Atakand plus

General characteristics. Structure:

One tablet contains active agents: a kandesartana tsileksetit 16 mg and a hydrochlorothiazide of 12,5 mg.
Excipients
Karmelloza of calcium (karmelloza calcic salt) 5,6 mg, hypro rod of 4,0 mg, lactoses monohydrate of 68 mg, magnesium stearate of 1,3 mg, starch of corn 20 mg, macrogoal of 2,6 mg, dye ferrous oxide yellow CI 77492 0,21 mg, dye ferrous oxide red CI 77491 0,050 mg.
Description
Pink oval biconvex tablet with a notch on both parties and A engraving on one party.
CS

Pharmacological properties:

Angiotensin II – the main hormone system renin-angiotensin-aldosteronovoy which plays an important role in a pathogeny of arterial hypertension, heart failure and other cardiovascular diseases. The main physiological effects of angiotensin II are vasoconstriction, stimulation of products of Aldosteronum, regulation of a water and electrolytic state and stimulation of cellular growth. All these effects are mediated by interaction of angiotensin II with angiotenzinovy receptors of 1 type (AT1 receptors).
Kandesartan is the selection antagonist of receptors of angiotensin II of 1 type (AT1 of receptors), does not inhibit the angiotensin-converting enzyme (ACE) which carries out transformation of angiotensin I into angiotensin II and bradikinin destroys; does not influence APF and does not lead to accumulation of bradikinin or substance P. When comparing a kandesartan with APF inhibitors development of cough occurred at the patients receiving a kandesartan tsileksetit less often. Kandesartan does not contact receptors of other hormones and does not block the ion channels participating in regulation of functions of cardiovascular system. Blocking of AT1 of receptors of angiotensin II is resulted by dozozavisimy increase in level of a renin, angiotensin I, angiotensin II and decrease in concentration of Aldosteronum in a blood plasma.
Tsileksetit clinical action of a kandesartan on incidence and at reception in a dose of 8 - 16 mg (an average dose of 12 mg) it was investigated mortality during randomized clinical trial with participation of 4937 elderly patients (age from 70 to 89 years, 21% of patients at the age of 80 years and is more senior) with arterial hypertension of soft and moderate severity receiving therapy kandesartany tsileksetily on average within 3,7 years once a day (the research SCOPE - a research of cognitive functions and the forecast at elderly patients). Patients received кандесартан or placebo, if necessary, in a combination with other anti-hypertensive means. In group of the patients receiving кандесартан the lowering of arterial pressure (ABP) from 166/90 to 145/80 mm рт.ст and in control group from 167/90 to 149/82 mm hg is noted. Statistically significant distinctions of frequency of cardiovascular complications (a lethality as a result of cardiovascular diseases,
frequency of a myocardial infarction and stroke, not led to death) between two groups of patients it was not noted. The hydrochlorothiazide oppresses an active reabsorption of sodium, generally in
distal departments of renal tubules also strengthens allocation of ions of sodium, chlorine and water. Release of potassium and magnesium kidneys amplifies depending on a dose while calcium begins to reabsorbirovatsya in large numbers, than earlier. The hydrochlorothiazide reduces the volume of a blood plasma and extracellular liquid and reduces intensity of transport of blood heart and the ABP. During long-term treatment, the hypotensive effect develops due to expansion of arterioles. It is shown that at prolonged use of a hydrochlorothiazide the risk of cardiovascular diseases and mortality decreases. Kandesartan and a hydrochlorothiazide render the summing-up hypotensive
action. At the patients having arterial hypertension, Atakand Plus causes effective and long decrease in the ABP without increase in the heart rate (HR). Orthostatic hypotension at the first administration of drug is not observed, and also arterial hypertension amplifies after the end of treatment. After a single dose Atakand Plus the main hypotensive effect develops within 2 hours. At long treatment stable decrease in the ABP occurs within 4 weeks after the beginning of administration of drug and can be supported at a long course of treatment. Atakand Plus at reception effectively and softly reduces once a day the ABP within 24 hours with an insignificant difference between the maximum and average effect of action. In clinical trials the frequency of development of side effects, especially cough, was more rare at use Atakand Plus, than at reception of a combination of APF inhibitors with hypothiazid. Efficiency of a combination of a kandesartan and hydrochlorothiazide does not depend on gender and age of the patient. Now there are no data on use кандесартана / a hydrochlorothiazide patients with renal
the insufficiency/nephropathy lowered by function of the left ventricle / an acute heart failure and the patients who had a myocardial infarction.

