Co-Diovan

Description overdue on 11/12/2014

• Latin name: Co-Diovan
• ATC code: C09DA03
• Active substance:   Valsartan + Hydrochlorothiazide (Valsartan + Hydrochlorothiazide)
• Manufacturer: Novartis Pharma, Switzerland

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• Composition
• Product form
• Pharmacological action
• Pharmacodynamics and pharmacokinetics
• Indications
• Contraindications
• Side effects
• Instructions for use Co-Diovan
• Overdose
• Cooperation
• Terms of sale
• Storage conditions
• Shelf life
• Cautions
• Analogs
• Synonyms
• Babies
• During pregnancy (and lactation)
• Reviews
• Price, where to buy

Composition

1 coated tablet comprises as active ingredient - valsartan / hydrochlorothiazide In a weight ratio - 80/12, 5 mg, 160/12, 160/25 mg or 5 mg.

Additional ingredients: anhydrous colloidal silicon dioxide, crospovidone, microcrystalline cellulose, magnesium stearate.

Coated tablet consisting of: hypromellose, talc, Macrogol 8000, E 171, E 172.

Product form

Preparation Co-Diovan (Co-Diovan) is produced in the form of coated tablets, 14 or 28 units per first package.

Pharmacological action

Hypotensive.

Pharmacodynamics and pharmacokinetics

Co-Diovan (Co-Diovan) included in the group of combined antihypertensive drugs, due to the presence in its composition in addition antagonist receptors Angiotensin II   - valsartan . thiazide diuretic   - hydrochlorothiazide .

Valsartan It shows the blocking effect on the receptors Angiotensin II   AT1 subtype, thereby increasing its serum concentration That leads to a more active stimulation of AT2 receptors and balancing effects associated with activation of the AT1 receptor. Valsartan It has no significant agonistic action of AT1 receptor, but its affinity for this receptor subtype is much stronger than for the AT2 receptor.

Valsartan It does not inhibit ACE ( angiotensin-converting enzyme ), Transforming angiotensin I   at Angiotensin II   and destroys bradykinin In this connection, much less gives rise to dry cough   as a side effect. Valsartan It does not interact with other receptors hormones and blocks ion channels Who are active regulation Cardiovascular   functional system. It lowers blood pressure ( arterial pressure ) Without affecting the heart rate ( heart rate ). In most cases, the beginning of the hypotensive effect valsartan After oral administration of a single dose it is observed in the boundaries of 2 hours, reaching its peak during 4-6 hours. Antihypertensive effectiveness remains high for at least a day. Prolonged use of any therapeutic doses valsartan Maximum   low blood pressure Primarily developed for 2-4 weeks, and such is recommended throughout the treatment period.

Incorporation of Co-Diovan diuretic component - hydrochlorothiazide It leads to a significant to extension   lowering blood pressure . Hydrochlorothiazide   acts on receptors the distal tubules of the kidneys Thereby increasing the excretion Sodium ion   and Chlorine and decreasing the amount of circulating plasma. Due to this enhanced activity of renin secretion aldosterone , Renal excretion of potassium   and correspondingly lowering its level in the serum. Loss Potassium To some extent, compensate for the impact of parallel valsartan .

After oral administration (p.o.) valsartan It absorbed quickly, although the extent of its absorption is quite variable. Average observed bioavailability at 23%. T1 / 2 in the range of 9 hours.

Linear kinetics valsartan It remains unchanged throughout its administration. With a single daily intake of recommended doses, there is some small cumulation of valsartan . The binding to plasma proteins occurs at 94-97% (mainly albumin ). The volume of distribution is equal to 17 liters. Meaning   plasma clearance   about 2 L / h, the hepatic blood flow of approximately 30 l / h.

Extraction of valsartan   It carried out mainly in unchanged form, 70% intestine and 30% kidney . Together with food intake valsartan At the beginning it reduces the AUC by 48%. This figure comes back to normal 8-hour of taking the pill and entails a reduction in the therapeutic effect.

