Lercamen Duo, 10 mg+20 mg 28 pcs

The drug is a combination of an ACE inhibitor and a slow calcium channel blocker.

Indications

• Essential hypertension (ineffective monotherapy with lercanidipine 10 mg) – dose 10 mg+10 mg;
• Essential hypertension (ineffective monotherapy with enalapril 20 mg) – dose 10 mg+20 mg.

Active ingredient

Lercanidipine, Enalapril

How to take, the dosage

Tablets are taken orally, preferably in the morning, at least 15 minutes before a meal, without chewing, with plenty of water. Do not drink grapefruit juice.

Coripren® is not intended for initial treatment of hypertension.

If monotherapy with lercanidipine 10 mg is ineffective, the drug Coripren® 10 mg lercanidipine + 10 mg enalapril should be started.

If monotherapy with enalapril 20 mg is ineffective, Coripren® 10 mg lercanidipine + 20 mg enalapril should be started. The dose of the drug shall be determined by the physician.

Interaction

The antihypertensive effect of Coripren can be potentiated by other BP-lowering drugs, such as diuretics, beta-adrenoblockers, alpha-adrenoblockers, and others.

Special Instructions

Patients with severe arterial hypotension with systolic BP less than 90 mm Hg require special attention during treatment of arterial hypertension,

Transient arterial hypotension is not a contraindication to the continuation of therapy since after the BOD replenishment an adequate response to the drug administration can be expected.

Particular caution should be exercised in the initial stages of treatment in patients with mild to moderate renal insufficiency.
Patients with bilateral renal artery stenosis or artery stenosis of the only functioning kidney are particularly at risk of hypotension or renal failure due to ACE inhibitors. For this group of patients, treatment should be performed under close supervision of a physician, with careful dosage selection and prescription of low doses of the drug. Renal function should be monitored before and during treatment.

Particular caution should be exercised during the initial stages of treatment in patients with mild to moderate degree of hepatic function insufficiency. In case of jaundice and significant increase in liver enzymes activity, the ACE inhibitors should be stopped immediately and a physician should be consulted.

Due to increased risk of anaphylactic reactions the drug should not be administered to patients undergoing hemodialysis with high strength polyacrylonitrile membranes (AN69) undergoing low density lipoprotein apheresis with dextran sulfate and immediately before desensitization to wasp or bee venom.

Like other ACE inhibitors, it has less pronounced antihypertensive effect in patients of the Negro race compared to other races.

Enalapril administration may result in angioedema of the face, limbs, tongue, pharynx or larynx. If this occurs, the drug should be stopped immediately. Angioedema of the larynx may be fatal. Angioedema of the tongue, pharynx or larynx may cause airway obstruction, 0.3-0.5 ml of epinephrine (adrenaline) solution 1:1000 by injection and airway patency should be maintained (intubation or tracheostomy).

The incidence of angioedema is higher among patients of the Negro race receiving ACE inhibitor therapy than among patients of other races.

Patients with a history of angioedema not associated with the use of ACE inhibitors have an increased risk of developing angioedema when using any ACE inhibitor.

Before surgical procedures (including dentistry) the surgeon/anesthesiologist should be warned about the use of ACE inhibitors. During surgical interventions and/or during general anesthesia with the use of agents causing arterial hypotension, ACE inhibitors may block angiotensin II formation in response to compensatory renin release. If in this case a marked BP decrease develops due to such a mechanism, it can be corrected by the increase of the circulatory volume.

Hyperkalemia may develop against the background of therapy with ACE inhibitors, including enalapril. Risk factors of hyperkalemia are renal insufficiency, elderly age, diabetes mellitus, some concomitant conditions (decreased BOD, decompensated acute heart failure, metabolic acidosis), simultaneous use of potassium-saving diuretics (such as spironolactone, eplerenone, triamterene, amiloride), potassium preparations or potassium-containing table salt substitutes and use of other drugs thatbr> contributing to an increase in plasma potassium content (e.g., heparin). Hyperkalemia can lead to serious cardiac rhythm disturbances, sometimes fatal. The combined use of the above drugs should be conducted with caution.
It is not recommended to drink alcohol during therapy with the drug.

There is information about reversible biochemical changes in sperm heads when using calcium channel blockers, which may impair their ability to fertilize.

Effect on driving and operating machinery

It is necessary to be aware of the possibility of weakness and drowsiness, so caution should be exercised when performing work requiring increased attention, especially at the beginning of treatment, when increasing the dose of the drug and when driving vehicles.

Contraindications

• Left ventricular outflow tract abnormalities including aortic valve stenosis;
• chronic heart failure in decompensation;
• heritable and/or idiopathic angioedema (including a history of
• anhyoneurotic edema when using ACE inhibitors (in anamnesis);
• unstable angina pectoris;
• the first month after myocardial infarction (within 28 days);
• severe renal insufficiency (CK < 30 ml/min), including patients on hemodialysis;
• severe hepatic insufficiency;
• lactase deficiency, lactose intolerance, glucose/galactose malabsorption syndrome;
• children and adolescents under 18 years of age;
• high sensitivity to lercanidipine, enalapril or any other ACE inhibitor and other PBMCs, dihydropyridine derivatives, or any other component of the drug.

With caution

• Sinus node weakness syndrome (without concomitant use of an artificial pacemaker);
• left ventricular dysfunction and CHD;
• renal insufficiency (CK more than 30 ml/min);
• Renovascular hypertension;
• a post renal transplant condition (experience with limited use);
• hepatic insufficiency;
• inhibition of medullary hematopoiesis;
• severe autoimmune diseases of connective tissue (including.ч. scleroderma, systemic lupus erythematosus);
• current use with immunosuppressants, allopurinol, procainamide;
• diabetes mellitus;
• Patients on a salt restricted diet;
• hyperkalemia;
• CRC-associated conditions includingdiarrhea, vomiting, primary aldosteronism.
  

Side effects

The incidence of adverse events was classified as follows: very common (1/10), common (1/100), infrequent (1/1000), rare (1/10,000), very rare (<1/10,000).

Overdose

There is no information about the drug overdose. Presumably, in case of overdose it may cause conditions caused by overdose of any of the active substances.

Lercanidipine
Symptoms: peripheral vasodilation with marked BP reduction and reflex tachycardia, vomiting.
Treatment: treatment is symptomatic, the choice of treatment depends on the degree of overdose and on the observed symptoms. The following methods of medical care are used: gastric lavage, high doses of catecholamines, furosemide, cardiac glycosides and plasma substitutes, activated charcoal, laxatives and intravenous dopamine. Also, to prevent bradycardia, intravenous injection of atropine is possible.

Enalapril
Symptoms: the main sign of overdose is a marked decrease in BP, which is accompanied by blockade of the renin-angiotensin-aldosterone system. Collapse, electrolyte imbalance, renal failure, hyperventilation, tachycardia, palpitations, bradycardia, dizziness, anxiety and cough may also develop.

Treatment: treatment is symptomatic. In severe cases, intravenous injection of 0.9% sodium chloride solution and, if possible, infusion of angiotensin II and/or catecholamines is recommended. If the symptoms of overdose developed immediately after taking the drug, it is necessary to induce vomiting, gastric lavage and take drugs from the group of adsorptive agents or sodium sulfate.