Pharmacokinetics. Absorption and distribution
Kandesartana tsileksetit
Kandesartana tsileksetit is pro-medicine for intake. Quickly turns into active agent – кандесартан by means of radio hydrolysis at absorption from a digestive tract, strongly contacts AT1-receptors and slowly dissociates, has no properties of an agonist. Absolute bioavailability of a kandesartan after intake of solution of a kandesartan of a tsileksetil makes about 40%. Relative bioavailability of the tableted drug in comparison with solution for intake makes about 34%. Thus, settlement absolute bioavailability of the tableted form of drug makes 14%. The maximum concentration in blood serum (Cmax) is reached in 3 - 4 hours after reception of the tableted drug form. At increase in a dose of drug in the recommended limits concentration of a kandesartan increases linearly. Pharmacokinetic parameters of a kandesartan do not depend on a sex of the patient. Meal concentration - time" does not exert significant impact on the area under a curve "(AUC), i.e. food significantly does not influence bioavailability of drug. Kandesartan actively contacts proteins of a blood plasma (more than 99%). The plasma volume of distribution of a kandesartan makes 0,1 l/kg.
Hydrochlorothiazide
The hydrochlorothiazide is quickly soaked up from digestive tract, bioavailability makes about 70%. The accompanying meal increases absorption approximately by 15%. Bioavailability can be reduced at patients with heart failure and the expressed hypostases. Communication with proteins of a blood plasma makes about 60%. The visible volume of distribution makes about 0,8 l/kg.
Metabolism and removal
Kandesartan
Kandesartan, is generally brought from an organism with urine and bile in not changed look and only in insignificant degree is metabolized in a liver. The elimination half-life of a kandesartan makes about 9 hours. Cumulation of drug in an organism is not observed.
The general clearance of a kandesartan makes about 0,37 ml/min., at the same time renal clearance – about 0,19 ml/min. Renal excretion of a kandesartan is carried out by glomerular filtering and active canalicular secretion. At intake radioactive меченного a kandesartan of a tsileksetil about 26% of the entered quantity are removed with urine in the form of a kandesartan and 7% in the form of an inactive metabolite whereas in Calais 56% of the entered quantity in the form of a kandesartan and 10% in the form of an inactive metabolite are found.
Hydrochlorothiazide
The hydrochlorothiazide is not metabolized and allocated almost completely in the form of an active form of drug by glomerular filtering and active canalicular secretion in proximal department of nephron. The elimination half-life makes about 8 hours. About 70% of the dose accepted inside are removed with urine within 48 hours. The elimination half-life does not change at reception together with kandesartany. When using a combination of drugs additional accumulation of a hydrochlorothiazide in comparison with monotherapy is not revealed.
Pharmacokinetics of a kandesartan in special groups
At elderly patients (65 years are more senior) Cmax and AUC of a kandesartan increase by 50% and 80%, respectively, in comparison with young patients. However, the hypotensive effect and frequency of development of side effects at use Atakanda Plus do not depend on age of patients.
At patients with an easy and moderate renal failure of Cmax and AUC of a kandesartan increased by 50% and 70% respectively whereas the elimination half-life of drug does not change in comparison with patients with normal function of kidneys. At patients with a heavy renal failure of Cmax and AUC of a kandesartan increased by 50% and 110%, respectively, and the elimination half-life of drug increased twice. At the patients who are on a hemodialysis the same pharmacokinetic parameters of a kandesartan, as at patients with a heavy renal failure were revealed.
At patients with an easy and moderate abnormal liver function increase in AUC of a kandesartan for 23% was noted.
Hydrochlorothiazide
The elimination half-life is more long at the patients having a renal failure.

Indications to use:

Treatment of arterial hypertension at patients to whom the combination therapy is shown.

