Kombisart 5mg/160mg 30 tablets — Made in Ukraine — Free Delivery
(Kombisart )
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Description Kombisart 5mg/160mg 30 tablets — Made in Ukraine — Free Delivery
Pharmacological properties
Pharmacodynamics. Kombisart contains two antihypertensive components with additional mechanisms for controlling blood pressure in patients with essential arterial hypertension: amlodipine belongs to the class of calcium antagonists, and valsartan belongs to the class of angiotensin receptor antagonists (ara) ii. the combination of these ingredients has an additive antihypertensive effect and reduces blood pressure to a greater extent than either of the components alone.
Amlodipine. Amlodipine inhibits the transmembrane penetration of calcium ions into the smooth muscles of the heart and blood vessels. The mechanism of the antihypertensive action of amlodipine is due to a direct relaxing effect on vascular smooth muscle, which leads to a decrease in peripheral vascular resistance and leads to a decrease in blood pressure. Experimental data confirm that amlodipine binds at the sites of dihydropyridine and nonhydropyridine bonds. The contractile processes of the heart muscle and vascular smooth muscles depend on the passage of extracellular calcium into these cells through specific ion channels.
After administration of the preparation in therapeutic doses to patients with hypertension, amlodipine causes vasodilation, which leads to a decrease in blood pressure in the patient's lying and standing positions. Such a decrease in blood pressure is not accompanied by a significant change in heart rate or the level of catecholamines in the blood plasma with prolonged use.
The effect correlates with plasma concentrations in young and elderly patients.
In patients with hypertension and normal renal function, therapeutic doses of amlodipine lead to a decrease in renal vascular resistance and an increase in the level of glomerular filtration, as well as effective renal blood plasma flow without changes in the filtering fraction or proteinuria.
As with other calcium channel blockers, measurements of hemodynamics of cardiac function at rest and during exercise (or while walking) in patients with normal ventricular function treated with amlodipine generally showed a slight increase in cardiac index without significant effect on the maximum rate of pressure increase in left ventricle (dP / dt) or end diastolic blood pressure, or left ventricular volume. In hemodynamic studies, amlodipine did not show a negative inotropic effect when used in therapeutic doses, even when combined with β-adrenergic receptor blockers.
Amlodipine does not alter the function of the sinus node or atrioventricular conduction. When using amlodipine in combination with β-adrenergic receptor blockers in patients with essential hypertension or angina pectoris, no changes in ECG parameters are noted.
Positive clinical effects of amlodipine were observed in patients with chronic stable angina pectoris, vasospastic angina pectoris and coronary artery disease, confirmed by angiography.
Valsartan. Valsartan is an active, powerful and specific ARA II, which is intended for internal use. It acts selectively on receptors of the AT1 subtype, which are rarely abundant and are responsible for the effects of angiotensin II. Elevated levels of angiotensin II due to blockade of AT1 receptors by valsartan can stimulate free AT2 receptors, which balances the effect of AT1 receptors. Valsartan does not have any partial agonist activity for AT1 receptors and has a much greater (approximately 20,000-fold) similarity with AT1 receptors than with AT2 receptors.
Valsartan does not inhibit ACE, also known as kininase II, which converts angiotensin I to angiotensin II and destroys bradykinin. Based on the absence of an effect on ACE and potentiation of the activity of bradykinin or substance P, the use of ARA II, as a rule, is not accompanied by a cough. Valsartan does not interact with or block other hormone receptors or ion channels, which are known to play an important role in the regulation of the functions of the cardiovascular system.
The use of the preparation in patients with hypertension leads to a decrease in blood pressure, without affecting the pulse rate.
In most patients, after oral administration of a single dose of the preparation, the onset of antihypertensive activity is noted within 2 hours, and the maximum decrease in blood pressure is achieved within 4-6 hours.
The antihypertensive effect persists for more than 24 hours after taking a single dose. With the regular use of the preparation, the maximum therapeutic effect, as a rule, is achieved within 2-4 weeks and is maintained at the achieved level during long-term therapy. Abrupt withdrawal of valsartan does not lead to a resumption of hypertension or other side effects.
It was found that valsartan significantly reduces the hospitalization rate of patients with chronic heart failure (II – IV class according to NYHA). A more significant effect was achieved in patients who did not use ACE inhibitors (ACE inhibitors) or β-adrenergic receptor blockers. It was also found that valsartan reduced cardiovascular mortality in clinically stable patients with left ventricular pathology or left ventricular dysfunction after myocardial infarction.
