Ванатекс komb

General characteristics. Structure:

Active agents: a valsartana of 80 mg, a hydrochlorothiazide of 12,5 mg (for a dosage of 80/12,5 mg), a valsartana of 160 mg, a hydrochlorothiazide of 12,5 mg (a dlyadozirovka of 160/12,5 mg), a valsartana of 160 mg, a hydrochlorothiazide of 25 mg (a dlyadozirovka of 160/25 mg)

Excipients: lactoses monohydrate, sodium of a kroskarmelloz, silicon dioxide colloid anhydrous, magnesium stearate.

Pharmacological properties:

Pharmacodynamics. Valsartan
Valsartan is orally active and specific antagonist of receptors of angiotensin II (AT). It affects selectively the subtype of receptors of AT1 which is responsible for action of AT II. The increased AT II levels after blockade of a receptor of AT1 valsartany can stimulate not blocked receptor of AT2 which, quite possibly, neutralizes action of blockade of a receptor of AT1 in a blood plasma. Valsartan does not show activity of a partial agonist concerning a receptor of AT1 and has bigger affinity to AT1 receptors, than to AT2 receptors is considerable. Valsartan does not inhibit APF (also known as a kinase of II) which turns AT I into AT II and bradikinin destroys. During clinical trials in which валсартан compared to APF inhibitor the frequency of development of dry cough was much lower (р <0,05) at the patients accepting валсартан than at treated APF inhibitor (2,6% in comparison with 7,9%). During clinical trial with participation of patients with dry cough in the anamnesis during treatment by APF inhibitors at 19,5% of the examinees accepting валсартан, and 19% of those who accepted thiazide diuretic, noted cough in comparison with 68,5% of the patients treated by APF inhibitors (р <0,05).
Purpose of a valsartan the patient with AG leads to decrease in the ABP, without influencing at the same time ChSS. At most of patients after reception of a single peroral dose anti-hypertensive action is shown during 2 h, and the maximum decrease in the ABP is reached during 4–6 h. The hypotensive effect remains during 24 h after administration of drug. At repeated administration of drug the maximum decrease in the ABP at any dose is generally reached during 2–4 weeks and remains throughout prolonged treatment. In combination with a hydrochlorothiazide essential additional decrease in the ABP is reached.
At patients with the raised ABP, a diabetes mellitus of the 2nd type and a microalbuminuria it is shown that валсартан reduced release of albumine with urine.
The conclusion is drawn that use of a valsartan in a dose of 160-320 mg leads to clinically significant reduction of excretion of albumine with urine at patients with the raised ABP and a diabetes mellitus of the 2nd type.

Hydrochlorothiazide. The scene of action of thiazide diuretics, first of all — renal distal gyrose tubules. It is shown that in bark of a kidney there are high-affine receptors which are the main binding site of effect of thiazide diuretics and oppressions of transportation of chloride sodium (NaCl) in distal gyrose tubules. The mechanism of action of tiazid consists in oppression of Na+Cl – the unidirectional carrier, perhaps, by the competition for the Cl-site, influences mechanisms of a reabsorption of electrolytes directly — increasing release of sodium and chlorine approximately to the same extent, and indirectly — by such diuretic action reduces volume in a blood plasma with the subsequent increase in activity of a renin in a blood plasma, secretion of Aldosteronum, potassium excretion with urine and decrease in potassium in a blood plasma. Renin-aldosteronovaya communication is mediated by AT II therefore at a concomitant use of a valsartan decrease in level of potassium in a blood plasma is less expressed, than at monotherapy by a hydrochlorothiazide.

Pharmacokinetics. System bioavailability of a hydrochlorothiazide decreases approximately by 30% at simultaneous use with valsartany. Simultaneous use of a hydrochlorothiazide has no significant effect on kinetics of a valsartan. Noted interaction does not influence efficiency of the combined use of a valsartan and a hydrochlorothiazide as during controlled clinical trials the accurate anti-hypertensive effect of this combination which exceeded effect of active agent separately, and also effect of placebo is revealed.
Valsartan
Absorption. After oral administration separately the valsartana of its Cmax in a blood plasma is reached during 2–4 h. Average bioavailability makes 23%. Food reduces action approximately by 50%.
Distribution. The equilibrium volume of distribution of a valsartan in/in introductions makes later about 17 l, indicating that it валсартан is not distributed widely in fabrics. Valsartan substantially contacts proteins of a blood plasma (94–97%), mainly plasma albumine.
Biotransformation. Valsartan biotransformirutsya substantially as only about 20% of a dose reveal in the form of metabolites.
Removal. Valsartan shows kinetics of polyexponential disintegration (T½α <1 h and T½β about 9 h). Valsartan is generally brought with a stake (about 83% of a dose) and urine (about 13% of a dose), is preferential in not changed look. After introduction the clearance of a valsartan makes about 2 l/h, and its renal clearance makes 0,62 l/h (about 30% of the general clearance). T½ of a valsartan makes 6 h.

