MykardisPlus® (MicardisPlus®)

Composition Pharmacodynamics Indications Carefully Contraindications Dosing and Administration Side effects Form release / dosage
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Active substanceHydrochlorothiazide + TelmisartanHydrochlorothiazide + Telmisartan
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    • Dosage form: & nbsppills
    Composition:

    1 tablet contains:

    active ingredients:

    hydrochlorothiazide 25 mg,

    telmisartan 80 mg.

    Excipients: sodium hydroxide 6,720 mg, povidone (polyvidone K25 +) 24,000 mg, meglumine 24,000 mg, sorbitol 337,280 mg, magnesium stearate 9,000 mg, lactose monohydrate 99,100 mg, microcrystalline cellulose 64,000 mg, iron stain oxide yellow (E 172) 0.900 mg, corn starch 6,000 mg, sodium carboxymethyl starch 4,000 mg.

    Description:Oval, biconvex, two-layered tablets, one layer - white, with possible inclusions of yellow color, the second layer - yellow. On the white surface of the tablets there is an engraving "N9" and the company logo.
    Pharmacotherapeutic group:A combined hypotensive drug (angiotensin II receptor antagonist + diuretic)
    ATX: & nbsp

    C.09.D.A.07   Telmisartan in combination with diuretics

    Pharmacodynamics:MICARDI DP is a combination of telmisartan (angiotensin II receptor antagonist) and hydrochlorothiazide - a thiazide diuretic. Simultaneous application MICRADISPLUS is a combination of telmisartan (angiotensin II receptors antagonist) and hydrochlorothiazide - thiazide diuretic. The simultaneous use of these components leads to a more pronounced antihypertensive Action than the application of each of them separately.

    Taking the drug MICARDIPIPLYUS once a day leads to a significant gradual decrease in blood pressure (BP).

    Telmisartan

    Telmisartan is a specific angiotensin receptor antagonist II (subtype AT1), effective at ingestion. Has a high affinity for the AT subtype1- angiotensin receptor II, through which the action of angiotensin II is realized. Releases angiotensin II from the receptor binding, without exhibiting the properties of an agonist for this receptor. Telmisartan binds only to the subtype AT1 receptors of angiotensin II. Communication is of a lasting nature. Has no affinity for other receptors, including AT2 receptor and other, less studied receptors of angiotensin. The functional significance of these receptors, as well as the effect of their possible excessive stimulation with angiotensin II, whose concentration increases with the appointment of telmisartan, have not been studied. Telmisartan reduces the concentration of aldosterone in the blood, does not inhibit renin in the blood plasma and does not block the ion channels. Telmisartan does not inhibit the angiotensin-converting enzyme (kininase II) (an enzyme that also breaks down bradykinin). Therefore, the enhancement of bradykinin-induced side effects is not expected. In patients with hypertension telmisartan in a dose of 80 mg completely blocks the hypertensive effect of angiotensin II. The onset of antihypertensive action is noted within 3 hours after the first intake of telmisartan inside. The drug remains for 24 hours and remains significant up to 48 hours. The pronounced antihypertensive effect usually develops 4 weeks after regular intake of the drug. In patients with hypertension, telmisartan reduces systolic and diastolic blood pressure (BP), without affecting the heart rate (heart rate).

    In the case of a sharp cancellation of telmisartan, blood pressure gradually returns to the original without the development of the "withdrawal" syndrome. The telmisartan study evaluated cardiovascular mortality, non-fatal myocardial infarction, no fatal stroke, or hospitalization due to chronic heart failure. Cardiovascular morbidity and mortality were reduced in patients with high cardiovascular risk (coronary artery disease, stroke, peripheral arterial disease, or diabetes mellitus with concomitant lesion of target organs such as retinopathy, left ventricular hypertrophy, history of macro or microalbuminuria) in over 55 years of age.