Route of administration and doses:

Atakand Plus it is necessary to accept regardless of meal once a day.
Dosage
The recommended dose - 1 tablet of 1 times a day.
Titration of a dose of a kandesartan before transfer of the patient into therapy by Atakand Plus is recommended. In need of patients transfer from monotherapy by Atakand on therapy by drug Atakand Plus.
The main hypotensive effect is reached, as a rule, in the first 4 weeks after an initiation of treatment.
Patients of advanced age
It is not required from patients of advanced age of dose adjustment.
Patients with a renal failure
At patients with a renal failure use of loopback diuretics in comparison with thiazide is more preferable. Prior to therapy by drug Atakand Plus at patients with an easy or moderate renal failure (clearance of creatinine ≥ 30 ml/min. / 1,73 sq.m), including the patients who are on a hemodialysis is recommended titration of a dose of a kandesartan (by means of monotherapy by drug Atakand), since 4 mg.
Drug Atakand Plus is contraindicated to patients with a heavy renal failure (clearance of creatinine <30 ml/min. / 1,73 to BSA sq.m).
Patients with a reduced volume of the circulating blood
For patients with risk of arterial hypotension, for example, for patients with a reduced volume of the circulating blood, titration of a dose of a kandesartan (by means of monotherapy by drug Atakand), since 4 mg is recommended.
Use for children and teenagers
Safety and efficiency of use Atakanda Plus at children and teenagers (aged up to 18 years) are not established.

Features of use:

Renal failure
In this situation use of loopback diuretics is more preferable thiazide. For patients with a renal failure when using Atakand Plus is recommended to control constantly the level of potassium, creatinine and uric acid.
Renal transplantation
Data on use Atakanda Plus at the patients who recently transferred renal transplantation no.
Renal artery stenosis
Other drugs influencing renin-angiotensin-aldosteronovuyu system, for example, APF inhibitors can lead to increase in content of urea in blood and creatinine level in serum of patients with a bilateral renal artery stenosis or a stenosis of an artery of the only kidney. The similar effect should be expected also from antagonists of receptors of angiotensin II.
Decrease in volume of the circulating blood
At patients with deficit of intravaskulyarny volume and/or sodium development of symptomatic hypotension is possible as it is described for other drugs influencing renin-angiotensin-aldosteronovuyu system. Therefore Atakand Plus before disappearance of these symptoms is not recommended to apply.
General anesthesia and surgical intervention
At the patients receiving antagonists of angiotensin II during anesthesia and at surgical interventions arterial hypotension as a result of blockade a system renin-angiotenzinovoy can develop. Very seldom cases of the heavy arterial hypotension demanding intravenous administration of liquid and/or vazopressor can be noted.
Liver failure
Patients, with abnormal liver functions or the progressing liver disease, should apply tiazida with care in a type of the fact that insignificant fluctuations of volume of liquid and electrolytic structure can cause a hepatic coma. Data on use Atakand Plus by patients with a liver failure are absent.
Stenosis of the aortal and mitral valve (hypertrophic subaortic stenosis)
At appointment Atakanda Plus, as well as other vazodilatator, patients should be careful with a subaortic hypertrophic stenosis or hemodynamically significant stenosis of the aortal or mitral valve.
Primary hyper aldosteronism
Patients with primary hyper aldosteronism usually rezistentna to therapy by the anti-hypertensive means influencing renin-angiotensin-aldosteronovuyu system. In this regard Atakand Plus is not recommended to appoint to such patients.
Disturbance of water-salt balance
As well as in all cases of administration of drugs possessing diuretic action it is necessary to control electrolytes in a blood plasma.
The drugs on the basis of tiazid possessing diuretic action are capable to reduce allocation of calcium ions with urine and can cause spasmodic changes and insignificant increase in concentration of calcium ions in a blood plasma.
Tiazida, including a hydrochlorothiazide, disturbances of water-salt balance (a hypercalcemia, a hypopotassemia, a hyponatremia, a hypomagnesiemia and a gipokhloremichesky alkalosis) can cause.
The revealed hypercalcemia can be a sign of the hidden hyperthyroidism. Reception of thiazide means should be stopped before obtaining results of analyses of a research of epithelial body.
The hydrochlorothiazide дозозависимо increases release of potassium that can become the hypopotassemia reason. Similar action of a hydrochlorothiazide is shown less if to apply it in combination with кандесартан tsileksetily. The risk of a hypopotassemia is raised at the patients having cirrhosis at patients with a diuresis and at the patients accepting liquid with the lowered content of salts and at the patients who are receiving medical treatment in parallel for corticosteroids or accepting adrenocorticotropic hormone.
On the basis of experience of use of the drugs influencing renin-angiotensin-aldosteronovuyu system, parallel use Atakand Plus and increasing release of potassium of diuretics it is possible to compensate by use of the nutritional supplements containing potassium or other drugs capable to increase the content of potassium in a blood plasma.
Use Atakand Plus with an angiotensin-converting enzyme or inhibitors of a receptor of angiotensin II can cause a hypopotassemia, especially if the patient suffers from heart failure or a renal failure though similar cases are documentary not registered.
It is shown that tiazida increase release of magnesium that can cause a hypomagnesiemia.
Influence on metabolism and endocrine system
Treatment of a tiazidama can break glucose level in blood. Selection of a dose of hypoglycemic means, including insulin can be required. During therapy tiazidy manifestation latentno of the proceeding diabetes mellitus is possible. Tiazidy also connect increase in level of cholesterol and triglyceride with treatment. However when using Atakand Plus, containing a dose in 12,5 mg, the minimum quantity or lack of similar effects was observed. Thiazide diuretics increase concentration of uric acid in a blood plasma and can promote developing of gout at predisposed patients.
The general
Patients who have a vascular tone and function of kidneys preferential depend on activity system renin-angiotensin-aldosteronovoy (for example, patients with heavy chronic heart failure or diseases of kidneys, including a renal artery stenosis), are especially sensitive to the drugs operating on renin-angiotensin-aldosteronovuyu system. Purpose of similar drugs is followed at these patients with sharp arterial hypotension, an azotemia, oliguria less often – an acute renal failure. The possibility of development of the listed effects cannot be excluded also when using antagonists of receptors of angiotensin II. Sharp decrease in the ABP at patients with an ischemic cardiopathy or cerebrovascular diseases of ischemic genesis, when using any anti-hypertensive means, can lead to development of a myocardial infarction or stroke.
Manifestation of hypersensitivity reactions to a hydrochlorothiazide is possible also at the patients who did not have before an allergy or bronchial asthma, but it is more probable for the patients who had similar symptoms.
When using thiazide diuretics cases of an aggravation or emergence of symptoms of congestive seborrhea are noted.
Drug contains lactose therefore it should not be accepted to the patients suffering from the rare hereditary diseases which are shown in lack of tolerance to lactose, deficit of lactose or disturbance of absorption of glucose and lactose.
Influence on ability to drive the car or to work with the equipment
Influence on ability to drive the car or to work with the equipment was not studied, but pharmakodinamichesky properties of drug indicate that similar influence is absent. Patients should be careful at control of motor transport or work with the equipment as during treatment there can be dizziness and the increased fatigue can be observed.

