Buy Atacand Plus tablets 16mg + 12.5mg No. 28 in pharmacies

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

Atacand Plus is an antihypertensive combination drug. Angiotensin type 2 is important in the pathogenesis of heart failure, arterial hypertension and other diseases of the circulatory system. The main effects of angiotensin type 2 are vasoconstriction, stimulation of aldosterone , correction of water-electrolyte status and activation of cell growth. The effects are associated with the interaction of angiotensin type 2 with angiotensin type 1 receptors.

Candesartan is a selective antagonist of angiotensin receptor 2, does not suppress angiotensin-converting enzyme (converts angiotensin type I into angiotensin type II, which inactivates bradykinin ), and does not cause accumulation of bradykinin and substance P. A dose-dependent increase in the content of angiotensin type 1, renin, angiotensin type 2 and a decrease in the content of aldosterone in the blood occurs as a result of suppression of AT1 type receptors of angiotensin type 2.

Candesartan does not interact with receptors other than those mentioned above and does not inhibit ion channels .

Hydrochlorothiazide is a diuretic from the thiazides , inhibits the active reabsorption of sodium ions in the distal parts of the renal tubules and stimulates the release of chlorine, sodium and water ions. excretion of magnesium and potassium is stimulated in a dose-dependent manner, and calcium is reabsorbed to a much greater extent than before.

Reduces the volume of extracellular fluid and plasma, suppresses the intensity of blood transport through the heart, and lowers pressure. After long-term treatment, the effect develops due to an increase in arterioles .

Candesartan and hydrochlorothiazide have a cumulative hypotensive effect. In people with arterial hypertension, the drug causes a prolonged decrease in pressure without increasing the contractile activity of the heart. Orthostatic hypotension is not observed at the initial stages of treatment; after completion of treatment, arterial hypertension does not increase.

After one dose of the drug, the hypotensive effect is detected after 2 hours. Using the drug once a day gently and effectively lowers blood pressure for 24 hours. With long-term treatment, a reliable decrease in pressure occurs after four weeks. The effectiveness of the drug does not depend on age or gender.

Pharmacokinetics

Candesartan cilexetil . Prodrug for internal use. When absorbed from the intestine, cilexetil candesartan , undergoing ether hydrolysis , is quickly transformed into the active substance tightly bound to AT1 - candesartan . Absolute bioavailability reaches 14%. Food intake does not affect pharmacokinetics.

The maximum concentration in the blood occurs four hours after consuming the drug. The interaction of candesartan with plasma proteins reaches 99%. Pharmacokinetic parameters do not depend on the gender of the patient.

It is excreted in urine and bile in its original form, and undergoes changes in the liver to an extremely small extent. The half-life of candesartan is approximately 9 hours. Accumulation of the drug in the body is not detected.

Hydrochlorothiazide . Rapidly absorbed from the intestines. Bioavailability reaches 70%. Taken together with food increases the level of absorption by 15%. Interaction with plasma proteins is 60%. It is not metabolized and is excreted through the kidneys. The half-life is 8 hours. 70% of the dose is excreted by the kidneys within two days.

