Mikardis - instructions for use, reviews, analogs and formulations (tablets 40 mg and 80 mg, plus with a diuretic hydrochlorothiazide) drug for the treatment of hypertension and pressure reduction in adults, children and pregnancy. Composition

In this article, you can read the instructions for using the drug Mykaridis. Presented are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Mikardis in their practice. 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 Mikardis in the presence of existing structural analogues. Use to treat hypertension and reduce blood pressure in adults, children, as well as during pregnancy and lactation. Composition of the preparation.

 

Mykaridis antihypertensive drug.

 

Telmisartan (active ingredient preparation Mikardis) - specific antagonist of the angiotensin receptor 2 has high affinity for angiotensin subtype 2 AT1-receptor, which is realized through the action of angiotensin 2. Angiotensin 2 Telmisartan displaces from its association with the receptor, having no agonist action against this receptor. Forms a link only to the AT1 receptor subtype of angiotensin 2. Linkage is of a long duration. Telmisartan does not have an affinity for other receptors (including AT2 receptors) and other less studied angiotensin receptors. The functional significance of these receptors, as well as their possible effect of excessive stimulation by angiotensin 2, the concentration of which increases with telmisartan, have not been studied. Reduces the concentration of aldosterone in the blood, does not inhibit renin in the blood plasma and does not block the ion channels. It does not inhibit ACE (kininazu 2), an enzyme that also destroys bradykinin, bradykinin induced gain so side effects are not expected.

 

Mycidis in a dose of 80 mg completely blocks the hypertensive effect of angiotensin 2.The onset of hypotensive action is noted within 3 hours after the first administration of telmisartan. The effect of the drug persists for 24 hours and remains significant until 48 hours. The pronounced antihypertensive effect usually develops after 4-8 weeks of regular administration.

 

In patients with arterial hypertension telmisartan reduces systolic and diastolic blood pressure, without affecting the heart rate.

 

In the case of a sharp cancellation of Mikardis, blood pressure gradually returns to the initial level without the development of withdrawal syndrome.

 

Hydrochlorothiazide (the active ingredient of the preparation Mikardis Plus) is a thiazide diuretic. Thiazide diuretics affect the reabsorption of electrolytes in the renal tubules, directly increasing the excretion of sodium and chlorides (approximately in equivalent amounts). The diuretic effect of hydrochlorothiazide leads to a decrease in bcc, an increase in plasma renin activity, an increase in aldosterone secretion, and is accompanied by an increase in the potassium and bicarbonate levels in the urine, and as a consequence, a decrease in the potassium content in the blood plasma. With the simultaneous use of telmisartan, there is a tendency to stop the loss of potassium caused by these diuretics, presumably due to the blockade of the RAAS.

 

After taking hydrochlorothiazide, diuresis is intensified after 2 hours, and the maximum effect is observed after about 4 hours. The diuretic effect of the drug persists for approximately 6-12 hours.

 

Prolonged use of hydrochlorothiazide reduces the risk of complications of cardiovascular diseases and mortality from them.

 

The maximum antihypertensive effect of Mikardis Plus is usually achieved in 4-8 weeks after the start of treatment.

 

Composition

 

Telmisartan + auxiliary substances (Mikardis).

 

Telmisartan + Hydrochlorothiazide + excipients (Micardis Plus).

 

Pharmacokinetics

 

Telmisartan

 

When administered, telmisartan is rapidly absorbed from the digestive tract. Bioavailability - 50%. When taken concomitantly with food, a decrease in AUC ranges from 6% (when administered at a dose of 40 mg) to 19% (when administered at a dose of 160 mg). After 3 hours after administration, the concentration in the blood plasma levels out regardless of the time of meal. Metabolized by conjugation with glucuronic acid. Metabolites are not pharmacologically active. Output through the intestine in an unchanged form, excretion by the kidneys - less than 2% of the dose.

 

There is a difference in concentrations between men and women. In women, Cmax and AUC were approximately 3 and 2 times higher, respectively, than men (without significant effect on efficacy).

 

The pharmacokinetics of telmisartan in elderly patients does not differ from pharmacokinetics in young patients. Correction of the dose is not required.

 

A dose change in patients with renal insufficiency is not required, including patients on hemodialysis. Telmisartan is not removed by hemodialysis.

