Atakand Plus: instructions for use, reviews

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

Atacand Plus is an antihypertensive combination drug. Angiotensin type 2 is important in the pathogenesis of heart failure, arterial hypertension and other diseases of the circulatory system. The main effects of angiotensin type 2 are vasoconstriction, stimulation of aldosterone , correction of water-electrolyte status and activation of cell growth. The effects are associated with the interaction of angiotensin type 2 with angiotensin type 1 receptors.

Candesartan is a selective antagonist of angiotensin receptor 2, does not suppress angiotensin-converting enzyme (converts angiotensin type I into angiotensin type II, which inactivates bradykinin ), and does not cause accumulation of bradykinin and substance P. A dose-dependent increase in the content of angiotensin type 1, renin, angiotensin type 2 and a decrease in the content of aldosterone in the blood occurs as a result of suppression of AT1 type receptors of angiotensin type 2.

Candesartan does not interact with receptors other than those mentioned above and does not inhibit ion channels .

Hydrochlorothiazide is a diuretic from the thiazides , inhibits the active reabsorption of sodium ions in the distal parts of the renal tubules and stimulates the release of chlorine, sodium and water ions. excretion of magnesium and potassium is stimulated in a dose-dependent manner, and calcium is reabsorbed to a much greater extent than before.

Reduces the volume of extracellular fluid and plasma, suppresses the intensity of blood transport through the heart, and lowers pressure. After long-term treatment, the effect develops due to an increase in arterioles .

Candesartan and hydrochlorothiazide have a cumulative hypotensive effect. In people with arterial hypertension, the drug causes a prolonged decrease in pressure without increasing the contractile activity of the heart. Orthostatic hypotension is not observed at the initial stages of treatment; after completion of treatment, arterial hypertension does not increase.

After one dose of the drug, the hypotensive effect is detected after 2 hours. Using the drug once a day gently and effectively lowers blood pressure for 24 hours. With long-term treatment, a reliable decrease in pressure occurs after four weeks. The effectiveness of the drug does not depend on age or gender.

Pharmacokinetics

Candesartan cilexetil . Prodrug for internal use. When absorbed from the intestine, cilexetil candesartan , undergoing ether hydrolysis , is quickly transformed into the active substance tightly bound to AT1 - candesartan . Absolute bioavailability reaches 14%. Food intake does not affect pharmacokinetics.

The maximum concentration in the blood occurs four hours after consuming the drug. The interaction of candesartan with plasma proteins reaches 99%. Pharmacokinetic parameters do not depend on the gender of the patient.

It is excreted in urine and bile in its original form, and undergoes changes in the liver to an extremely small extent. The half-life of candesartan is approximately 9 hours. Accumulation of the drug in the body is not detected.

Hydrochlorothiazide . Rapidly absorbed from the intestines. Bioavailability reaches 70%. Taken together with food increases the level of absorption by 15%. Interaction with plasma proteins is 60%. It is not metabolized and is excreted through the kidneys. The half-life is 8 hours. 70% of the dose is excreted by the kidneys within two days.

Contraindications

Anuria.
Liver damage or cholestasis .
Kidney damage.
Refractory hypercalcemia and hypokalemia .
Gout.
Pregnancy.
Lactation.
Age less than 18 years.
Hypersensitivity to sulfonamide .
Hypersensitivity to the components of the drug.

Use Atacand Plus with caution in severe forms of heart failure , bipolar stenosis of the renal arteries , hemodynamically significant narrowing of the aortic or mitral valves, cerebrovascular diseases, coronary heart disease, obstructive hypertrophic cardiomyopathy, liver cirrhosis , reduced blood volume, primary hyperaldosteronism, lactose intolerance, renal failure, hyponatremia , surgery, kidney transplantation and diabetes mellitus .

