Atacand - instructions for use, real counterparts and release form (tablets 8 mg, 16 mg and 32 mg, plus a diuretic) drug for the treatment of hypertension and reduce the pressure in adults, children and in pregnancy. Composition

In this article, you can read the instructions for using the drug Atacand. Comments of visitors of the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Atakanda in their practice are presented. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Atakanda in the presence of existing structural analogs. Use to treat hypertension and reduce blood pressure in adults, children, as well as during pregnancy and lactation. Composition of the preparation.

 

Atacand - antihypertensive agent, angiotensin receptor antagonist 2. It blocks AT1-receptors, which leads to a decrease in the biological effects of angiotensin 2 (mediated by this type of receptor), incl. vasoconstrictive action, stimulating effect on the release of aldosterone, regulation of salt and water homeostasis, and stimulation of cell growth. Antihypertensive effect is due to a decrease in OPSS without a reflex increase in heart rate.

 

Does not inhibit ACE. It does not interact and does not block the receptors of other hormones or ion channels, which are important for the regulation of the functions of the cardiovascular system.

 

Composition

 

Candesartan cilexetil + auxiliary substances (Atacand).

 

Candesartan cilexetil + hydrochlorothiazide + excipients (Atacand Plus).

 

Pharmacokinetics

 

The concentration in the plasma increases linearly with increasing dose in the therapeutic range (up to 32 mg). Binding to plasma proteins - 99.8%. It is slightly metabolized in the liver (20-30%) with the participation of CYP2C with the formation of an inactive metabolite. Candesartan is excreted by the kidneys (by glomerular filtration and active tubular secretion): 26% in the form of candesartan and 7% in the form of an inactive metabolite; with bile - 56% and 10%, respectively.After a single dose of 72 hours, more than 90% of the dose is withdrawn.

 

Hydrochlorothiazide is rapidly absorbed from the digestive tract. Bioavailability is approximately 70%. Concomitant ingestion increases absorption by approximately 15%. Bioavailability can be reduced in patients with heart failure and severe swelling. Binding to plasma proteins is approximately 60%. Hydrochlorothiazide is not metabolized and is released almost completely as an active form of the drug by glomerular filtration and active tubular secretion in the proximal part of the nephron. Approximately 70% of the dose taken orally is excreted in the urine within 48 hours. When using a combination of drugs, no additional accumulation of hydrochlorothiazide is found in comparison with monotherapy.

 

Indications

• Essential (primary) arterial hypertension (decreased elevated blood pressure).

 

Forms of release

 

Tablets 8 mg, 16 mg and 32 mg (Atacand).

 

Tablets 16 mg + 12.5 mg (Atacand Plus).

 

Instructions for use and dosage

 

Atacand

 

Take inside once a day. The initial dose is 4 mg, the maintenance dose is 8 mg, the maximum dose is 16 mg.

 

For patients with impaired liver and / or kidney function, the initial dose is 2 mg.

 

Atacand Plus

 

Atakand Plus should be taken 1 time a day, regardless of food intake.

 

The recommended dose is 1 tablet once a day.

 

It is recommended to titrate the dose of candesartan before transferring the patient to Atakand Plus therapy. If necessary, patients are transferred from Atacand monotherapy to Atakand Plus therapy. The main antihypertensive effect is achieved, as a rule, in the first 4 weeks after the start of treatment.

 

In patients with impaired renal function, it is preferable to use loop diuretics compared with thiazide. Prior to therapy with Atacand Plus in patients with mild or moderate renal impairment (creatinine clearance of more than 30 ml / min / 1.73 m2), including patients undergoing hemodialysis, it is recommended dose titration candesartan (by monotherapy Atacand) starting with 4 mg.

 

Atakand Plus is contraindicated in patients with severe renal insufficiency (CC less than 30 ml / min / 1.73 m2).

 

For patients at risk for hypotension (e.g., with reduced BCC) recommended dose titration candesartan (monotherapy by Atacand) starting with 4 mg.

 

In elderly patients, dose adjustment is not required.