 

In patients with impaired hepatic and mild liver function (class A and B on the Child-Pugh scale), the daily dose of the drug should not exceed 40 mg.

 

The main indicators of the pharmacokinetics of telmisartan in children and adolescents aged 6 to 18 years after receiving telmisartan at a dose of 1 mg / kg or 2 mg / kg for 4 weeks are generally comparable to those obtained in the treatment of adults and confirm the non-linearity of pharmacokinetics telmisartan, especially with respect to Cmax.

 

Hydrochlorothiazide

 

After ingestion of Mycardis Plus, Cmax hydrochlorothiazide is reached within 1-3 hours. Absolute bioavailability is estimated by cumulative renal excretion of hydrochlorothiazide and is about 60%. It binds to blood plasma proteins by 64%.It is not metabolized in the human body and is excreted in the urine almost unchanged. About 60% of the dose taken internally is eliminated within 48 hours.

 

There is a difference in plasma concentrations in men and women. Women have a tendency to clinically significant increase in blood plasma concentrations of hydrochlorothiazide.

 

In patients with impaired renal function, the rate of excretion of hydrochlorothiazide is reduced.

 

Indications

• arterial hypertension (pressure reduction);
• reduction in cardiovascular morbidity and mortality in patients aged 55 years and older with a high risk of cardiovascular disease.

 

Forms of release

 

Tablets of 40 mg and 80 mg.

 

Tablets 40 mg + 12.5 mg and 80 mg + 12.5 mg (Mykardis Plus).

 

Instructions for use and dosage

 

Mykaridis

 

The drug is administered orally, regardless of food intake.

 

With arterial hypertension, the recommended initial dose of the drug Mikardis is 1 tablet (40 mg) once a day. In cases where the therapeutic effect is not achieved, the dose of the drug can be increased to 80 mg once a day. When deciding whether to increase the dose, it should be taken into account that the maximum antihypertensive effect is usually achieved within 4-8 weeks after the start of treatment.

 

To reduce cardiovascular morbidity and mortality, the recommended dose is 1 tablet (80 mg) once a day. In the initial period of treatment, an additional correction of blood pressure may be required.

 

Patients with renal insufficiency (including those on hemodialysis) do not need a dose adjustment.

 

In patients with impaired hepatic and mild liver function (class A and B on the Child-Pugh scale), the daily dose of the drug should not exceed 40 mg.

 

Dosing regimen in elderly patients does not require changes.

 

Mykardis Plus

 

Mikardis Plus should be taken orally 1 time per day, regardless of food intake.

 

Mykardis Plus 40 / 12.5 mg can be given to patients in whom the use of the drug Mycardis in a dose of 40 mg or hydrochlorothiazide does not lead to adequate control of blood pressure.

 

Mikardis Plus 80 / 12.5 mg can be given to patients in whom the use of the drug Mycardis in a dose of 80 mg or Mykardis Plus 40 / 12.5 mg does not lead to adequate control of blood pressure.

 

In patients with severe arterial hypertension, the maximum daily dose of telmisartan is 160 mg per day. This dose was effective and well tolerated.

 

