Xarelto pills 20 mg 14 pcs
Condition: New product
1000 Items
Rating:
Be the first to write a review!
More info
Active ingredients
Rivaroxaban
Release form
Pills
Composition
enalapril maleate 10 mg.
Pharmacological effect
Antihypertensive drug, ACE inhibitor. The mechanism of action of enalapril is associated with inhibition of ACE activity, which reduces the formation of angiotensin II, which contributes to the narrowing of blood vessels, and simultaneously activates the formation of kinins and prostacyclin, which have vasodilating action. Enalapril belongs to prodrugs, after its hydrolysis enalaprilat is formed in the body, which inhibits this enzyme. Enalapril also has some diuretic effect associated with moderate inhibition of aldosterone synthesis. Along with a decrease in blood pressure, the drug reduces the pre- and afterload on the myocardium in heart failure, improves blood circulation in the small circle and respiratory function, reduces resistance in the kidney vessels, which helps normalize blood circulation in them.
Pharmacokinetics
After ingestion, the absorption is 60%. Food intake does not affect absorption. In the liver undergoes metabolism with the formation of the active metabolite enalaprilat. Binding to plasma proteins for enalaprilat is 50-60%. C max enalapril is reached after 1 h, enalaprilat after 3-4 h. Enalaprilat does not penetrate through the BBB, in a small amount through the placental barrier and is excreted in small amounts in breast milk. It is excreted by the kidneys (up to 60%, of which 20% is in the form of enalapril and 40% is in the form of enalaprilat) and through the intestine (33%, of which 6% is in the form of enalapril and 27% in the form of enalaprilat).
Indications
- various forms of arterial hypertension (including renovascular); - chronic heart failure (as part of combination therapy).
Contraindications
- angioedema associated with the use of ACE inhibitors (in history); - progressive azotemia in bilateral stenosis of the renal arteries or stenosis of the artery of the only kidney; - childhood; - pregnancy; - lactation (breastfeeding); - hypersensitivity to enalapril and other components - hypersensitivity to other ACE inhibitors.
Precautionary measures
Do not exceed the recommended daily dose.
Use during pregnancy and lactation
Renipril is contraindicated during pregnancy and lactation.
Dosage and administration
Renipril is prescribed orally regardless of food intake. When treating essential hypertension, the initial dose of Renipril is 10-20 mg / day. In the future, the dose is selected individually. In moderate hypertension, a dose of 10 mg / day is sufficient. The maximum daily dose is 80 mg. In Renovascular hypertension, Renipril is prescribed in smaller doses. The initial dose is usually 5 mg / day, then the dose is selected individually. The maximum dose is 20 mg / day. In case of heart failure, Renipril is prescribed starting from 2.5 mg, then the dose is gradually increased to 10-20 mg (1-2 times / day). The duration of treatment depends on the effectiveness of the therapy. In all cases, when too severe lowering the blood pressure dose of the drug is gradually reduced. The drug is used both in monotherapy and in combination with other antihypertensive drugs. In patients with impaired renal function, reduce the single dose or increase the intervals between doses.
Side effects
The safety of Xarelto; evaluated in four phase III trials involving 6097 patients undergoing major orthopedic surgery on the lower limbs (total knee or hip replacement) and 3997 patients hospitalized for medical reasons who received Xarelto treatment; 10 mg for up to 39 days, as well as in three phase III studies of the treatment of venous thromboembolism, which included 4566 patients who received Xarelto; either 15 mg 2 times / day daily for 3 weeks, followed by a dose of 20 mg 1 time / day, or 20 mg 1 time / day with a duration of treatment up to 21 months. In addition, during two phase III studies, including 7750 patients, data were obtained on the safety of the drug in patients with atrial fibrillation of non-valvular origin who received at least one dose of Xarelto; over a period of up to 41 months, as well as 10,225 patients with ACS who received at least one dose of 2.5 mg (2 times / day) or 5 mg (2 times / day) of Xarelto; in addition to treatment with acetylsalicylic acid or acetylsalicylic acid with clopidogrel or ticlopidine, the duration of treatment is up to 31 months. Considering the mechanism of action, the use of Xarelto; may be accompanied by an increased risk of latent or overt bleeding from any organs and tissues, which can lead to post-hemorrhagic anemia.The risk of bleeding may increase in patients with uncontrolled arterial hypertension and / or when used together with drugs that affect hemostasis. Signs, symptoms and severity (including possible death) vary depending on the location, intensity or duration of bleeding and / or anemia Hemorrhagic complications may manifest weakness, pallor, dizziness, headache, shortness of breath, as well as an enlarged limb in volume or shock that cannot be explained. other reasons. In some cases, due to anemia, symptoms of myocardial ischemia, such as chest pain and angina, developed. When taking Xarelto; It has been reported about known complications secondary to severe bleeding, such as interfascial space syndrome and renal failure. Therefore, you should consider the possibility of bleeding when assessing the condition of the patient receiving anticoagulants. Generalized data on the frequency of adverse reactions recorded for Xarelto; are