Side effects:

The side effects revealed during clinical trials had moderate and passing character and were comparable on frequency to group of placebo. Frequency of cases of the termination of therapy in connection with side effects was similar when using a kandesartan/hydrochlorothiazide (3,3%) and placebo (2,7%).
In the integrated analysis of results of clinical trials the following side effects caused by appointment кандесартана / a hydrochlorothiazide were noted. The described side effects were observed with a frequency at least 1% more, than in group of placebo.
From the central nervous system: dizziness, weakness
On the following side effects during post-marketing use of drug it was reported very seldom (<1/10,000):
Kandesartan
From circulatory and lymphatic system: leukopenia, neutropenia and agranulocytosis;
The disturbance of metabolism and disease caused by metabolism disturbance: hyperpotassemia, hyponatremia;
From the central nervous system: dizziness, headache;
From digestive tract: nausea;
From a liver and biliary tract: increase in activity of "hepatic" enzymes, abnormal liver function or hepatitis;
From integuments: Quincke's disease, rash, small tortoiseshell, skin itch;
From a musculoskeletal system, connecting fabric: dorsodynia, arthralgia, mialgiya;
From an urinary system: a renal failure, including a renal failure at predisposed patients.
At monotherapy the hydrochlorothiazide, usually in a dose of 25 mg or more, noted the following side effects: often (> 1/100), sometimes (> 1/1000 and <1/100), it is rare (<1/1000).
Hydrochlorothiazide
From circulatory and lymphatic system:
Seldom: leukopenia, neutropenia/agranulocytosis, thrombocytopenia, aplastic anemia, marrow depression, anemia;
From immune system:
Seldom: anaphylactic reactions; The Disturbance of metabolism and a disease caused by metabolism disturbance:
Often: hyperglycemia, hyperuricemia, hyponatremia and hypopotassemia;
From the central nervous system:
Often: slight dizziness, headache;
Seldom: sleep disorder, depression, concern, parasthesias;
From an organ of sight:
Seldom: passing illegibility of the image;
From cardiovascular system:
Sometimes: orthostatic hypotension;
Seldom: arrhythmia; necrotic vasculitis, skin vasculitis;
From a respiratory organs:
Seldom: the complicated breath (pneumonia and a fluid lungs);
From a digestive tract:
Sometimes: appetite loss, diarrhea, lock;
Seldom: pancreatitis;
From a liver:
Seldom: intra hepatic cholestatic jaundice;
From integuments:
Sometimes: skin rash, small tortoiseshell, reactions of a photosensitization;
Seldom: necrosis of epidermis, reaction similar to a skin eritematoz, recurrence of a skin eritematoz;
From skeletal and muscular and connecting fabrics:
Seldom: mialgiya;
From kidneys and urinogenital system:
Often: glucosuria;
Seldom: renal failure and intersticial nephrite;
General disturbances:
Often: weakness;
Seldom: feeling of heat;
Laboratory indicators:
Often: hypercholesterolemia, gipertriglitseridemiya;
Seldom: increase in level of creatinine.
Increase in content of uric acid and ALT in a blood plasma and glucose level in blood were noted as the side effects which are found when using a kandesartan of a tsileksetil (approximate frequency of complaints of 1,1%, 0,9% and 1,0%, respectively) is insignificant more often than when using placebo (0,4%, 0% and 0,2%, respectively). At the certain patients accepting кандесартан / a hydrochlorothiazide insignificant decrease in concentration of hemoglobin and increase in nuclear heating plant in a blood plasma was observed.
Also increase in content of creatinine, urea, a hyperpotassemia and a hyponatremia was observed.