Hydrochlorothiazide also it absorbed quickly and reaches Tmax about 2 hours. Communication with plasma proteins   It ranges from 40 to 60%. T1 / 2 in the range 6-15 o'clock. With increasing doses of growth observed AUC. Cumulation , With once daily dosing, is negligible. Absolute bioavailability at the level of 60-80%. Ingestion of even affect the bioavailability (in either direction), but remains low.

Greater measure of output kidney (greater than 95%) in the form hydrolyzate (about 4%).

The combination valsartan and hydrochlorothiazide It leads to a decrease in systemic bioavailability of the latter by about 30%, although the hydrochlorothiazide does not affect the kinetics of valsartan. The interaction of these two drugs only increase the hypotensive effects   each other.

Indications

The drug Co-Diovan is used for long-term treatment hypertension When one therapy valsartan (eg, Diovanom ), Is not effective enough.

Contraindications

• liver disease severe, cholestasia and biliary cirrhosis ;
• hypersensitivity to the active or additional ingredient Co-Diovan;
• pregnancy ;
• childhood unidentified because safety and efficacy;
• breast-feeding ;
• renal disease, with the established creatinine clearance   (QC) is less than 30 ml / min;
• anuria ;
• hyponatremia . hypokalemia . hypercalcemia (refractory), as well as clinical symptoms hyperuricemia .

Carefully:

renal artery stenosis .

Side effects

In most cases, the negative side displays use Co-Diovan were transient in nature and Just noticeable.

With a frequency of greater than 1% and often up to 5% was observed:

• headache ;
• nasopharyngitis ;
• dizziness ;
• pain in the back, chest and limbs;
• feeling tired;
• upper respiratory infection;
• cough ;
• diarrhea ;
• sinusitis ;
• nausea.

With a frequency below 1% and do not established a causal relationship with the reception of Co-Diovan manifested:

• pain in the abdomen;
• anxiety ;
• blurred vision;
• arthritis ;
• arthralgia ;
• bronchitis ;
• breathlessness ;
• dyspepsia ;
• impotence;
• convulsions leg muscles;
• insomnia ;
• frequent urination;
• rash ;
• feeling heartbeat ;
• stretching;
• viral infection;
• urinary tract infections;
• swelling ;
• vertigo ;
• asthenia .

There is information about rare cases of hypersensitivity reactions, including:

• itch ;
• vasculitis ;
• rash;
• angioedema ;
• serum sickness .

It was also reported isolated cases of renal dysfunction.

Instructions for use Co-Diovan

Conducting long-term therapy hypertension   using Co-Diovan drug typically occurs at doses of 80/12, 160/12, or 5 mg, 5 mg, depending on the severity of the disease. Less commonly,   severe hypertension   may require a dose of 160/25 mg. All Co-Diovan dosage taken once a day (one tablet per day), preferably at the same time of day. Correction doses at kidney disease with CC than 30 ml / min, and at a moderate hepatic insufficiency , not required.

Overdose

Although to date information on the cases of drug overdose Co-Diovan no, its expected primary symptom is excessive low blood pressure .

In this case it is necessary to artificially induce vomiting   and wash out the stomach   (if detected soon receive ultrahigh doses). In the future, an adequate solution to the treatment of an overdose will be introducing (infusion) saline . Carrying Hemodialysis It is likely to be ineffective, as the procedure takes only hydrochlorothiazide and does not affect the concentration valsartan .

Cooperation

The antihypertensive effect of Co-Diovan can be hard for parallel reception of other antihypertensive agents .

Combines reception of potassium salts, potassium-containing products and other potassium-sparing diuretics, potassium content increase funds requires caution and control the amount of potassium in the blood.

When concurrent therapy lithium preparations   you need to monitor its concentration in the blood serum.

Preparations Cimetidine . Furosemide . Amlodipine . Warfarin . Atenolol . Digoxin . Indomethacin . Glibenclamide do not reveal clinically significant interactions with the Co-Diovanom.

Due to the presence in the composition of Co-Diovan hydrochlorothiazide ( thiazide diuretic ), There may be some drug interactions typical of this group of drugs.

The potentiation of the action curariform relaxants .

Lowering Effects hydrochlorothiazide with parallel reception NSAIDs . Related hypovolemia increases the risk of renal failure acute.

