Buy Cardosal Plus film-coated tablets 12.5 mg+20 mg No. 28 in pharmacies

Pharmacological properties of the drug Cardosal

Olmesartan medoxomil is a potent, selective angiotensin II receptor antagonist (type AT1), which inhibits the effects of angiotensin II mediated by AT1 receptors, regardless of the source and route of angiotensin II synthesis. Selective antagonism of AT1 receptors and angiotensin II leads to an increase in the concentrations of renin, angiotensin I and II in the blood plasma, as well as a slight decrease in the concentration of aldosterone. In hypertension (arterial hypertension), olmesartan medoxomil causes a dose-dependent, long-lasting decrease in blood pressure. There is no data regarding the development of arterial hypotension after taking the first dose of the drug, tachyphylaxis during prolonged treatment and withdrawal syndrome. Dosing olmesartan medoxomil once a day provides an effective and gentle reduction in blood pressure over 24 hours. The maximum antihypertensive effect is achieved after 8 weeks from the start of therapy, although a significant effect of lowering blood pressure is noted after 2 weeks of treatment. Olmesartan medoxomil is a prodrug. It is rapidly converted to the pharmacologically active metabolite olmesartan by esterases in the intestinal mucosa and in the blood of the portal vein during absorption in the digestive tract. Undegraded olmesartan medoxomil or the intact side chain of the medoxomil group was not detected in plasma or secretions. The average absolute bioavailability of olmesartan when used in tablet dosage form is 25.6%. The maximum concentration of olmesartan in blood plasma is on average reached approximately 2 hours after oral administration of the drug and increases almost linearly with an increase in the single oral dose taken to 80 mg. Concomitant food intake has virtually no effect on the bioavailability of olmesartan. The binding of olmesartan to plasma proteins is 99.7%, however, the potential for a clinically significant shift in protein binding when olmesartan interacts with other highly protein-bound drugs is low (this is confirmed by the fact that there is no clinically significant interaction between olmesartan and warfarin). Olmesartan is excreted in urine (approximately 40%) and bile (approximately 60%), its half-life is 10–15 hours. Cumulation of olmesartan was not observed.

Compound

One tablet of Cardosal 40 contains 40 mg of medoxomil olmesartan.
One tablet of Cardosal 20 contains 20 mg of medoxomil olmesartan.

One tablet of Cardosal 10 contains 10 mg of medoxomil olmesartan.

Additional substances: hyprolose, microcrystalline cellulose, lactose monohydrate, magnesium stearate.

Shell composition: hypromellose, talc, titanium dioxide.

Use of the drug Cardosal

Adults. The initial daily dose of olmesartan medoxomil is 10 mg. If blood pressure does not decrease sufficiently, the dose of the drug is increased to the optimal daily dose of 20 mg. If necessary, the dose of the drug can be increased to a maximum of 40 mg/day. The drug is taken daily at the same time, regardless of meals. Elderly patients. There is usually no need for dose adjustment in elderly patients (see recommended doses for patients with impaired renal function). If it is necessary to increase the daily dose to a maximum of 40 mg/day, the increase should be carried out under close monitoring of blood pressure. mild or moderate renal impairment The maximum daily dose for these patients is 20 mg. To enhance the effect of the drug, hydrochlorothiazide is used.

Indications for use, restrictions

Cardosal is prescribed for hypertension, which is marked by a persistent increase in systolic and diastolic blood pressure. As a rule, it is prescribed for primary (essential) hypertension. This pathology has no connection with disease of the organs that regulate blood pressure. It is based on hereditary predisposition.

At risk are people who are obese, abuse alcohol, have a nicotine addiction, suffer from stress, as well as pregnant women and representatives of the black race.

Reasons for the development of headache

The medicine has a number of contraindications that should be taken into account before prescribing it. It is strictly forbidden to take it in the following conditions:

• individual intolerance to components;
• obstruction of the bile ducts;
• malabsorption or lactase deficiency;
• severe kidney damage in the period after transplantation of this organ;
• pregnancy;
• breastfeeding.