Valsartan / amlodipine. The combination of amlodipine and valsartan provides a dose-dependent additive decrease in blood pressure over the entire range of therapeutic doses. The antihypertensive effect after taking a single dose of the combination persists for 24 hours.
Pharmacokinetics
Linearity. Valsartan and amlodipine exhibit linear pharmacokinetics.
Amlodipine. Suction. After internal use of amlodipine in therapeutic doses, Cmax in blood plasma is achieved separately within 6–12 hours. The calculated absolute bioavailability is 64–80%. Food intake does not affect the bioavailability of amlodipine.
Distribution. The volume of distribution is approximately 21 l / kg body weight. In patients with essential hypertension, approximately 97.5% of the circulating preparation binds to plasma proteins.
Biotransformation. Amlodipine is extensively (approximately 90%) metabolized in the liver to inactive metabolites.
Excretion. Excretion of amlodipine from blood plasma is biphasic with T½ approximately 30-50 hours. Equilibrium plasma levels are achieved after continuous administration for 7-8 days. 10% of the initial amlodipine and 60% of amlodipine metabolites are excreted in the urine.
Valsartan. Suction. After taking the preparation inside Cmax of valsartan in blood plasma is achieved within 2-4 hours. The average value of the absolute bioavailability of the preparation is 23%. Food reduces the exposure of valsartan, as shown by the AUC (plasma concentration - time), by approximately 40%, and Cmax by 50%, although 8 hours after use, the concentration of valsartan in the blood plasma is the same for participants in the group who took the preparation on an empty stomach, and groups of patients who used the preparation after meals. The decrease in AUC is not accompanied by a clinically significant decrease in the therapeutic effect, therefore, valsartan can be taken regardless of food intake.
Distribution. The equilibrium volume of distribution of valsartan after intravenous administration is approximately 17 liters, which indicates that valsartan is not intensively distributed in tissues. Valsartan strongly binds to blood plasma proteins (94–97%), mainly to serum albumin.
Biotransformation. Valsartan is largely not transformed, since only 20% of the dose is converted to metabolites. In blood plasma in low concentrations (10% AUC of valsartan), a hydroxy metabolite was identified, which is pharmacologically inactive.
Excretion. Valsartan is characterized by multi-exponential elimination kinetics (T½a 1 h and T½b approximately 9 h). Valsartan is excreted mainly unchanged in the feces (≈83% of the dose) and urine (≈13% of the dose). After intravenous administration, the clearance of valsartan in the blood plasma is approximately 2 l / h, and its renal clearance is approximately 0.62 l / h (≈30% of the total clearance). T1 / 2 valsartan - 6 hours
Valsartan / amlodipine. After oral administration of the preparation Kombisart, Cmax of valsartan and amlodipine in blood plasma is achieved in 3 and 6-8 hours, respectively. The rate and degree of absorption of the preparation are equivalent to the bioavailability of valsartan and amlodipine when used in separate tablets.
Special populations
Children. There are no data on the pharmacokinetics of the preparation in children.
Elderly patients (over 65 years old). The time to reach Cmax of amlodipine in blood plasma is approximately the same in younger patients and the elderly. In elderly patients, the clearance of amlodipine tends to decrease, which leads to an increase in AUC and a lengthening of T½. The average systemic AUC of valsartan in the elderly is 70% higher than in younger patients, therefore, caution must be exercised when increasing the dose.
Renal failure Renal impairment does not significantly affect the pharmacokinetics of amlodipine. For a compound whose renal clearance is only 30% of the total plasma clearance, no correlation was observed between the state of renal function and systemic exposure to valsartan.
Liver dysfunction. In patients with hepatic impairment, the clearance of amlodipine decreases, which leads to an increase in AUC by approximately 40-60%. In patients with mild and moderate chronic liver diseases, the exposure of valsartan (determined by the AUC values) is, on average, twice that of healthy volunteers (selected by age, sex and body weight). Patients with liver disease need caution when using the preparation.
Indications
Essential arterial hypertension in adult patients whose blood pressure is not regulated by monotherapy with amlodipine or valsartan.
Application
Patients in whom blood pressure is inadequately controlled with monopreparations of amlodipine or valsartan can be transferred to combination therapy with the preparation kombisart. the recommended dose is 1 tablet per day. Kombisart tablets can be taken with or without food. it is recommended to take kombisart with a little water.