    Hydrochlorothiazide

    Hydrochlorothiazide is a thiazide diuretic. Thiazide diuretics affect the reabsorption of electrolytes in the renal tubules, directly increasing the excretion of sodium and chlorides (approximately, in equivalent amounts). The diuretic effect of hydrochlorothiazide leads to a decrease in the volume of circulating blood (BCC), an increase in renin activity of the blood plasma, an increase in the secretion of aldosterone,with the subsequent increase in the content in the urine of potassium and hydrocarbonates and. as a consequence, a decrease in the content potassium in the blood plasma. At simultaneous reception with telmisartan is noted the tendency to stop the loss of potassium, caused by these diuretics, presumably due to the blockade of the renin-angiotensin-aldosterone system (RAAS). After intake of diuresis is intensified after 2 hours, and the maximum effect is observed after about 4 hours. Diuretic effect of the drug is maintained for approximately, 6-12 hours. Prolonged use of hydrochlorothiazide reduces the risk of complications cardiovascular diseases and mortality from them. Maximum antihypertensive effect preparation MICRADISPLUS usually is achieved 4-8 weeks after the start treatment.

    Pharmacokinetics:

    The combined use of telmisartan and hydrochlorothiazide does not affect the pharmacokinetics of each component of the drug.

    Telmisartan: when ingested quickly absorbed from the gastrointestinal tract. Bioavailability is approximately 50%. The maximum concentration is achieved in about 0.5-1.5 hours.At reception simultaneously with food decrease AUC (the area under the concentration-time curve) ranges from 6% (when taking a dose of 40 mg) to 19% (with a dose of 160 mg). After 3 hours after ingestion, the concentration in the blood plasma levels up, regardless of food intake. There is a difference in the concentrations of telmisartan in the blood plasma in men and women. FROMm(the maximum concentration in the blood plasma) is approximately 2-3 times, respectively, higher in women than in men without a significant effect on efficacy. Nevertheless, - the increase in the hypotensive effect is not observed in women.

    The connection with blood plasma proteins is significant (more than 99.5%), mainly with albumin and alpha-acid glycoprotein. The distribution volume is approximately 500 liters.

    Metabolized telmisartan by conjugation with glucuronic acid. Metabolites are pharmacologically inactive. The half-life (T1/2) - more than 20 hours. Output through the intestine in an unchanged form, excretion by the kidneys - less than 2%. The total plasma clearance is high (about 900 ml / min.).

    Elderly patients:

    The pharmacokinetics of telmisartan in elderly patients does not differ from young patients. Dose correction is not required.

    Patients with renal insufficiency

    A change in the dose of telmisartan in patients with renal insufficiency is not required, including patients on hemodialysis. Telmisartan is not removed by hemodialysis.

    Patients with hepatic insufficiency

    Studies of pharmacokinetics in patients with hepatic insufficiency showed an increase in the absolute bioavailability of telmisartan to almost 100%. With hepatic insufficiency T1/2 does not change (see section "Method of administration and dose"),

    Hydrochlorothiazide: after ingestion of the drug MICARDIUMPLUS, the maximum concentrations of hydrochlorothiazide in the plasma are reached within 1-3 hours. Absolute bioavailability, based on total excretion by the kidneys, is about 60%. It binds with blood plasma proteins 64% hydrochlorothiazide, and the volume of distribution is 0.8 + 0.3 l / kg. Hydrochlorothiazide is not metabolized in the body and is excreted by the kidneys almost unchanged. About 60% of the dose taken internally is eliminated within 48 hours. Kidney clearance is about 250-300 ml / min. T1/2 hydrochlorothiazide - 10 - 15 hours. There is a difference in plasma concentrations in men and women. In women, the concentration of telmisartan in blood plasma is 2-3 times higher than in men,also in women there is a tendency to increase in blood plasma concentrations of hydrochlorothiazide is clinically insignificant.

    Patients with renal insufficiency

    In patients with impaired renal function, the rate of excretion of hydrochlorothiazide is reduced. Studies conducted with the participation of patients with creatinine clearance (CK) of 90 ml / min, showed that T1/2 hydrochlorothiazide is increased. In patients with decreased renal function T1/2 about 34 hours.

