Logimax (long-acting tablet 5mg/50mg No. 30)

A country

Sweden
The country of production may vary depending on the batch of goods. Please check with the operator for detailed information when confirming your order.

Active substance

Metoprolol + Felodipine

Compound

Active ingredients: felodipine + metoprolol.

pharmachologic effect

Hypotensive. Blocks myocardial beta1-adrenergic receptors (metoprolol) and inhibits the entry of calcium ions into vascular smooth muscle cells (felodipine). Completely absorbed from the gastrointestinal tract. The half-life of felodipine is 25 hours, metoprolol is 3-5 hours. The active substances are metabolized in the liver. Metoprolol reduces the stimulating effect of catecholamines on the myocardium, cardiac output and blood pressure. Felodipine relaxes the smooth muscles of the vascular wall, reduces total peripheral vascular resistance and potentiates (mutually) metoprolol-induced hypotension. The hypotensive effect is stable for 24 hours.

Indications for use

Hypertension, symptomatic arterial hypertension.

Mode of application

Inside, in the morning, without chewing, with liquid, 1 tablet. 1 time per day; if necessary, 1 table. 2 times a day.

Interaction

Calcium channel blockers such as verapamil potentiate the negative ino- and chronotropic effect. It enhances the negative ino- and dromotropic effect of antiarrhythmic drugs (quinidine analogues, amiodarone), and the cardiodepressive effect of inhalational anesthetics. The concentration of metoprolol in plasma is increased by cimetidine, hydralazine, and alcohol, and decreased by rifampicin. Indomethacin and other prostaglandin synthetase inhibitors weaken the hypotensive effect.

Side effect

From the nervous system and sensory organs: headache, weakness, dizziness, paresthesia, depression, decreased concentration, drowsiness or insomnia, nervousness, anxiety, blurred vision, dry or irritated eyes, conjunctivitis, amnesia, confusion, hallucinations, noise in ears, impaired taste. From the cardiovascular system and blood (hematopoiesis, hemostasis): facial flushing, bradycardia, palpitations, postural disturbances, cold extremities, peripheral edema, tachycardia, AV block of the first degree, pain in the heart, syncope, gangrene in patients with severe peripheral circulatory disorders, thrombocytopenia. From the respiratory system: shortness of breath on exertion, rhinitis. From the gastrointestinal tract: nausea, abdominal pain, diarrhea or constipation, vomiting, weight loss; dry mouth, changes in liver function tests, hyperplasia of the mucous membrane, increased concentration of liver enzymes. From the genitourinary system: impotence, sexual dysfunction. From the musculoskeletal system: myalgia, arthralgia. From the skin: rash (in the form of urticaria psoriasiform ), dystrophic skin lesions, hair loss; photosensitivity. Allergic reactions: angioedema.

Contraindications

Hypersensitivity, acute myocardial infarction, unstable angina, severe sinus bradycardia, AV block II-III degree, sick sinus syndrome, severe peripheral circulatory disorders, decompensated heart failure, cardiogenic shock, pregnancy, breastfeeding.

Overdose

Symptoms: hypotension, sinus bradycardia, AV block, heart failure, cardiogenic shock, cardiac arrest, bronchospasm, nausea, vomiting, cyanosis. Treatment: induction of vomiting, gastric lavage; symptomatic therapy.

special instructions

Should not be prescribed to patients with suspected acute myocardial infarction, with a heart rate less than 45 beats/min, with systolic blood pressure less than 100 mm Hg. Careful medical supervision is required when used simultaneously with ganglion blockers, other beta-blockers, and MAO inhibitors. When used concomitantly with clonidine and it is necessary to discontinue the latter, treatment with Logimax should be interrupted several days before discontinuation of clonidine. Before surgery, you should warn the anesthesiologist about taking the drug. Cancel gradually, over 1.5-2 weeks.

Dispensing conditions in pharmacies

On prescription

Logimax®

Co-administration with drugs that interact with the cytochrome P450 enzyme system may affect the concentration of metoprolol and felodipine in the blood plasma. There is no interaction between metoprolol and felodipine, since they are metabolized by various isoenzymes of the cytochrome P450 system.

Interactions with metoprolol

Metoprolol is a substrate for the CYP2D6 isoenzyme. Medicines that inhibit CYP2D6, such as quinidine, terbinafine, paroxetine, fluoxetine, sertraline, celecoxib, propafenone and diphenhydramine, may alter the plasma concentrations of metoprolol. It may be necessary to reduce the dose of Logimax® when used in combination with these drugs.