Special instructions for the use of the drug Atacand plus

Kidney failure . In this category of patients, the use of loop diuretics is preferable to thiazides. When using Atacand Plus for renal failure, it is recommended to periodically monitor the levels of potassium, creatinine and uric acid. Kidney transplantation . There is no experience with the use of Atacand Plus in patients who have recently undergone kidney transplantation. Renal artery stenosis . Other drugs that affect the renin-angiotensin-aldosterone system (ACE inhibitors) may increase plasma urea and creatinine levels in bilateral or unilateral renal artery stenosis. A similar effect can be expected with the use of angiotensin II receptor antagonists. Hypovolemia . With a decrease in blood volume and/or hyponatremia, symptomatic hypotension may occur, as with the use of other drugs that affect the renin-angiotensin-aldosterone system. Therefore, it is not recommended to use Atacand Plus until these conditions are corrected. Anesthesia and surgical interventions . When using angiotensin II antagonists, hypotension may develop during anesthesia and surgery due to blockade of the renin-angiotensin-aldosterone system. In very rare cases, hypotension may be severe and require fluid resuscitation and/or vasopressors. Liver failure . Thiazides are used with caution in patients with liver failure or progressive liver disease, since minor changes in fluid or electrolyte balance may precipitate the development of hepatic coma. There is no clinical experience with the use of Atacanda Plus in patients with liver failure. Aortic or mitral valve stenosis, obstructive hypertrophic cardiomyopathy . As with other vasodilators, special caution should be exercised when treating patients with hemodynamically significant aortic or mitral valve stenosis, or obstructive hypertrophic cardiomyopathy. Primary hyperaldosteronism . The use of Atacanda Plus is not recommended, since in primary hyperaldosteronism there is usually no clinical effect when using drugs that act by inhibiting the renin-angiotensin-aldosterone system. Violation of water and electrolyte balance . As with therapy with other diuretics, blood plasma electrolyte levels are monitored at certain intervals. Thiazides, including hydrochlorothiazide, can cause fluid and electrolyte imbalance (hypercalcemia, hypokalemia, hyponatremia, hypomagnesemia and hypochloremic alkalosis). Thiazide diuretics may reduce urinary calcium excretion and cause a transient and slight increase in plasma calcium concentrations. Overt hypercalcemia may be a sign of latent hyperparathyroidism. Before testing the function of the parathyroid gland, the use of thiazides is discontinued. Hydrochlorothiazide dose-dependently increases urinary potassium excretion, which can lead to hypokalemia. This effect of hydrochlorothiazide is less pronounced when used in combination with candesartan cilexetil. The risk of developing hypokalemia may increase in patients with liver cirrhosis, increased diuresis, insufficient dietary electrolytes, and with concomitant therapy with corticosteroids or ACTH. Given the experience with the use of other drugs that affect the renin-angiotensin-aldosterone system, the simultaneous use of Atacand Plus and potassium-sparing diuretics, potassium supplements, salt substitutes or other drugs that increase the level of potassium in the blood plasma (for example, heparin) may lead to hyperkalemia. Although there are no confirmed data regarding Atacanda Plus, treatment with ACE inhibitors or angiotensin II antagonists may cause hyperkalemia, especially in cardiac and/or renal failure. Thiazides have been shown to increase urinary excretion of magnesium, which may lead to hypomagnesemia. Effect on metabolism and endocrine system . Treatment with thiazide diuretics may impair glucose tolerance. Dosage adjustment of hypoglycemic agents, including insulin, may be necessary. During therapy with thiazides, latent diabetes mellitus may occur. Increases in cholesterol and TG levels have been associated with thiazide diuretic therapy. However, minimal or no effects have been reported at the 12.5 mg dose contained in Atacanda Plus. Thiazide diuretics increase the concentration of uric acid in the blood plasma and can provoke the occurrence of gout in patients with a corresponding predisposition. General information . When the activity of the renin-angiotensin-aldosterone system is critical to vascular tone and renal function (for example, in severe congestive heart failure or kidney disease, including renal artery stenosis), treatment with other drugs that affect this system has been associated with acute hypotension, azotemia, oliguria and sometimes acute renal failure. The possibility of similar effects cannot be excluded when using angiotensin II receptor antagonists. As with other antihypertensive drugs, a pronounced decrease in blood pressure due to coronary artery disease or ischemic cerebrovascular disease can lead to myocardial infarction or stroke. Hypersensitivity reactions to hydrochlorothiazide are more likely with allergies and a history of asthma, but can also occur without a corresponding history. Exacerbation or activation of systemic lupus erythematosus has been reported with the use of thiazide diuretics. Atacand Plus contains lactose, therefore the drug should not be used in patients with rare hereditary galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. During pregnancy and breastfeeding . There are very limited data regarding the use of Atacanda Plus during pregnancy. These data are insufficient to draw conclusions regarding the potential risk to the fetus when using the drug in the first trimester of pregnancy. In humans, fetal renal perfusion depends on the development of the renin-angiotensin-aldosterone system and begins in the second trimester. So, the risk to the fetus increases if you take Atacand Plus in the second or third trimester of pregnancy. The use of drugs that directly affect the renin-angiotensin system in the second and third trimester of pregnancy can cause hypotension, renal dysfunction, oliguria and/or anuria, oligohydramnios, cranial hypoplasia, intrauterine growth retardation and death of the newborn. Cases of pulmonary hypoplasia, facial development anomalies and limb contractures have been described. Animal studies of candesartan cilexetil have demonstrated renal damage in fetuses late in pregnancy and in newborns. This mechanism is considered to be a pharmacologically mediated effect on the renin-angiotensin-aldosterone system. Hydrochlorothiazide may decrease plasma volume as well as uteroplacental blood flow; may be a cause of neonatal thrombocytopenia. Considering the above information, Atacand Plus is contraindicated during pregnancy. If pregnancy is diagnosed during treatment, use of Atacanda Plus is discontinued. It is not known whether candesartan cilexetil passes into breast milk, but due to potential adverse effects on a breastfed baby, Atacand Plus should not be used during breastfeeding. Impact on the ability to drive vehicles and operate machinery . The effect of Atacanda Plus on the ability to drive vehicles and operate machinery has not been studied, however, given the pharmacodynamic properties of candesartan, this effect is unlikely. When driving vehicles and working with machinery, take into account dizziness and fatigue that may occur during treatment.