 

Side effect

• leukopenia, neutropenia, thrombocytopenia, anemia and agranulocytosis;
• dizziness;
• weakness;
• feeling of heat;
• headache;
• sleep disturbance;
• depression;
• anxiety;
• paresthesia;
• orthostatic arterial hypotension;
• arrhythmia;
• nausea;
• backache;
• arthralgia;
• myalgia;
• impaired renal function (including kidney failure in predisposed patients);
• angioedema;
• rash;
• hives;
• itching;
• necrotizing vasculitis;
• cutaneous vasculitis.

 

Contraindications

• impaired liver function and / or cholestasis;
• renal dysfunction (CC less than 30 ml / min / 1.73 m2);
• anuria;
• refractory hypokalemia and hypercalcemia;
• gout;
• pregnancy;
• lactation period (breastfeeding);
• children and adolescents under 18 years of age (efficacy and safety not established);
• increased sensitivity to active or auxiliary components of the drug;
• hypersensitivity to derivatives of sulfonamides.

 

Application in pregnancy and lactation

 

The experience of using Atakand and Atakand Plus in pregnant women is limited.These data are not enough to judge the possible danger to the fetus in the first trimester of pregnancy.

 

In a human embryo, the kidney blood supply system, which depends on the development of RAAS, begins to form in the 2nd trimester of pregnancy: the risk for the fetus increases with the appointment of Atakand in the last 6 months of pregnancy.

 

Funds that have a direct effect on RAAS can cause fetal developmental disorders or have a negative effect on the newborn (arterial hypotension, renal dysfunction, oliguria and / or anuria, oligohydramnion, hypoplasia of the skull bones, intrauterine growth retardation), up to lethal outcome, with application of the drug in the last six months of pregnancy. Cases of lung hypoplasia, facial anomalies and limb contractures were also described.

 

In animal studies, kidney damage in the embryonic and neonatal periods was identified with candesartan. It is assumed that the mechanism of damage is due to the pharmacological effect of the drug on RAAS.

 

Hydrochlorothiazide is able to reduce the volume of blood plasma,utero-placental blood flow and cause a thrombocytopenia in a newborn.

 

Based on the information received, Atacand Plus should not be used during pregnancy. If the pregnancy occurred during the period of Atacand Plus treatment, therapy should be discontinued.

 

Now it is not known whether candesartan penetrates into breast milk. However, candesartan is released from the milk of lactating rats. Hydrochlorothiazide penetrates into the mother's milk. In connection with the possible undesirable effect on infants, Atakand Plus should not be used during breastfeeding.

 

Use in children

 

Atakand is contraindicated in children and adolescents under the age of 18 (efficacy and safety not established).

 

Application in elderly patients

 

In elderly patients, dose adjustment is not required.

 

special instructions

 

Impaired renal function

 

In this situation, the use of "loop" diuretics is preferable to thiazide-like ones. For patients with renal insufficiency with Atacand Plus therapy it is recommended to constantly monitor the level of potassium, creatinine and uric acid.

 

Stenosis of the renal artery

 

Other drugs that affect RAAS (eg, ACE inhibitors) may lead to increased urea levels in the blood and serum creatinine levels in patients with bilateral renal artery stenosis or stenosis of the single kidney artery. A similar effect should be expected from angiotensin 2 receptor antagonists.

 

Decrease of BCC

 

In patients with intravascular volume and / or sodium deficiency, symptomatic arterial hypotension may develop: Atakand Plus is not recommended until these symptoms disappear.

 

General anesthesia and surgery

 

Patients receiving angiotensin 2 antagonists may develop arterial hypotension as a result of blockade of the renin-angiotensin system during anesthesia and during surgical interventions. Very rarely there can be cases of severe arterial hypotension, requiring intravenous fluid and / or vasoconstrictor.

 

Liver failure

 

Patients with impaired liver function or progressive liver disease should use thiazide-like diuretics with caution: minor fluctuations in fluid volume and electrolyte composition mayto cause a hepatic coma. Data on the application of Atacand Plus to patients with hepatic insufficiency are absent.

 

Stenosis of the aortic and mitral valve (hypertrophic obstructive cardiomyopathy)

 

When assigning Atakanda Plus, patients with obstructive hypertrophic cardiomyopathy or hemodynamically significant stenosis of the aortic or mitral valve should be careful.

 

Primary hyperaldosteronism

 

Patients with primary hyperaldosteronism are usually resistant to therapy with antihypertensive agents that affect RAAS. In this regard, it is not recommended to assign such patients Atakand Plus.