Side effect

• respiratory distress syndrome (including pneumonia and pulmonary edema);
• dyspnea;
• arrhythmias;
• tachycardia;
• bradycardia;
• marked decrease in blood pressure (including orthostatic hypotension);
• fainting;
• paresthesia;
• sleep disorders;
• insomnia;
• dizziness;
• anxiety;
• depression;
• increased excitability;
• headache;
• diarrhea, constipation;
• dryness of the oral mucosa;
• flatulence;
• abdominal pain;
• vomiting;
• gastritis;
• decreased appetite;
• anorexia;
• hyperglycemia;
• hypercholesterolemia;
• pancreatitis;
• abnormal liver function;
• jaundice (hepatocellular or cholestatic);
• dyspepsia;
• increased sweating;
• backache;
• muscle spasms;
• myalgia;
• arthralgia;
• cramps of the calf muscles;
• arthrosis;
• tendonitis-like symptoms;
• pain in the chest;
• iron-deficiency anemia, aplastic anemia, hemolytic anemia, thrombocytopenia, eosinophilia, leukopenia, agranulocytosis, thrombocytopenia;
• kidney failure, including acute renal failure;
• interstitial nephritis;
• glucosuria;
• impaired vision;
• transient blurred vision;
• acute closed angle glaucoma;
• impotence;
• sepsis, including fatal cases;
• infections of the upper respiratory tract (bronchitis, pharyngitis, sinusitis);
• urinary tract infections (including cystitis);
• inflammation of the salivary glands;
• increased activity of hepatic enzymes;
• increased activity of CK;
• increased concentration of uric acid in the blood;
• hypertriglyceridemia;
• hypokalemia, hyperkalemia;
• hyponatremia;
• hyperuricemia;
• hypoglycemia (in patients with diabetes mellitus);
• violation of glucose tolerance;
• decrease in hemoglobin level in the blood;
• angioedema (including fatal cases);
• erythema;
• itching;
• rash;
• anaphylactic reactions;
• eczema;
• drug rash;
• toxic epidermal necrolysis;
• lupus-like reactions;
• exacerbation or worsening of symptoms of systemic lupus erythematosus;
• necrotizing vasculitis;
• systemic vasculitis;
• photosensitivity reaction;
• recurrence of systemic lupus erythematosus;
• vasculitis;
• influenza-like syndrome;
• fever;
• weakness.

 

Contraindications

• obstructive diseases of the biliary tract;
• expressed violations of the liver (class C on the scale Child-Pugh);
• severe renal dysfunction (KK less than 30 ml / min);
• refractory hypokalemia, hypercalcemia;
• simultaneous application of aliskiren in patients with diabetes and renal failure (GFR of less than 60 ml / min / 1.73 m2);
• hereditary intolerance to fructose (the drug contains sorbitol);
• deficiency of lactase, lactose intolerance, glucose-galactose malabsorption syndrome;
• age under 18 years (safety and efficacy not established);
• pregnancy;
• lactation period (lactation);
• hypersensitivity to the active ingredient or auxiliary components of the drug or other sulfonamide derivatives.

 

Carefully:

• bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney;
• impaired liver function or progressive liver disease (class A and B on the Child-Pugh scale);
• decrease in BCC due to previous therapy with diuretics, restriction of salt intake, diarrhea or vomiting;
• hyperkalemia;
• condition after kidney transplantation (no experience of application);
• chronic heart failure 3-4 FC according to the classification of the New York Heart Association;
• stenosis of the aortic and mitral valve;
• idiopathic hypertrophic subaortic stenosis;
• hypertrophic obstructive cardiomyopathy;
• diabetes;
• primary aldosteronism;
• gout;
• Closed-angle glaucoma (due to the presence of hydrochlorothiazide in the composition).

 

Application in pregnancy and lactation

 

The use of drugs Mikardis and Mykardis Plus is contraindicated in pregnancy.

 

Telmisartan

 

The use of angiotensin 2 receptor antagonists in the 1 trimester of pregnancy is not recommended, these drugs should not be prescribed during pregnancy. At the onset of pregnancy, the drug should be discontinued immediately. If necessary, alternative therapy should be prescribed (other classes of antihypertensive drugs permitted for use in pregnancy).

 

The use of angiotensin 2 receptor antagonists in the 2 and 3 trimesters of pregnancy is contraindicated. Pre-clinical studies of telmisartan did not reveal teratogenic effects, but fetotoxicity was established. It is known that the effect of angiotensin 2 receptor antagonists in the 2nd and 3rd trimester of pregnancy causes in humans fetotoxicity (decreased kidney function, oligohydramnion, slowing ossification of the skull),as well as neonatal toxicity (renal failure, hypotension, hyperkalemia). Patients planning a pregnancy should be prescribed alternative therapy. If treatment with angiotensin 2 receptor antagonists was carried out in the 2nd trimester of pregnancy, ultrasound of the kidneys and bones of the skull in the fetus is recommended.

 

Newborns whose mothers received angiotensin 2 receptor antagonists should be carefully monitored for arterial hypotension.