Hydrochlorothiazide
Absorption. After oral administration absorption of a hydrochlorothiazide happens quickly (tmax is about 2 h) to similar characteristics of absorption both in the form of suspension, and in the form of tablets. Absolute bioavailability of a hydrochlorothiazide makes 60–80% after oral administration of drug.
Distribution. The kinetics of distribution and removal is usually described by function of bieksponentsialny disintegration. The expected volume of distribution makes 4–8 l/kg.
The hydrochlorothiazide contacts proteins of a blood plasma (40–70%), generally plasma albumine.
Removal.> 95% of the absorbed hydrochlorothiazide are removed in not changed view with urine. The renal clearance consists of passive filtering and active secretion in renal tubules. T½ makes 6–15 h.
Special groups of patients
Patients of advanced age. Limited data indicate that the general clearance of a hydrochlorothiazide decreases both at healthy volunteers, and at patients of advanced age with the raised ABP, in comparison with young healthy volunteers.
Renal failure. At use of Vanateks Kombi in the recommended dose patients have no need for dose adjustment with clearance of creatinine of 30-70 ml/min.
There are no data on use of drug of Vanateks Kombi for patients with a heavy renal failure (clearance of creatinine <30 ml/min.) and the patients who are on dialysis. Valsartan substantially contacts proteins of a blood plasma and is not brought by means of dialysis whereas the hydrochlorothiazide is removed by dialysis.
The renal clearance of a hydrochlorothiazide consists of passive filtering and active secretion in renal tubules. As expected for drug which is emitted almost only with kidneys function of kidneys considerably influences hydrochlorothiazide kinetics.
Liver failure. During the pharmacokinetic research of patients with easy (n=6) and the liver dysfunction moderated (n=5) action of a valsartan was approximately twice more in comparison with healthy volunteers.
There are no data on use of a valsartan for patients with heavy dysfunction of a liver. Liver diseases significantly do not influence hydrochlorothiazide pharmacokinetics.

Indications to use:

AG at patients at whom the ABP is not regulated properly by monotherapy valsartany or a hydrochlorothiazide.

Route of administration and doses:

The recommended dose of Vanateks Kombi of 80/12,5 mg — 1 tablet of 1 times a day. At insufficient decrease in the ABP in 3–4 weeks of treatment recommend to consider the possibility of continuation of treatment in a dosage 1 tablet 160/12,5 of mg of 1 times a day. Tablets 160/25 of mg are appointed to patients at whom it is not reached sufficient decrease in the ABP at use of tablets 160/12,5 of mg. If further at use of tablets 160/25 of mg of the ABP decreases insufficiently, it is recommended to consider the possibility of continuation of treatment in a dosage of 320/12,5 mg (it is necessary to apply to receiving such dosing валсартан and a hydrochlorothiazide in other dosage form). The dose of 320/25 mg is appointed to patients at whom it is not reached sufficient decrease in the ABP at use of a dose of 320/12,5 mg.
The maximum daily dose makes 320/25 mg (2 tablets 160/12,5 of mg).
The maximum anti-hypertensive effect is reached during 2–4 weeks.
Vanateks Kombi can be accepted irrespective of meal, washing down with water.
Additional information for special groups of patients
Renal failure. Selection of a dose is not required from patients with a slight and moderate renal failure (clearance of creatinine of ≥30 ml/min.). Because of existence of a hydrochlorothiazide of Vanateks Kombi it is contraindicated to patients with a heavy renal failure.
Liver failure. For patients with a slight and moderate liver failure without cholestasia the dose of a valsartan should not exceed 80 mg. Vanateks Kombi is contraindicated to patients with a heavy liver failure.
Patients of advanced age. Selection of a dose is not required from patients of advanced age.

