Cardosal: instructions for use, analogues, price and reviews from doctors

Compound

One tablet of Cardosal 40 contains 40 mg of medoxomil olmesartan.
One tablet of Cardosal 20 contains 20 mg of medoxomil olmesartan.

One tablet of Cardosal 10 contains 10 mg of medoxomil olmesartan.

Additional substances: hyprolose, microcrystalline cellulose, lactose monohydrate, magnesium stearate.

Shell composition: hypromellose, talc, titanium dioxide.

Cardosal® 40

Olmesartan medoxomil, the active substance of the drug Cardosal 40, is a powerful specific antagonist of angiotensin II receptors (type AT1).

Angiotensin II is the primary vasoactive hormone of the renin-angiotensin-aldosterone system and plays a significant role in the pathophysiology of arterial hypertension by acting on AT1 receptors. It is assumed that olmesartan medoxomil blocks all AT1 receptor-mediated actions of angiotensin II, regardless of the source and route of angiotensin II synthesis. The specific antagonism of olmesartan medoxomil towards angiotensin II receptors (AT1 type) leads to an increase in the activity of renin, angiotensin I and II in the blood plasma, and also helps to reduce the plasma concentration of aldosterone.

In arterial hypertension, olmesartan medoxomil causes a dose-dependent, prolonged decrease in blood pressure (BP). There is no data on the development of arterial hypotension after taking the first dose of the drug, tachyphylaxis during long-term treatment or withdrawal syndrome (a sharp increase in blood pressure after discontinuation of the drug).

Taking olmesartan medoxomil once a day provides an effective and uniform reduction in blood pressure over 24 hours, and the effect after a single dose is similar to the effect of taking the drug 2 times a day at the same daily dose.

The antihypertensive effect of olmesartan medoxomil usually develops within 2 weeks, and the maximum effect develops approximately 8 weeks after the start of therapy.

The effect of olmesartan medoxomil on mortality and complication rates has not been established.

The ROADMAP trial, a randomized trial of 4447 patients with type 2 diabetes mellitus, normoalbuminuria, and at least one additional cardiovascular risk factor, assessed the ability of olmesartan medoxomil to prolong the time to onset of microalbuminuria. During the study period (median follow-up of 3.2 years), patients received olmesartan medoxomil or placebo in addition to other antihypertensive agents other than angiotensin-converting enzyme (ACE) inhibitors or other angiotensin II receptor antagonists.

The study demonstrated a significant reduction in the risk of the primary endpoint (time to onset of microalbuminuria) in favor of olmesartan medoxomil. After adjusting for differences in BP using double-blind prespecified parameters, the risk reduction was 17% (relative risk (RR) 0.834; 95% confidence interval (CI): 0.681 to 1.021; p = 0.0789) for systolic BP (SBP) adjusted for area under the curve (AUC) and 18% (RR 0.823; 95% CI: 0.672 - 1.008; p = 0.0596) for diastolic blood pressure (DBP) adjusted for AUC in favor of olmesartan medoxomil. Microalbuminuria developed in 8.2% of patients in the olmesartan medoxomil group (178 of 2160 patients) and 9.8% in the placebo group (210 of 2139 patients).

Cardiovascular events (secondary endpoints) were reported in 96 patients (4.3%) receiving olmesartan medoxomil and in 94 patients (4.2%) receiving placebo. Cardiovascular mortality was higher in the olmesartan medoxomil group compared with the placebo group (15 (0.7%) and 3 (0.1%) patients, respectively). At the same time, in the olmesartan medocomil group and the placebo group, a similar incidence of non-fatal stroke was observed (in 14 (0.6%) and 8 (0.4%) patients, respectively), non-fatal myocardial infarction (in 17 (0.8%) and 26 (1.2%) patients, respectively) and mortality from non-cardiovascular causes (in 11 (0.5%) and 12 (0.5%) patients, respectively). Overall mortality was numerically higher in the olmesartan medoxomil group than in the placebo group (in 26 (1.2%) and 15 (0.7%) patients, respectively), which was mainly due to a higher number of fatal cardiovascular events.

The randomized ORIENT trial, conducted in Japan and China, examined the effects of olmesartan medoxomil on renal and cardiovascular outcomes in 577 patients with type 2 diabetes mellitus and advanced nephropathy. During the study (median follow-up of 3.1 years), patients received olmesartan medoxomil or placebo in addition to other antihypertensive drugs, including ACE inhibitors.