    Indications:Arterial hypertension (in case of ineffectiveness of telmisartan or hydrochlorothiazide in monotherapy).
    Contraindications:

    - Hypersensitivity to the active substance or auxiliary components of the drug or other derivatives of sulfonamides;

    - Pregnancy;

    - Breastfeeding period;

    - Obstructive diseases of the biliary tract;

    - Severe violations of liver function (class C on the Child-Pugh scale);

    - Severe renal dysfunction (CC less than 30 ml / min);

    - Refractory hypokalemia, hypercalcemia;

    - Simultaneous therapy with aliskiren in patients with diabetes mellitus and renal insufficiency (Glomerular filtration rate (GFR) <60 ml / min / 1.73 m2);

    - Hereditary intolerance to fructose (contains sorbitol);

    - Lactase deficiency, lactose intolerance, glucose-galactose malabsorption syndrome;

    - Age under 18 years (efficiency and safety not established).

    Carefully:

    - bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney (see section "Special instructions");

    - Dysfunction of the liver or progressive liver disease (class A and B on the Child-Pugh scale) (see section "Special instructions");

    - Decrease in BCC due to previous therapy with diuretics, restriction of salt intake, diarrhea or vomiting;

    - Hyperkalemia;

    - Condition after kidney transplantation (no experience is available);

    - Chronic heart failure III-IV FC according to the classification of the New York Heart Association;

    - Stenosis of the aortic and mitral valve;

    - Idiopathic hypertrophic subaortic stenosis;

    - Hypertrophic obstructive cardiomyopathy;

    - Diabetes;

    - Primary aldosteronism;

    - Gout;

    - Closed-angle glaucoma (due to the presence of hydrochlorothiazide in the composition);

    - Experience in patients with renal insufficiency (QC more than 30 ml / min) is limited,but does not confirm the development of side effects on the part of the kidneys and dose adjustment is not required.

    Pregnancy and lactation:

    The use of the drug MICARDI DP is contraindicated during pregnancy.

    Telmisartan

    The use of angiotensin II receptor antagonists during the first trimester of pregnancy is not recommended, these drugs should not be administered during pregnancy. When diagnosing pregnancy, the drug should be stopped immediately. If necessary, alternative therapy should be prescribed (other classes of antihypertensive drugs permitted for use during pregnancy). The use of angiotensin II receptor antagonists during the second and third trimesters of pregnancy is contraindicated. In preclinical Studies of telmisartan did not reveal teratogenic effects, but fetotoxicity was established. It is known that the effect of angiotensin II receptor antagonists during the second and third trimester of pregnancy causes fetotoxicity in a person (decreased kidney function, oligohydroamnion, slowing ossification of the skull bones), as well as neonatal toxicity (kidney failure, arterial hypotension, hyperkalemia). Patients planning a pregnancy, should be prescribe alternative therapy. If treatment with antagonists of angiotensin II receptors occurred during the second trimester of pregnancy, it is recommended that ultrasound be checked for kidney function and skull bones in the fetus. Newborns whose mothers received angiotensin II receptor antagonists should be carefully monitored for arterial hypotension.

    Hydrochlorothiazide

    The experience with hydrochlorothiazide during pregnancy, especially during the first trimester, is limited. Hydrochlorothiazide penetrates the placental barrier. Taking into account the pharmacological mechanism of action of hydrochlorothiazide, it is assumed that its use during the second and third trimesters of pregnancy may interfere fetoplacental perfusion and cause such a change in the embryo and fetus, as jaundice, disorders of water-electrolyte balance and thrombocytopenia. Hydrochlorothiazide It should not be used in pregnant edema, arterial hypertension during pregnancy or during preeclampsia, since there is a risk reduction in plasma volume and decrease of placental perfusion, and a beneficial effect in these clinical situations offline. Hydrochlorothiazide should not be used to treat essential hypertension in pregnant women, except in those rare situations when other types of treatment can not be used. Therapy with the drug MICARDI DP is contraindicated in the period of breastfeeding. In animal studies, the effects of telmisartan and hydrochlorothiazide on fertility were not observed. Studies of the impact on human fertility have not been conducted.