given below. In groups divided by frequency, undesirable effects are presented in order of decreasing severity, as follows: very often (≥1 / 10); often (≥1 / 100 and <1/10); infrequently (≥1 / 1000 and <1/100); rarely (≥1 / 10,000 and <1/1000). All adverse reactions that occurred during the treatment period in patients who participated in phase III clinical trials: From the hematopoietic system: often anemia (including appropriate laboratory parameters); infrequently, thrombocythemia (including elevated platelet count). * From the side of the cardiovascular system: often - marked reduction in blood pressure, hematoma; infrequently - tachycardia. From the organ of vision: often - hemorrhage in the eye (including hemorrhage into the conjunctiva). From the alimentary system: often - bleeding gums, gastrointestinal bleeding (including rectal bleeding), pain in the gastrointestinal tract, dyspepsia, nausea, constipation *, diarrhea, vomiting *; infrequently - dry mouth. From the side of the liver: infrequently - abnormal liver function; rarely - jaundice. From the laboratory indicators: often - increased activity of hepatic transaminases; infrequently - increasing the concentration of bilirubin, increasing the activity of alkaline phosphatase *, increasing the activity of LDH *, increasing the activity of lipase *, increasing the activity of amylase *,increased activity of GGT *; rarely - an increase in the concentration of conjugated bilirubin (with a concomitant increase in the activity of ALT or without it). From the nervous system: often - dizziness, headache; infrequently - intracerebral and intracranial hemorrhage, short-term syncope. From the urogenital system: often - bleeding from the urogenital tract (including hematuria and menorrhagia **), renal failure (including increased creatinine, urea) *. - nosebleeds, hemoptysis. On the side of the skin and subcutaneous tissues: often - itching (including infrequent cases of generalized itching), rash, ecchymosis, skin and subcutaneous hemorrhages; infrequently - urticaria. From the immune system: rarely - allergic reactions, allergic dermatitis. From the musculoskeletal system: often - pain in the extremities *; infrequently - hemarthrosis; rarely - a hemorrhage in the muscles. On the whole body: often - fever *, peripheral edema, deterioration of general muscle strength and tone (including weakness, asthenia); infrequently - deterioration of general well-being (including malaise); rarely, local edema *. Other: often - hemorrhages after the procedures (including postoperative anemia and bleeding from a wound), excessive hematoma with bruising; infrequently - discharge from a wound *; rarely - vascular pseudoaneurysm ***. * - were recorded after major orthopedic operations. ** - were recorded in the treatment of VTE as very frequent in women <55 years. *** - were recorded as infrequent in the prevention of sudden death and myocardial infarction in patients after acute coronary syndrome (after percutaneous interventions). During the post-registration monitoring, the following adverse reactions were reported, the development of which had a temporary connection with the use of the drug Xarelto ;. It is impossible to estimate the frequency of occurrence of such adverse reactions in the framework of post-registration monitoring. On the immune system: angioedema, allergic edema. Within the framework of phase 3 RCTs, such undesirable effects were regarded as infrequent (from> 1/1000 to <1/100). On the side of the liver: cholestasis, hepatitis (including hepatocellular damage).Within the framework of phase 3 RCTs, such undesirable effects were regarded as rare (from> 1/10 000 to <1/1000). From the hematopoietic system: thrombocytopenia. Within the framework of phase 3 RCTs, such undesirable effects were regarded as infrequent (from> 1/1000 to <1/100). From the musculoskeletal system: the frequency is unknown - increased subfascial pressure syndrome (compartment syndrome) due to hemorrhage into the muscles. side of the urinary system: the frequency is unknown - renal failure / acute renal failure due to bleeding, leading to renal hypoperfusion.
Overdose
Symptoms: hypotension. Treatment: put the patient in a position with raised legs. In mild cases, appoint saline solution. In more severe cases, in a hospital setting, measures are taken to stabilize blood pressure: IV injection of saline or plasma substitutes. Perhaps the use of hemodialysis.
Interaction with other drugs
With the simultaneous appointment of Renipril and NSAIDs may decrease the effectiveness of Renipril; with potassium-sparing diuretics (spironolactone, triamterene, amiloride) - hyperkalemia may develop; with lithium salts - slow lithium elimination (control of lithium concentration in blood plasma is shown). When used simultaneously with antipyretic analgesics, the effectiveness of Renipril may be reduced. Reniril weakens the effect of drugs containing theophylline. adrenergic blockers, methyldopa, nitrates, calcium channel blockers, hydralazine, prazosin enhances the hypotensive effect. Ethanol enhances the antihypertensive effect of pre Arata.
special instructions
With extreme caution should use the drug in patients with autoimmune diseases, impaired liver or kidney function, with the loss of fluids and salts, simultaneously with immunosuppressants and diuretics. In the case of previous treatment with diuretics, in particular in chronic heart failure, Renipril increases the risk of arterial hypotension, therefore, before starting treatment with Renipril, it is necessary to compensate for the loss of fluid and salt. .