Also, you should not use the drug to treat small children and adolescents before they reach adulthood. It is possible to take the drug with extreme caution for the following pathologies:

• cardiac ischemia;
• cardiomyopathic conditions;
• disruption of the heart valves;

• 
  mild kidney failure;

• narrowing of the lumen of the renal arteries;
• liver dysfunction;
• hyperkalemia;
• hyponatremia;
• diabetes;
• bronchial asthma;
• chronic heart failure;
• dehydration (for example, after diarrhea, severe vomiting);
• cerebrovascular pathologies;
• aldosteronism.

If there are restrictions, you should carefully study the patient’s health status and medical record. If the expected benefits are higher than the possible risks, the medicine may be prescribed. In this case, the attending physician must constantly monitor the patient’s condition.

Side effects of the drug Cardosal

By frequency of occurrence, side effects are distributed as follows: very often (≥1/10); often (≥1/100, but ≤1/10); sometimes (≥1/1000, but ≤1/100); rare (≥1/10,000, but ≤1/1000); very rare (≤1/10,000), including isolated reports. During clinical trials and post-marketing, the following adverse events were reported with olmesartan medoxomil:

Cardosal price, where to buy

In Russia, the price of Cardosal 10 No. 28 is 460-570 rubles, the price of Cardosal 20 No. 28 is 505-660 rubles, and Cardosal 40 with the same number is 670-715 rubles.

In Ukraine, prices for the drug in the same release forms are close to 248, 328 and 374 hryvnia, respectively.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine

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• Cardosal tablets p.p.o.
  10 mg 28 pcs. Daichi Sankyo Europe GmbH RUR 638 order
• Cardosal tablets p.p.o. 40 mg 28 pcs. Daichi Sankyo Europe GmbH

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• Cardosal Plus tablets p.p.o. 12.5mg+20mg 28pcs Daichi Sankyo Europe GmbH

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• Cardosal tablets p.p.o. 20 mg 28 pcs. Daichi Sankyo Europe GmbH

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• Cardosal (tablet p/o 20 mg No. 28)Berlin-Chemie AG/Menarini

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• Cardosal plus (tab. p.pl/vol. 12.5 mg + 20 mg No. 28) Daiichi Sankyo

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Pharmacy24

• Cardosal plus 20/12.5 No. 28 tablets Daichie Sankio Europe GmbH/Berlin Chemie AG (Menarini Group), Nimechchina/Nimechchina
  380 UAH.order
• Cardosal 40 mg No. 28 tablets Berlin Chemi AG, /Daichi Sankio Europe GmbH/Labor.Menarini S.A., Nimechchina

  427 UAH. order

• Cardosal plus 20/25 No. 28 tablets Berlin Chemi AG, Nimechchina

  380 UAH. order

• Cardosal 20 mg No. 28 tablets Berlin Chemi AG, /Daichi Sankio Europe GmbH/Labor.Menarini S.A., Nimechchina

  388 UAH order

• Cardosal 10 mg N28 tablets Berlin Chemi AG, /Daichi Sankio Europe GmbH/Labor.Menarini S.A., Nimechchina

  312 UAH. order

Special instructions for the use of the drug Cardosal

Due to the lack of sufficient clinical experience, the use of olmesartan medoxomil is not recommended in patients with severe renal failure (creatinine clearance ≤20 ml/min) or in patients with impaired liver function. If the patient, before prescribing olmesartan medoxomil, received intensive diuretic therapy, followed a salt-free diet, or had diarrhea and/or vomiting, then after taking the first dose of the drug, arterial hypotension may develop as a result of a decrease in blood volume. Therefore, it is necessary to eliminate the possibility of hypovolemia before starting treatment with olmesartan medoxomil. Olmesartan medoxomil should be prescribed with caution to patients with heart failure, kidney disease, or stenosis of the renal artery of both or a single kidney, since there is a risk of developing acute hypotension, azotemia, oliguria, and acute renal failure. When treating patients with impaired renal function, it is recommended to periodically monitor the level of potassium and creatinine in the blood serum. Caution should be exercised when using olmesartan medoxomil in patients with aortic or mitral valve stenosis or obstructive hypertrophic cardiomyopathy. Patients with primary hyperaldosteronism do not respond to the use of ACE inhibitors, therefore it is not recommended to prescribe them olmesartan medoxomil. It should be remembered that an excessive decrease in blood pressure in patients with coronary artery disease or cerebral atherosclerosis can lead to the development of myocardial infarction or ischemic stroke. When using olmesartan medoxomil, dizziness or increased fatigue may occasionally occur, which must be taken into account in patients driving vehicles and/or servicing technical equipment. The drug contains lactose, so it should not be used in patients with hereditary galactose intolerance, lactase deficiency or glucose/galactose malabsorption syndrome.