    Dosing and Administration:

    Inside, regardless of food intake.

    MICARDIUMPLUS must be taken once a day.

    MICRADISPLUS 80/25 mg can be given to patients in whom the application of Mycardis in a dose of 80 mg or MICARDIUMPLUS 80 / 12.5 mg does not lead to adequate control of blood pressure, or to patients whose condition was previously stabilized by telmisartan or hydrochlorothiazide when administered separately.

    Renal impairment

    The limited experience of using MICARDI lipids in patients with small or moderately impaired renal function does not require a change in the dose of the drug in these cases. In such patients, kidney function should be monitored.

    Dysfunction of the liver.

    In patients with small or moderate impairment of liver function (class A and B on the Child-Pugh scale), the daily dose of MICARDIUMPLUS should not exceed 40 / 12.5 mg per day (see Pharmacokinetics section).

    Elderly patients

    Dosing regimen does not require any changes.

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

    Side effects:

    1) expected on the basis of experience with telmisartan

    2) Expected on the basis of the experience of using hydrochlorothiazide

    3) side effects that were not observed in clinical studies with concomitant use of telmisartan and hydrochlorothiazide, but are expected during the application of the drug MICRADISPLUS

    From the respiratory system: Respiratory distress syndrome (including pneumonia and pulmonary edema)3) , dyspnea3).

    From the cardiovascular system:

    arrhythmias3), tachycardia3), bradycardia1), a marked decrease in blood pressure (including orthostatic hypotension)3).

    From the central nervous system: syncope / fainting3), paresthesia3), sleep disorders3), insomnia3), dizziness3), anxiety3), depression3), increased excitability2), headache2).

    From the digestive system:

    diarrhea3), dryness of the oral mucosa3), flatulence3), abdominal pain3), constipation3), vomiting3), gastritis3), decrease

    appetite2), anorexia2), hyperglycemia2), hypercholesterolemia2), pancreatitis2), impaired liver function3), jaundice (hepatocellular or cholestatic)2), dyspepsia1)2)3).

    From the skin:

    increased sweating3).

    From the musculoskeletal system:

    backache3), muscle spasms3), myalgia3), arthralgia3), spasms of gastrocnemius muscles3), arthrosis1), tendonitis-like symptoms1), chest pain3).

    From the hemopoietic system and lymphatic system:

    Iron-deficiency anemia1), aplastic anemia2), hemolytic anemia2), thrombocytopenia1), eosinophilia1), leukopenia2), neutropenia / agranulocytosis2), thrombocytopenia2).

    From the urinary system:

    renal insufficiency1)2) , including acute renal failure1), interstitial nephritis2), glucosuria2).

    From the sense organs:

    blurred vision3), transient blurred vision3), xanthopsy2), acute angle-closure glaucoma2) , acute myopia2).

    On the part of the reproductive system:

    impotence3).

    Infections:

    sepsis, including fatal cases1), upper respiratory tract infection (bronchitis, pharyngitis, sinusitis)1)3), urinary tract infections (including cystitis)1), inflammation of the salivary glands2).

    Metabolic disorders:

    increase in the concentration of creatinine in the blood plasma3), increased activity of "hepatic" enzymes3), increased activity of creatine phosphokinase3), an increase in the concentration of uric acid in the blood3), hypertriglyceridemia2), hypokalemia2)3), hyperkalemia1), hyponatraemia2)3), hyperuricemia3), decrease in BCC2), hypoglycemia (in patients with diabetes mellitus)1), impaired glucose tolerance2), a decrease in hemoglobin in the blood1).

    Allergic reactions: angioedema (including fatal cases)3), erythema3), itchy skin3), rash3), anaphylactic reactions1)2), eczema1), drug rash1)2), toxic epidermal necrosis1)2), lupus-like reactions2), exacerbation or exacerbation of symptoms of systemic lupus erythematosus3), necrotizing vasculitis2), photosensitization2), recurrence of systemic lupus erythematosus2), vasculitis2).