Patients taking valsartan and amlodipine separately can be transferred to Kombisart, which contains the same doses of the components.
Before switching to a combination of fixed doses, it is recommended to individually select the dose for the components (that is, for amlodipine and valsartan). In case of clinical need, the possibility of direct replacement of monotherapy with a fixed dose combination can be considered.
The maximum daily dose of the preparation Kombisart is 2 tablets of 5 mg / 160 mg or 1 tablet of 10 mg / 160 mg (the maximum allowable doses of the components of the preparation are 10 mg for the content of amlodipine, 320 mg for the content of valsartan).
Dosing for specific patient groups
Impaired renal function. The preparation Kombisart is contraindicated in patients with severe renal impairment.
Patients with mild to moderate renal impairment do not require dose adjustment. In patients with moderate renal impairment, it is recommended to monitor the levels of potassium and creatinine in the blood.
The simultaneous use of the preparation Kombisart with aliskiren is contraindicated in patients with impaired renal function (glomerular filtration rate (GFR) 60 mg / min / 1.73 m2).
Diabetes. The simultaneous use of the preparation Kombisart with aliskiren is contraindicated in patients with diabetes mellitus.
Liver dysfunction. The preparationKombisart is contraindicated in patients with severely impaired liver function.
Kombisart should be used with caution in patients with impaired liver function or obstructive diseases of the biliary tract. Recommendations for dosing amlodipine in patients with mild to moderate hepatic impairment have not been developed.
Elderly patients (over 65 years old). For elderly patients, the usual dosage regimens are recommended.
Caution should be exercised when increasing the dose of the preparation in elderly patients.
Pediatric populations. The safety and efficacy of using the preparation Kombisart in children (under the age of 18) have not been studied. No data available.
Contraindications
Hypersensitivity to the active substance, dihydropyridine derivatives or to any of the excipients of the preparation.
Severe liver dysfunction, biliary cirrhosis or cholestasis.
Severe renal dysfunction (GFR 30 mg / min / 1.73 m2); also the preparation is contraindicated in patients on dialysis.
Concomitant use of ARBs, including valsartan, or ACE inhibitors with aliskiren in patients with diabetes mellitus or with impaired renal function (GFR 60 mg / min / 1.73 m2).
Pregnancy or planning a pregnancy (see Use during pregnancy and lactation).
Severe hypotension.
Shock (including cardiogenic shock).
Left ventricular outflow tract obstruction (eg, hypertrophic obstructive cardiomyopathy and severe aortic stenosis).
Hemodynamically unstable heart failure after acute myocardial infarction.
Side effects
During the use of the preparation, the following adverse reactions may occur:
- from the immune system: hypersensitivity;
- on the part of the organ of vision: visual impairment, impaired vision;
- from the side of the psyche: excitement;
- from the nervous system: headache, impaired coordination, dizziness, drowsiness, postural dizziness, paresthesia;
- from the organ of hearing and labyrinth: dizziness, tinnitus;
- from the heart: tachycardia, palpitations, fainting;
- from the vascular system: orthostatic hypotension, arterial hypotension;
- from the respiratory system: cough, sore throat and larynx;
- on the part of nutrition and metabolism: hypokalemia, anorexia, hypercalcemia, hyperlipidemia, hyperuricemia, hyponatremia;
- from the digestive tract: abdominal discomfort and pain in the upper abdomen, constipation, diarrhea, nausea, dry mouth;
- on the part of the skin and subcutaneous tissues: rash, erythema, excessive sweating, urticaria, exanthema, itching;
- from the musculoskeletal system: joint swelling, back pain, arthralgia, muscle cramps, feeling of heaviness;
- on the part of the kidneys and urinary system: accelerated urination, increased urine output;
- from the reproductive system: erectile dysfunction;
- general disorders: edema, soft tissue edema, facial edema, peripheral edema, increased fatigue, facial flushing, hot flashes, asthenia, hyperemia;
- infections: nasopharyngitis, flu.
Additional information regarding the combination
Peripheral edema, a known side effect of amlodipine, was generally noted with a lower incidence in patients using the amlodipine / valsartan combination than with amlodipine alone.
Additional information on the components of the preparation
Adverse reactions that were previously noted with the use of one of the components of the preparation (amlodipine or valsartan) may also occur with the use of the preparation Kombisart, even if they were not noted during clinical trials.