Buy Cardosal Plus film-coated tablets 12.5 mg+20 mg No. 28 in pharmacies

Instructions for use Cardosal Plus tab p.o 12.5mg+20mg No. 28 Buy Cardosal Plus tab p.o 12.5mg+20mg No. 28 Dosage forms film-coated tablets 12.5+20mg Manufacturers Daichi Sankyo Europe GmbH, packaged Berlin- Chemi AG (Germany) Group Antihypertensives - angiotensin (AII) receptor blockers Composition hydrochlorothiazide + olmesartan medoxomil. International nonproprietary name hydrochlorothiazide + olmesartan medoxomil. Synonyms Cardosal 10, Cardosal 20 Indications : essential arterial hypertension (if monotherapy with olmesartan medoxomil is ineffective). ICD-10 codes Dosage regimen Cardosal® plus tablets are taken orally, regardless of meals. Before prescribing the combination drug Cardosal® plus, it is recommended to pre-select the dose of each of the active ingredients separately (i.e. olmesartan medoxomil and hydrochlorothiazide). Recommended dose: Daily, 1 tablet of Cardosal® plus containing 20 mg of olmesartan medoxomil and 12.5 mg of hydrochlorothiazide, in the absence of adequate blood pressure control during monotherapy with olmesartan medoxomil at a dose of 20 mg; In the absence of adequate blood pressure control while taking the drug Cardosal® plus, containing 20 mg of olmesartan medoxomil and 12.5 mg of hydrochlorothiazide, it is possible to use the drug Cardosal® plus, containing 20 mg of olmesartan medoxomil and 25 mg of hydrochlorothiazide daily, 1 tablet. The maximum dose of Cardosal® plus is 20 mg of olmesartan medoxomil and 25 mg of hydrochlorothiazide once a day. Elderly patients (over 65 years of age) with normal renal function (creatinine clearance more than 90 ml/min.) and patients with impaired renal function (creatinine clearance = 30-60 ml/min.) do not require dose adjustment. Side effects Possible side effects are listed below in descending frequency of occurrence: common (> 1/100, < 1/10), uncommon (> 1/1000, < 1/100), rare (> 1/10000, < 1/1000) , very rare (< 1/10000), including isolated reports. Combination of olmesartan medoxomil and hydrochlorothiazide From the central nervous system Often: dizziness. Uncommon: syncope. From the cardiovascular system: Uncommon: palpitations, marked decrease in blood pressure, orthostatic hypotension. From the skin Uncommon: skin rash, eczema. Metabolic disorders Uncommon: hyper- or hypokalemia, hypercalcemia, hypertriglyceridemia, hyperuricemia, increased concentrations of lipids in the blood. From laboratory parameters Very rare: a slight increase in the concentration of creatinine, uric acid and urea nitrogen in the blood serum, a slight decrease in the concentration of hemoglobin and hematocrit. Olmesartan Medoxomil (monotherapy) From the hematopoietic system Very rare: thrombocytopenia. From the side of the central nervous system: Very rare: dizziness, headache. From the cardiovascular system Rarely: marked decrease in blood pressure. Uncommon: angina pectoris. From the respiratory system Often: bronchitis, pharyngitis, rhinitis. Very rare: cough. From the digestive tract Often: diarrhea, dyspepsia, gastroenteritis. Very rare: abdominal pain, nausea, vomiting. From the urinary system Often: hematuria, urinary tract infection. Very rare: acute renal failure. From the musculoskeletal system Often: arthritis, back pain. Very rare: muscle cramps, myalgia. From the skin Very rarely: skin itching, exanthema, angioedema, allergic dermatitis, urticaria. Metabolic disorders: Often: increased activity of creatine phosphokinase, hypertriglyceridemia, hyperuricemia. Rarely: hyperkalemia. From laboratory parameters Very rare: increased concentrations of creatinine and urea in the blood serum. Often: increased activity of liver transaminases. Other disorders Common: chest pain, flu-like symptoms, peripheral edema. Very rare: weakness, increased fatigue, drowsiness, malaise. Hydrochlorothiazide (monotherapy) From the hematopoietic system Rarely: leukopenia, neutropenia, agranulocytosis, thrombocytopenia, and plastic anemia, hemolytic anemia, suppression of bone marrow hematopoiesis. From the central and peripheral nervous system Often: dizziness, weakness, headache, increased fatigue. Rarely: anxiety, sleep disturbance, confusion, apathy, depression, numbness, paresthesia, convulsions. From the organ of vision Rarely: xanthopsia, transient disturbance of accommodation, decreased formation of tear fluid. From the cardiovascular system: Uncommon: orthostatic hypotension. Rarely: arrhythmias, thrombosis, embolism. From the respiratory system Rarely: dyspnea (including interstitial pneumonia and pulmonary edema). From the digestive tract: Uncommon: anorexia, abdominal pain, nausea, vomiting, diarrhea, constipation, flatulence, inflammation of the salivary glands. Rarely: pancreatitis, acute cholecystitis, intrahepatic cholestatic jaundice. Very rare: paralytic ileus. From the genitourinary system Rarely: impaired renal function, interstitial nephritis, acute renal failure, impaired potency. From the musculoskeletal system Rarely: muscle cramps, muscle weakness, paresis. From the skin Uncommon: photosensitivity, skin rash, urticaria. Rarely: development of lupus-like syndrome (fever, arthralgia, myalgia, serositis, vasculitis, increased erythrocyte