Pharmacological properties of the drug Atacand plus

Pharmacodynamics . Candesartan cilexetil is a prodrug that, during absorption in the gastrointestinal tract, is rapidly converted into the active substance, candesartan, by hydrolysis of the ester bond. Candesartan is an angiotensin II receptor antagonist, selective for AT1 receptors, with strong binding to the receptor and slow dissociation from it, but does not have agonist activity. Candesartan does not affect ACE and other enzyme systems, which is usually associated with the use of ACE inhibitors, since it does not affect the breakdown of kinins into other substances (substance P). Angiotensin II antagonist practically does not cause cough. Candesartan does not bind to or block other hormone receptors and ion channels. Antagonism of angiotensin II receptors (AT1) leads to a dose-dependent increase in the levels of plasma renin, angiotensin I and II, as well as a decrease in the concentration of aldosterone in the blood plasma. Hydrochlorothiazide blocks sodium reabsorption, mainly in the distal renal tubules, and promotes the excretion of sodium, chloride and water. Renal excretion of potassium and magnesium increases in a dose-dependent manner, whereas calcium is reabsorbed to a greater extent. Hydrochlorothiazide reduces the volume of blood plasma, extracellular fluid and IOC, and reduces blood pressure. With prolonged therapy, OPSS decreases, which helps lower blood pressure. Candesartan and hydrochlorothiazide have an additive antihypertensive effect. In case of hypertension (arterial hypertension), the use of Atacanda Plus leads to an effective and long-lasting decrease in blood pressure without a reflex increase in heart rate. There is no information regarding severe hypotension after the first dose and withdrawal symptoms. After a single dose of Atacanda Plus, the onset of the antihypertensive effect usually occurs within 2 hours. With continuous treatment, the optimal reduction in blood pressure is achieved within 4 weeks and is maintained with prolonged treatment. Atacand Plus, when taken once a day, provides an effective and uniform reduction in blood pressure over 24 hours with a small difference between the maximum and minimum effects between doses of the drug. The effectiveness of Atakanda Plus does not depend on the age and gender of the patient. There are currently no data on the use of candesartan cilexetil/hydrochlorothiazide in renal disease/nephropathy, left ventricular dysfunction/congestive heart failure and after myocardial infarction. Pharmacokinetics . Absorption and distribution . Candesartan cilexetil after oral administration is converted to the active substance candesartan. Absolute bioavailability is 40%. The maximum concentration in blood plasma is achieved 3–4 hours after taking the drug. The concentration of candesartan in the blood plasma increases linearly with increasing dose within its therapeutic value. There were no significant differences in the pharmacokinetics of candesartan. Concomitant food intake does not significantly affect AUC. Candesartan is highly bound to plasma proteins (99%). The apparent volume of distribution of candesartan is 0.1 l/kg. Hydrochlorothiazide is rapidly absorbed from the gastrointestinal tract with an absolute bioavailability of 70%. Concomitant food intake improves absorption by approximately 15%. Bioavailability may be reduced in patients with heart failure and severe edema. The binding of hydrochlorothiazide to plasma proteins is about 60%, the apparent volume of distribution is about 0.8 l/kg. Metabolism and excretion Candesartan cilexetil is excreted mainly unchanged in urine and bile, and only in small amounts is metabolized by the liver (CYP 2C9). Existing interaction studies indicate no effect on CYP 2C9 and CYP 3A4. Based on in vitro , in vivo with drugs whose metabolism is dependent on the cytochrome P450 isoenzymes CYP 1A2, CYP 2A6, CYP 2C9, CYP 2C19, CYP 2D6, CYP 2E1 or CYP 3A4 are not expected. The half-life of candesartan is about 9 hours. There is no accumulation of the drug after repeated multiple doses. The half-life of candesartan does not change after taking candesartan cilexetil in combination with hydrochlorothiazide. There is an increase in AUC (15–18%) and maximum concentration (23–24%) of candesartan when used in combination with hydrochlorothiazide, but this is not clinically significant. In addition, before switching to the use of Atacanda Plus, separate titration of the constituent components of the drug is recommended. No additional accumulation of candesartan was observed after repeated doses of this combination compared to monotherapy. The total plasma clearance of candesartan is about 0.37 ml/min/kg, and the renal clearance is about 0.19 ml/min/kg. Candesartan is excreted by the kidneys by glomerular filtration and active tubular secretion. Following oral administration of 14C-labeled candesartan cilexetil, approximately 26% of the dose is excreted in the urine as candesartan and 7% as an inactive metabolite, while 56% of the dose is recovered in the feces as candesartan and 10% as an inactive metabolite. Hydrochlorothiazide is not metabolized and is excreted mainly unchanged by glomerular filtration and active tubular secretion. The final half-life is 8 hours. About 70% of a dose taken orally is excreted in the urine within 48 hours. The half-life of hydrochlorothiazide does not change when combined with candesartan cilexetil. No additional accumulation of hydrochlorothiazide was detected after repeated doses of the combination compared to monotherapy. Pharmacokinetics in special categories of patients Candesartan cilexetil In elderly patients (over 65 years of age), the maximum concentration and AUC of candesartan increase by approximately 50 and 80%, respectively, compared with young people. However, the hypotensive effect and the incidence of adverse reactions after taking Atacanda Plus are the same in young patients and the elderly. In patients with mild to moderate renal impairment, compared with patients without renal impairment, the maximum concentration and AUC for candesartan increased after repeated dosing by 50 and 70%, respectively, but the half-life remained unchanged. The change in maximum concentration and AUC in patients with severe renal impairment was 50 and 110%, respectively. The terminal half-life of candesartan doubles in patients with severe renal impairment. Pharmacokinetics in patients on hemodialysis were the same as in patients with severe renal failure. The AUC of candesartan in patients on hemodialysis was similar to that in patients with severe renal impairment. In patients with mild to moderate hepatic impairment, a 23% increase in the AUC of candesartan was observed. Hydrochlorothiazide The final half-life of hydrochlorothiazide is increased in renal failure.