 

Hydrochlorothiazide

 

The experience with hydrochlorothiazide during pregnancy, especially in the first trimester, is limited. Hydrochlorothiazide penetrates the placental barrier. Given the pharmacological mechanism of action of hydrochlorothiazide, it is expected that its use in the 3rd and 3rd trimesters of pregnancy can disrupt fetoplacental perfusion and cause such changes in the embryo and fetus as jaundice, electrolyte balance disorders and thrombocytopenia. Hydrochlorothiazide should not be used with edema of pregnant women, with hypertension of pregnant women or during preeclampsia, because there is a risk of a decrease in plasma volume and a decrease in placental perfusion, and there is no favorable effect in these clinical situations.

 

Hydrochlorothiazide should not be used to treat essential hypertension in pregnant women, except in those rare situations when other types of treatment can not be used.

 

Therapy with Mikardis and Mikardis Plus is contraindicated during breastfeeding.

 

In experimental animal studies, the effects of telmisartan and hydrochlorothiazide on fertility were not observed.

 

Studies of the impact on human fertility have not been conducted.

 

Use in children

 

Drugs Mikardis and Mykardis Plus are contraindicated for use in children and adolescents under the age of 18, data on efficacy and safety in this category of patients are absent.

 

Application in elderly patients

 

Changes in the dosing regimen in elderly patients are not required.

 

special instructions

 

The states that contribute to an increase in the activity of the RAAS

 

In some patients, due to the suppression of the activity of RAAS, especially with the simultaneous administration of drugs acting on this system, renal function (including acute renal failure) is impaired. Therefore, therapy, accompanied by a similar double blockade of the RAAS (for example,with the addition of an ACE inhibitor or direct inhibitor of renin-aliskiren to blockers of angiotensin 2 receptor antagonists, should be carried out strictly individually and with regular monitoring of kidney function (including periodic monitoring of serum potassium and serum levels of creatinine).

 

The use of thiazide diuretics in patients with impaired renal function can lead to azotemia. Periodic monitoring of renal function is recommended.

 

Renovascular hypertension

 

In patients with bilateral stenosis of the renal arteries or stenosis of the artery of a single functioning kidney, the risk of development of severe arterial hypotension and renal failure increases with the use of drugs that affect RAAS.

 

Dysfunction of the liver

 

In patients with impaired liver function or progressive liver disease, the MycardisPlus drug should be used with caution, since even small changes in the water-electrolyte balance can contribute to the development of hepatic coma.

 

Effect on the metabolism and function of the endocrine glands

 

Patients with diabetes may require a change in the dose of insulin or hypoglycemic agents for oral administration. During the treatment with thiazide diuretics, it can manifest latent diabetes mellitus.

 

In some cases, with the use of thiazide diuretics, it is possible to develop hyperuricemia and exacerbation of gout.

 

Diabetes

 

In patients with diabetes mellitus and an additional cardiovascular risk, for example, in patients with diabetes mellitus and ischemic heart disease, in the case of drugs that lower blood pressure, such as angiotensin 2 receptor antagonists or ACE inhibitors, the risk of fatal myocardial infarction and sudden cardiac- cardiovascular death. In patients with diabetes, IHD can be asymptomatic and therefore can be undiagnosed. Before starting the use of the drug Mikardis and Mykardis Plus for the identification and treatment of coronary artery disease, appropriate diagnostic tests should be carried out, incl. a test with physical activity.

 

Acute myopia and secondary closed angle glaucoma

 

Hydrochlorothiazide, being a sulfonamide derivative, can cause an idiosyncratic reaction in the form of acute transient myopia and acute closed-angle glaucoma.Symptoms of these disorders are an unexpected reduction in visual acuity or eye pain, which typically occurs within a few hours to several weeks after starting the drug. If treatment is not performed, acute angle-closure glaucoma can lead to loss of vision. The main treatment consists in the fastest possible removal of hydrochlorothiazide. It should be borne in mind that if intraocular pressure remains uncontrolled, urgent surgical or surgical treatment may be required. The risk factors for the development of acute closed-angle glaucoma include information about allergies to sulfonamides or penicillin in the anamnesis.

 

Violations of the water-electrolyte balance

 

With the use of the drug Mikardis Plus, as in the case of diuretic therapy, periodic monitoring of the content of electrolytes in the blood serum is necessary.