Quinidine:

Quinidine inhibits the metabolism of metoprolol in a special group of patients with “rapid” hydroxylation (in Sweden, approximately 90% of the population), causing mainly a significant increase in plasma concentrations of metoprolol and increased beta-blockade. It is believed that a similar interaction is typical for other beta-blockers, the metabolism of which involves cytochrome P4502D6.

Propaphenone:

when using propafenone in 4 patients treated with metoprolol, there was an increase in the plasma concentration of metoprolol by 2-5 times, while 2 patients had side effects characteristic of metoprolol. This interaction was confirmed in a study in 8 volunteers. The interaction is likely due to propafenone's inhibition, like quinidine, of the metabolism of metoprolol via the cytochrome P4502D6 system. Taking into account the fact that propafenone has beta-blocker properties, the combined use of Logimax® and propafenone does not seem appropriate.

Diphenhydramine:

diphenhydramine reduces the clearance of metoprolol to alpha-hydroxymetoprolol by 2.5 times. At the same time, an increase in the effect of metoprolol is observed.

Antiarrhythmics
:
Class I antiarrhythmics and beta-blockers, when used concomitantly, may result in additive negative inotropic effects, leading to serious hemodynamic side effects in patients with left ventricular dysfunction. The use of this combination should also be avoided in patients with sick sinus syndrome and impaired AV conduction. The interaction is described using disopyramide as an example.

Barbituric acid derivatives:

barbiturates (the study was conducted with phenobarbital) slightly increase the metabolism of metoprolol due to the induction of microsomal liver enzymes.

Nonsteroidal anti-inflammatory drugs (NSAIDs):

NSAIDs weaken the antihypertensive effect of beta-blockers. This interaction has been most studied for indomethacin. No reported interaction was observed for sulindac. This reaction was not observed in studies with diclofenac.

Phenylpropanolamine:

Phenylpropanolamine (norephedrine) in a single dose of 50 mg can cause an increase in diastolic blood pressure to pathological values in healthy volunteers. Propranolol mainly prevents the increase in blood pressure caused by phenylpropanolamine. However, beta-blockers may cause paradoxical hypertension reactions in patients receiving high doses of phenylpropanolamine. Several cases of hypertensive crisis have been reported while taking phenylpropanolamine.

Epinephrine:

10 cases of severe hypertension and bradycardia were reported in patients taking non-selective beta-blockers (including pindolol and propranolol) and receiving epinephrine. The interaction was also observed in the group of healthy volunteers. It is assumed that similar reactions can be observed when epinephrine is used together with local anesthetics if it accidentally enters the vascular bed. It is assumed that this risk is much lower with the use of cardioselective beta-blockers.

Amiodarone:

Concomitant use of amiodarone and metoprolol can lead to severe sinus bradycardia. Given the extremely long half-life of amiodarone (50 days), a possible interaction should be considered long after discontinuation of amiodarone.

Rifampicin:

Rifampicin may increase the metabolism of metoprolol, reducing plasma concentrations of metoprolol.

Clonidine:

The increase in blood pressure upon abrupt withdrawal of clonidine may be more pronounced when taken together with beta-blockers. When used together, if clonidine is discontinued, discontinuation of beta-blockers should begin several days before discontinuation of clonidine.

Verapamil and diltiazem:

when beta-blockers are used together with BMCCs such as verapamil and diltiazem, an increase in negative inotropic and chronotropic effects may be observed. BMCCs such as verapamil should not be administered intravenously.

Cardiac glycosides:

in combination with beta-blockers, they can disrupt AV conduction and cause bradycardia.

The concentration of metoprolol in blood plasma may increase when combined with cimetidine, hydralazine, selective serotonin reuptake inhibitors such as paroxetine, fluoxetine and sertraline. Patients concomitantly taking metoprolol and other beta-blockers (in the form of eye drops) or monoamine oxidase inhibitors (MAOIs) should be closely monitored. While taking beta-blockers, inhalational anesthetics enhance the cardiodepressive effect. While taking beta-blockers, patients receiving oral hypoglycemic agents may require dose adjustment of the latter.

Interactions with felodipine

Felodipine is a substrate for the CYP3A4 isoenzyme. Drugs that induce or inhibit the CYP3A4 isoenzyme have a significant effect on the plasma concentration of felodipine.

Drugs that induce the cytochrome P450 system:

phenytoin, carbamazepine, phenobarbital and rifampicin, as well as St. John's wort preparations enhance the metabolism of felodipine due to the induction of the cytochrome P450 system. The combined use of phenytoin, carbamazepine, phenobarbital and rifampicin leads to a decrease in the area under the concentration-time curve (AUC) by 93% and Cmax of felodipine by 82%. Avoid combined use with inducers of the CYP3A4 isoenzyme.