sedimentation rate (ESR), leukocytosis, eosinophilia), activation of the cutaneous form of systemic lupus erythematosus, anaphylactic reactions, toxic epidermal necrolysis. From laboratory parameters Often: hyperglycemia, glucosuria, hyperuricemia, increased serum creatinine concentrations, water and electrolyte imbalance (including hyponatremia, hypomagnesemia, hypochloremia, hypokalemia and hypercalcemia), increased concentrations of cholesterol and triglycerides in the blood. Other disorders Rare: fever. Contraindications for use - hereditary lactose intolerance, deficiency of lactase in the body or malabsorption syndrome of glucose and lactose; - severe liver dysfunction (more than 9 points on the Child-Pugh scale) (risk of developing hepatic coma), biliary obstruction and cholestasis; - severe renal dysfunction (creatinine clearance less than 30 ml/min.); - refractory hypokalemia, hyponatremia, hypercalcemia and symptomatic hyperuricemia; - pregnancy; - lactation period; - age under 18 years (the effectiveness and safety of the drug have not been studied); - hypersensitivity to olmesartan medoxomil, hydrochlorothiazide or other sulfonamide derivatives or to any of the excipients included in the drug (see section Composition). With caution: - bronchial asthma; — coronary heart disease (CHD); — chronic heart failure in the stage of decompensation; - severe cerebrovascular disorders; - stenosis of the aortic or mitral valve; — hypertrophic obstructive cardiomyopathy; - mild to moderate liver dysfunction (less than 9 points on the Child-Pugh scale); - impaired renal function (creatinine clearance more than 30 ml/min., but less than 60 ml/min.); - bilateral renal artery stenosis or stenosis of the artery of a single kidney; — condition after a recent kidney transplant (no experience with the drug); - primary aldosteronism; - diabetes mellitus, gout; - water-electrolyte imbalance, dehydration; — connective tissue diseases, including systemic lupus erythematosus; - patients on a salt-restricted diet or on hemodialysis; - when bone marrow hematopoiesis is suppressed; - conditions accompanied by a decrease in circulating blood volume; — (OTSK) incl. diarrhea, vomiting or previous diuretic therapy. Use during pregnancy and lactation There is no experience with the use of olmesartan medoxomil in pregnant women. However, due to existing reports of severe teratogenic effects of drugs acting on the RAAS, like any drug of this class, Cardosal® plus is contraindicated for use during pregnancy. If pregnancy is planned or occurs during therapy with Cardosal® plus, the drug should be discontinued as soon as possible. It is not known whether olmesartan medoxomil is excreted in breast milk, but thiazides are excreted in breast milk and may suppress lactation, therefore, if it is necessary to use the drug Cardosal® plus during lactation, breastfeeding should be discontinued while taking it. Use for liver dysfunction Contraindicated in severe liver dysfunction (more than 9 points on the Child-Pugh scale) (risk of developing hepatic coma), biliary obstruction and cholestasis. Use for impaired renal function Contraindicated in cases of severe impaired renal function (creatinine clearance less than 30 ml/min.). With caution: - impaired renal function (creatinine clearance more than 30 ml/min., but less than 60 ml/min.); - bilateral renal artery stenosis or stenosis of the artery of a single kidney; - condition after a recent kidney transplant (no experience with the drug). Patients with impaired renal function (creatinine clearance = 30-60 ml/min.) do not require dose adjustment. Use in children Contraindicated in children under 18 years of age. Use in elderly patients Elderly patients (over 65 years of age) with normal renal function (creatinine clearance more than 90 ml/min) do not require dose adjustment. Special instructions Symptomatic arterial hypotension, especially after taking the first dose of the drug, may occur in patients with reduced blood volume and/or reduced sodium concentration due to intensive diuretic therapy, limited dietary salt intake during dietary nutrition, and also due to diarrhea or vomiting. Relevant factors should be eliminated before starting the use of Cardosal® plus. Thiazide diuretics, including hydrochlorothiazide, may cause disturbances in the blood volume or water-electrolyte balance of the blood serum (including hypokalemia, hyponatremia and hypochloremic alkalosis). Precursor symptoms are: dryness of the oral mucosa, thirst, weakness, drowsiness, anxiety, myalgia or cramps, muscle weakness, arterial hypotension, oliguria, tachycardia, nausea and vomiting (see section Side effects). The highest risk of developing hypokalemia exists in patients with liver cirrhosis, in patients undergoing forced diuresis, and in those patients who are simultaneously taking glucocorticosteroids or ACTT (see section Interaction with other drugs). Conversely, due to the antagonism of the angiotensin II (AT1) receptors contained in Cardosal plus olmesartan medoxomil, hyperkalemia may occur, especially in patients with decreased renal function and/or chronic heart failure, as well as patients with diabetes. In patients with risk factors, regular monitoring of serum