Side effects

Side effects of cilexetil candesartan :

from the hematopoietic system – neutropenia, leukopenia, agranulocytosis ;
from the digestive system - nausea , liver damage, increased levels of liver enzymes, hepatitis ;
from the musculoskeletal system – arthralgia, lumbodynia, myalgia ;
from the nervous system – headache , dizziness ;
from the genitourinary system – kidney damage;
from the metabolic side - hyponatremia, hyperkalemia ;
allergic reactions – urticaria , rash , angioedema , itching .

Side effects of hydrochlorothiazide :

from the hematopoietic system - neutropenia, leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia, bone marrow depression ;
from the nervous system - dizziness , headache, depression , sleep disturbance , paresthesia ;
from the sensory organs – blurred image;
from the circulatory system - orthostatic hypotension, necrotizing vasculitis, arrhythmia, cutaneous vasculitis ;
from the respiratory system – difficulty breathing;
from the digestive system - pancreatitis , diarrhea , constipation , cholestatic jaundice ;
from the musculoskeletal system – myalgia ;
from the genitourinary system - glucosuria , kidney damage, nephritis ;
from the metabolic side - hyperuricemia, hyperglycemia, hypokalemia, hyponatremia, hypertriglyceridemia, hypercholesterolemia, increased creatinine ;
allergic reactions - anaphylactic reactions , rash , urticaria , erythematous-like skin reactions.