Simultaneous with the appointment of derivatives salicylic acid . corticosteroids . saluretics , ACTH, Carbenoxolone . Amphotericin . Penicillin G It increases the possibility of hypokalemia .

While taking thiazide diuretics   We watched the progression hypomagnesemia or hypokalemia That can lead to the formation of Arrhythmia In case of reception of a combination with drugs foxglove .

Oral hypoglycemics   and insulin dosage may need revision.

Thiazide diuretics   increase the frequency of the possible reactions hypersensitivity towards Allopurinol . Strengthen the effectiveness of hyperglycemic Diazoxide . Increase the risk of adverse events Amantadine . Reduce ekskretirovanie kidneys cytotoxic   drugs (e.g. Methotrexate . Cyclophosphamide ), Thereby increasing their myelosuppressive effects .

The bioavailability of hydrochlorothiazide   It can be increased by taking holinoblokatorov (eg, b iperidena and Atropine ).

The probability of occurrence of hemolytic anemia in the combined reception Methyldopa and thiazide diuretic .

May reduce absorption hydrochlorothiazide when receiving Kolestiramin .

Thiazide diuretics Salts Calcium and Vitamin D , When used together, can increase the calcium content in the blood.

Simultaneous treatment Cyclosporine increases the risk of formation hyperuricemia and manifestations podagraticheskih symptoms .

Terms of sale

Co-Diovan available on medical prescription.

Storage conditions

Tablets Co-Diovan should be stored in its original packaging and in a dry place at a temperature of 30 ° C.

Shelf life

For tablets 80/12, 5 mg and 160/12, 5 mg a shelf life of 3 years.

160/25 mg tablets for a shelf life of 2 years.

Cautions

In the case of diagnosing a patient expressed sodium deficiency   and / or reducing the volume of blood , You may experience hypotension   at the beginning of therapy Ko Diovanom, in connection with which, before his appointment, it is necessary to adjust the level sodium and / or blood volume .

With the development of hypotension   the patient should be put to a horizontal position with raised legs and, if necessary, enter (infusion) saline solution . Therapy Co-Diovanom continue after stabilization of blood pressure.

Kidney disease   with CC greater than 30 ml / min do not require dose adjustments Co-Diovan. Study of the effects of the drug with CC less than 30 ml / min have not been conducted.

Liver disease   Slight or moderate nature and do not require adjustment of doses of Co-Diovan. In severe nature of the disease, due to the lack of practical use of the drug, it is better to find another drug.

Hydrochlorothiazide can change glucose tolerance   and increase in the blood concentration triglycerides . cholesterol and   Uric acid .

Analogs

Match code ATC 4th level:

• Atacand Plus
• Mikardis Plus
• Vasari H
• Valz H
• Lorista N / ND

• Atacand Plus ;
• Vazotenz H ;
• Gizaar ;
• Kardosal Plus ;
• Koaprovel ;
• Losap   P Luce ;
• Lorista H ;
• Mikardis Plus ;
• Teveten Plus ;
• Ibertan Plus ;
• Kandekor H .

Synonyms

• DioCore ;
• Vasari H ;
• Valz H ;
• Vanateks Combi ;
• Valsacor H .

Babies

Co-Diovan is not administered to children, due to lack of experience in such applications.

During pregnancy (and lactation)

In periods pregnancy   and Lactation Co-Diovan medication is not applicable.

Reviews of Co-Diovan

Unfortunately, at this time, patient testimonials about the drug Co-Diovan is quite scarce, although it is worth noting that among existing reviews, the effectiveness of the drug is estimated extremely positive. Those patients who take Co-Diovan, fully satisfied hypotonic effects   drug and note the virtual absence of its adverse events. Despite its considerable cost, soon, Co-Diovan should take its rightful place in the treatment of hypertension.

Price Co-Diovan, where to buy

The average price of the drug in pharmacies of Russia:

• Tablets of 80 mg / 12 mg 5 №28 - 1400 rubles;
• tablets 160 mg / 12 mg 5 number 28 - 1800 rubles;
• tablets 160 mg / 25 mg number 28 - 1700 rubles.

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