Co-Vamloset, 10 mg+160 mg+25 mg 30 pcs.
€19.46 €16.21
Hypotensive drug combined (slow calcium channel blocker [BMCC] + angiotensin II receptor antagonist [ARA II] + diuretic)
Indications
Grade II and III arterial hypertension.
Composition
1 film-coated tablet,5 mg + 160 mg + 12.5 mg/10 mg + 160 mg + 12.5 mg/10 mg + 160 mg + 25 mg contains:
Core:
Active substances:
Amlodipine besylate (amlodipine besylate) 6.94 mg/13.88 mg/13.88 mg, equivalent to amlodipine 5.00 mg/10.00 mg/10.00 mg
Valsartan A, substance-granules 251.35 mg/251.35 mg/251.35 mg
[Active substance of granule substance: valsartan 160.00 mg/160.00 mg/160.00 mg
Auxiliary substances of the granule substance: microcrystalline cellulose (type 200), croscarmellose sodium, povidone K-25, sodium lauryl sulfate]
Hydrochlorothiazide 12.50 mg/12.50 mg/25.00 mg
Supplements:
Mannitol, magnesium stearate, colloidal silicon dioxide
Film shell:
Film-forming compound:
– polyvinyl alcohol
– macrogol-3350
– titanium dioxide (E171)
– talc
Red iron oxide dye (E172) (for 10 mg + 160 mg + 12.5 mg tablets)
Yellow iron oxide dye (E172) (for 10 mg + 160 mg + 25 mg tablets)
How to take, the dosage
The drug Co-Vamloset should be taken orally with a little water, regardless of meal times.
The recommended daily dose is 1 tablet containing amlodipine + valsartan + GXTZ at a dose of 5 mg + 160 mg + 12.5 mg, 10 mg + 160 mg + 12.5 mg (as Co-Vamloset, film-coated tablets, 5 mg + 160 mg + 12.5 mg, 10 mg + 160 mg + 12.5 mg) or 1 tablet containing amlodipine + valsartan + GXTZ at a dose of 10 mg + 160 mg + 25 mg (as Co-Vamloset, film-coated tablets, 10 mg + 160 mg + 25 mg).
The drug Co-Vamloset is taken once daily.
For convenience, patients receiving amlodipine, valsartan and GXTZ monotherapy in separate tablets can be switched to therapy with Co-Vamloset containing the same doses of active ingredients. Patients with insufficient BP control on dual combination therapy (valsartan + GXTZ, amlodipine + valsartan and amlodipine + GXTZ) may be switched to triple combination therapy with Co-Vamloset in appropriate doses. The dose of Co-Vamloset shall be adjusted after previously titrated doses of monocomponent drugs containing the active ingredients of Co-Vamloset. If it will be necessary to change a dose of one of active substances in KoVamloset (e.g. in connection with newly diagnosed disease, change of patient’s condition or drug interaction) individual selection of doses of individual components is necessary.
Patients with sodium deficiency and/or hypovolemia, such as those receiving high doses of diuretics, may develop symptomatic arterial hypotension at the beginning of therapy with Co-Vamloset. This combination should be used only after correction of hyponatremia and/or hypovolemia.
If a patient has dose-dependent side effects when using dual combination therapy with any component of Co-Vamloset, a Co-Vamloset containing a lower dose of the active component that caused the side effect may be used to achieve a comparable decrease in BP.
Increase the dose 2 weeks after starting therapy.
The maximum antihypertensive effect of Co-Vamloset is noted 2 weeks after increasing the dose. The maximum dose is 10 mg + 320 mg + 25 mg per day.
Application in patients over 65 years
No adjustment of the drug dose is necessary. In patients in this category, if necessary, it is possible to reduce the initial dose to contain the lowest dose of amlodipine, i.e. 1 tablet containing amlodipine + valsartan + GXTZ at a dose of 5 mg + 160 mg + 12.5 mg (as Co-Vamloset, film-coated tablets, 5 mg + 160 mg + 12.5 mg) or 5 mg + 160 mg + 25 mg (as Co-Vamloset, film-coated tablets, 5 mg + 160 mg + 25 mg).