Features of use:

Changes of level of electrolytes in a blood plasma
Valsartan
Simultaneous use with potassium additives, kaliysberegayushchy diuretics, the salt substitutes containing potassium or other means which can increase potassium level (heparin, etc.) is not recommended. If necessary it is necessary to carry out control of content of potassium.
Hydrochlorothiazide
It is reported about a hypopotassemia at treatment by thiazide diuretics, including a hydrochlorothiazide. Recommend frequent control of content of potassium in a blood plasma.
Treatment by thiazide diuretics, including a hydrochlorothiazide, was connected with a hyponatremia and a gipokhloremichesky alkalosis. Tiazida, including a hydrochlorothiazide, increase release of magnesium with urine that can lead to a hypomagnesiemia. Release of calcium decreases owing to reception of thiazide diuretics. It can lead to a hypercalcemia.
As well as at any patient receiving treatment by diuretics it is necessary to carry out periodic determination of level of electrolytes in a blood plasma through the corresponding periods.
Patients with a hypovolemia
Behind a condition of the patients accepting thiazide diuretics including a hydrochlorothiazide, it is necessary to establish observation of rather clinical manifestations of a water and electrolytic imbalance. At a heavy hypovolemia the patients accepting diuretics in high doses can seldom have a symptomatic hypotension after the begun therapy by drug of Vanateks Kombi. The hypovolemia needs to be adjusted before an initiation of treatment drug of Vanateks Kombi.
Patients with heavy chronic heart failure. Use of Vanateks Kombi for patients with heavy chronic heart failure was not investigated.
Renal artery stenosis. Vanateks Kombi should not apply to treatment of AG at patients about one - or a bilateral renal artery stenosis or a renal artery stenosis of the only kidney as at such patients the level of urea and creatinine in a blood plasma can increase.
Primary hyper aldosteronism. Patients with primary hyper aldosteronism should not be treated drug of Vanateks Kombi as their renin-angiotenzinovaya system is not activated.
Stenosis of the aortal and mitral valve, subaortic hypertrophic stenosis. As well as in a case with other vazodilatator, it is necessary to observe extra care at treatment of patients with a stenosis of the aortal or mitral valve or a hypertrophic subaortic stenosis.
Renal failure. In view of oppression (inhibition) system renin-angiotensin-aldosteronovoy, use of Vanateks Kombi can be also connected with a renal failure. Vanateks Kombi should not be applied at such patients.
Dose adjustment is not required from patients with a renal failure and clearance of creatinine of ≥30 ml/min. Recommend periodic control of level of potassium in a blood plasma, creatinine and urea if Vanateks Kombi apply at patients with a renal failure. At clearance of creatinine <30 ml/min. of Vanateks Kombi should not be applied.
Transplantation of kidneys. There is no experience of safe use of Vanateks Kombi for the patients who recently transferred transplantation of kidneys now.
Liver failure. Patients with a slight and moderate liver failure without cholestasia of Vanateks Kombi should take with caution.
System lupus erythematosus. It was reported that thiazide diuretics, including a hydrochlorothiazide, aggravate or activate a system lupus erythematosus.
Other metabolic disturbances (disbolism). Thiazide diuretics, including a hydrochlorothiazide, can change tolerance to glucose and increase levels XC, TGI of uric acid in a blood plasma. At patients with a diabetes mellitus selection (correction) of a dose of insulin or peroral drugs for decrease in level of glucose in blood can be required.
Tiazida can reduce removal of calcium with urine and lead to temporary and slight increase of level of calcium in a blood plasma in the absence of the known disturbances of calcic exchange. The expressed hypercalcemia can testify to an estimated hyperparathyreosis (hyperfunction of epithelial bodies). It is necessary to stop reception of tiazid before conducting a research of function of epithelial bodies.
Photosensitivity. It was reported about cases of reactions of a photosensitivity at treatment by thiazide diuretics. If reaction of a photosensitivity arises during treatment, recommend to stop administration of drug. If repeated purpose of diuretic drugs is considered necessary, recommend to protect vulnerable sites from the sun or artificial ultraviolet radiation And.
Drug test. It must be kept in mind that drug can lead to positive reaction at anti-doping control.
General information. It is necessary to be careful to patients who in the anamnesis have a hypersensitivity to other antagonists of receptors of AT II. Allergic reactions to a hydrochlorothiazide are more probable at patients with an allergy and OH.
Excipients. Patients with rare hereditary conditions of intolerance of a galactose, a lactose intolerance or a sprue of glucose should not accept this drug.
Use during pregnancy and feeding by a breast
Valsartan
Use of antagonists of receptors of AT II is not recommended in the I trimester of pregnancy. It is known that action of antagonists of receptors of AT II on a uterus in case of their appointment to pregnant women in II and the III trimester leads to disturbance and death of the developing fruit. Use of antagonists of receptors of AT II is contraindicated in II and the III trimester of pregnancy.
Hydrochlorothiazide
Experience of use of a hydrochlorothiazide during pregnancy, especially in the I trimester, is organic. Administration of thiazide diuretic in a cavity of the uterus led to development of thrombocytopenia in a fruit or the newborn, and also to development of other undesirable phenomena. The hydrochlorothiazide gets through a placenta. Considering the pharmacological mechanism of action of a hydrochlorothiazide, its use in II and the III trimester can lead to threat of disturbance of fetoplacental perfusion and can cause such disturbances in a fruit and the newborn as jaundice, disturbance of electrolytic balance and thrombocytopenia.
There are no data on use of a valsartan during feeding by a breast. The hydrochlorothiazide gets into breast milk. Thus, Vanateks Kombi do not recommend to apply during feeding by a breast. If pregnancy is revealed during treatment, drug should be cancelled as soon as possible.
Children. Safety and efficiency of use of Vanateks Kombi for children are not established.
Ability to influence speed of response at control of vehicles or work with other mechanisms. As well as at use of other anti-hypertensive means, it is desirable to be careful at control of vehicles and work with other mechanisms.