The composite cardiovascular endpoint included: death from cardiovascular causes in 10 (3.5%) patients in the olmesartan medoxomil group and in 3 (1.1%) patients in the placebo group); total mortality (19 (6.7%) cases in the olmesartan medoxomil group and 20 (7.0%) cases in the placebo group), non-fatal stroke (8 (2.8%) cases in the olmesartan medoxomil group and 11 (3.9 %) cases in the placebo group), non-fatal myocardial infarction (3 (1.1%) cases in the olmesartan medoxomil group and 7 (2.5%) cases in the placebo group).

Children and teenagers

The antihypertensive effect of olmesartan medoxomil in children and adolescents was analyzed in a randomized, double-blind, placebo-controlled study involving 302 patients aged 6 to 17 years. The study group consisted of black patients (112 people) and a racially mixed group (190 patients, 38 of whom were black). The etiology of arterial hypertension was predominantly primary (87% of the group consisting of patients of the Negroid race and 67% of the “mixed” group).

Patients weighing 20 to <35 kg were randomized to receive olmesartan medoxomil 2.5 mg (low dose) or 20 mg (high dose) once daily, and patients weighing ≥35 kg were randomized into groups receiving olmesartan medoxomil at doses of 5 mg (low dose) or 40 mg (high dose) once daily. At a dose adjusted according to body weight, olmesartan medoxomil significantly reduced both systolic and diastolic blood pressure. At both low and high doses of olmesartan, medoxomil significantly reduced systolic blood pressure by 6.6 and 11.9 mmHg, respectively. Art. (from the initial level). This effect was also observed during the 2-week randomized withdrawal phase, with both mean systolic and diastolic blood pressure showing statistically significant increases in the placebo group compared with the olmesartan medoxomil group. In children and adolescents, treatment was effective for both primary and secondary arterial hypertension. As in adult patients, blood pressure in black patients decreased to a lesser extent.

In the same study, 59 patients aged 1 to 5 years weighing ≥ 5 kg received 0.3 mg/kg olmesartan medoxomil once daily for three weeks in the open-label phase of the study and were then randomized in the double-blind phase of the study. into groups receiving either olmesartan medoxomil or placebo. At the end of the 2-week withdrawal phase, the mean systolic/diastolic blood pressure at the nadir was 3/3 mm Hg. Art. lower in the olmesartan medoxomil group; this difference in blood pressure was not statistically significant (95% CI: 2-7/1-7).

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

An angiotensin type 2 receptor blocker , which is a hormone and plays a major role in the development of arterial hypertension .

Olmesartan presumably inhibits the effects of angiotensin II type by blocking the corresponding receptors.

In arterial hypertension it causes a dose-dependent long-term decrease in pressure. There is no evidence of the occurrence of arterial hypotension, tachycardia (during long-term treatment) or withdrawal syndrome after taking the drug.

Taking olmesartan once a day provides a gentle and effective reduction in blood pressure throughout the day. The hypotensive effect develops after two weeks, and the greatest effect occurs approximately two months after the start of treatment.

Pharmacokinetics

The active substance is a prodrug. In the mucous membrane of the digestive tract, under the action of enzymes , it quickly turns into an active metabolite . Olmesartan medoxomil the blood in its original form . Bioavailability is approximately 25.6%. The highest concentration in the blood is achieved on average two hours after oral administration. Food intake does not affect bioavailability.

Binds to plasma proteins by 99.7%. The connection with blood cells is weak. 40% of the drug is excreted by the kidneys, another 60% - with bile. The half-life is 11-14 hours.

Cardosal® 20

Olmesartan medoxomil, the active ingredient of Cardosal® 20, is a potent specific antagonist of angiotensin II receptors (type AT1).

The antihypertensive effect of olmesartan medoxomil usually develops within 2 weeks, and the maximum effect develops approximately 8 weeks after the start of therapy.

The effect of olmesartan medoxomil on mortality and complication rates has not been established.

The ROADMAP trial, a randomized trial of 4447 patients with type 2 diabetes mellitus, normoalbuinuria, and at least one additional cardiovascular risk factor, assessed the ability of olmesartan medoxomil to prolong the time to onset of microalbuminuria.

During the study period (median follow-up of 3.2 years), patients received olmesartan medoxomil or placebo in addition to other antihypertensive agents other than angiotensin-converting enzyme (ACE) inhibitors or other angiotensin II receptor antagonists.