Application in children and adolescents under the age of 18
“Since the safety and effectiveness of Co-Vamloset in children and adolescents (under 18 years) has not been established, the drug is not recommended for use in this patient population.
Patients with impaired renal function
For patients with renal dysfunction of mild to moderate degree (FFR ≥ 30 ml/min/1.73 m2 of body surface area, but ≤ 90 ml/min/1.73 m2 of body surface area) the initial dose adjustment is not required. The drug should not be used in patients with severe renal dysfunction (GFR < 30 ml/min/1.73 m2 body surface area) due to the presence of HCTS in the drug.
The use of thiazide diuretics in monotherapy in patients with severe renal dysfunction (GFR < 30 ml/min/1.73 m2 body surface area) is ineffective, however simultaneous use with “loop” diuretics in patients of this category is possible.
Patients with impaired liver function
Interaction
Amlodipine
When amlodipine monotherapy is used, there are no clinically significant interactions with Thiazide diuretics, beta-adrenoblockers, ACE inhibitors, long-acting nitrates, nitroglycerin for sublingual use, digoxin, warfarin, atorvastatin, sildenafil, aluminum- and magnesium hydroxide, simethicone, cimetidine, non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics and hypoglycemic drugs for oral administration.
Concurrent administration of amlodipine and ethanol does not affect pharmacokinetics of the latter.
CYP3A4 isoenzyme inhibitors
Concurrent use of amlodipine at a dose of 5 mg/day with diltiazem at a dose of 180 mg/day in elderly patients with arterial hypertension resulted in a 1.6-fold increase in systemic exposure to amlodipine. When using amlodipine with potent CYP3A4 isoenzyme inhibitors (e.g., ketoconazole, itraconazole and ritonavir) an even more pronounced increase in systemic exposure to amlodipine may occur. Caution is necessary when using amlodipine with CYP3A4 isoenzyme inhibitors.
Due to CYP3A4 isoenzyme inhibition, concomitant administration with grapefruit juice may increase the bioavailability of amlodipine. However, in a clinical study in healthy volunteers no significant changes in pharmacokinetics were found when taking amlodipine at a dose of 10 mg with 240 ml of grapefruit juice.
CYP3A4 isoenzyme inducers
Because the use of amlodipine with CYP3A4 isoenzyme inducers (e.g., carbamazepine, phenobarbital, phenytoin, fosphenytoin, primidone, rifampicin, herbal preparations containing St. John’s Wort<) may cause significant decrease of its concentration in plasma, caution should be exercised when using amlodipine with inducers of CYP3A4 isoenzyme.
Simvastatin
Tacrolimus
There is a risk of increased serum concentrations of tacrolimus when used concomitantly with amlodipine. In order to avoid tacrolimus toxicity, when using amlodipine in patients receiving tacrolimus, tacrolimus serum concentrations should be monitored and the dose should be adjusted if necessary.
Clarithromycin
Clarithromycin is an inhibitor of the CYP3A4 isoenzyme. There is an increased risk of arterial hypotension in patients concomitantly using clarithromycin with amlodipine. In concomitant use of amlodipine with clarithromycin, close patient monitoring is recommended.
Valsartan
Valsartan monotherapy has been found to lack clinically significant interaction with the following drugs cimetidine, warfarin, furosemide, digoxin, atenolol, indomethacin, GXTZ, amlodipine, glibenclamide.
Double RAAS blockade when using ARA II, ACE inhibitors, or aliskiren
The concomitant use of ARA II with drugs containing aliskiren is contraindicated in patients with diabetes and/or moderate to severe renal impairment (FFR < 60 ml/min/1.73 m2 body surface area) and is not recommended in other patients. Concomitant use of ARA IIc with ACE inhibitors is contraindicated in patients with diabetic nephropathy and is not recommended in other patients.