potassium concentration is recommended. There are no data on whether olmesartan medoxomil can reduce or prevent diuretic-induced hyponatremia. In hot weather, dilution hyponatremia may occur in patients prone to edema. The decrease in chloride concentration is generally insignificant and usually does not require treatment. Thiazides can reduce the excretion of calcium ions by the kidneys and also lead to a transient slight increase in the concentration of calcium in the blood serum in the absence of a history of disturbances in its metabolism. Hyperkalygemia may indicate latent hyperparathyroidism. Before studying the function of the parathyroid glands, thiazides should be discontinued. It has been proven that thiazide diuretics increase the excretion of magnesium ions by the kidneys, which can lead to hypomagnesemia. In patients in whom vascular tone and renal function depend to a large extent on the activity of the RAAS (for example, in patients with severe chronic heart failure or impaired renal function, including renal artery stenosis), treatment with other drugs affecting the RAAS is associated with the possibility of developing acute arterial hypotension, azotemia, oliguria or, in rare cases, acute renal failure. The possibility of a similar effect cannot be excluded when using angiotensin P receptor antagonists. There is an increased risk of developing severe arterial hypotension and renal failure if a patient with bilateral renal artery stenosis or arterial stenosis of a single functioning kidney receives therapy with drugs that affect the RAAS. When using the drug Cardosal® plus in patients with impaired renal function, it is recommended to periodically monitor the concentration of potassium ions, creatinine and uric acid in the blood serum. There is no experience with the use of olmesartan medoxomil in patients with recent kidney transplantation or in patients with end-stage renal impairment. In patients with limited renal function, taking thiazide diuretics may be accompanied by azotemia. With obvious progression of renal failure, it is necessary to reconsider therapy and decide on the abolition of diuretics. As with any antihypertensive drug, excessive reduction of blood pressure in patients with coronary artery disease or cerebrovascular insufficiency can lead to myocardial infarction or stroke. Thiazide diuretics may cause impaired glucose tolerance, as well as increased serum concentrations of cholesterol, triglycerides and uric acid. In patients with diabetes mellitus, it may be necessary to adjust the dose of insulin or oral hypoglycemic agent (see section Interactions with other drugs). When treated with thiazide diuretics, latent diabetes mellitus can manifest itself. There are reports that thiazide diuretics may precipitate an attack of gout and cause exacerbation of systemic lupus erythematosus. Hypersensitivity reactions to hydrochlorothiazide may be more likely to occur in patients with a history of allergies or bronchial asthma (history). Effect on the ability to drive vehicles and operate machinery The effect of the drug Cardosal® plus on the ability to drive vehicles and operate machinery has not been specifically studied, therefore, during treatment with Cardosal® plus, caution should be exercised when driving vehicles and engaging in potentially hazardous activities that require increased concentration attention and speed of psychomotor reactions. Overdose Symptoms: in case of an overdose of olmesartan medoxomil, a pronounced decrease in blood pressure is most likely, as well as tachycardia, bradycardia, nausea, drowsiness; in case of an overdose of hydrochlorothiazide - symptoms of electrolyte deficiency (hypokalemia, hypochloremia, hyponatremia) and dehydration due to excessive diuresis. Treatment: gastric lavage and/or intake of activated charcoal is recommended; therapy aimed at correcting dehydration and water-electrolyte imbalances. If there is a pronounced decrease in blood pressure, it is recommended to place the patient in a horizontal position, raising his legs, and carry out therapy aimed at replenishing blood volume. Hemodialysis is not effective. Drug interactions of Olmesartan medoxomil It is not recommended to use it together with potassium-sparing diuretics, potassium preparations, salt substitutes containing potassium, or other drugs that can increase the concentration of potassium in the blood serum (for example, heparin) - an increase in the concentration of potassium in the blood serum is possible. Nonsteroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid in doses greater than 3 g/day, as well as cyclooxygenase-2 (COX-2) inhibitors and angiotensin II receptor antagonists may act synergistically to reduce glomerular filtration. With the simultaneous use of NSAIDs and angiotensin II receptor antagonists, there may be a risk of developing acute renal failure, therefore monitoring of renal function at the beginning of treatment, as well as regular intake of sufficient fluids, is recommended. However, simultaneous treatment may reduce the antihypertensive effect of angiotensin II receptor antagonists, leading to a partial loss of their therapeutic effectiveness. When used simultaneously with antacids (magnesium and