    Other:

    influenza-like syndrome3), fever2), weakness1)2).

    Overdose:

    Cases of overdose have not been identified. Possible symptoms of an overdose consist of symptoms from the individual components of the drug.

    Telmisartan - marked decrease in blood pressure, tachycardia, bradycardia.

    Hydrochlorothiazide - violations of the water-electrolyte balance of blood (hypokalemia, hypochloraemia), decreased bcc, which can lead to muscle spasms and / or increase cardiovascular disorders: arrhythmias caused by the simultaneous use of cardiac glycosides or some antiarrhythmic agents.

    Treatment: symptomatic therapy, hemodialysis is not effective. The degree of removal of hydrochlorothiazide during hemodialysis is not established. Regular monitoring of the electrolytes and creatinine content in the blood serum is required.

    Interaction:

    TELMISARTAN

    With the simultaneous use of telmisartan with:

    - other antihypertensive agents: possibly increased antihypertensive effect. In one study, combined use of telmisartan and ramipril showed an increase AUC0-24 and CmOh ramipril and ramiprilata 2.5 times.The clinical significance of this interaction is not established. When analyzing the undesirable phenomena that led to the cessation of treatment and the analysis of serious adverse events from clinical study, it was found that cough and angioedema were more often observed with ramipril therapy, while arterial hypotension was more common with telmisartan therapy. Cases of hyperkalemia, renal insufficiency, arterial hypotension and syncope were significantly more frequent in the joint use of telmisartan and ramipril;

    - lithium preparations: There was a reversible increase in the concentration of lithium in the blood, accompanied by toxic effects when taking ACE inhibitors. In rare cases, such changes were registered with the appointment of angiotensin II receptor antagonists, in particular telmisartan. When simultaneous appointment of lithium drugs and antagonists of the angiotensin II receptor is recommended to determine the content of lithium in the blood;

    - non-steroidal anti-inflammatory drugs (NSAIDs), including

    acetylsalicylic acid in doses used as anti-inflammatory facilities, inhibitors of cyclooxygenase-2 (COX-2) and nonselective NSAIDs. can cause the development of acute renal failure in patients with reduced BCC. Drugs that affect RAAS may have a synergistic effect. In patients receiving NSAIDs and telmisartan, at the beginning of treatment should be compensated for BCC and kidney function monitoring performed.

    Reduction of the effect of antihypertensive drugs, such as telmisartan, by inhibiting vasodilator

    the effect of prostaglandins was noted in the joint treatment with NSAIDs. With the simultaneous administration of telmisartan with ibuprofen or paracetamol, there was no clinically significant effect;

    - digoxin, warfarin, hydrochlorothiazide, glibenclamide,

    simvastatin and amlodipine: no clinically significant

    interaction. An increase in the average concentration of digoxin in the blood plasma was observed on average by 20% (in one case by 39%). With the simultaneous administration of telmisartan and digoxin, it is advisable to periodically determine the concentration of digoxin in the blood.

    HYDROCHLOROTHYASIDE

    When used simultaneously with:

    - ethanol, barbiturates or narcotic analgesics: risk of orthostatic hypotension;

    - hypoglycemic agents for ingestion and insulin: it may be necessary to correct a dose of hypoglycemic agents for ingestion and insulin;

    - Metformin: risk of lactic acidosis;

    - colstiramine and colestipol: in the presence of anion exchange resins hydrochlorothiazide absorption is impaired;

    - cardiac glycosides: the risk of hypokalemia or hypomagnesemia caused by thiazide diuretics, the development of arrhythmias caused by the intake of cardiac glycosides;

    - Pressor amines (for example, norepinephrine): possible weakening of the effect of pressor amines;

    - nondepolarizing mioreclactants (for example, tubocurarine chloride): hydrochlorothiazide can enhance the effect of nondepolarizing myorex-clavants;

    - - antidotal agents: the concentration of uric acid in the blood serum may increase and, therefore, changes in the dose of uricosuric agents may be required. The use of thiazide diuretics increases the frequency of development of hypersensitivity reactions to allopurinol;