Simultaneous use of ARA II with other drugs that affect the RAAS leads to an increased incidence of arterial hypotension, hyperkalemia, impaired renal function. It is necessary to monitor indexes of BP, renal function, and plasma electrolytes content when using Co-Vamloset with other drugs affecting the RAAS.
Drugs and substances affecting serum potassium
When used concomitantly with biologically active potassium supplements, potassium-saving diuretics, eplerenone, potassium-containing salt substitutes, or other drugs that may cause an increase in plasma potassium (e.g., with heparin),care should be taken and plasma potassium should be monitored regularly.
Drugs, including selective cyclooxygenase-2 (COX-2)inhibitors
The diuretic and antihypertensive effects of valsartan may be reduced when used concomitantly with NSAIDs, including selective COX-2 inhibitors such as salicylic acid derivatives, indomethacin. Moreover, in elderly patients with concomitant hypovolemia (including due to diuretics) or with impaired renal function, simultaneous use of APA II and NSAIDs, including selective COX-2 inhibitors may lead to worsening of renal function. In patients of this group it is recommended to monitor renal function.
Squirrel carriers
Co-administration of valsartan with the OATP1B1 transporter protein inhibitors (rifampicin, cyclosporine)and with the MRP2 transporter protein inhibitor (ritonavir) may lead to increased systemic bioavailability of valsartan.
GHTZ
Other hypotensive drugs
Thiazide diuretics increase antihypertensive effect of other hypotensive drugs (including guanethidine, methyldopa, beta-adrenoblockers, vasodilators, BMCC, ACE inhibitors, ARA II, direct renin inhibitors).
Curare-like muscle relaxants
Thiazide diuretics, including HCTC, potentiate the effects of curare-like myorelaxants (e.g., tubocurarine chloride).
NPVP
The diuretic and antihypertensive effects of thiazide component of Co-Vamloset may decrease if used concomitantly with NSAIDs, e.g. acetylsalicylic acid, indomethacin. Concomitant hypovolemia may lead to acute renal failure.
Drugs affecting serum potassium
The risk of hypokalemia is increased with the simultaneous use of other diuretics, glucocorticosteroids, adrenocorticotropic hormone, amphotericin B, carbenoxolone and acetylsalicylic acid (in dose more than 3 g).
Drugs affecting serum sodium
The hyponatremic effect caused by diuretics may be enhanced with concomitant use with antidepressants, antipsychotics, anticonvulsants, etc. Caution should be exercised when prolonged concomitant use of Co-Vamloset by the above drugs.
Hypoglycemic agents
Alterations in glucose tolerance are observed while using GGCTZ, due to this the doses of insulin and hypoglycemic agents for oral administration should be corrected in diabetic patients.
Since HCTZ administration with metformin may lead to lactoacidosis (due to impaired renal function during HCTZ therapy), caution should be exercised when using Co-Vamloset in patients treated with metformin.
Heart glycosides
Hypokalemia and hypomagnesemia (unwanted effects of thiazide diuretics) may contribute to cardiac rhythm disturbances in patients receiving cardiac glycosides.
H- and m-cholinoblockers
H- and m-cholinoblockers (incl.atropine, biperiden) may increase the bioavailability of HCCH, which is associated with decreased gastrointestinal peristalsis and gastric emptying rate. Accordingly, gastrointestinal motility stimulators (cisapride) may decrease the bioavailability of HCTS.
Anion exchange resins
HCHTZ absorption is reduced in the presence of colestyramine and colestipol. HCTS should be taken 4 hours before or 4-6 hours after taking these compounds.
Vitamin D and calcium salts
Simultaneous use of HCTS with vitamin D or calcium preparations may increase the calcium content in the blood serum.
Cyclosporine
The simultaneous use of HCTS and cyclosporine increases the risk of hyperuricemia and the appearance of gout-like symptoms.