aluminum hydroxides), a moderate decrease in the bioavailability of olmesartan medoxomil is possible. There are reports of a reversible increase in serum lithium concentrations and toxicity during concomitant use of lithium preparations with angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists, therefore the use of olmesartan medoxomil in combination with lithium preparations is not recommended. If it is necessary to use appropriate combined therapy, regular control of the concentration of lithium in the blood serum is recommended. In rare cases, ACE inhibitors can enhance the hypoglycemic effect of insulin and hypoglycemic agents for oral administration (for example, sulfonyl gross derivatives) in patients with diabetes. In these cases, with the simultaneous use of ACE inhibitors, a decrease in the dose of the hypoglycemic agent for oral and insulin is required. Hylorotiazide glucocorticosteroids, adrenocorticotropic hormone (ACTH), amphotericin B (parenterally), carbenoksolon, penicillin G sodium salt, salicylic acid derivatives: while they are used with hydrochlorotiazide, an increase in electrolyte loss, especially the development of hypokalism. Simultaneous intake of ion -exchange drugs (steering wheel, rhinoma) reduces the absorption of hydrochlorotiazide. With the simultaneous use of hydrochlorotiazide with calcium salts, it is possible to increase the concentration of calcium in the blood serum, due to a decrease in its excretion. If it is necessary to prescribe calcium preparations, it should be controlled by its concentration in the blood serum and correctly adjust its dose. With the simultaneous use of hydrochlorotiazide with cardiac glycosides, arrhythmias are possible. Medicines capable of calling Ari (“Torsades des Pointes”) (a special form of polymorphic ventricular tachycardia with an excitement, spindle-shaped configuration of ventricular complexes in combination with an increase or decrease in the amplitude of the QRS complex, which can lead to ventricular fibrillation or asystole) : из-за риска развития гипокалиемии требуется осторожность при одновременном применении гидрохлоротиазида с некоторыми антиаритмическими средствами (хинидин, гидрохинидин, дизопирамид, амиодарон, соталол, дофетилид, ибутилид), нейролептиками (тиоридазин, хлорпромазин, левомепромазин, трифлуоперазин, циамемазин, сульпирид, сультоприд, амисульприд Tiapid, Pimoside, Haloperidol, Dropperidol) and others (Bephopal, Cisapride, Depemanil Methyl Sulfate, Erythromycin for intravenous administration, halophantrin, mizolastine, nantamidin, sparfloxacin, terphenin, vincamine for intravenous administration), which are known that they can cause Ari. With the joint use of hydrochlorotiazide with non -trapping muscle relaxants (including so chocoucurine chloride) - strengthening the action of muscle relaxants. Tiazids can increase the risk of side effects of Amantadine. Tiaside diuretics treatment can disrupt glucose tolerance. With the simultaneous use of M-cholin blockors (atropine) and thiazides, due to the decrease in the motility of the gastrointestinal tract, the bioavailability of thiazide diuretics may increase. It may be required to reduce the dose of hypoglycemic agents for oral and insulin. Contragric agents (probenecid, sulfinpirazone, allopurinol): It may be necessary to correct the dose of the hypouricemic agent (increasing the dose of probenecide or sulfinpirazone), since hydrochlorotiazide can increase the concentration of uric acid in the blood serum. Simultaneous use with thiazide diuretics can increase the frequency of development of increased sensitivity to allopurinol. The action of sympathomy meters with the simultaneous use of thiazide diuretics can be weakened. Tiazide diuretics can reduce the excretion of cytotoxic agents with the kidneys and strengthen their myelosupressive effect. When taking salicylates in high doses, hydrochlorotiazide can enhance their toxic effect on the central nervous system. There are reports of single cases of hemolytic anemia while taking methyldopa with hydrochlorotiazide. The simultaneous use of cyclosporine with hydrochlorotiazide can increase the risk of hyperuricemia and exacerbation of gout. The simultaneous use of tetracyclines with thiazide diuretics increases the risk of increasing the concentration of urea caused by tetracyclines. This interaction does not apply to doxycycline. Olmesartan Medoxomil/ hydrochlorotiazide in combination simultaneously using lithium preparations with thiazide diuretics can increase the already increased risk of lithium intoxication due to ACE inhibitors, therefore, the joint use of the drug Cardosal® Plus and lithium drugs are not recommended. If such a combination is still necessary, then careful control of the concentration of lithium in the blood serum is also necessary. With the simultaneous use of Cardosal* Plus with Baclofen and Amifostin, an increase in antihypertensive effect is possible. With the simultaneous use of other antihypertensive agents, the hypotensive effect of the drug Cardosal® plus may intensify. Ethanol, barbiturates, narcotic analgesics or antidepressants when used with Cardosal® Plus can lead to aggravation of orthostatic hypotension. Storage conditions and periods