Contraindications

• Anuria.
• Liver damage or cholestasis .
• Kidney damage.
• Refractory hypercalcemia and hypokalemia .
• Gout.
• Pregnancy.
• Lactation.
• Age less than 18 years.
• Hypersensitivity to sulfonamide .
• Hypersensitivity to the components of the drug.

Use Atacand Plus with caution in severe forms of heart failure , bipolar stenosis of the renal arteries , hemodynamically significant narrowing of the aortic or mitral valves, cerebrovascular diseases, coronary heart disease, obstructive hypertrophic cardiomyopathy, liver cirrhosis , reduced blood volume, primary hyperaldosteronism, lactose intolerance, renal failure, hyponatremia , surgery, kidney transplantation and diabetes mellitus .

Side effects

Side effects of cilexetil candesartan :

• from the hematopoietic system – neutropenia, leukopenia, agranulocytosis ;
• from the digestive system - nausea , liver damage, increased levels of liver enzymes, hepatitis ;
• from the musculoskeletal system – arthralgia, lumbodynia, myalgia ;
• from the nervous system – headache , dizziness ;
• from the genitourinary system – kidney damage;
• from the metabolic side - hyponatremia, hyperkalemia ;
• allergic reactions – urticaria , rash , angioedema , itching .

Side effects of hydrochlorothiazide :

• from the hematopoietic system - neutropenia, leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia, bone marrow depression ;
• from the nervous system - dizziness , headache, depression , sleep disturbance , paresthesia ;
• from the sensory organs – blurred image;
• from the circulatory system - orthostatic hypotension, necrotizing vasculitis, arrhythmia, cutaneous vasculitis ;
• from the respiratory system – difficulty breathing;
• from the digestive system - pancreatitis , diarrhea , constipation , cholestatic jaundice ;
• from the musculoskeletal system – myalgia ;
• from the genitourinary system - glucosuria , kidney damage, nephritis ;
• from the metabolic side - hyperuricemia, hyperglycemia, hypokalemia, hyponatremia, hypertriglyceridemia, hypercholesterolemia, increased creatinine ;
• allergic reactions - anaphylactic reactions , rash , urticaria , erythematous-like skin reactions.