Drugs that inhibit the cytochrome P450 system:

Azole antifungals (itraconazole, ketoconazole), macrolide antibiotics (for example, erythromycin, clarithromycin) and HIV protease inhibitors are inhibitors of the CYP3A4 isoenzyme. When used together with itraconazole, felodipine Cmax increases 8 times, AUC increases 6 times. When co-administered with erythromycin, the Cmax and AUC of felodipine increase approximately 2.5-fold. The combined use of felodipine and inhibitors of the CYP3A4 isoenzyme should be avoided.

Grapefruit juice inhibits the enzyme system of the CYP3A4 isoenzyme. The use of felodipine with grapefruit juice increases the Cmax and AUC of felodipine by approximately 2 times. Concomitant use should be avoided.

Tacrolimus:

felodipine may cause an increase in tacrolimus plasma concentrations. When used together, it is recommended to monitor the concentration of tacrolimus in the blood serum; a dose adjustment of tacrolimus may be required.

Cyclosporine:

when cyclosporine and felodipine are used together, felodipine Cmax increases by 150%, AUC increases by 60%. However, the effect of felodipine on the pharmacokinetic parameters of cyclosporine is minimal.

Cimetidine:

The combined use of cimetidine and felodipine leads to an increase in Cmax and AUC of felodipine by 55%.

Logimax extended-release film-coated tablets 5 mg/50 mg 30 pcs.

Registration Certificate Holder

ASTRAZENECA (Sweden)

Dosage form

Medicine - Logimax® (Logimax)

Description

Extended-release film-coated tablets

pink with apricot tint, round, biconvex, with “A/FG” engraving on one side.

1 tab.

felodipine 5 mg metoprolol succinate 47.5 mg, which is resp. content of metoprolol tartrate 50 mg

Excipients

: sodium aluminosilicate, lactose anhydrous, hypromellose, hydroxypropylcellulose, ethylcellulose, silicon dioxide, polyoxyl 40 hydrogenated castor oil, microcrystalline cellulose, macrogol 6000, sodium stearyl fumarate, paraffin, propyl gallate, iron oxide yellow (E172), iron oxide red (E172), titanium dioxide (E171), purified water.

30 pcs. — plastic bottles (1) — cardboard packs.

Indications

arterial hypertension.

The drug can be used in cases where treatment with beta-blockers or slow calcium channel blockers of the dihydropyridine series, used as monotherapy, does not have a clinically significant effect.

Contraindications for use

AV block II and III degrees;
SSSU;
chronic heart failure in the decompensation stage (pulmonary edema, hypoperfusion or arterial hypotension) and continuous or intermittent inotropic therapy with β-adrenergic receptor agonists;
suspicion of the acute stage of myocardial infarction (heart rate less than 45 beats/min, PQ interval more than 0.24 seconds or systolic blood pressure less than 100 mm Hg);
cardiogenic shock;
unstable angina;
acute myocardial infarction;
symptomatic bradycardia;
arterial hypotension;
severe obliterating disorders of peripheral circulation with the threat of gangrene development;
pregnancy;
age under 18 years (efficacy and safety have not been established);
hypersensitivity to felodipine or metoprolol or other components of the drug.

with caution
(comparing benefit/risk) for severe renal failure (creatinine clearance <30 ml/min), aortic stenosis, liver dysfunction, myocardial infarction, arterial hypotension, acute metabolic acidosis, chronic heart failure, bronchial asthma.

In patients with bronchial asthma or chronic obstructive pulmonary disease, concomitant therapy with beta2-adrenergic agonists is necessary. When a patient starts taking Logimax®, it may be necessary to increase the dose of beta2-agonists.

pharmachologic effect

Combination antihypertensive drug. It has hypotensive, antianginal and antiarrhythmic effects.

The complementary mechanism of action of felodipine, which reduces peripheral vascular resistance, and metoprolol, which reduces cardiac output, leads to a more pronounced antihypertensive effect and better tolerability compared to monotherapy with felodipine and metoprolol. When taking Logimax, the reduction in blood pressure is stable and effective throughout the entire interval between doses (24 hours).

Felodipin

Felodipine, a dihydropyridine derivative, is a vasoselective slow calcium channel blocker and is intended for the treatment of arterial hypertension and stable angina. Felodipine is a racemic mixture.