Adverse reactions characteristic of amlodipine
Vomiting, nausea, alopecia, dyspepsia, dyspnea, rhinitis, gastritis, abdominal pain, gingival hyperplasia, gynecomastia, hyperglycemia, impotence, urinary disorders, increased urinary frequency, leukopenia, general malaise, tinnitus, mood changes (including anxiety), myalgia , muscle cramps, ankle swelling, peripheral neuropathy, pancreatitis, hepatitis, thrombocytopenia, vasculitis, allergic reactions, angioedema, Quincke's edema, erythema multiforme, insomnia, depression, confusion, fainting, dizziness, drowsiness, drowsiness vision (including diplopia), discoloration of the skin, hyperhidrosis, exfoliative dermatitis, Stevens-Johnson syndrome, photosensitivity, weight gain / loss, jaundice, urticaria, purpura, exanthema, pruritus; there have been isolated cases of extrapyramidal syndrome, increased levels of liver enzymes (usually associated with cholestasis), chest pain, palpitations, hypertension, arrhythmia, myocardial infarction (including bradycardia, ventricular tachycardia and atrial fibrillation).
Adverse reactions characteristic of valsartan
Decreased hemoglobin levels, decreased hematocrit, neutropenia, thrombocytopenia, increased plasma potassium levels, increased liver function tests, including plasma bilirubin concentration, renal failure and impaired renal function, increased plasma creatinine levels, angioedema, myalgia, vasculitis, hypersensitivity reactions, including serum sickness.
Special instructions
Patients with sodium and / or bcc deficiency in the body. in patients with uncomplicated arterial hypertension (0.4%), excessive hypotension was noted. in patients with an activated renin-angiotensin system (races - with a reduced sodium content and / or volume and in the case of high-dose diuretics) who take angiotensin receptor blockers, symptomatic hypotension may occur. correction of this condition is recommended before using the preparation kombisart or careful medical supervision at the beginning of therapy.
If arterial hypotension occurs during the use of the preparation Kombisart, the patient should be placed on his back and, if necessary, given an intravenous infusion of a physiological solution. After stabilization of blood pressure, treatment can be continued.
Hyperkalemia. Care should be taken to concurrent treatment with potassium supplements, potassium-sparing diuretics, salt substitutes containing potassium, or other preparations that can increase potassium levels (heparin, etc.), and also provide for frequent monitoring of potassium content.
Renal artery stenosis. The preparation Kombisart should be used with caution for the treatment of hypertension in patients with unilateral or bilateral renal artery stenosis or stenosis of a single kidney, since serum urea and creatinine levels may increase.
Kidney transplant. There is no experience with the safe use of the preparation Kombisart in patients with recent kidney transplantation.
Liver dysfunction. Valsartan is excreted mainly unchanged in the bile. T1 / 2 of amlodipine is prolonged and the AUC is higher in patients with impaired liver function; dosage recommendations have not been established. Particular care is required when using the preparation Kombisart in patients with mild to moderate hepatic dysfunction or obstructive gallbladder disease.
Impaired renal function. Patients with mild to moderate renal impairment (GFR 30 ml / min / 1.73 m2) do not require dose adjustment. In moderate renal impairment, it is recommended to monitor the levels of potassium and creatinine in the blood.
The simultaneous use of ARBs, including valsartan, or an ACE inhibitor with aliskiren is contraindicated in patients with impaired renal function (GFR 60 mg / min / 1.73 m2).
Primary hyperaldosteronism. Patients with primary hyperaldosteronism should not take ARA II valsartan, since their RAS is impaired due to the underlying disease.
Angioedema. Quincke's edema, including edema of the larynx and glottis, which can lead to airway obstruction, and / or edema of the face, lips, pharynx and / or tongue have occurred in patients using valsartan. Some of these patients had a history of Quincke's edema while taking other preparations, including an ACE inhibitor. The use of the preparation Kombisart should be discontinued immediately if Quincke's edema occurs; reapplication is not recommended.
Heart failure / condition after myocardial infarction. Due to the inhibition of the renin-angiotensin-aldosterone system (RAAS) in sensitive patients, renal dysfunction is possible. In persons with severe heart failure, in whom renal function may depend on the activity of the RAAS, the use of ACE inhibitors and ARBs caused the development of oliguria and / or progressive azotemia, as well as (in rare cases) ARF and / or death. Similar results were noted with valsartan. Renal function should be assessed in patients with heart failure or after a history of myocardial infarction.