Side effects of the drug Atacand plus

During controlled clinical trials with candesartan cilexitil/hydrochlorothiazide, side effects were mild and transient. Treatment discontinuation rates due to adverse reactions were comparable for candesartan cilexetil/hydrochlorothiazide (3.3%) and placebo (2.7%). During clinical trials with candesartan cilexetil/hydrochlorothiazide, the following common (1/100) side effects were reported (the incidence of side effects was at least 1% higher than the rate of these side effects with placebo). Candesartan cilexetil/hydrochlorothiazide From the central nervous system: dizziness/vertigo. Candesartan cilexetil Since the introduction of the drug into widespread practice, the following adverse reactions have been reported very rarely (≤1/10,000): From the blood and lymphatic system: leukopenia, neutropenia and agranulocytosis. From the side of water and electrolyte balance: hyperkalemia, hyponatremia. From the side of the central nervous system: dizziness, headache. From the gastrointestinal tract: nausea. From the hepatobiliary system: increased levels of liver enzymes, impaired liver function, hepatitis. From the skin and subcutaneous tissue: angioedema, rash, urticaria, itching. From the musculoskeletal system: back pain, arthralgia, myalgia. From the urinary system: impaired renal function, including renal failure in patients with an increased risk of developing this condition. Hydrochlorothiazide When monotherapy with hydrochlorothiazide at a dose of ≥25 mg, the following adverse reactions were reported with an incidence: often (1/100), uncommon (1/1000 and ≤1/100) and rare (≤1/1000). From the blood and lymphatic system: rarely - leukopenia, neutropenia/agranulocytosis, thrombocytopenia, aplastic anemia, bone marrow suppression, hemolytic anemia. From the immune system: rarely - anaphylactic reactions. From the side of metabolism and water-electrolyte balance: often - hyperglycemia, hyperuricemia, hyponatremia and hypokalemia. Mental disorders: rarely - dyssomnia, depression, anxiety. From the side of the central nervous system: often - dizziness, vertigo; rarely - paresthesia. On the part of the organ of vision: rarely - transient visual impairment in the form of blurred objects. From the cardiovascular system: infrequently - postural hypotension; rarely - arrhythmia, necrotizing vasculitis. From the respiratory system: rarely - disturbance of external respiration, including pneumonitis and pulmonary edema. From the gastrointestinal tract: infrequently - anorexia, irritation of the gastric mucosa, diarrhea, constipation; rarely - pancreatitis. From the hepatobiliary system: rarely - cholestatic jaundice. From the skin and subcutaneous tissue: infrequently - rash, urticaria, photosensitivity; rarely - toxic epidermal necrolysis, skin lupus-like reactions, reactivation of skin manifestations of systemic lupus erythematosus. From the musculoskeletal system: rarely - muscle spasm. From the urinary system: often - glucosuria; rarely - renal dysfunction and interstitial nephritis. General disorders: often - weakness; rarely - fever. Laboratory indicators: often - increased levels of cholesterol and TG in the blood plasma; infrequently - increased levels of blood urea nitrogen and creatinine in the blood plasma. Increases in plasma uric acid, glucose and ALT levels as side effects were reported more frequently with candesartan cilexetil/hydrochlorothiazide (incidence 1.1, 1.0 and 0.9%, respectively) than with placebo (incidence 0. 4; 0.2 and 0%, respectively). A slight decrease in hemoglobin and an increase in AST were noted in one patient receiving candesartan cilexetil/hydrochlorothiazide. Increases in creatinine, urea, or potassium levels and decreases in sodium levels were determined.

Overdose

Symptoms: the main manifestations of an overdose of candesartan are a pronounced decrease in blood pressure and dizziness . The main symptoms of hydrochlorothiazide are acute loss of water and electrolytes. Symptoms such as dizziness, low blood pressure, ventricular arrhythmia, tachycardia , and muscle cramps are possible.

Treatment: symptomatic, stabilization of the patient's condition. A supine position with legs elevated is recommended. If it is necessary to increase the volume of circulating blood, isotonic sodium chloride . Hemodialysis is not effective.

Overdose of the drug Atacand plus, symptoms and treatment

Symptoms: Based on pharmacological analysis, the main manifestations of overdose are likely to include symptomatic hypotension and dizziness. The report of an individual case of overdose (dose up to 672 mg of candesartan cilexetil) reports a favorable outcome without consequences for the patient's health. The main manifestation of hydrochlorothiazide overdose is acute loss of fluid and electrolytes. Dizziness, hypotension, thirst, tachycardia, ventricular arrhythmia, sedation/loss of consciousness, and convulsions may also occur. Treatment: There are no specific data regarding the treatment of overdose with Atacand Plus. In case of overdose, it is necessary to induce vomiting or perform gastric lavage. If symptomatic hypotension occurs, treat symptomatically and monitor vital signs. The patient is placed on his back with his legs slightly elevated. Infusion therapy is carried out (isotonic solution of sodium chloride) to increase the volume of blood volume. If necessary, monitor and adjust electrolyte balance and COR. If the effect of the therapy is insufficient, symptomatic medications are used. Candesartan is not eliminated by hemodialysis. It is not known to what extent hydrochlorothiazide is eliminated during hemodialysis.

Interaction

Hydrochlorothiazide, Digoxin, Warfarin, Glibenclamide, oral contraceptives, Nifedipine and E nalapril do not reveal any particular interactions with the components of Atacanda Plus.

The use of Atacanda Plus with other antihypertensive drugs enhances the hypotensive effect. The effects of hydrochlorothiazide , which cause potassium loss, can be potentiated by other drugs that stimulate hypokalemia and potassium loss ( diuretics, Amphotericin, laxatives, Penicillin G sodium, Carbenoxolone, salicylic acid derivatives ).

Potassium-sparing diuretics , potassium-containing salt substitutes, potassium preparations and other drugs that increase potassium levels in the blood when taken together with Atacand Plus lead to hyperkalemia .

Simultaneous therapy lithium preparations causes a reversible increase in the concentration of lithium in the blood and the development of characteristic toxic reactions.