Side effects:

Side reactions at use валсартана / a hydrochlorothiazide
From a metabolism and food: infrequently — dehydration.
From a nervous system: very seldom — dizziness; often — paresthesias, a hypesthesia; it is unknown — a faint, sleeplessness.
From an organ of sight: seldom — a sight illegibility, a vision disorder.
From an acoustic organ: infrequently — a ring in ears, average otitis.
From cardiovascular system: seldom — arterial hypotension, tachycardia.
From respiratory system: seldom — cough; it is unknown — not cardiogenic fluid lungs.
From a GIT: very seldom — diarrhea.
From a musculoskeletal system: seldom — a mialgiya (muscle pain); very seldom — an arthralgia.
From an urinary system: it is unknown — a renal failure.
General disturbances: often — fatigue.
Laboratory indicators: it is unknown — increase in level of uric acid in a blood plasma, increase in level of bilirubin and creatinine in a blood plasma, a hypopotassemia, a hyponatremia, increase in level of an urea nitrogen in blood, a neutropenia.
Additional information on separate components of drug
Undesirable reactions about which it was reported earlier, caused by one of separate components of drug can be also potential undesirable influence of Vanateks Kombi.
Side reactions at use of a valsartan
From system of blood and lymphatic system: it is unknown — decrease in hemoglobin, decrease in a hematocrit, a neutropenia, thrombocytopenia.
From immune system: it is unknown — other allergic reactions / reactions of hypersensitivity, including a serum disease.
From a metabolism and food: it is unknown — increase in level of potassium in a blood plasma, a hyponatremia.
From an acoustic organ: infrequently — dizziness (вертиго).
From cardiovascular system: it is unknown — a vasculitis.
From a GIT: seldom — an abdominal pain.
From the alimentary system: it is unknown — increase in indicators of function of a liver, including increase in level of bilirubin in a blood plasma.
From skin and hypodermic fabrics: it is unknown — a Quincke's edema (Quincke's disease), rash, an itch.
From an urinary system: it is unknown — a renal failure and a renal failure, increase in level of creatinine in a blood plasma.
From respiratory system: very seldom — bronchitis, upper respiratory tract infections.
Side reactions at use of a hydrochlorothiazide
The hydrochlorothiazide was widely applied for many years, it is frequent in higher doses, than contained in Vanateks Kombi. It is reported about side below-mentioned reactions at the patients receiving monotherapy by thiazide diuretics including a hydrochlorothiazide.
From system of blood and lymphatic system: seldom — thrombocytopenia, sometimes with a purpura; very seldom — an agranulocytosis, a leukopenia, hemolitic anemia, oppression of function of marrow.
From immune system: very seldom — allergic reactions (hypersensitivity reaction).
From mentality: seldom — a depression, a sleep disorder.
From a nervous system: seldom — a headache.
From cardiovascular system: seldom — arrhythmia; often — orthostatic hypotension.
From respiratory system: very seldom — the complicated breath (asthma), including pneumonia and a fluid lungs.
From a GIT: often — lack of appetite, slight nausea and vomiting; seldom — a lock, discomfort in a GIT; very seldom — pancreatitis.
From the alimentary system: seldom — a cholestasia, jaundice.
From skin and hypodermic fabrics: often — a small tortoiseshell and other types of rash; seldom — a photosensitization; very seldom — a necrotizing vasculitis and a toxic epidermal necrolysis, a system lupus erythematosus, eritematozopodobny reactions, reactivation of skin manifestations of a lupus erythematosus.
From reproductive system and mammary glands: often — impotence.