Side effects of the drug Atacand plus

During controlled clinical trials with candesartan cilexitil/hydrochlorothiazide, side effects were mild and transient. Treatment discontinuation rates due to adverse reactions were comparable for candesartan cilexetil/hydrochlorothiazide (3.3%) and placebo (2.7%). During clinical trials with candesartan cilexetil/hydrochlorothiazide, the following common (1/100) side effects were reported (the incidence of side effects was at least 1% higher than the rate of these side effects with placebo). Candesartan cilexetil/hydrochlorothiazide From the central nervous system: dizziness/vertigo. Candesartan cilexetil Since the introduction of the drug into widespread practice, the following adverse reactions have been reported very rarely (≤1/10,000): From the blood and lymphatic system: leukopenia, neutropenia and agranulocytosis. From the side of water and electrolyte balance: hyperkalemia, hyponatremia. From the side of the central nervous system: dizziness, headache. From the gastrointestinal tract: nausea. From the hepatobiliary system: increased levels of liver enzymes, impaired liver function, hepatitis. From the skin and subcutaneous tissue: angioedema, rash, urticaria, itching. From the musculoskeletal system: back pain, arthralgia, myalgia. From the urinary system: impaired renal function, including renal failure in patients with an increased risk of developing this condition. Hydrochlorothiazide When monotherapy with hydrochlorothiazide at a dose of ≥25 mg, the following adverse reactions were reported with an incidence: often (1/100), uncommon (1/1000 and ≤1/100) and rare (≤1/1000). From the blood and lymphatic system: rarely - leukopenia, neutropenia/agranulocytosis, thrombocytopenia, aplastic anemia, bone marrow suppression, hemolytic anemia. From the immune system: rarely - anaphylactic reactions. From the side of metabolism and water-electrolyte balance: often - hyperglycemia, hyperuricemia, hyponatremia and hypokalemia. Mental disorders: rarely - dyssomnia, depression, anxiety. From the side of the central nervous system: often - dizziness, vertigo; rarely - paresthesia. On the part of the organ of vision: rarely - transient visual impairment in the form of blurred objects. From the cardiovascular system: infrequently - postural hypotension; rarely - arrhythmia, necrotizing vasculitis. From the respiratory system: rarely - disturbance of external respiration, including pneumonitis and pulmonary edema. From the gastrointestinal tract: infrequently - anorexia, irritation of the gastric mucosa, diarrhea, constipation; rarely - pancreatitis. From the hepatobiliary system: rarely - cholestatic jaundice. From the skin and subcutaneous tissue: infrequently - rash, urticaria, photosensitivity; rarely - toxic epidermal necrolysis, skin lupus-like reactions, reactivation of skin manifestations of systemic lupus erythematosus. From the musculoskeletal system: rarely - muscle spasm. From the urinary system: often - glucosuria; rarely - renal dysfunction and interstitial nephritis. General disorders: often - weakness; rarely - fever. Laboratory indicators: often - increased levels of cholesterol and TG in the blood plasma; infrequently - increased levels of blood urea nitrogen and creatinine in the blood plasma. Increases in plasma uric acid, glucose and ALT levels as side effects were reported more frequently with candesartan cilexetil/hydrochlorothiazide (incidence 1.1, 1.0 and 0.9%, respectively) than with placebo (incidence 0. 4; 0.2 and 0%, respectively). A slight decrease in hemoglobin and an increase in AST were noted in one patient receiving candesartan cilexetil/hydrochlorothiazide. Increases in creatinine, urea, or potassium levels and decreases in sodium levels were determined.

Overdose

Symptoms: the main manifestations of an overdose of candesartan are a pronounced decrease in blood pressure and dizziness . The main symptoms of hydrochlorothiazide are acute loss of water and electrolytes. Symptoms such as dizziness, low blood pressure, ventricular arrhythmia, tachycardia , and muscle cramps are possible.

Treatment: symptomatic, stabilization of the patient's condition. A supine position with legs elevated is recommended. If it is necessary to increase the volume of circulating blood, isotonic sodium chloride . Hemodialysis is not effective.

Interaction

Hydrochlorothiazide, Digoxin, Warfarin, Glibenclamide, oral contraceptives, Nifedipine and E nalapril do not reveal any particular interactions with the components of Atacanda Plus.

The use of Atacanda Plus with other antihypertensive drugs enhances the hypotensive effect. The effects of hydrochlorothiazide , which cause potassium loss, can be potentiated by other drugs that stimulate hypokalemia and potassium loss ( diuretics, Amphotericin, laxatives, Penicillin G sodium, Carbenoxolone, salicylic acid derivatives ).

Potassium-sparing diuretics , potassium-containing salt substitutes, potassium preparations and other drugs that increase potassium levels in the blood when taken together with Atacand Plus lead to hyperkalemia .