Interaction with other medicines:

In pharmacokinetic researches the combined use Atakanda Plus with a hydrochlorothiazide, warfarin, digoxin, oral contraceptives (ethinylestradiol/levonorgestrel), glibenclamide, nifedipine and enalapril was studied. Clinically significant medicinal interactions were not revealed.
Kandesartan is metabolized in a liver in insignificant degree (CYP2C9). The conducted researches on interaction did not reveal influence of drug on CYP2C9 and CYP3A4, action on other isoenzymes of system of P450 cytochrome is not studied.
Combined use Atakanda Plus with other anti-hypertensive means exponentiates hypotensive effect.
It is necessary to expect that the action of a hydrochlorothiazide leading to potassium loss can be strengthened by other means leading to loss of potassium and a hypopotassemia (for example, diuretics, laxatives, Amphotericinum, карбеноксолон, penicillin G sodium, derivatives of salicylic acid).
Experience of use of other medicines operating on renin-angiotensin-aldosteronovuyu system shows that the accompanying therapy by kaliysberegayushchy diuretics, potassium drugs, substitutes of salt, containing potassium, and other means which can increase potassium level in blood serum (for example, heparin) can lead to development of a hyperpotassemia.
The hypopotassemia induced by diuretic means and hypomagnesiemia contribute to possible cardiotoxic action of a glycoside of a foxglove and antiarrhytmic means. At reception Atakand Plus in parallel with such drugs is required control of level of potassium in blood.
At the combined purpose of drugs of lithium with APF inhibitors it was reported about reversible increase in concentration of lithium in blood serum and development of toxic reactions. Similar reactions can meet also when using antagonists of receptors of angiotensin II in this connection it is recommended to control lithium level in blood serum at the combined use of these drugs.
Bioavailability of a kandesartan does not depend on meal.
Diuretic, natriuretic and hypotensive actions of a hydrochlorothiazide are weakened by non-steroidal anti-inflammatory drugs.
Absorption of a hydrochlorothiazide is weakened at use of a kolestipol or Colestyraminum.
Action of not depolarizing muscle relaxants (for example, tubocurarine) can be strengthened by a hydrochlorothiazide.
Thiazide diuretic means can cause increase in level of calcium in blood in connection with reduction of its excretion. In need of reception of kaltsiysoderzhashchy nutritional supplements or vitamin D, it is necessary to control calcium level in a blood plasma and if necessary to correct a dose.
Tiazida strengthen hyper glycemic effect of beta adrenoblockers and diazoxide.
Anticholinergics (for example, atropine, Biperidinum) can increase bioavailability of diuretics on the basis of tiazid owing to decrease in motility of digestive tract.
Tiazida can increase risk of adverse action of an amantadin.
Tiazida can slow down removal of cytostatic means (such as cyclophosphamide, a methotrexate) from an organism and to strengthen their miyelopodavlyayushchy action.
The risk of a hypopotassemia can increase at the accompanying reception of steroid medicines or adrenocorticotropic hormone.
Against the background of administration of drug the frequency of development of orthostatic hypotension at alcohol intake can increase, barbiturates or the general anesthetics.
Treatment of a tiazidama can reduce tolerance to glucose. Selection of a dose of antidiabetic drugs, including insulin can be required.
The hydrochlorothiazide can reduce influence of vasoconstrictive amines (for example, Epinephrinum (adrenaline)).
The hydrochlorothiazide can increase risk of development of an acute renal failure, especially in total with high doses of the iodated filler.
Considerable interaction of a hydrochlorothiazide with food is not revealed.