The conductivity and contractility of vascular smooth muscle is inhibited by affecting the calcium channels of cell membranes. Due to its high selectivity for arteriole smooth muscle, felodipine in therapeutic doses does not have a negative inotropic effect on cardiac contractility or conduction.

The antihypertensive effect of felodipine is due to a decrease in peripheral vascular resistance. Felodipine effectively reduces blood pressure in patients with arterial hypertension both in a horizontal position and in a sitting and standing position, at rest and during physical activity. Since felodipine has no effect on venous smooth muscle or adrenergic vasomotor control, orthostatic hypotension does not occur. At the beginning of treatment, as a result of a decrease in blood pressure while taking felodipine, a temporary reflex increase in heart rate and cardiac output may be observed, which is leveled out when combined with beta-blockers. The effect of felodipine on blood pressure and peripheral vascular resistance correlates with the plasma concentration of felodipine. After achieving a stable equilibrium plasma concentration of felodipine, the antihypertensive effect persists for 24 hours.

Treatment with felodipine leads to reversal of left ventricular hypertrophy.

Felodipine relaxes the smooth muscles of the respiratory tract. Felodipine has been shown to have little effect on gastrointestinal motility. With long-term use, felodipine does not have a clinically significant effect on blood lipids. In patients with type 2 diabetes mellitus, no clinically significant effect on metabolic processes was observed when using felodipine for 6 months. Felodipine may also be prescribed to patients with reduced left ventricular function receiving standard therapy and to patients with asthma, diabetes mellitus, gout or hyperlipidemia.

Felodipine reduces vascular resistance in the kidneys, has a natriuretic and diuretic effect and does not have a kaliuretic effect (due to a decrease in tubular reabsorption of sodium and water). Felodipine has no effect on glomerular filtration and albumin excretion.

Metoprolol

Metoprolol is a cardioselective β1-adrenergic receptor antagonist; in therapeutic doses, it does not affect β2-adrenergic receptors, which are localized mainly in peripheral vessels and bronchi. It has a slight membrane-stabilizing effect and does not have internal sympathomimetic activity.

Beta-blockers have negative inotropic and chronotropic effects. Metoprolol reduces the stimulating effect of catecholamines on the myocardium and helps reduce heart rate, cardiac output and blood pressure. In a state of stress with increased secretion of adrenaline, metoprolol does not interfere with normal physiological vasodilation.

In therapeutic doses, metoprolol has a lesser contractile effect on the bronchial muscles than non-selective beta-blockers.

Metoprolol affects insulin secretion and carbohydrate metabolism to a lesser extent than non-selective beta-blockers, and therefore metoprolol can be prescribed to patients with diabetes mellitus. Metoprolol has less effect on cardiovascular reactions during hypoglycemia, such as tachycardia. When treated with metoprolol, blood glucose levels are restored to normal levels faster than when treated with non-selective beta-blockers.

Metoprolol reduces high blood pressure both in a standing and horizontal position, as well as during physical activity. At the beginning of therapy, metoprolol causes an increase in peripheral vascular resistance. However, with long-term treatment, a decrease in blood pressure is observed due to a decrease in peripheral vascular resistance with unchanged cardiac output. In patients with arterial hypertension, metoprolol reduces mortality from cardiovascular complications.

No changes in blood electrolyte balance were observed while taking metoprolol.

Drug interactions

Co-administration with substances that interact with the cytochrome P450 enzyme system may affect the concentration of felodipine and metoprolol in the blood plasma. There is no interaction between felodipine and metoprolol, since they are metabolized by various isoenzymes of the cytochrome P450 system.

Felodipin

Felodipine is a substrate for CYP3A4. Drugs that induce or inhibit CYP3A4 have a significant effect on felodipine plasma concentrations.

Drugs that induce isoenzymes of the cytochrome P450 system (phenytoin, carbamazepine, phenobarbital and rifampicin, as well as St. John's wort tincture) increase the metabolism of felodipine. The combined use of phenytoin, carbamazepine, phenobarbital and rifampicin leads to a decrease in felodipine AUC by 93% and Cmax by 82%. Co-administration with CYP3A4 inducers should be avoided.

Azole antifungals (itraconazole, ketoconazole), macrolide antibiotics (eg, erythromycin) and HIV protease inhibitors are inhibitors of the CYP3A4 enzyme system. When co-administered with itraconazole, the Cmax of felodipine increases by 8 times, and the AUC by 6 times. When erythromycin is co-administered, the Cmax and AUC of felodipine increases approximately 2.5 times. Co-administration of felidipine and CYP3A4 inhibitors should be avoided.