Absorption of hydrochlorothiazide is weakened by the use of K olestipol and K olestyramine .

Thiazide-like diuretics calcium levels in the blood, enhance the hyperglycemic effect of beta-blockers and diazoxide , increase sensitivity to glucose, slow down the excretion of cytostatics ( cyclophosphamide , methotrexate ) and activate their myelosuppressive effect .

The effects of non-depolarizing muscle relaxants are enhanced by hydrochlorothiazide.

Anticholinergics ( B iperidine, Atropine ) increase the bioavailability of diuretics from the thiazides group due to weakening of intestinal motility.

Hydrochlorothiazide can weaken the effect of vasoconstrictor amines ( epinephrine ) and increase the likelihood of acute renal failure .

Use of the drug Atacand plus

The recommended dose of Atacanda Plus is 1 tablet per day. Before transferring the patient to Atacanda Plus, the dose of candesartan cilexetil should be titrated. If clinically appropriate, a direct transition from the use of single drugs to the combination drug Atacand Plus is possible. The most pronounced antihypertensive effect is achieved within 4 weeks from the start of treatment. Atacand Plus is taken 1 time per day at the same time or regardless of meals. In elderly patients, no adjustment of the initial dose is required. Use for hypovolemia . Titration of the drug dose is recommended if there is an increased risk of hypotension, for example, with a possible decrease in blood volume (in such patients, the initial dose of candesartan can be reduced to 4 mg). These patients are not recommended to use the combination drug at a dose of 16/12.5 mg; use the single drug candesartan cilexetil (Atacand) at a dose of 4 or 8 mg, depending on the severity and tolerability, with the addition of an appropriate dose of hydrochlorothiazide if necessary. Use for renal failure. In this case, the use of loop diuretics is preferable to thiazides. It is recommended to titrate the dose of candesartan cilexetil for patients with renal impairment with creatinine clearance ≥30 ml/min/1.73 m2 body surface area (BSA) before initiation of treatment with Atacand Plus (for patients with mild to moderate renal impairment, the recommended starting dose of candesartan cilexetil is 4 mg). Atacand Plus should not be used to treat patients with severe renal impairment (creatinine clearance ≤30 ml/min/1.73 m2 BSA). Use for liver failure . It is recommended to titrate the dose of candesartan cilexetil for patients with mild to moderate hepatic impairment before starting treatment with Atacand Plus (the recommended starting dose of candesartan cilexetil for such patients is 2 mg). Atacand Plus should not be used to treat patients with severe liver failure and/or cholestasis. Use in children . The safety and effectiveness of Atacanda Plus in children have not been established.

special instructions

The occurrence of allergic reactions to hydrochlorothiazide is most common in patients suffering from bronchial asthma , a history of hypersensitivity reactions however, it is possible that similar symptoms may occur in other patients.

When using thiazide-like diuretics, congestive seborrhea have been reported .

The drug contains lactose , so it should not be taken by patients with low lactose tolerance, lactase deficiency or impaired absorption of glucose or lactose .

Caution must be exercised while driving with Atacand Plus during treatment.