Contraindications:

Hypersensitivity to the active or auxiliary components which are a part of drug, to derivatives of sulfonamides.
Pregnancy and period of a lactation.
Abnormal liver functions and/or cholestasia.
Renal failures (clearance of creatinine less than 30 ml/min. / 1,73 sq.m). Anury.
Refractory hypopotassemia and hypercalcemia.
Gout.
Age up to 18 years (efficiency and safety are not established).
With care: patients with cerebrovascular diseases and coronary heart disease, a hypertrophic subaortic stenosis, at patients with a reduced volume of the circulating blood, cirrhosis, at the patients having a lactose intolerance, disturbance of absorption of lactose and a galactose, a hyponatremia, primary hyper aldosteronism, surgical intervention at patients have a heavy chronic heart failure, a bilateral stenosis of renal arteries, a stenosis of an artery of the only kidney, hemodynamically significant stenosis of the aortal and mitral valve after transplantation of a kidney, a renal failure, a diabetes mellitus.
Pregnancy and period of a lactation
Pregnancy
Experience of use of drug Atakand Plus at pregnant women is limited.
These data are not enough to judge possible danger to a fruit in the first trimester of pregnancy. At a human embryo the system of blood supply of a kidney which depends on development system renin-angiotensin-aldosteronovoy begins to form in the second trimester of pregnancy. Thus, the risk for a fruit increases at appointment Atakanda Plus in the last 6 months of pregnancy. The means making direct impact on renin-angiotensin-aldosteronovuyu system can cause disturbances of fetation or have negative effect on the newborn (arterial hypotension, a renal failure, an oliguria and/or an anury, олигогидрамнион, a hypoplasia of bones of a skull, a delay of pre-natal development), up to a lethal outcome at use of drug in the last six months of pregnancy. Cases of a hypoplasia of lungs, front anomalies and contractures of extremities were also described.
In researches on animals injury of kidneys to the embryonal and neonatal periods at use of a kandesartan is revealed. It is supposed that the mechanism of damage is caused by pharmacological impact of drug on renin-angiotensin-aldosteronovuyu system.
The hydrochlorothiazide is capable to reduce blood plasma volume, and also to reduce an uteroplacental blood stream, can also become the thrombocytopenia reason at the newborn.
Based on the acquired information, it is not necessary to apply Atakand Plus during pregnancy. If pregnancy occurred during treatment by Atakand Plus, therapy has to be stopped (see the section "Contraindications").
Lactation period
Now it is unknown whether gets кандесартан into breast milk. However кандесартан it is allocated from milk of the lactating rats. The hydrochlorothiazide gets into mother's milk.
Due to the possible undesirable action on babies, Atakand Plus should not be applied during breastfeeding.

Overdose:

Symptoms
The analysis of pharmacological properties of drug allows to assume that clinically expressed decrease in the ABP and dizziness can be the main manifestation of overdose. The separate cases of overdose of drug (to 672 mg of a kandesartan) which ended with recovery of patients without serious consequences were described.
The main manifestation of overdose by a hydrochlorothiazide is acute loss of liquid and electrolytes. Also such symptoms as dizziness, decrease in the ABP, dryness in a mouth, tachycardia, ventricular arrhythmia, a loss of consciousness and muscular spasms were observed.
Treatment
At development of clinically expressed decrease in the ABP it is necessary to carry out a symptomatic treatment and to control a condition of the patient. To lay the patient on a back and to raise legs. If necessary it is necessary to increase the volume of the circulating blood, for example, by intravenous administration of isotonic solution of sodium chloride. Sympathomimetic means can be in case of need appointed. Removal of a kandesartan and hydrochlorothiazide by means of a hemodialysis is improbable.

Storage conditions:

To store at a temperature not above 30 °C, in the place, unavailable to children. List B. Period of validity 3 years. Not to apply after a period of validity.

Issue conditions:

According to the recipe

Packaging:

Tablets. On 14 tablets in the blister from PVC/aluminium, on 2 blisters in a cardboard pack with the application instruction.