Methyldopa
Cases of hemolytic anemia have been reported when simultaneous use of HCTS and methyldopa.
other interactions
Concurrent use of thiazide diuretics, including HCTC, may result in increased incidence of hypersensitivity reactions to allopurinol, increased risk of side effects of amantadineincreased hyperglycemic effect of diazoxide, decreased renal excretion of drugs with cytotoxic effects (e.g., cyclophosphamide, methotrexate), to potentiation of their myelosuppressive effects. Also, GCHT can decrease the body’s response to the administration of pressor amines (noradrenaline), but this effect is clinically insignificant and can not prevent the simultaneous use of the drugs.
Ethanol, barbiturates and narcotics
Combined use with HCTS may contribute to orthostatic hypotension.
General drug interactions for valsartan and GXTZ
Lithium preparations
Concomitant use of lithium preparations with ACE inhibitors, ARA II or thiazide diuretics resulted in a reversible increase in serum lithium and an associated increase in toxic manifestations. The risk of toxic effects associated with the use of lithium drugs may be further increased with concomitant use of Co-Vamloset because renal clearance of lithium drugs is slowed by thiazide diuretics. In this regard, it is recommended to monitor carefully the lithium content in blood serum.
.
Special Instructions
If you have any of the following conditions, inform your doctor before taking this medicine.
Caution should be exercised when using the drug in patients with unilateral or bilateral renal artery stenosis or artery stenosis of the single kidney, with conditions accompanied by decreased CER and water-electrolyte disturbances: nephropathies accompanied by salt loss, prerenal (cardiogenic) renal dysfunction, in patients with hypercalcemia, in patients with mitral or aortic stenosis, hypertrophic obstructive cardiomyopathy, hypokalemia, hyponatremia, hypomagnesemia, hypochloremia In patients with CHF class III-IV according to NYHA classification, with acute coronary syndrome, with diabetes, with systemic lupus erythematosus, with hyperuricemia, with elevated concentrations of cholesterol and triglycerides in plasma, in patients with closed-angle glaucoma, in patients with a history of nonmelanoma skin cancer (NMSc) (see “Administration Instructions”). see section “Special indications”), as well as in patients after kidney transplantation. Caution should be exercised when using the drug in elderly patients.
Caution should be exercised when using Co-Vamloset concomitantly with potassium salts, potassium-saving diuretics, potassium-containing salt substitutes, and with drugs that may increase plasma potassium levels (e.g., heparin).
Application in children and adolescents under the age of 18
“Since the safety and effectiveness of Co-Vamloset in children and adolescents (under 18 years) has not been established, the drug is not recommended for use in this patient population.
Application in patients over age 65
No adjustment of the drug dose is necessary. In patients in this category, if necessary, it is possible to reduce the initial dose to contain the lowest dose of amlodipine, i.e. 1 tablet containing amlodipine + valsartan + GXTZ at a dose of 5 mg + 160 mg + 12.5 mg (as Co-Vamloset, film-coated tablets, 5 mg + 160 mg + 12.5 mg) or 5 mg + 160 mg + 25 mg (as Co-Vamloset, film-coated tablets, 5 mg + 160 mg + 25 mg).
Patients with impaired renal function
For patients with renal dysfunction of mild to moderate degree (FFR ≥ 30 ml/min/1.73 m2 of body surface area, but ≤ 90 ml/min/1.73 m2 of body surface area) the initial dose adjustment is not required. The drug should not be used in patients with severe renal dysfunction (GFR < 30 ml/min/1.73 m2 body surface area) due to the presence of HCTS in the drug.
The use of thiazide diuretics in monotherapy in patients with severe renal function impairment (GFR < 30 ml/min/1.73 m2 body surface area) is ineffective, however simultaneous use with “loop” diuretics in patients of this category is possible.
Patients with impaired liver function
Safety and effectiveness of amlodipine in hypertensive crisis have not been established.