 

Violation of the water-salt balance

 

As in all cases of taking drugs that have a diuretic effect, you should monitor the electrolytes in the blood plasma.

 

Drugs based on thiazides, which have a diuretic effect, can reduce the release of calcium ions in the urine and can cause abrupt changes and a slight increase in the concentration of calcium ions in the blood plasma.

 

Thiazides, incl. and hydrochlorothiazide, can cause disturbances in the water-salt balance (hypercalcemia, hypokalemia, hyponatremia,hypomagnesemia and hypochloraemic alkalosis).

 

The revealed hypercalcemia can be a sign of latent hyperthyroidism. The use of thiazide-like diuretics should be discontinued until the results of parathyroid examinations are obtained.

 

Hydrochlorothiazide increases the release of potassium in a dose-dependent manner, which can cause hypokalemia. This action of hydrochlorothiazide is less apparent if it is used in combination with candesartan cilexetil. The risk of hypokalemia appears to be elevated in patients with cirrhosis of the liver, increased diuresis, taking a fluid with a reduced salt content, concurrently treated with SCS or ACTH.

 

Based on the experience of using drugs that affect the renin-angiotensin-aldosterone system, the concurrent use of Atacand Plus and increasing the release of potassium diuretics can be compensated by the use of food additives containing potassium or other drugs that can increase the potassium content in the blood plasma.

 

Atakand Plus can cause hypokalemia, especially in patients with cardiac or renal insufficiency (such cases have not been documented).

 

Thiazide-like diuretics increase the release of magnesium, which can cause hypomagnesemia.

 

Influence on metabolism and endocrine system

 

The use of thiazide-like diuretics can change the level of glucose in the blood right up to the manifestation of latent diabetes mellitus. You may need to adjust the dose of hypoglycemic agents, including insulin.

 

With the use of thiazide-like diuretics, an increase in the level of cholesterol and triglyceride in blood plasma is associated. However, when Atakand Plus was used at a dose of 12.5 mg, a minimal or no such effect was observed.

 

Thiazide-like diuretics increase the concentration of uric acid in the blood plasma and may contribute to the occurrence of gout in predisposed patients.

 

Are common

 

Patients who have vascular tone and renal function preferentially depend on RAAS activity (for example, patients with severe chronic heart failure, kidney disease, including renal artery stenosis) are particularly sensitive to drugs acting on RAAS. The appointment of such drugs is accompanied in these patients by severe arterial hypotension, azotemia, oliguria and, more rarely, acute renal failure.The possibility of developing these effects is not ruled out with the use of angiotensin receptor antagonists. 2. A sharp decrease in blood pressure in patients with ischemic cardiopathy, cerebrovascular disease of ischemic origin with the use of any antihypertensive agents, may lead to the development of myocardial infarction or stroke.

 

The manifestation of hypersensitivity reactions to hydrochlorothiazide is most likely in patients with bronchial asthma, allergic reactions in the anamnesis; that does not exclude the appearance of allergic symptoms in other patients.

 

With the use of thiazide-like diuretics, cases of exacerbation or the appearance of symptoms of congestive seborrhea are noted.

 

The drug contains lactose, so it should not be taken to patients with rare hereditary diseases, manifested in the absence of lactose tolerance, lactose deficiency or impaired absorption of glucose and lactose.

 

Impact on the ability to drive vehicles and manage mechanisms

 

Influence on the ability to drive a car or work with machinery has not been studied, but the pharmacodynamic properties of the drug indicate that such an effect is absent.Patients should be cautious when driving or working with machinery, as dizziness may occur during treatment and fatigue may occur.

 

Drug Interactions

 

In pharmacokinetic studies, the combined use of Atacand Plus with hydrochlorothiazide, warfarin, digoxin, oral contraceptives (ethinylestradiol / levonorgestrel), glibenclamide, nifedipine, and Enalapril was studied. Clinically significant drug interactions were not identified.

 

Candesartan is metabolized in the liver to a small extent (CYP2C9). The conducted studies on the interaction did not reveal the effect of the drug on CYP2C9 and CYP3A4, the effect on other isoenzymes of the cytochrome P450 system has not been studied.