 

Thiazide diuretics, incl. hydrochlorothiazide, can cause violations of the water-electrolyte balance and acid-base state (hypokalemia, hyponatremia and hypochloraemic alkalosis).Symptoms that alarm these disorders include dryness of the oral mucosa, thirst, general weakness, drowsiness, anxiety, myalgia or spasmodic twitching of the calf muscles, muscle weakness, marked decrease in blood pressure, oliguria, tachycardia and such gastrointestinal symptoms, Intestinal disturbances like nausea or vomiting.

 

With the use of thiazide diuretics, hypokalemia can develop, but concomitant telmisartan can increase the potassium content in the blood. The risk of hypokalemia is greatest in patients with cirrhosis of the liver, with increased diuresis, while observing a salt-free diet, as well as in the case of simultaneous use of gluco- and mineralocorticosteroids or corticotropin. Telmisartan, which is part of the preparations of Mycardis and Mycardis Plus, on the contrary, can lead to hyperkalemia due to antagonism to angiotensin 2 receptors (subtype AT1). Although the use of Mikardis Plus, clinically significant hyperkalemia has not been documented, it should be taken into account that renal and / or cardiac insufficiency and diabetes mellitus are at risk of developing it.

 

Data that the preparation of Micardis Plus can reduce or prevent hyponatremia, caused by the use of diuretics, no. Hypochloremia is usually minor and does not require treatment.

 

Thiazide diuretics can reduce the excretion of calcium by the kidneys and cause (in the absence of obvious violations of calcium metabolism) a transient and small increase in the serum calcium level. More pronounced hypercalcemia may be a sign of latent hyperparathyroidism. Before performing an evaluation of parathyroid function, thiazide diuretics should be discontinued.

 

It is shown that thiazide diuretics increase the excretion of magnesium by the kidneys, which can lead to hypomagnesemia.

 

In patients with ischemic heart disease, the use of any antihypertensive agent, in the event of excessive reduction in blood pressure, can lead to myocardial infarction or stroke.

 

There are reports of the development of systemic lupus erythematosus with the use of thiazide diuretics.

 

Mikardis and Mykardis Plus can, if necessary, be used simultaneously with other antihypertensive agents.

 

Disorders of liver function in the appointment of telmisartan in most cases were observed in the inhabitants of Japan.

 

Impact on the ability to drive vehicles and manage mechanisms

 

Special clinical studies to assess the effect of the drug Micardis Plus on the ability to drive vehicles and work with mechanisms that require increased attention, was not conducted. However, when driving and dealing with potentially hazardous activities, one should take into account the possibility of developing dizziness and drowsiness, which requires caution.

 

Drug Interactions

 

Telmisartan

 

With the simultaneous use of telmisartan with:

• other antihypertensive agents may increase the antihypertensive effect. In one study, combined use of telmisartan and ramipril increased the AUC0-24 and Cmax ramipril and ramiprilata by 2.5 times. The clinical significance of this interaction is not established. When analyzing adverse events that led to discontinuation of treatment and analysis of serious adverse events in a clinical trial, it was found that cough and angioedema were more likely to occur with ramipril therapy, while arterial hypotension was more common with telmisartan.Cases of hyperkalemia, renal insufficiency, arterial hypotension and syncope were significantly more frequent with the simultaneous use of telmisartan and ramipril;
• lithium preparations showed a reversible increase in the concentration of lithium in the blood, accompanied by toxic phenomena with the use of ACE inhibitors. In rare cases, such changes were registered with the appointment of angiotensin 2 receptor antagonists, in particular telmisartan. With the simultaneous use of lithium drugs and angiotensin II receptor antagonists, it is recommended to determine the content of lithium in the blood;
• Non-steroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid in doses used as an anti-inflammatory drug, COX-2 inhibitors and nonselective NSAIDs, can cause the development of acute renal failure in patients with reduced BCC. Drugs that affect RAAS may have a synergistic effect. In patients receiving NSAIDs and telmisartan, at the beginning of treatment should compensate for BCC and conduct a study of kidney function.Reduction of the effect of antihypertensive agents, such as telmisartan, by inhibiting the vasodilating effect of prostaglandins was noted in co-treatment with NSAIDs. With the simultaneous use of telmisartan with ibuprofen or paracetamol, there was no clinically significant effect;
• digoxin, warfarin, hydrochlorothiazide, glibenclamide, simvastatin and amlodipine, there was no clinically significant interaction. An increase in the average concentration of digoxin in the blood plasma was observed on average by 20% (in one case by 39%). With the simultaneous administration of telmisartan and digoxin, it is advisable to periodically determine the concentration of digoxin in the blood.