Sodium deficiency and/or hypovolemia
Severe arterial hypotension, including orthostatic hypotension, was noted in 1.7% of patients receiving the maximum dose combination of amlodipine + valsartan + GXTZ (10 mg + 320 mg + 25 mg) compared with 1.8% of patients receiving the combination of valsartan + GXTZ (320 mg + 25 mg), 0.4% of patients receiving amlodipine + valsartan (10 mg + 320 mg) combination and 0.2% of patients receiving amlodipine + GXTZ (25 mg + 10 mg) combination in a controlled trial involving patients with uncomplicated moderate to severe arterial hypertension.
Patients with sodium deficiency and/or hypovolemia, such as those receiving high-dose diuretics, may develop symptomatic hypotension at the start of therapy with Co-Vamloset. This combination should be used only after correction of hyponatremia and/or hypovolemia.
In case of severe arterial hypotension during Co-Vamloset therapy, the patient should be placed in supine position and, if necessary, given intravenous infusion of 0.9% sodium chloride solution. Treatment with the drug can be continued after BP stabilization.
Changes in plasma electrolyte content
Co-Vamloset
In a controlled study in many patients, when the combination of amlodipine + valsartan + GXTZ was used, the effects of valsartan at 320 mg and GXTZ at 25 mg on serum potassium levels nearly balanced each other. In other patients, one of the effects may have predominated. Periodic plasma electrolyte determinations to detect possible electrolyte imbalances should be performed at set intervals.
Periodic determination of serum electrolytes, particularly potassium, should be performed at appropriate intervals to detect possible electrolyte imbalances, especially in patients with risk factors such as impaired renal function, use of other medications or a history of electrolyte imbalances.
Valsartan
Concurrent use with potassium-containing supplements, potassium-saving diuretics, eplerenone, potassium-containing salt substitutes, or other drugs that may cause an increase in plasma potassium (e.g., heparin) is not recommended. Plasma potassium levels should be monitored.
GCTZ
Therapy with Co-Vamloset should be started only after hypokalemia and concomitant hypomagnesemia have been eliminated. Thiazide diuretics may contribute to recurrence of hypokalemia or aggravate existing hypokalemia. Thiazide diuretics should be used with caution in patients with conditions with increased potassium loss, such as nephropathy, and prerenal (cardiogenic) renal dysfunction. If hypokalemia develops during treatment with HCTS, Co-Vamloset should be discontinued until steady normalization of plasma potassium.
Thiazide diuretics can promote hyponatremia and hypochloremic alkalosis again or aggravate already existing hyponatremia. Hyponatremia accompanied by neurological symptoms (nausea, progressive disorientation, apathy) has been observed. HCTH treatment should be started only after elimination of already existing hyponatremia. In case of severe or rapidly developing hyponatremia during combination amlodipine + valsartan + GXTZ treatment should be stopped until normalization of plasma sodium content.
All patients receiving thiazide diuretics should be monitored periodically for electrolyte disturbances, especially plasma potassium, sodium, and magnesium.
Kidney function impairment
Thiazide diuretics may contribute to azotemia in patients with chronic kidney disease. When using Co-Vamloset in patients with impaired renal function, it is recommended to monitor periodically electrolytes (including potassium), serum creatinine and uric acid concentrations. Co-Vamloset is contraindicated in patients with severe renal impairment (CK < 30 ml/min), anuria and patients on dialysis (see section “Contraindications”).
Patients with mild to moderate renal dysfunction (GFR ≥ 30 ml/min/1.73 m2 body surface area) do not require dose adjustment of Co-Vamloset.
renal artery stenosis
In patients with unilateral or bilateral renal artery stenosis or stenosis of the artery of the single kidney, administration of Co-Vamloset may be accompanied by elevated serum urea and creatinine concentrations, so Co-Vamloset should be used with caution in such patients.
Kidney transplantation
Today, there are no data on the safe use of the combination amlodipine + valsartan + GXTZ in patients after kidney transplantation.