Store at a temperature not exceeding 30°C. Keep the medicine out of the reach of children! Shelf life: 3 years.

Interactions of the drug Cardosal

When used with other antihypertensive drugs, the effect of olmesartan medoxomil may be enhanced. When olmesartan medoxomil is used simultaneously with NSAIDs, its antihypertensive effect may be reduced and there may be a risk of acute renal failure. After therapy with antacids (magnesium-aluminum hydroxide), a decrease in the bioavailability of olmesartan medoxomil was noted. The combined use of warfarin and digoxin does not change the pharmacokinetics of olmesartan. It is not recommended to use olmesartan medoxomil with lithium preparations due to the increased toxicity of the latter. Due to the possibility of developing hyperkalemia, it is not recommended to use olmesartan medoxomil with potassium-sparing diuretics, drugs containing potassium, or with other drugs that can lead to an increase in serum potassium levels (for example, heparin). When using olmesartan medoxomil with pravastatin, no clinically significant interactions were observed. The interactions of olmesartan medoxomil with drugs that are metabolized by the cytochrome P450 enzyme have not been determined.

Contraindications

• Renal failure , a condition after a kidney transplant.
• Obstruction of the biliary tract.
• Lactase deficiency , malabsorption or galactosemia.
• Age less than 18 years.
• Pregnancy and lactation .
• Hypersensitivity to the components of the drug.

It is recommended to use the drug with caution in the following diseases and conditions:

• obstructive hypertrophic cardiomyopathy;
• heart valve stenosis
• primary aldosteronism;
• mild renal failure
• hyperkalemia or hyponatremia;
• chronic cardiac failure;
• cardiac ischemia;
• bilateral renal artery stenosis
• cerebrovascular disorders;
• decreased volume of circulating fluid due to diet , vomiting or diarrhea;
• liver dysfunction;
• elderly age;
• combined use with diuretics.