 

Hydrochlorothiazide

 

When used simultaneously with:

• ethanol (alcohol), barbiturates or opioid analgesics, there is a risk of developing orthostatic hypotension;
• hypoglycemic drugs for ingestion and insulin may require correction of the dose of hypoglycemic agents for oral and insulin intake;
• metformin, there is a risk of developing lactic acidosis;
• colestyramine and colestipol - in the presence of anion exchange resins hydrochlorothiazide absorption is impaired;
• cardiac glycosides increase the risk of hypokalemia or hypomagnesemia caused by thiazide diuretics, the development of arrhythmias caused by cardiac glycosides;
• pressor amines (eg, norepinephrine), weakening of the effect of pressor amines is possible;
• nondepolarizing muscle relaxants (eg, tubocurarine chloride) hydrochlorothiazide can enhance the effect of nondepolarizing muscle relaxants;
• antidotograficheskimi means can increase the concentration of uric acid in the blood serum and, therefore, changes in the dose of uricosuric agents may be required. The use of thiazide diuretics increases the frequency of development of hypersensitivity reactions to allopurinol;
• calcium preparations - thiazide diuretics can increase the calcium content in the blood serum due to the reduction of its excretion by the kidneys. If you want to use calcium preparations, you should regularly monitor the calcium content in the blood and, if necessary, change the dose of calcium preparations;
• beta-adrenoblockers and diazoxide, thiazide diuretics can enhance hyperglycemia caused by beta-blockers and diazoxide;
• m-holinoblokatorami (for example, atropine, biperidinom) - a decrease in motility of the gastrointestinal tract, an increase in the bioavailability of thiazide diuretics;
• amantadine, thiazide diuretics may increase the risk of undesirable effects caused by amantadine;
• cytotoxic agents (eg, cyclophosphamide, methotrexate) - decrease in renal excretion of cytotoxic agents and enhancement of their myelosuppressive action;
• NSAIDs - combined use with thiazide diuretics can lead to a decrease in diuretic and antihypertensive effect;
• drugs that lead to the excretion of potassium and hypokalemia (for example, diuretics, potassium, laxatives, gluco- and mineralocorticosteroids, corticotropin, amphotericin B, carbenoxolone, benzylpenicillin, derivatives of acetylsalicylic acid) -increase in hypokalemic effect. Hypokalemia caused by hydrochlorothiazide is compensated by the potassium-sparing effect of telmisartan;
• potassium-sparing diuretics, potassium preparations, other agents capable of increasing the potassium content in the blood serum (for example, heparin) or replacing sodium in table salt with potassium salts may develop hyperkalemia.Periodic monitoring of the potassium content in the blood plasma is recommended in cases when the preparation of Mikaridis Plus is used concomitantly with drugs that can cause hypokalemia, as well as with drugs that can increase the potassium content in the blood serum.

 

Analogues of the drug Micardis

 

Structural analogs for the active substance:

• Mykardis Plus;
• Pritor;
• Tanidol;
• Theseo;
• Telzap;
• Telmisartan;
• Telmist;
• Telsartan.

 

Analogues on the pharmacological group (angiotensin 2 receptor antagonists:

• Angiakand;
• Aprovel;
• Atacand;
• Bloktran;
• Vasotensis;
• Wales;
• Valsartan;
• Valsafors;
• Walsakor;
• Hypoart;
• Diovan;
• Zisakar;
• Ibertan;
• Irbesartan;
• Irsar;
• Candecor;
• Candesartan;
• Cardosal;
• Cardosten;
• Cardostine;
• Karzartan;
• Cosaar;
• Ksarten;
• Lacka;
• Lozap;
• Lozarel;
• Losartan;
• Lorist;
• Losakor;
• Lothor;
• Mykardis Plus;
• Naviten;
• Nortivan;
• Olimestra;
• Ordiss;
• Pritor;
• Prezartan;
• Renikard;
• Sartavell;
• Tanidol;
• Tantordio;
• Tareg;
• Teveten;
• Theseo;
• Telzap;
• Telmisartan;
• Telmist;
• Telsartan;
• Firmas;
• Edarby.

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