Hdisordered liver function
Ndisordered liver
Valsartan is excreted mainly in unchanged form with bile. T½ amlodipine is prolonged, and AUC values are higher in patients with impaired hepatic function; there are no dose recommendations. In patients with mild to moderate hepatic impairment without cholestasis, the maximum recommended dose is 80 mg of valsartan, so Co-Vamloset is contraindicated in these patients.
Angioneurotic edema
Angioneurotic edema, including laryngeal and pharyngeal edema causing airway obstruction and/or swelling of the face, lips, larynx, and/or tongue, has been noted in patients receiving valsartan. Some of these patients had previously noted angioedema against the background of the use of other drugs, including ACE inhibitors. If angioedema develops, Co-Vamloset should be discontinued immediately and the drug should not be used again.
CHF and coronary heart disease/after myocardial infarction
In susceptible patients, there may be changes in renal function due to inhibition of the RAAS. In patients whose renal function depends on RAAS activity (e.g., patients with CHF of functional class III-IV [according to NYHA classification]), therapy with ACE inhibitors and ARA II may be accompanied by oliguria and/or progressive azotemia and in rare cases may lead to acute renal failure and death. Similar outcomes have been reported with valsartan therapy. Assessment of patients with CHF or post-myocardial infarction should always include renal function assessment.
In a long-term placebo-controlled trial (PRAISE-2) of amlodipine in patients with CHF of NYHA functional class III-IV nonischemic etiology, there was an increased incidence of pulmonary edema with amlodipine despite a slight difference in the incidence of worsening heart failure compared with placebo.
In patients with NYHA functional class III-IV CHF, BMCCs, including amlodipine, should be used with caution because they may increase the risk of cardiovascular events and death.
Caution is advised in patients with CHF and coronary heart disease because available data are limited in these patient populations.
Aortic and mitral valve stenosis
As with other vasodilators, caution should be exercised in patients with low-grade mitral valve stenosis or severe aortic valve stenosis.
Pregnancy
ARA II therapy should not be started during pregnancy. Patients planning to become pregnant should switch to an alternative hypotensive therapy with an established safety profile for use during pregnancy. If pregnancy is diagnosed, APA II therapy should be discontinued immediately or switched to an alternative hypotensive therapy with an established safety profile of use in pregnancy.
Primary hyperaldosteronism
Patients with primary hyperaldosteronism should not use ARA II (including valsartan) because the RAAS is not activated in such patients. Therefore, Co-Vamloset should not be used in this population.
Systemic lupus erythematosus
A worsening of the course or development of systemic lupus erythematosus has been reported with thiazide diuretics, including GXTZ.
Other metabolic disorders
Thiazide diuretics, including HCTC, may alter glucose tolerance and increase serum cholesterol, triglycerides, and uric acid concentrations. In patients with diabetes mellitus it may be necessary to adjust the dose of insulin or hypoglycemic drugs for oral administration.
Due to the HCTS component, Co-Vamloset is contraindicated in symptomatic hyperuricemia. HCTS may increase serum uric acid concentration due to decreased uric acid clearance and may cause or aggravate hyperuricemia and contribute to gout in susceptible patients.
Thiazides decrease renal calcium excretion and may cause intermittent and small increases in serum calcium concentrations in the absence of known calcium metabolism disorders. Co-Vamloset is contraindicated in patients with hypercalcemia and should be used only after the existing hypercalcemia has been resolved. Co-Vamloset should be discontinued if hypercalcemia develops during treatment. Serum calcium concentration should be periodically monitored during thiazide therapy. Severe hypercalcemia may be a sign of occult hyperparathyroidism. Thiazide therapy should be interrupted before parathyroid function is investigated.