The study demonstrated a significant reduction in the risk of the primary endpoint (time to onset of microalbuminuria) in favor of olmesartan medoxomil. After adjustment for differences in BP using prespecified parameters for double-blind design, the risk reduction was 17% (relative risk (RR) 0.8 [34; 95% confidence interval (CI): 0.681 - 1.021; p = 0.0789 ) for systolic blood pressure (SBP) adjusted for area under the curve (AUC) and 18% (RR 0.823; 95% CI: 0.672 - 1.008; p = 0.0596) for diastolic blood pressure (DBP) adjusted for AUC in the benefits of olmesartan medoxomil. Microalbuminuria developed in 8.2% of patients in the olmesartan medoxomil group (178 of 2160 patients) and 9.8% in the placebo group (210 of 2139 patients).

The primary composite endpoint (time to first event: doubling of plasma creatinine concentration, development of end-stage chronic kidney disease, death from all causes) was recorded in 116 patients in the olmesartan medoxomil group (41.1%) and in 129 patients in the placebo group (45.4%) (RR 0.97; 95% CI: 0.75-1.24; p = 0.791). The secondary composite cardiovascular endpoint was recorded in 40 patients in the olmesartan medoxomil group (14.2%) and in 53 patients in the placebo group (18.7%). The composite cardiovascular endpoint included: death from cardiovascular causes in 10 (3.5%) patients in the olmesartan medoxomil group and in 3 (1.1%) patients in the placebo group; total mortality (19 (6.7%) cases in the olmesartan medoxomil group and 20 (7.0%) cases in the placebo group), non-fatal stroke (8 (2.8%) cases in the olmesartan medoxomil group and 11 (3.9 %) cases in the placebo group), non-fatal myocardial infarction (3 (1.1%) cases in the olmesartan medoxomil group and 7 (2.5%) cases in the placebo group).

Children and teenagers

Patients weighing 20 to <35 kg were randomized to receive olmesartan medoxomil 2.5 mg (low dose) or mg (high dose) once daily, and patients weighing ≥ 35 kg were randomized to receive olmesartan medoxomil 2.5 mg (low dose) or mg (high dose) once daily. groups receiving olmesartan medoxomil at doses of 5 mg (low dose) or 40 mg (high dose) once daily. At a dose adjusted according to body weight, olmesartan medoxomil significantly reduced both systolic and diastolic blood pressure. At both low and high doses of olmesartan, medoxomil significantly reduced systolic blood pressure by 6.6 and 11.9 mmHg, respectively. Art. (from the initial level). This effect was also observed during the 2-week randomized withdrawal phase, with both mean systolic and diastolic blood pressure showing statistically significant increases in the placebo group compared with the olmesartan medoxomil group. In children and adolescents, treatment was effective for both primary and secondary arterial hypertension. As in adult patients, blood pressure in black patients decreased to a lesser extent.

Contraindications

Renal failure , a condition after a kidney transplant.
Obstruction of the biliary tract.
Lactase deficiency , malabsorption or galactosemia.
Age less than 18 years.
Pregnancy and lactation .
Hypersensitivity to the components of the drug.

It is recommended to use the drug with caution in the following diseases and conditions:

obstructive hypertrophic cardiomyopathy;
heart valve stenosis
primary aldosteronism;
mild renal failure
hyperkalemia or hyponatremia;
chronic cardiac failure;
cardiac ischemia;
bilateral renal artery stenosis
cerebrovascular disorders;
decreased volume of circulating fluid due to diet , vomiting or diarrhea;
liver dysfunction;
elderly age;
combined use with diuretics.

Side effects

Hematopoietic reactions: thrombocytopenia.
Reactions from nervous activity: dizziness , headache .
Reactions from breathing: cough, rhinitis, pharyngitis, bronchitis.
Digestive reactions: nausea, diarrhea, dyspepsia , abdominal pain, gastroenteritis , vomiting.
Skin reactions: itching , skin rash, allergic dermatitis, Quincke's edema, urticaria.
Reactions from the musculoskeletal system: pain in bones and joints, arthritis, back pain, cramps .
Reactions from the genitourinary tract: genitourinary tract infections, hematuria, acute renal failure.
Reactions from laboratory tests: increased levels of urea and creatinine in the blood, increased levels of liver enzymes.
Circulatory reactions: tachycardia, angina , decreased blood pressure.
Metabolic reactions: increased creatine phosphokinase levels, hyperuricemia, hypertriglyceridemia, hyperkalemia.
General reactions: flu-like symptoms, chest pain, asthenia , peripheral edema, malaise, fatigue, drowsiness .