Calcium channel blockers, including amlodipine, should be used with caution in patients with congestive heart failure as they may increase the risk of cardiovascular events and death.
Stenosis of the aorta and mitral valve. As with treatment with other vasodilators, special care should be taken in patients who have mitral valve stenosis or severe mild aortic stenosis.
Double blockade of the RAAS. There is evidence that the combined use of an ACE inhibitor, ARB, or aliskiren increases the risk of arterial hypotension, hyperkalemia and decreased renal function (including ARF). Therefore, it is not recommended to carry out a double blockade of the RAAS by the combined use of an ACE inhibitor, ARA or aliskiren.
If double blockade is absolutely necessary, it should be carried out exclusively under the supervision of a specialist with frequent close monitoring of renal function, electrolyte concentration and blood pressure. Should not be used in combination with an ACE inhibitor and ARB in patients with diabetic nephropathy.
The use of the preparation Kombisart has not been studied in patients with diseases other than hypertension.
Use during pregnancy and lactation
Pregnancy. The preparation is contraindicated for pregnant women or women planning pregnancy. If pregnancy is confirmed during treatment with this preparation, its use should be stopped immediately and replaced with another preparation approved for use in pregnant women.
Data from epidemiological studies of the risk of teratogenicity after exposure to ACE inhibitors in the first trimester of pregnancy were not conclusive; however, a slight increase in risk cannot be ruled out. Although data from controlled epidemiological studies of ARA II are not available, a similar risk may arise with the use of preparations in this class.
The accumulation of ARA II in the II and III trimester is known to lead to toxic effects on the human fetus (decreased renal function, oligohydramnios, delayed ossification of the skull bones) and the newborn (renal failure, arterial hypotension, hyperkalemia).
If ARA II has been used since the second trimester of pregnancy, an ultrasound of the kidneys and fetal skull bones is recommended.
Infants whose mothers took ARAII should be closely monitored for the development of arterial hypotension.
Breastfeeding period. Since there is no information on the use of the preparation Kombisart during breastfeeding, the preparation is not recommended for use during breastfeeding; it is desirable to use alternative preparations with a studied safety profile, especially in the case of breastfeeding of newborns or premature babies.
Fertility Clinical studies of the effect on fertility have not been carried out.
Children. No study has been conducted on the treatment of children (under the age of 18) with this preparation. Therefore, until more complete information is obtained, Kombisart is not recommended for use in children.
The ability to influence the reaction rate when driving or working with other mechanisms. Patients using the preparation Kombisart may experience dizziness or a feeling of weakness after taking the preparation, so they should take this into account when driving and working with potentially dangerous mechanisms.
Amlodipine may slightly or moderately affect the ability to drive vehicles or work with other mechanisms. If patients experience dizziness, headache, fatigue or nausea while using amlodipine, their response may be impaired.
Interactions
Preparation-preparation interactions. studies of preparation-preparation interactions between kombisart and other preparations have not been carried out.
Medicines, the concomitant use of which requires care
Other antihypertensive preparations. Frequently used antihypertensive preparations (for example, blockers of α-adrenergic receptors, diuretics) and other preparations that can cause the appearance of undesirable antihypertensive effects (for example, tricyclic antidepressants, blockers of α-adrenergic receptors, used to treat benign prostatic hyperplasia), can enhance the antihypertensive effect of the combination ...
Interactions associated with amlodipine
Simultaneous use is not recommended
Grapefruit or grapefruit juice. The use of amlodipine with grapefruit juice or grapefruit is not recommended, since in some patients the bioavailability of the preparation may be increased, which will lead to an increase in the severity of the hypotensive effect.
Medicines that require care at the same time
Inhibitors of CYP 3A4. The simultaneous use of amlodipine with more or less potent inhibitors of CYP 3A4 (protease inhibitors, azole antifungal preparations, macrolides such as erythromycin or clarithromycin, verapamil or diltiazem) can lead to a significant increase in the systemic effect of amlodipine. The clinical manifestations of such pharmacokinetic changes may be exacerbated in elderly patients. Clinical monitoring and dose adjustment may be required.
CYP3A4 inducers (anticonvulsants (eg carbamazepine, phenobarbital, phenytoin, phosphenytoin, primidone), rifampicin, St. John's wort (Hypericum perforatum). There are no studies on the effect of CYP 3A4 inducers on amlodipine. Concomitant use of CYP3A4 inducers (eg rifampicin) may lead to a decrease in the concentration of amlodipine in the blood plasma.It is recommended to use amlodipine with caution with inducers of CYP 3A4.