Photosensitivity
Photosensitivity reactions have been reported when using thiazide diuretics (see See section “Side effects”). If photosensitivity reactions develop during treatment with Co-Vamloset, it is recommended to discontinue therapy. If repeated use of the diuretic is necessary, it is recommended to protect the skin areas exposed to sunlight or artificial UV radiation.
acute closed angle glaucoma
HCHTZ, being a sulfonamide, causes an idiosyncratic reaction leading to the development of acute transient myopia and acute closed-angle glaucoma. Symptoms include a sudden decrease in visual acuity or pain in the eye, usually within a few hours or a week after starting the drug. Left untreated, acute closed angle glaucoma can lead to permanent vision loss.
Initial therapy consists of stopping use of HCTZ as soon as possible. If intraocular pressure remains uncontrolled, urgent conservative or surgical treatment may be necessary. A history of allergic reactions to sulfonamides and penicillin may be risk factors for acute closed angle glaucoma.
General
Caution should be exercised in patients with previous hypersensitivity to other ARA II. Hypersensitivity reactions to HCTS are more likely in patients with allergies and bronchial asthma.
Elderly patients (≥65 years)
Caution, including frequent BP monitoring, should be exercised in elderly patients because available data in this patient population are limited.
Double RAAS blockade
The concomitant use of ACE inhibitors, ARA II, or aliskiren is accompanied by a higher incidence of adverse events, such as arterial hypotension, hyperkalemia, and decreased renal function (including acute renal failure). If combined therapy by dual RAAS blockade is considered absolutely necessary, it should be performed only under the supervision of a specialist and with careful monitoring of renal function, plasma electrolytes and blood pressure.
The concomitant use of ARA IIc drugs containing aliskiren is contraindicated in patients with diabetes and/or with moderate or severe renal impairment (FFR < 60 ml/min/1.73 m2 body surface area) and is not recommended in other patients. Concomitant use of ARA IIc with ACE inhibitors is contraindicated in patients with diabetic nephropathy and is not recommended in other patients.
Hypertensive crises
Co-Vamloset should not be used to control hypertensive crises.
Doping test
When using Co-Vamloset, athletes may have a positive doping test (due to the presence of HCTS in the drug).
NMRC
Two pharmacoepidemiological studies using data from the Danish National Cancer Registry demonstrated an association between HCTC intake and an increased risk of developing basal cell carcinoma and squamous cell carcinoma (SCC). The risk of NSCLC development increased with increasing total (cumulative) dose of HCTS. A possible mechanism of NMRK development is the photosensitizing effect of HCTS.
Patients taking HCTC as monotherapy or in combination with other medications should be aware of the risk of developing NMR. It is recommended that such patients have regular skin examinations to detect any new suspicious lesions as well as changes in existing skin lesions.
Any suspicious skin changes should be reported to the physician immediately. Suspicious skin areas should be examined by a specialist. Histological examination of skin biopsy specimens may be required to confirm the diagnosis.
Patients should be advised to follow preventive measures such as limiting exposure to sunlight and ultraviolet (UV) rays and use appropriate protective equipment to minimize the risk of developing SLE.
In patients with a history of NMRCC, it is recommended that the appropriateness of HCTC be reconsidered.
Some side effects of the drug, including dizziness or visual disturbances, may adversely affect the ability to perform potentially hazardous activities requiring increased concentration and rapid psychomotor reactions (driving vehicles, operating moving machinery). Patients taking Co-Vamloset should be cautious when driving vehicles and operating moving mechanisms.
Synopsis
Tablets 5 mg + 160 mg + 12.5 mg:
Oval, biconvex, film-coated tablets in white or nearly white with K1 engraved on one side.
Fracture appearance: white or almost white rough surface with white or almost white film coating.
Tablets 10 mg + 160 mg + 12.5 mg:
Oval, biconvex, film-coated tablets in pink with K2 engraved on one side.
Fracture appearance: white or almost white rough surface with pink film coating.
Tablets 10 mg + 160 mg + 25 mg:
Oval, biconvex, film-coated tablets brown-yellow with K4 engraved on one side.