Grapefruit juice inhibits the CYP3A4 enzyme system. The use of felodipine with grapefruit juice increases the Cmax and AUC of felodipine by approximately 2 times. Concomitant use should be avoided.

Felodipine may cause an increase in tacrolimus plasma concentrations. When used together, it is recommended to monitor the concentration of tacrolimus in the blood serum; a dose adjustment of tacrolimus may be required.

When cyclosporine and felodipine are co-administered, Cmax of felodipine increases by 150%, AUC increases by 60%. However, the effect of felodipine on the pharmacokinetic parameters of cyclosporine is minimal.

The combined use of cimetidine and felodipine leads to an increase in Cmax and AUC of felodipine by 55%.

Metoprolol

Co-administration of Logimax with the following drugs should be avoided:

Barbiturates (study conducted with phenofarbital) slightly increase the metabolism of metoprolol due to enzyme induction.

When propafenone was prescribed to 4 patients treated with metoprolol, there was an increase in the plasma concentration of metoprolol by 2-5 times, while 2 patients experienced side effects characteristic of metoprolol. This interaction was confirmed in a study on 8 volunteers. The interaction is likely due to propafenone's inhibition, like quinidine, of the metabolism of metoprolol via the CYP2D6 isoenzyme. Taking into account the fact that propafenone has beta-blocker properties, the joint administration of Logimax and propafenone does not seem appropriate.

The combination of beta-blockers (atenolol, propranolol and pindolol) and verapamil can cause bradycardia and lead to a decrease in blood pressure. Verapamil and beta-blockers have complementary inhibitory effects on AV conduction and sinus node function.

The combination of Logimax with the following drugs may require dose adjustment.

Class I antiarrhythmics and beta blockers may result in additive negative inotropic effects, which may lead to serious hemodynamic side effects in patients with impaired left ventricular function. This combination should also be avoided in patients with sick sinus syndrome and impaired AV conduction. The interaction is described using disopyramide as an example.

Diphenhydramine reduces the clearance of metoprolol to α-hydroxymetoprolol by 2.5 times. At the same time, an increase in the effect of metoprolol is observed.

Hypertensive reactions during abrupt withdrawal of clonidine may be exacerbated by concomitant use of beta-blockers. When used together, if clonidine is discontinued, discontinuation of beta-blockers should begin several days before discontinuation of clonidine.

Diltiazem and beta-blockers mutually enhance the inhibitory effect on AV conduction and sinus node function. When metoprolol was combined with diltiazem, cases of severe bradycardia were observed.

NSAIDs weaken the antihypertensive effect of beta-blockers. This interaction is best documented for indomethacin. There is no reported interaction observed for sulindac. In studies with diclofenac, the described reaction was not observed.

Ten cases of severe hypertension and bradycardia have been reported in patients taking non-selective beta blockers (including pindolol and propranolol) and receiving epinephrine (adrenaline). The interaction was also observed in the group of healthy volunteers. It is assumed that similar reactions can be observed when epinephrine is used together with local anesthetics if it accidentally enters the vascular bed. It is assumed that this risk is much lower with the use of cardioselective beta-blockers.

Quinidine inhibits the metabolism of metoprolol in a special group of patients with rapid hydroxylation (in Sweden, approximately 90% of the population), causing mainly a significant increase in plasma concentrations of metoprolol and increased beta-adrenergic receptor blockade. It is believed that such an interaction is also typical for other beta-blockers, the metabolism of which involves the CYP2D6 isoenzyme.

The combined use of amiodarone and metoprolol can lead to severe sinus bradycardia. Taking into account the extremely long T1/2 of amiodarone (50 days), the possible interaction should be considered long after discontinuation of amiodarone.

Rifampicin may increase the metabolism of metoprolol, reducing plasma concentrations of metoprolol.

The concentration of metoprolol in the blood plasma may increase when combined with cimetidine, hydralazine, selective serotonin inhibitors such as paroxetine, fluoxetine and sertraline.

Patients concomitantly taking metoprolol and other beta-blockers (eye drops) or MAO inhibitors should be closely monitored.

While taking beta-blockers, inhalational anesthetics enhance the cardiodepressive effect.

While taking beta-blockers, patients receiving oral hypoglycemic agents may require dose adjustment of the latter.

Dosage regimen

The drug is prescribed orally. The tablets should be taken in the morning with water, do not split, crush or chew. The drug can be used on an empty stomach or with a small amount of food low in fat and carbohydrates.

The dose of Logimax is selected individually. When choosing the initial dose, it is recommended to take into account the effect of previously taken doses of beta-blockers or slow calcium channel blockers.