    - - preparations of calcium: Thiazide diuretics can increase the calcium content in the blood serum due to the decrease in its excretion by the kidneys. If you want to use calcium preparations, you should regularly monitor the calcium content in the blood and, if necessary, change the dose of calcium preparations;

    - beta adrenoblockers and diazoxide: Thiazide diuretics can increase hyperglycemia caused by beta-blockers and diazoxide;

    - m-holinoblokatorami (for example, atropine, biperidin): a decrease in the motility of the gastrointestinal tract, an increase in the bioavailability of thiazide diuretics;

    - amantadine: Thiazide diuretics can increase the risk of unwanted effects caused by amantadine;

    - cytotoxic agents (eg, cyclophosphamide, methotrexate): decrease in renal excretion of cytotoxic agents and enhancement of their myelosuppressive action;

    - NSAIDs: co-administration with thiazide diuretics can lead to a decrease in the diuretic and antihypertensive effect;

    - drugs that lead to the excretion of potassium and hypokalemia (for example, diuretics that excrete potassium, laxatives, gluco- and mineralocorticosteroids;corticotropin; amphotericin B; carbenoxolone; benzylpenicillin; derivatives of acetylsalicylic

    acid): increased hypokalemic effect. Hypokalemia caused by hydrochlorothiazide is compensated

    potassium-sparing effect of telmisartan;

    - potassium-sparing diuretics, potassium preparations, other agents capable of increasing the serum potassium content (eg, heparin) or the replacement of sodium in table salt with potassium salts can lead to hyperkalemia. Periodic testing is recommended the content of potassium in the blood plasma in cases when the drug MICARDI DP is assigned together with drugs that can cause hypokalemia, as well as with drugs that can increase the potassium content in the blood serum.

    Special instructions:

    The states that contribute to an increase in the activity of the RAAS

    In some patients, due to the suppression of the activity of RAAS, especially with the simultaneous administration of drugs acting on this system, renal function (including acute renal failure) is impaired. Therefore, therapy. accompanied by a similar double blockade of the RAAS (for example,with the addition of ACE inhibitors or a direct inhibitor of renin-aliskiren to angiotensin II receptor antagonists) should be carried out strictly individually and with regular monitoring of kidney function, including periodic monitoring of serum potassium and serum creatinine (see "Contraindications"), Application Thiazide diuretics in patients with impaired renal function can lead to azotemia. Periodic monitoring of renal function is recommended.

    Renovascular hypertension

    In patients with bilateral stenosis of the renal arteries or stenosis of the artery of a single functioning kidney with use of medicines, influencing RAAS, the risk increases development of severe arterial hypotension and renal failure.

    Dysfunction of the liver

    In patients with impaired function liver or progressive liver disease drug MICADISPLUS should be applied with caution, because even small

    changes in the water-electrolyte balance can promote the development of "hepatic" coma.

    Influence on metabolism and function endocrine glands

    In patients with diabetes mellitus, need to change the dose of insulin or

    hypoglycemic agents for admission inside. During the therapy thiazide diuretics can manifest latent diabetes.

    In some cases, when applying Thiazide diuretics may develop hyperuricemia and exacerbation of the course gout.

    Diabetes

    In patients with diabetes mellitus and additional cardiovascular risk, for example, in patients with sugar diabetes and ischemic heart disease (IHD), in the case of drugs, reducing blood pressure, such as angiotensin II receptor antagonists (APAII) or ACE inhibitors. may increase the risk of fatal myocardial infarction and sudden cardiovascular death. In patients with diabetes, IHD can be asymptomatic and therefore can be undiagnosed. In patients with diabetes before the use of the drug

    MICRADISPLUS for the identification and treatment of coronary artery disease should be carried out appropriate diagnostic Studies, including a sample with physical activity.