Fracture appearance: white or almost white rough surface with brown-yellow film coating.
Contraindications
Hypersensitivity to amlodipine, valsartan, GXTZ, other sulfonamide derivatives and dihydropyridine series, as well as other excipients of the drug.
– Hereditary angioedema, or edema in patients on prior therapy with ARA II.
– Pregnancy, pregnancy planning and breastfeeding period.
– Liver failure, biliary cirrhosis and cholestasis.
– Severe renal function impairment (CK < 30 ml/min), anuria, hemodialysis patients.
– Hypokalemia, hyponatremia, hypercalcemia, and hyperuricemia with clinical manifestations refractory to adequate therapy.
– Age <18 years (effectiveness and safety not established).
– Severe arterial hypotension (systolic BP < 90 mm Hg), collapse, cardiogenic shock.
– Clinically significant aortic stenosis.
– Hemodynamically unstable heart failure after acute myocardial infarction.
– Concurrent use with aliskiren and drugs containing aliskiren in patients with diabetes mellitus and/or moderate to severe renal function impairment (FFR < 60 ml/min/1.73 m2 body surface area).
– Concurrent use with ACE inhibitors in patients with diabetic nephropathy.
Overdose
There are currently no data on cases of drug overdose.
Amlodipine
Alodipine overdose may result in excessive peripheral vasodilation and possible reflex tachycardia. Severe and prolonged BP lowering up to the development of shock with lethal outcome has also been reported.
Valsartan
In an overdose of valsartan, you can expect to develop a marked decrease in BP and dizziness.
In case of pronounced BP decrease, the patient should be in a horizontal position with elevated legs and take active measures to support cardiovascular activity, including regular monitoring of cardiac and respiratory system activity, CPR, and urine output.
Vasopressor drugs may be used to maintain normal vascular tone if there are no contraindications. If Co-Vamloset has been taken recently, vomiting or gastric lavage may be effective. The use of activated charcoal in healthy volunteers was accompanied by a decrease in absorption of amlodipine.
Valsartan and amlodipine are not eliminated by hemodialysis, whereas hemodialysis may be effective for HCTC elimination.
Pregnancy use
As with any drug that affects the renin-angiotensin-aldosterone system (RAAS), Co-Vamloset should not be used in women planning to become pregnant. When prescribing any drug that affects the RAAS, the physician should inform women of childbearing age about the potential dangers of these drugs during pregnancy.
The use of Co-Vamloset in pregnancy is contraindicated.
It is known that the use of ACE inhibitors that affect the RAAS in the II and III trimesters of pregnancy leads to the damage or death of the developing fetus. Given the mechanism of action of ARA II, the risk to the fetus cannot be excluded. According to a retrospective analysis, the use of ACE inhibitors in the first trimester of pregnancy was accompanied by the development of fetal and neonatal pathology. HCTC penetrates through the placenta. Thiazide diuretics, including HCTC, may cause fetal or neonatal jaundice or thrombocytopenia during pregnancy, as well as other adverse reactions seen in adult patients. Inadvertent administration of valsartan in pregnant women has resulted in cases of spontaneous abortions, scarcity of water, and renal dysfunction in the newborn. There are insufficient data on the use of amlodipine in pregnant women to judge its effect on the fetus.
If pregnancy is diagnosed during treatment with Co-Vamloset, the drug should be discontinued as soon as possible.
It is unknown whether valsartan and/or amlodipine are excreted with breast milk. Excretion of valsartan with breast milk has been reported in experimental studies. HCTS is also excreted with breast milk. Co-Vamloset is contraindicated during breastfeeding.
Weight | 0.037 kg |
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Shelf life | 2 years. Do not use the product after the expiration date. |
Conditions of storage | At a temperature not exceeding 25°C, in the original contour cell pack. Store out of reach of children. |
Manufacturer | KRKA-RUS, Russia |
Medication form | pills |
Brand | KRKA-RUS |
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