For adults and elderly patients

the initial dose is 1 tablet. 1 time/day If necessary, the dose can be increased (1 tablet 2 times a day).

Renal dysfunction

does not affect the concentration of the drug in the blood plasma.
There is no need to adjust the treatment regimen in patients with impaired renal function, but caution should be exercised when prescribing the drug to patients with severe renal failure
.
There is usually no need to adjust the treatment regimen in patients with liver cirrhosis
, because metoprolol binds to blood proteins only to a small extent (5-10%). If there are symptoms of serious liver dysfunction (for example, patients who have undergone bypass surgery), the dose of Logimax should not exceed 5 mg/47.5 mg.

Experience of using the drug in children

limited.

Overdose

Toxicity

When using felodipine

At a dose of 10 mg, minor intoxication was noted in a 2-year-old child. Felodipine at a dose of 150-200 mg in a 17-year-old patient and at a dose of 250 mg in an adult caused minor to moderate toxicity. It is likely that felodipine has a more significant effect on the peripheral circulation than on the heart, compared with other drugs in this therapeutic group.

Metoprolol

at a dose of 7.5 g in an adult caused intoxication with a fatal outcome. A 5-year-old child who took 100 mg of metoprolol showed no signs of intoxication after gastric lavage. Taking metoprolol at a dose of 450 mg by a 12-year-old child resulted in moderate intoxication. Administration of metoprolol at doses of 1.4 g and 2.5 g to adults caused moderate and severe intoxication, respectively. Taking metoprolol in a dose of 7.5 g by adults led to extremely severe intoxication.

Symptoms

In case of overdose with long-acting drugs, symptoms of intoxication appear 12-16 hours after administration; severe symptoms may occur several days after administration.

felodipine overdose

the greatest effect on the cardiovascular system is observed: bradycardia (sometimes tachycardia), marked decrease in blood pressure, AV block, ventricular extrasystole, atrioventricular dissociation, asystole, ventricular fibrillation, headache, dizziness, impaired consciousness (or coma), convulsions, shortness of breath, pulmonary edema (not cardiac) and apnea; possible development of respiratory distress syndrome in adults; acidosis, hypokalemia, hyperglycemia, hypocalcemia, hot flashes, hypothermia, nausea and vomiting.

In case of overdose with metoprolol

the most serious are symptoms from the cardiovascular system, but sometimes, especially in children and adolescents, symptoms from the central nervous system and suppression of pulmonary function, bradycardia, AV block I-III degree, asystole, marked decrease in blood pressure, weak peripheral perfusion may predominate , heart failure, cardiogenic shock, depression of pulmonary function, apnea, as well as increased fatigue, impaired consciousness, loss of consciousness, tremor, convulsions, increased sweating, paresthesia, bronchospasm, nausea, vomiting, possible esophageal spasm, hypoglycemia (especially in children) or hyperglycemia, hyperkalemia; effects on the kidneys; transient myasthenic syndrome. Concomitant use of alcohol, antihypertensive drugs, quinidine or barbiturates may worsen the patient's condition. The first signs of overdose can be observed 20 minutes - 2 hours after taking the drug.

Treatment

Felodipin

The administration of activated carbon, and, if necessary, gastric lavage, is in some cases effective even at the late stage of intoxication. Symptomatic therapy is carried out.

Atropine (0.25-0.5 mg IV for adults, 10-20 mcg/kg for children) should be given before gastric lavage (due to the risk of vagus nerve stimulation). ECG monitoring is carried out. If necessary, maintain airway patency and adequate ventilation. Correction of acid-base status and serum electrolytes is indicated. In case of bradycardia and AV blockade, atropine 0.5-1 mg is prescribed intravenously for adults (20-50 mcg/kg for children), repeat the administration if necessary, or isoprenaline is initially administered at a dose of 0.05-0.1 mcg/kg/min. In case of acute intoxication at an early stage, it may be necessary to install an artificial pacemaker. Arterial hypotension is corrected with intravenous fluid administration. If necessary, adrenaline or dopamine is infused. In case of acute intoxication, glucagon may be prescribed. Cardiac arrest due to an overdose may require resuscitation for several hours. For convulsions, diazepam is prescribed. Other symptomatic treatment is carried out.

Metoprolol

Prescription of activated carbon and, if necessary, gastric lavage.