 

The combined use of Atacand Plus with other antihypertensive agents potentiates the hypotensive effect. The action of hydrochlorothiazide, leading to a loss of potassium, can be intensified by other means leading to a loss of potassium and hypokalemia (eg, diuretics, laxatives, amphotericin, carbenoxolone, penicillin G sodium, derivatives of salicylic acid).

 

The experience of using other drugs acting on the renin-angiotensin-aldosterone system shows that concomitant therapy with potassium-sparing diuretics, potassium preparations, salt substitutes containing potassium, and other means that raise serum potassium level (for example, heparin) can lead to development of hyperkalemia.

 

Diuretic-induced hypokalemia and hypomagnesemia predispose to the possible cardiotoxic effect of digitalis glycoside and antiarrhythmic agents. At reception Atakand Plus in parallel with such preparations control of a level of a potassium in a blood is required.

 

When combined prescription of lithium preparations with ACE inhibitors, a reversible increase in the concentration of lithium in the serum and the development of toxic reactions occur. Similar reactions can occur with the use of angiotensin 2 receptor antagonists, and therefore it is recommended to monitor the level of lithium in the serum when combined with these drugs.

 

Diuretic, natriuretic and hypotensive actions of hydrochlorothiazide are weakened by non-steroidal anti-inflammatory drugs (NSAIDs).

 

The absorption of hydrochlorothiazide is weakened by the use of colestipol, colestyramine.

 

The action of nondepolarizing muscle relaxants (eg, tubocurarine) can be enhanced by hydrochlorothiazide.

 

Thiazide-like diuretics can cause an increase in the level of calcium in the blood due to a decrease in its excretion. If you need calcium supplements or vitamin D, you should monitor the level of calcium in the blood plasma and, if necessary, adjust the dose.

 

Thiazide-like diuretics increase the hyperglycemic effect of beta-adrenoblockers and diazoxide.

 

Anticholinergic agents (eg, atropine, biperidine) can increase the bioavailability of thiazide-like diuretics due to decreased GI motility.

 

Thiazide-like diuretics may increase the risk of adverse effects of amantadine.

 

Thiazide-like diuretics can slow down the excretion of cytostatic agents (such as cyclophosphamide, methotrexate) from the body and enhance their myelo-suppressing action.

 

The risk of hypokalemia may increase with the concomitant administration of GCS or ACTH.

 

Against the background of the use of Atakand Plus, the frequency of orthostatic arterial hypotension may increase with alcohol, barbiturates or general anesthetics.

 

In the treatment of thiazide-like diuretics, a decrease in glucose tolerance is possible, which may require the selection of a dose of hypoglycemic drugs (including insulin).

 

Hydrochlorothiazide can reduce the effect of vasoconstrictive amines (eg, epinephrine).

 

Hydrochlorothiazide may increase the risk of developing acute renal failure, especially when combined with large doses of iodinated excipients.

 

There was no significant interaction of hydrochlorothiazide with food.

 

Analogs of the drug Atacand

 

Structural analogs for the active substance:

• Angiakand;
• Atakand Plus;
• Hypoart;
• Candecor;
• Candesartan SZ;
• Candesartan cilexetil;
• Ordiss.

 

Analogues on the curative effect (drugs for the treatment of hypertension and pressure reduction):

• Adelphan Ezidrex;
• Amlodipine;
• Anaprilin;
• Atenolol;
• Berlipril;
• Betalk;
• Bisoprolol;
• Vasotensis;
• Walsakor;
• Verapamil;
• Veroshpiron;
• Hypothiazide;
• Diltiazem;
• Diroton;
• Diver;
• The Zocardis;
• Indapamide;
• Kapoten;
• Captopril;
• Carvedilol;
• Cardura;
• Clopheline;
• Concor;
• Concor;
• Corvitol;
• Cordaflex;
• Corinfar;
• Coenzyme Q10 with Ginkgo;
• Qudesan;
• Lasix;
• Lysinopril;
• Lozap;
• Lorist;
• Metoprolol;
• Mycardis;
• Non-ticket;
• Nifedipine;
• Noliprel;
• Obsidan;
• Prestan;
• Prestarium;
• Propranolol;
• Raunatin;
• Renipril;
• Renitek;
• Spironolactone;
• Physiotherapy;
• Furosemide;
• Hartil;
• Egilok;
• Equator;
• Enalapril;
• Enap;
• Enarenal;
• Enziks;
• Estecor.

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