    Acute myopia and secondary closed angle glaucoma

    Hydrochlorothiazide, being a sulfonamide derivative, can cause idiosyncratic reaction in the form of acute transient myopia and acute closed-angle glaucoma. Symptoms of these disorders are an unexpected reduction in visual acuity or eye pain, which typically occurs within a few hours to several weeks after starting the drug. If treatment is not performed, acute angle-closure glaucoma can lead to loss of vision. The main treatment consists in the fastest possible removal of hydrochlorothiazide. It should be borne in mind that if intraocular pressure remains uncontrolled, urgent surgical or surgical treatment may be required. Risk factors for the development of acute angle-closure glaucoma include information about allergies to sulfonamides or penicillin in the anamnesis.

    Violations of the water-electrolyte balance

    When using the drug MIKARDISPLUS, as in the case of diuretic therapy, requires periodic monitoring of the content of electrolytes in the blood serum.

    Thiazide diuretics, including hydrochlorothiazide, can cause violations of water-electrolyte balance and acid-base state (hypokalemia, hyponatremia and hypochloraemic alkalosis). Symptoms that alarm these disorders include dryness of the oral mucosa, thirst, general weakness, drowsiness, anxiety, myalgia or spasmodic twitching of the calf muscles, muscle weakness, marked decrease in blood pressure. oliguria, tachycardia and such gastrointestinal disturbances. like nausea or vomiting.

    With the use of thiazide diuretics hypokalemia may develop, but simultaneously it can be used telmisartan can increase the content of potassium in the blood. The risk of hypokalemia is greatest in patients with cirrhosis of the liver, with increased diuresis, while observing a salt-free diet, and also in the case of simultaneous application of glucose mineralocorticosteroids or corticotropin. Telmisartan, which is part of the drug MICARDIPIPLYUS, on the contrary, can lead to hyperkalemia due to antagonism to angiotensin II receptors (subtype AT1). Although with the use of the drug MICARDI DP, the clinically significant hyperkalemia was not registered,should be taken into account that the risk factors for its development include renal and / or heart failure and diabetes mellitus.

    The data that the drug MICARDI DP can not reduce or prevent hyponatremia, caused by the use of diuretics, no. Hypochloremia is usually minor and does not require treatment.

    Thiazide diuretics can reduce the excretion of calcium by the kidneys and cause (in the absence of obvious violations of calcium metabolism) a transient and small increase in the serum calcium level. More pronounced hypercalcemia may be a sign of latent hyperparathyroidism. Before performing an evaluation of parathyroid function, thiazide diuretics should be discontinued.

    It is shown that thiazide diuretics increase the excretion of magnesium by the kidneys, which can lead to hypomagnesemia. In patients with coronary heart disease, the use of any antihypertensive drug, in the event of excessive blood pressure lowering, can lead to myocardial infarction or stroke.

    There are reports of the development of systemic lupus erythematosus with the use of thiazide diuretics. MICRADISPLUS may, if necessary, be used in conjunction with other antihypertensive drugs.Disorders of liver function in the appointment of telmisartan in most cases were observed in the inhabitants of Japan. Mycardisplus is less effective in patients of the Negroid race.

    Effect on the ability to drive transp. cf. and fur:Special clinical studies to assess the effect of the drug MICARDI-PLUS on the ability to drive vehicles and work with mechanisms that require increased attention, was not conducted. However, when driving and dealing with potentially hazardous activities, one should take into account the possibility of developing dizziness and drowsiness, which requires caution.
    Form release / dosage:
    Tablets 25/80 mg.
    Packaging:

    For 7 tablets in a blister of polyamide / aluminum / PVC.

    For 1, 2 or 4 blisters in a cardboard box with instructions for use.

    Storage conditions:
    At a temperature of no higher than 25 ° C, in a dry place. 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:LP-001105
    Date of registration:03.11.2011 / 14.11.2013
    Expiration Date:03.11.2016
    The owner of the registration certificate:Boehringer Ingelheim International GmbHBoehringer Ingelheim International GmbH Germany
    Manufacturer: & nbsp
    Representation: & nbspBehringer Ingelheim, LLCBehringer Ingelheim, LLC
    Information update date: & nbsp24.04.2018
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