Atropine (0.25-0.5 mg IV for adults, 10-20 mcg/kg for children) should be given before gastric lavage (due to the risk of vagus nerve stimulation). If necessary, maintain airway patency (intubation) and adequate ventilation. Replenishment of blood volume and glucose infusion. ECG monitoring is carried out. Prescribe atropine at a dose of 1-2 mg IV, repeat the administration if necessary (especially in the case of vagal symptoms). In case of (suppression of) myocardial depression, infusion of dobutamine or dopamine is indicated. You can also use glucagon at a dose of 50-50 mcg/kg IV at intervals of 1 minute. In some cases, adding epinephrine to therapy may be effective. For arrhythmia and a widened ventricular (QRS) complex, solutions of sodium chloride or sodium bicarbonate are infused. It is possible to install an artificial pacemaker. Cardiac arrest due to an overdose may require resuscitation for several hours. Terbutaline (injected or inhaled) can be used to relieve bronchospasm. Symptomatic treatment is carried out.

Side effect

The incidence of adverse reactions was classified as follows: often (≥1/100), sometimes (≥1/1000, <1/100), rarely (≥1/10,000, <1/1000), very rarely (<1/10 000).

The most common adverse reactions when taking Logimax include headache (11%), swelling of the ankles, redness of the face, as well as headache, dizziness, fatigue, and nausea.

These adverse reactions may occur at the beginning of treatment or when the dose is increased and usually resolve on their own. Most of these effects are explained by the vasodilating properties of felodipine.

Felodipin

From the cardiovascular system:

often - redness of the face, accompanied by a feeling of heat, swelling of the ankles; sometimes - tachycardia, palpitations; rarely - fainting; very rarely - extrasystole, decreased blood pressure, accompanied by tachycardia, which in predisposed patients can cause exacerbation of angina pectoris, leukocytoplastic vasculitis.

From the side of the central nervous system:

often - headache; sometimes - paresthesia, dizziness.

From the reproductive system:

sometimes - impotence, sexual dysfunction.

From the digestive system:

sometimes - nausea, abdominal pain; rarely - vomiting; very rarely - hyperplasia of the mucous membrane of the tongue and gums, gingivitis, increased activity of liver enzymes in the blood serum.

Dermatological reactions:

sometimes - exanthema, itching; very rarely - photosensitivity.

From the musculoskeletal system:

rarely - arthralgia, myalgia.

From the urinary system:

very rarely - frequent urination.

From the endocrine system:

very rarely - hyperglycemia.

Allergic reactions:

rarely - urticaria; very rarely - angioedema (of the lips or tongue), hypersensitivity reactions.

Other:

less often - feeling tired; very rarely - fever.

There are isolated reports of sleep disturbances, but no association with felodipine has been established.

Cases of hyperplasia of the mucous membrane of the tongue and gums have been reported after taking felodipine in patients with severe gingivitis/periodontitis. This side effect can be avoided or reduced by good oral hygiene.

Hyperglycemia, which is specific to this group of drugs, was observed only in isolated cases while taking felodipine.

Metoprolol

From the central nervous system and peripheral nervous system:

often - dizziness, headache, feeling tired; sometimes - paresthesia, sleep disturbances; rarely - depression, decreased ability to concentrate, nightmares, memory impairment, increased nervous excitability, anxiety, hallucinations.

From the cardiovascular system:

often - bradycardia, palpitations, coldness of the extremities; sometimes - a reversible increase in symptoms of heart failure; rarely - arrhythmias, fainting, edema, conduction disturbances (increased conduction time).

From the digestive system:

often - nausea, vomiting, abdominal pain, diarrhea, constipation; rarely - increased levels of liver transaminases, impaired taste.

From the respiratory system:

sometimes - shortness of breath, bronchospasm in patients with bronchial asthma or asthmatic diseases.

From the senses:

rarely - blurred vision, dryness and/or irritation of the eyes, ringing in the ears.

Dermatological reactions:

rarely - hyperhidrosis, hair loss, exacerbation of psoriasis, photosensitivity.

From the hematopoietic system:

rarely - thrombocytopenia.
Other:
sometimes - weight gain, chest pain; rarely - reversible disturbance of libido, hypersensitivity reactions.

Isolated cases of arthralgia, hepatitis, muscle spasms, dry mouth, conjunctivitis, rhinitis, and gangrene have been reported in patients with severe peripheral circulatory disorders.

special instructions

Caution should be exercised when co-administering digitalis with drugs.

Logimax® may increase symptoms of peripheral circulatory disorders.

The drug should be prescribed with caution in severe renal failure (creatinine clearance <30 ml/min), aortic stenosis, liver dysfunction, acute myocardial infarction, acute myocardial infarction complicated by heart failure, arterial hypotension, which in predisposed patients can cause myocardial ischemia, acute metabolic acidosis. It is not recommended to start treatment with Logimax in patients who have not previously received antihypertensive therapy.