Simultaneous therapy lithium preparations causes a reversible increase in the concentration of lithium in the blood and the development of characteristic toxic reactions.

Absorption of hydrochlorothiazide is weakened by the use of K olestipol and K olestyramine .

Thiazide-like diuretics calcium levels in the blood, enhance the hyperglycemic effect of beta-blockers and diazoxide , increase sensitivity to glucose, slow down the excretion of cytostatics ( cyclophosphamide , methotrexate ) and activate their myelosuppressive effect .

The effects of non-depolarizing muscle relaxants are enhanced by hydrochlorothiazide.

Anticholinergics ( B iperidine, Atropine ) increase the bioavailability of diuretics from the thiazides group due to weakening of intestinal motility.

Hydrochlorothiazide can weaken the effect of vasoconstrictor amines ( epinephrine ) and increase the likelihood of acute renal failure .

Buy Atacand Plus tablets 16mg + 12.5mg No. 28 in pharmacies

Atacand Plus Buy Atacand Plus in pharmacies DOSAGE FORMS tablets 12.5mg+16mg

MANUFACTURERS AstraZeneca AB (Sweden) AstraZeneca AB/AstraZeneca GmbH (Sweden)

GROUP Combination of angiotensin II receptor antagonists and diuretics

COMPOSITION Candesartan, hydrochlorotazide.

INTERNATIONAL NON-PROPENTED NAME Candesartan + Hydrochlorotazide

PHARMACOLOGICAL ACTION Combined antihypertensive drug. Angiotensin II is the main hormone of the renin-angiotensin-aldosterone system, which plays an important role in the pathogenesis of arterial hypertension, heart failure and other cardiovascular diseases. Candesartan is a selective antagonist of AT1 receptors of angiotensin II, does not inhibit ACE (which converts angiotensin I into angiotensin II, which destroys bradykinin), does not lead to the accumulation of bradykinin or substance P. Candesartan does not bind to receptors of other hormones and does not block ion channels involved in regulation of the functions of the cardiovascular system. Hydrochlorothiazide is a thiazide-like diuretic that inhibits active sodium reabsorption, mainly in the distal renal tubules and increases the excretion of sodium, chlorine and water ions. Hydrochlorothiazide reduces the volume of blood plasma and extracellular fluid, reduces the intensity of blood transport by the heart, and lowers blood pressure. Long-term use of hydrochlorothiazide reduces the risk of cardiovascular disease and mortality. Candesartan and hydrochlorothiazide have a cumulative hypotensive effect. Orthostatic arterial hypotension is not observed when taking the drug for the first time; after treatment, arterial hypertension does not increase. The effectiveness of the combination of candesartan and hydrochlorothiazide does not depend on the gender and age of the patient.

INDICATIONS FOR USE Treatment of arterial hypertension in patients for whom combination therapy is indicated.

CONTRAINDICATIONS Impaired liver function and/or cholestasis, impaired renal function, anuria, refractory hypokalemia and hypercalcemia, gout, pregnancy, lactation (breastfeeding), children and adolescents under 18 years of age (efficacy and safety have not been established), hypersensitivity to active or auxiliary components of the drug, hypersensitivity to sulfonamide derivatives. The drug is used with caution in severe chronic heart failure, bilateral renal artery stenosis, stenosis of the artery of a single kidney, hemodynamically significant stenosis of the aortic and mitral valve, in patients with cerebrovascular diseases, coronary artery disease, hypertrophic obstructive cardiomyopathy, with reduced BCC, cirrhosis of the liver, with lactose intolerance , impaired absorption of lactose and galactose, hyponatremia, primary hyperaldosteronism, surgery, after kidney transplantation, renal failure and diabetes mellitus.