Interaction with other medicines:

The interactions connected as with valsartany, and a hydrochlorothiazide
The combined use is not recommended
Lithium. It was reported about reversible increase in level of lithium in a blood plasma and toxicity at the accompanying use of APF inhibitors and a tiazida, including a hydrochlorothiazide. Due to the lack of experience of the combined use of a valsartan and lithium this combination is not recommended. If необходимымо use of such combination, recommend careful control of level of lithium in a blood plasma.
The combined use demanding care
Other anti-hypertensive drugs. Vanateks Kombi can strengthen effect of other drugs with anti-hypertensive properties (for example APF inhibitors, blockers of β-adrenoceptors, blockers of calcium channels).
Pressor amines (for example Norepinephrinum, Epinephrinum). The reduction of expressiveness of reaction to pressor amines insufficient is possible to exclude use.
NPVP, including the selection TsOG-2 inhibitors, acetylsalicylic acid (> 3 g/days) and non-selective NPVP. NPVP can weaken anti-hypertensive effect of antagonists of receptors of AT II and hydrochlorothiazide at simultaneous use. Besides, simultaneous use of drug of Vanateks Kombi and NPVP can lead to deterioration in function of kidneys and increase in level of potassium in a blood plasma. Thus, control of function of kidneys in an initiation of treatment, and also the corresponding hydration is recommended.
The interactions connected with valsartany
Simultaneous use is not recommended
Kaliysberegayushchy diuretics, potassium additives, the salt substitutes containing potassium, and other substances which can increase potassium levels in a blood plasma. If it is considered that medicine which influences potassium level needs to be combined with valsartany, control of level of potassium in a blood plasma is recommended.
Interaction is absent
Researches of interaction of medicines with valsartany did not reveal clinically significant interactions with valsartany or any of the following medicines: Cimetidinum, warfarin, furosemide, digoxin, атенолол, indometacin, hydrochlorothiazide, амлодипин, Glibenclamidum. Digoxin and indometacin can interact with a component of drug of Vanateks Kombi a hydrochlorothiazide (see the Interactions connected with a hydrochlorothiazide).
The interactions connected with a hydrochlorothiazide
The simultaneous use demanding care
Medicines which use is connected with potassium loss, and at a hypopotassemia (for example at co-administration of potassiumuretic diuretics, GKS, purgatives, AKTG, Amphotericinum, karbenoksolon, penicillin G, salicylic acid and its derivatives). If it is necessary to appoint these medicines in a combination with a hydrochlorothiazide and valsartany, control of level of potassium in a blood plasma is recommended. These medicines can strengthen influence of a hydrochlorothiazide on potassium level in a blood plasma.
Medicines which can cause piruetny ventricular tachycardia:

• antiarrhytmic drugs of the class Ia (for example quinidine, hydroquinidine, Disopyramidum);
• antiarrhytmic drugs of a class III (for example Amiodaronum, соталол, дофетилид, ибутилид);
• some neuroleptics (for example thioridazine, Chlorpromazinum, levomepromazinum, трифлуоперазин, циамемазин, Sulpiridum, сультоприд, амисульприд, тиаприд, Pimozidum, haloperidol, Droperidolum);
• others (for example bepridit, цизаприд, difemanit, erythromycin (in/in), галофантрин, кетансерин, мизоластин, pentamidine, спарфлоксацин, терфенадин, Vincaminum (in/in).
Because of risk of a hypopotassemia the hydrochlorothiazide should be applied with care in combination with medicines which can cause piruetny ventricular tachycardia.
Cardiac glycosides. The hypopotassemia or a hypomagnesiemia caused tiazidy can arise as side effect which promotes development of digitalis arrhythmia.
Salts of calcium and vitamin D. Use of thiazide diuretics, including a hydrochlorothiazide, with vitamin D or salts of calcium can increase calcium level in a blood plasma.
Anti-diabetic means (peroral drugs and insulin). Treatment by thiazide diuretics can affect tolerance to glucose. Dose adjustment of antidiabetic medicines can be required. Metforminum should be applied with care because of risk of the lactacidemia caused by the possible functional renal failure connected with a hydrochlorothiazide.
Blockers of β-adrenoceptors and diazoxide. Simultaneous use of thiazide diuretics, including a hydrochlorothiazide, with blockers of β-adrenoceptors can increase risk of a hyperglycemia. Thiazide diuretics, including a hydrochlorothiazide, can strengthen hyper glycemic influence of diazoxide.
The medicines used at treatment of gout (пробенецид, Sulfinpyrazonum and Allopyrinolum). Dose adjustment of uricosuric drugs as the hydrochlorothiazide can increase the level of uric acid in a blood plasma can be required. Increase in a dose of a probenetsid or Sulfinpyrazonum can be required. Co-administration of thiazide diuretics, including a hydrochlorothiazide, can increase the frequency of allergic reactions to Allopyrinolum.
Anticholinergics (for example atropine, Biperidinum). Bioavailability of thiazide diuretics can increase anticholinergics probably because of reduction of motility of a GIT and speed of gastric emptying.
Amantadin. Tiazida, including a hydrochlorothiazide, can increase risk of emergence of adverse effects of an amantadin.
Kolestiraminovy and kolestipolovy pitches. Absorption of thiazide diuretics, including a hydrochlorothiazide, is broken in the presence of anionno-exchange pitches.
Cytotoxic means (for example cyclophosphamide, methotrexate). Tiazida, including a hydrochlorothiazide, can reduce release of cytotoxic substances kidneys and strengthen their myelosuppressive effect.
Not depolarizing muscle relaxants (for example tubocurarine). Tiazida, including a hydrochlorothiazide, strengthen action of derivative curares.
Cyclosporine. The accompanying reception with cyclosporine can increase risk of emergence of a hyperuricemia and emergence of the symptoms reminding an exacerbation of gout.
Alcohol, anesthetics and sedatives. Can strengthen orthostatic hypotension.
Methyldopum. The patients receiving the accompanying treatment metildopy and a hydrochlorothiazide have separate messages on cases of hemolitic anemia.
Carbamazepine. At patients who receive a hydrochlorothiazide along with carbamazepine the hyponatremia can develop. Therefore, such patients have to be informed on a possibility of giponatriyemichesky reactions and be under control.
Yodosoderzhashchy contrast agents. In case of the dehydration caused by diuretic there is an increased risk of development of OPN, especially at high doses of iodine. Sufficient hydration before reception is necessary.

Contraindications:

Hypersensitivity to a valsartan, a hydrochlorothiazide, other medicines on the basis of sulfonamide or to any of excipients. Heavy liver failure, cirrhosis and cholestasia. Heavy renal failure (clearance of creatinine <30 ml/min.), anury. Steady hypopotassemia, hyponatremia, hypercalcemia and symptomatic hyperuricemia.

Overdose:

Symptoms. The overdose of a valsartan can lead to the expressed arterial hypotension that, in turn, can become the reason of oppression of consciousness, a circulator collapse (vascular insufficiency) and/or shock (coma). Besides, such signs and symptoms can arise at overdose of a hydrochlorothiazide: the nausea, drowsiness, a hypovolemia and electrolytic disturbances connected with cardiac arrhythmias and muscular spasms.
Treatment. Therapeutic measures depend on time of meal and type and weight of symptoms, blood circulation stabilization is very important.
Therapeutic measures depend on time which passed from the overdose moment and also a look and weight of symptoms, at the same time a first-priority measure is haemo circulation normalization.
If drug was accepted recently, it is necessary to cause vomiting. If after use of drug there passed the long time, use of absorbent carbon in enough is necessary.
At arterial hypotension it is necessary to give to the patient horizontal position and to urgently provide recovery of water-salt balance by administration of isotonic salt solution.
Valsartan it is impossible to bring out of an organism by means of a hemodialysis owing to its linkng with proteins of a blood plasma, but for removal from a hydrochlorothiazide organism the hemodialysis is effective.

Storage conditions:

In the dry, protected from light place at a temperature not above 30 °C.

Issue conditions:

According to the recipe

Packaging:

On 14 tablets in planimetric cell упаковкуиз films of polyvinyl chloride and aluminum foil.

On the 2nd planimetric packaging together with the instruction on a medical use nagosudarstvenny and Russian languages put in a pack from a cardboard.