, incl. amlodipine.

    Neuroleptics and isoflurane - Increased hypotensive effect of dihydropyridine derivatives.

    Calcium preparations can reduce the effect of BCCC.

    When amlodipine is used together with lithium preparations, it is possible to intensify manifestations of neurotoxicity (nausea, vomiting, diarrhea, ataxia, tremor, tinnitus).

    Amlodipine does not change the pharmacokinetics of cyclosporine.

    Does not affect the concentration of serum digoxin and its renal clearance.

    Has no significant effect on the effect of warfarin (prothrombin time).

    Cimetidine does not affect the pharmacokinetics of amlodipine

    In studies in vitro Amlodipine does not affect the binding to blood proteins of digoxin, phenytoin, warfarin and indomethacin.

    Grapefruit juice: simultaneous single intake of 240 mg of grapefruit juice and 10 mg of amlodipine inwards is not accompanied by a significant change in the pharmacokinetics of amlodipine.

    Inhibitors of microsomal oxidation can increase the concentration of amlodipine in the blood plasma, increasing the risk of side effects, and inducers of microsomal enzymes of the liver - reduce.

    Special instructions:

    Simultaneous single intake of 240 ml of grapefruit juice and 10 mg of amlodipine inside is not accompanied by a significant change in the pharmacokinetics of amlodipine. Regardless of this, because of the possible risk of clinically significant potentiation of the action established in nifedipine and other dihydropyridine derivatives, it is recommended that during the treatment with Amlonorm, the use of grapefruit, as well as their juice, be stopped. The intake of products containing grapefruit extract during treatment with Amlonorm is contraindicated.

    The effectiveness and safety of the drug in hypertensive crisis is not established.

    During the period of treatment, it is necessary to control the body weight and sodium intake, the appropriate diet.

    It is necessary to maintain dental hygiene and frequent visits to the dentist (to prevent soreness, bleeding and gingival hyperplasia).

    Patients with low body weight, low growth patients and patients with severe liver dysfunction may need a lower dosage.

    Elderly patients may be lengthened T1/2 and clearance of the drug. Dosage changes for elderly patients are not required; with increasing the dose, more careful monitoring of patients is necessary.

    If the liver function is also impaired T1/2 Therefore, such patients Amlonorm should be administered with caution.

    Despite the absence of the "cancellation" syndrome in BCC, before the cessation of treatment a gradual reduction of doses is recommended.

    Amlodipine does not affect plasma concentrations of potassium ions, glucose, triglycerides, total cholesterol, low density lipoproteins, uric acid, creatinine and urea nitrogen.

    Effect on the ability to drive transp. cf. and fur:

    There have been no reports of Ammonorm's effects on vehicle management or work with machinery.However, some patients, mainly at the beginning of treatment, may experience drowsiness and dizziness. When they occur, the patient must observe special precautions when driving and working with complex mechanisms.

    Form release / dosage:

    Tablets of 5 and 10 mg.

    Packaging:

    10 tablets in a blister pack. For 3 blisters together with instructions for use in a pack of cardboard.

    For 20 tablets in a blister pack. 1 blister with instructions for use in a cardboard package.
    Storage conditions:

    List B.

    Store at a temperature not exceeding 25 ° C.

    Keep out of the reach of children.

    Shelf life:

    3 years.

    Do not use after the expiry date printed on the package.

    Terms of leave from pharmacies:On prescription
    Registration number:LSR-001055/10
    Date of registration:16.02.2010
    Expiration Date:Unlimited
    The owner of the registration certificate:Adifarm, EADAdifarm, EAD Bulgaria
    Manufacturer: & nbsp
    Information update date: & nbsp25.07.2017
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