SIDE EFFECTS of Candesartan cilexetil: From the hematopoietic system: leukopenia, neutropenia and agranulocytosis. From the side of the central nervous system: dizziness, headache. From the digestive system: nausea, increased activity of liver enzymes, impaired liver function, hepatitis. From the musculoskeletal system: back pain, arthralgia, myalgia. From the urinary system: impaired renal function (including renal failure in predisposed patients). Metabolism: hyperkalemia, hyponatremia. Allergic reactions: angioedema, rash, urticaria, itching. Hydrochlorothiazide: From the hematopoietic system: leukopenia, neutropenia, agranulocytosis, thrombocytopenia, aplastic anemia, bone marrow depression, anemia. From the central nervous system and peripheral nervous system: mild dizziness, headache, sleep disturbance, depression, anxiety, paresthesia. From the senses: transient blurriness of the image. From the cardiovascular system: orthostatic arterial hypotension, arrhythmia, necrotizing vasculitis, cutaneous vasculitis. From the respiratory system: difficulty breathing (pneumonia and pulmonary edema). From the digestive system: loss of appetite, diarrhea, constipation, pancreatitis, intrahepatic cholestatic jaundice. From the musculoskeletal system: myalgia. From the urinary system: glucosuria, renal dysfunction, interstitial nephritis. Metabolism: hyperglycemia, hyperuricemia, hyponatremia, hypokalemia, hypercholesterolemia, hypertriglyceridemia, increased creatinine levels. Allergic reactions: skin rash, urticaria, photosensitivity, anaphylactic reactions, necrosis of the epidermis, relapse of cutaneous erythematosis, reactions similar to cutaneous erythematosis. Other: weakness, feeling hot.

INTERACTIONS Candesartan is metabolized to a small extent in the liver (CYP2C9). Combined use of the drug with other antihypertensive drugs potentiates the hypotensive effect. The potassium-wasting effects of hydrochlorothiazide may be potentiated by other drugs that cause potassium wasting and hypokalemia (eg, diuretics, laxatives, amphotericin, carbenoxolone, sodium penicillin G, salicylic acid derivatives). Diuretic-induced hypokalemia and hypomagnesemia predispose to the possible cardiotoxic effects of digitalis glycoside and antiarrhythmic agents. When taking the drug in parallel with such drugs, monitoring the level of potassium in the blood is required. When lithium drugs are combined with ACE inhibitors, a reversible increase in the concentration of lithium in the blood serum and the development of toxic reactions occur. The diuretic, natriuretic and hypotensive effects of hydrochlorothiazide are weakened by NSAIDs. The absorption of hydrochlorothiazide is weakened by the use of colestipol and cholestyramine. The effect of non-depolarizing muscle relaxants (for example, tubocurarine) can be enhanced by hydrochlorothiazide. Thiazide-like diuretics may cause an increase in blood calcium levels due to a decrease in calcium excretion. If it is necessary to use calcium-containing nutritional supplements or vitamin D, the level of calcium in the blood plasma should be monitored and the dose adjusted if necessary. Thiazide-like diuretics enhance the hyperglycemic effect of beta-blockers and diazoxide. Anticholinergics (eg, atropine, biperidine) may increase the bioavailability of thiazide-like diuretics due to decreased GI motility. Thiazide-like diuretics may increase the risk of adverse effects from amantadine. Thiazide-like diuretics can slow down the removal of cytostatic drugs (such as cyclophosphamide, methotrexate) from the body and enhance their myelosuppressive effect. The risk of hypokalemia may increase with concomitant use of corticosteroids or ACTH. While using the drug, the incidence of orthostatic arterial hypotension may increase when taking alcohol, barbiturates or general anesthetics. When treated with thiazide-like diuretics, a decrease in glucose tolerance may occur, and therefore it may be necessary to adjust the dose of hypoglycemic drugs (including insulin). Hydrochlorothiazide may reduce the effects of vasoconstrictor amines (eg, epinephrine). Hydrochlorothiazide may increase the risk of acute renal failure, especially when taken with large doses of iodinated excipients. No significant interaction of hydrochlorothiazide with food was found.

METHOD OF APPLICATION AND DOSAGE Atacand Plus should be taken 1 time/day, regardless of meals. Recommended dose - 1 tablet. 1 time/day

OVERDOSE Symptoms: clinically pronounced decrease in blood pressure, dizziness, acute loss of fluid and electrolytes, dizziness, decreased blood pressure, dry mouth, tachycardia, ventricular arrhythmia, loss of consciousness and muscle cramps. Treatment: If a clinically significant decrease in blood pressure develops, it is necessary to carry out symptomatic treatment and monitor the patient’s condition. Place the patient on his back and elevate his legs. If necessary, the blood volume should be increased, for example, by intravenous administration of an isotonic sodium chloride solution. If necessary, sympathomimetic agents can be prescribed. Candesartan and hydrochlorothiazide are unlikely to be eliminated by hemodialysis.