Simvastatin. Repeated use of doses of 10 mg of amlodipine with 80 mg of simvastatin leads to an increase in the exposure of simvastatin by 77% compared with the use of simvastatin alone. It is recommended to reduce the daily dose of simvastatin to 20 mg for patients taking amlodipine.
Dantrolene (infusion). Due to the risk of hyperkalemia, it is recommended to avoid the combined use of calcium channel blockers, such as amlodipine, in patients prone to the development of malignant hyperthermia and in the treatment of malignant hyperthermia.
Medicines that require care at the same time
Other. Amlodipine did not affect the pharmacokinetics of atorvastatin, dioxin, warfarin, or cyclosporine.
Interactions associated with valsartan
Simultaneous use is not recommended
Lithium. With the simultaneous use of lithium with an ACE inhibitor or ARA II, including valsartan, a reversible increase in the concentration of lithium in the blood serum and its toxicity were noted. The simultaneous use of valsartan and lithium is not recommended. If the use of such a combination is necessary, the level of lithium in the blood serum should be carefully monitored. The risk of increased toxicity of lithium may be further increased when combined with Kombisart and diuretics.
Potassium supplements, potassium-sparing diuretics, salt substitutes containing potassium, or other medications that may increase potassium levels. If preparations that affect potassium channels are prescribed in combination with valsartan, regular monitoring of plasma potassium should be provided.
Medicines that require care at the same time
NSAIDs, including selective COX-2 inhibitors, acetylsalicylic acid (3 g / day) and non-selective NSAIDs. With the simultaneous use of ARA II and NSAIDs, it is possible to weaken the hypotensive effect. Also, the simultaneous use of ARA II and NSAIDs may increase the risk of impairment of renal function and serum potassium levels.
Therefore, at the beginning of treatment, it is recommended to monitor the state of kidney function, as well as ensure the proper level of fluid in the patient's body.
Inhibitors of the storage carrier (rifampicin, cyclosporine) or efflux carrier (ritonavir)
Valsartan is a substrate for the hepatic accumulation transporter OATP1B1 and the hepatic efflux transporter MRP2. The simultaneous use of inhibitors of the storage carrier (rifampicin, cyclosporine) or the efflux carrier (ritonavir) may increase the systemic exposure of valsartan.
Double blockade of RAAS with ARA, ACE inhibitors or aliskiren. Double blockade of the RAAS with the combined use of an ACE inhibitor, ARB or aliskiren leads to an increase in the incidence of such adverse events as hypotension, hyperkalemia and decreased renal function (including ARF), compared with treatment with a single preparation that affects the RAAS. Therefore, the simultaneous use of ARBs, including valsartan, or an ACE inhibitor with aliskiren is contraindicated in patients with diabetes mellitus or impaired renal function (GFR 60 mg / min / 1.73 m2).
Other. With valsartan monotherapy, clinically significant preparation interactions with such preparations have not been established: cimetidine, warfarin, furosemide, digoxin, atenolol, indomethacin, hydrochlorothiazide, amlodipine, glibenclamide.
Overdose
Symptoms to date, there is no experience of overdose of the preparation kombisart. the main symptom of an overdose of valsartan is probably severe arterial hypotension with dizziness. overdose of amlodipine can lead to increasing peripheral vasodilation and, probably, to reflex tachycardia. there is evidence of significant and potentially prolonged systemic hypotension, up to shock and death.
Treatment. If the preparation is recently taken, induce vomiting or gastric lavage. The absorption of amlodipine is significantly reduced when activated charcoal is used immediately or within 2 hours after taking amlodipine.
Clinically significant arterial hypotension caused by an overdose of the preparation Kombisart requires active support of the state of the cardiovascular system, including frequent monitoring of cardiac and respiratory functions, lifting the patient's lower limbs, attention to the volume of circulating fluid and urination. To restore vascular tone and blood pressure, a vasoconstrictor preparation can be used in the absence of contraindications to its use. With a persistent decrease in blood pressure, which is a consequence of calcium channel blockade, intravenous administration of calcium gluconate may be appropriate.
The elimination of valsartan and amlodipine by hemodialysis is unlikely.
Storage conditions
At a temperature not higher than 25 ° C.
Tags: Kombisart
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