It is not recommended to prescribe the drug to patients with latent or detected heart failure without appropriate therapy.

The use of Logimax may affect carbohydrate metabolism or mask hypoglycemia, however, when using Logimax, the risk of affecting carbohydrate metabolism is less than when using non-selective beta-blockers.

In some cases, existing AV conduction disturbances may intensify, leading to AV block.

Patients taking Logimax® should not be administered intravenous calcium channel blockers such as verapamil.

In patients with Prinzmetal's angina, the frequency and severity of angina attacks may increase due to coronary vasospasm caused by alpha-adrenergic receptor stimulation. In this regard, it is not recommended to prescribe non-selective beta-blockers to this group of patients. Beta1-blockers should be used with caution.

While taking beta-blockers, anaphylactic shock can take a more severe form. The use of epinephrine (adrenaline) in the usually used dosage does not always lead to the expected therapeutic effect.

Patients with pheochromocytoma are recommended to prescribe alpha-blockers simultaneously with Logimax.

The combined use of drugs that induce the CYP3A4 enzyme system leads to a significant decrease in the concentration of felodipine in the blood plasma and an insufficient therapeutic effect from taking the drug. Co-administration of such drugs should be avoided.

The combined use of drugs that inhibit the CYP3A4 enzyme system leads to a significant increase in the concentration of felodipine in the blood plasma.

Avoid taking Logimax with grapefruit juice due to a significant increase in felodipine plasma concentrations.

Abrupt withdrawal of beta-blockers should be avoided, especially in high-risk patients, due to the possible worsening of symptoms of chronic heart failure and an increased risk of myocardial infarction and sudden death. If necessary, discontinuation of Logimax should be carried out gradually by reducing the dose over 1-2 weeks.

In case of surgery, the anesthesiologist should be informed that the patient is taking Logimax®.
It is not recommended to stop treatment with beta-blockers in patients undergoing surgery. Effect on the ability to drive vehicles and operate machinery
When driving vehicles and engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions, it should be taken into account that dizziness and fatigue may occur when using Logimax.

Storage conditions

The drug should be stored out of the reach of children at a temperature not exceeding 30°C.

Best before date

Shelf life: 3 years.

Use during pregnancy and breastfeeding

Restrictions during pregnancy - Contraindicated. Restrictions when breastfeeding - Contraindicated.

Logimax® should not be used during pregnancy.

Currently, there is insufficient data on the use of felodipine in pregnant women. Based on animal data, felodipine should not be used during pregnancy. Slow calcium channel blockers may inhibit uterine contractions during preterm labor, but there is insufficient data to support an increase in the duration of physiological labor. There may be a risk of developing fetal hypoxia if the mother has arterial hypotension and a decrease in perfusion in the uterus due to redistribution of blood flow and peripheral vasodilation.

Metoprolol can be used during pregnancy and lactation only if absolutely necessary. Beta blockers can cause bradycardia in the fetus, newborns and breastfed children. This should be taken into account when deciding whether to prescribe the drug in the third trimester of pregnancy and immediately before childbirth.

Felodipine and metoprolol pass into breast milk. When a nursing mother takes felodipine in therapeutic doses, only a small amount of the drug passes into breast milk to the baby. Insufficient experience with the use of felodipine by women during lactation does not exclude the risk of drug exposure to the child, and therefore it is not recommended to prescribe felodipine to women during lactation. If it is necessary to continue therapy to achieve a clinical effect, you should consider stopping breastfeeding.

Use for renal impairment

Restrictions for impaired renal function - With caution.

Renal dysfunction

Use for liver dysfunction

Restrictions for liver dysfunction - With caution.

There is usually no need to adjust the treatment regimen in patients with cirrhosis

, because metoprolol binds to blood proteins only to a small extent (5-10%). If there are symptoms of serious liver dysfunction (for example, patients who have undergone bypass surgery), the dose of Logimax should not exceed 5 mg/47.5 mg.

Use in elderly patients

Restrictions for elderly patients - No restrictions.

For elderly patients

the initial dose is 1 tablet. 1 time/day If necessary, the dose can be increased (1 tablet 2 times a day).

Use in children

Experience of using the drug in children

limited.

Terms of sale

The drug is available with a prescription.

Contacts for inquiries

ASTRAZENECA Pharmaceuticals LLC (Russia)

123100 Moscow 1st Krasnogvardeisky pr-d, 21 bldg. 1, fl. 30, room 13, 14 Tel. Fax

Logimax® (Logimax)