SPECIAL INSTRUCTIONS For patients with renal failure during drug therapy, it is recommended to constantly monitor the levels of potassium, creatinine and uric acid. In patients with intravascular volume and/or sodium deficiency, symptomatic arterial hypotension may develop: it is not recommended to use the drug until these symptoms disappear. As with all cases of taking drugs that have a diuretic effect, blood plasma electrolytes should be monitored. Thiazide-like diuretics increase magnesium excretion, which may cause hypomagnesemia. The use of thiazide-like diuretics can change the level of glucose in the blood up to the manifestation of latent diabetes mellitus. Thiazide-like diuretics increase plasma uric acid concentrations and may precipitate gout in predisposed patients. The drug contains lactose, so it should not be taken by patients with rare hereditary diseases manifested by lactose intolerance, lactose deficiency or impaired absorption of glucose and lactose. The safety and effectiveness of the drug in children and adolescents under 18 years of age have not been established. Patients should be careful when driving or operating machinery, as dizziness and increased fatigue may occur during treatment.

STORAGE CONDITIONS List B. The drug should be stored out of the reach of children at a temperature not exceeding 30 degrees. WITH.

special instructions

The occurrence of allergic reactions to hydrochlorothiazide is most common in patients suffering from bronchial asthma , a history of hypersensitivity reactions however, it is possible that similar symptoms may occur in other patients.

When using thiazide-like diuretics, congestive seborrhea have been reported .

The drug contains lactose , so it should not be taken by patients with low lactose tolerance, lactase deficiency or impaired absorption of glucose or lactose .

Caution must be exercised while driving with Atacand Plus during treatment.

Use of the drug Atacand plus

The recommended dose of Atacanda Plus is 1 tablet per day. Before transferring the patient to Atacanda Plus, the dose of candesartan cilexetil should be titrated. If clinically appropriate, a direct transition from the use of single drugs to the combination drug Atacand Plus is possible. The most pronounced antihypertensive effect is achieved within 4 weeks from the start of treatment. Atacand Plus is taken 1 time per day at the same time or regardless of meals. In elderly patients, no adjustment of the initial dose is required. Use for hypovolemia . Titration of the drug dose is recommended if there is an increased risk of hypotension, for example, with a possible decrease in blood volume (in such patients, the initial dose of candesartan can be reduced to 4 mg). These patients are not recommended to use the combination drug at a dose of 16/12.5 mg; use the single drug candesartan cilexetil (Atacand) at a dose of 4 or 8 mg, depending on the severity and tolerability, with the addition of an appropriate dose of hydrochlorothiazide if necessary. Use for renal failure. In this case, the use of loop diuretics is preferable to thiazides. It is recommended to titrate the dose of candesartan cilexetil for patients with renal impairment with creatinine clearance ≥30 ml/min/1.73 m2 body surface area (BSA) before initiation of treatment with Atacand Plus (for patients with mild to moderate renal impairment, the recommended starting dose of candesartan cilexetil is 4 mg). Atacand Plus should not be used to treat patients with severe renal impairment (creatinine clearance ≤30 ml/min/1.73 m2 BSA). Use for liver failure . It is recommended to titrate the dose of candesartan cilexetil for patients with mild to moderate hepatic impairment before starting treatment with Atacand Plus (the recommended starting dose of candesartan cilexetil for such patients is 2 mg). Atacand Plus should not be used to treat patients with severe liver failure and/or cholestasis. Use in children . The safety and effectiveness of Atacanda Plus in children have not been established.

Analogs

Level 4 ATX code matches:
Diokor

Gizaar

Teveten Plus

Co Diovan

Mikardis Plus

Vazar N

Valz N

Analogs of Atakanda Plus: Candecor H , Candecor HD, Khizart-N-DS .