Atacand plus Tablets, 28 pcs, 16 + 12.5 mg + mg

special instructions

Impaired renal function In this situation, the use of “loop” diuretics is preferable to thiazide-like ones. For patients with renal failure during therapy with Atacand Plus, it is recommended to constantly monitor the levels of potassium, creatinine and uric acid. Kidney transplantation There are no data on the use of Atacanda Plus in patients who have recently undergone a kidney transplant. Renal artery stenosis Other drugs that affect the RAAS (eg, ACE inhibitors) may increase blood urea and serum creatinine in patients with bilateral renal artery stenosis or arterial stenosis of a solitary kidney. A similar effect should be expected from angiotensin II receptor antagonists. Decreased blood volume In patients with intravascular volume and/or sodium deficiency, symptomatic arterial hypotension may develop: it is not recommended to use Atacand Plus until these symptoms disappear. General anesthesia and surgery In patients receiving angiotensin II antagonists, hypotension may develop during anesthesia and during surgery as a result of blockade of the renin-angiotensin system. Very rarely, cases of severe arterial hypotension may occur, requiring IV fluids and/or vasoconstrictors. Hepatic impairment Patients with impaired liver function or progressive liver disease should use thiazide-like diuretics with caution: minor fluctuations in fluid volume and electrolyte composition may cause hepatic coma. There are no data on the use of Atacand Plus in patients with liver failure. Aortic and mitral valve stenosis (hypertrophic obstructive cardiomyopathy) When prescribing Atacand Plus to patients with obstructive hypertrophic cardiomyopathy or hemodynamically significant stenosis of the aortic or mitral valve, caution should be exercised. Primary hyperaldosteronism Patients with primary hyperaldosteronism are usually resistant to treatment with antihypertensive drugs that affect the RAAS. In this regard, it is not recommended to prescribe Atacand Plus to such patients. Violation of water-salt balance As in all cases of taking drugs that have a diuretic effect, electrolytes in the blood plasma should be monitored. Thiazide-based drugs that have a diuretic effect can reduce the excretion of calcium ions in the urine and can cause sudden changes and a slight increase in the concentration of calcium ions in the blood plasma. Thiazides, incl. and hydrochlorothiazide, can cause disturbances in water-salt balance (hypercalcemia, hypokalemia, hyponatremia, hypomagnesemia and hypochloremic alkalosis). Detected hypercalcemia may be a sign of latent hyperthyroidism. The use of thiazide-like diuretics should be discontinued until results of parathyroid tests are available. Hydrochlorothiazide increases potassium excretion in a dose-dependent manner, which may cause hypokalemia. This effect of hydrochlorothiazide is less pronounced when used in combination with candesartan cilexetil. The risk of hypokalemia appears to be increased in patients with liver cirrhosis, increased diuresis, taking fluids with a reduced salt content, and undergoing concurrent treatment with corticosteroids or ACTH. Based on experience with drugs that affect the renin-angiotensin-aldosterone system, concurrent use of Atacand Plus and diuretics that increase potassium excretion can be compensated by the use of nutritional supplements containing potassium or other drugs that can increase the content of potassium in the blood plasma. The use of Atacand Plus may cause hypokalemia, especially in patients with cardiac or renal failure (such cases have not been documented). Thiazide-like diuretics increase magnesium excretion, which may cause hypomagnesemia. Effect on metabolism and endocrine system The use of thiazide-like diuretics can change the level of glucose in the blood up to the manifestation of latent diabetes mellitus. Dosage adjustment of hypoglycemic agents, including insulin, may be required. Increases in plasma cholesterol and triglyceride levels have been associated with the use of thiazide-like diuretics. However, when using Atacand Plus at a dose of 12.5 mg, minimal or no such effects were observed. Thiazide-like diuretics increase plasma uric acid concentrations and may precipitate gout in predisposed patients. General Patients whose vascular tone and renal function are predominantly dependent on the activity of the RAAS (for example, patients with severe chronic heart failure, kidney disease, including renal artery stenosis) are especially sensitive to drugs acting on the RAAS. The prescription of such drugs is accompanied in these patients by severe arterial hypotension, azotemia, oliguria and, less commonly, acute renal failure. The possibility of developing these effects cannot be excluded when using angiotensin II receptor antagonists. A sharp decrease in blood pressure in patients with ischemic cardiopathy, cerebrovascular diseases of ischemic origin when using any antihypertensive drugs can lead to the development of myocardial infarction or stroke. The manifestation of hypersensitivity reactions to hydrochlorothiazide is most likely in patients with bronchial asthma, a history of allergic reactions; which does not exclude the occurrence of allergic symptoms in other patients. When using thiazide-like diuretics, there have been cases of exacerbation or the appearance of symptoms of congestive seborrhea. The drug contains lactose, so it should not be taken by patients with rare hereditary diseases manifested by lactose intolerance, lactose deficiency or impaired absorption of glucose and lactose. Use in pediatrics The safety and effectiveness of Atacanda Plus in children and adolescents under 18 years of age have not been established. Effect on the ability to drive vehicles and operate machinery The effect on the ability to drive a car or operate machinery has not been studied, but the pharmacodynamic properties of the drug indicate that there is no such effect. Patients should be careful when driving or operating machinery, as dizziness and increased fatigue may occur during treatment.

Analogs

Level 4 ATX code matches:
Diokor

Gizaar

Teveten Plus

Co Diovan

Mikardis Plus

Vazar N

Valz N

Analogs of Atakanda Plus: Candecor H , Candecor HD, Khizart-N-DS .