Buy Cardosal Plus film-coated tablets 12.5 mg+20 mg No. 28 in pharmacies

Instructions for use Cardosal Plus tab p.o 12.5mg+20mg No. 28 Buy Cardosal Plus tab p.o 12.5mg+20mg No. 28 Dosage forms film-coated tablets 12.5+20mg Manufacturers Daichi Sankyo Europe GmbH, packaged Berlin- Chemi AG (Germany) Group Antihypertensives - angiotensin (AII) receptor blockers Composition hydrochlorothiazide + olmesartan medoxomil. International nonproprietary name hydrochlorothiazide + olmesartan medoxomil. Synonyms Cardosal 10, Cardosal 20 Indications : essential arterial hypertension (if monotherapy with olmesartan medoxomil is ineffective). ICD-10 codes Dosage regimen Cardosal® plus tablets are taken orally, regardless of meals. Before prescribing the combination drug Cardosal® plus, it is recommended to pre-select the dose of each of the active ingredients separately (i.e. olmesartan medoxomil and hydrochlorothiazide). Recommended dose: Daily, 1 tablet of Cardosal® plus containing 20 mg of olmesartan medoxomil and 12.5 mg of hydrochlorothiazide, in the absence of adequate blood pressure control during monotherapy with olmesartan medoxomil at a dose of 20 mg; In the absence of adequate blood pressure control while taking the drug Cardosal® plus, containing 20 mg of olmesartan medoxomil and 12.5 mg of hydrochlorothiazide, it is possible to use the drug Cardosal® plus, containing 20 mg of olmesartan medoxomil and 25 mg of hydrochlorothiazide daily, 1 tablet. The maximum dose of Cardosal® plus is 20 mg of olmesartan medoxomil and 25 mg of hydrochlorothiazide once a day. Elderly patients (over 65 years of age) with normal renal function (creatinine clearance more than 90 ml/min.) and patients with impaired renal function (creatinine clearance = 30-60 ml/min.) do not require dose adjustment. Side effects Possible side effects are listed below in descending frequency of occurrence: common (> 1/100, < 1/10), uncommon (> 1/1000, < 1/100), rare (> 1/10000, < 1/1000) , very rare (< 1/10000), including isolated reports. Combination of olmesartan medoxomil and hydrochlorothiazide From the central nervous system Often: dizziness. Uncommon: syncope. From the cardiovascular system: Uncommon: palpitations, marked decrease in blood pressure, orthostatic hypotension. From the skin Uncommon: skin rash, eczema. Metabolic disorders Uncommon: hyper- or hypokalemia, hypercalcemia, hypertriglyceridemia, hyperuricemia, increased concentrations of lipids in the blood. From laboratory parameters Very rare: a slight increase in the concentration of creatinine, uric acid and urea nitrogen in the blood serum, a slight decrease in the concentration of hemoglobin and hematocrit. Olmesartan Medoxomil (monotherapy) From the hematopoietic system Very rare: thrombocytopenia. From the side of the central nervous system: Very rare: dizziness, headache. From the cardiovascular system Rarely: marked decrease in blood pressure. Uncommon: angina pectoris. From the respiratory system Often: bronchitis, pharyngitis, rhinitis. Very rare: cough. From the digestive tract Often: diarrhea, dyspepsia, gastroenteritis. Very rare: abdominal pain, nausea, vomiting. From the urinary system Often: hematuria, urinary tract infection. Very rare: acute renal failure. From the musculoskeletal system Often: arthritis, back pain. Very rare: muscle cramps, myalgia. From the skin Very rarely: skin itching, exanthema, angioedema, allergic dermatitis, urticaria. Metabolic disorders: Often: increased activity of creatine phosphokinase, hypertriglyceridemia, hyperuricemia. Rarely: hyperkalemia. From laboratory parameters Very rare: increased concentrations of creatinine and urea in the blood serum. Often: increased activity of liver transaminases. Other disorders Common: chest pain, flu-like symptoms, peripheral edema. Very rare: weakness, increased fatigue, drowsiness, malaise. Hydrochlorothiazide (monotherapy) From the hematopoietic system Rarely: leukopenia, neutropenia, agranulocytosis, thrombocytopenia, and plastic anemia, hemolytic anemia, suppression of bone marrow hematopoiesis. From the central and peripheral nervous system Often: dizziness, weakness, headache, increased fatigue. Rarely: anxiety, sleep disturbance, confusion, apathy, depression, numbness, paresthesia, convulsions. From the organ of vision Rarely: xanthopsia, transient disturbance of accommodation, decreased formation of tear fluid. From the cardiovascular system: Uncommon: orthostatic hypotension. Rarely: arrhythmias, thrombosis, embolism. From the respiratory system Rarely: dyspnea (including interstitial pneumonia and pulmonary edema). From the digestive tract: Uncommon: anorexia, abdominal pain, nausea, vomiting, diarrhea, constipation, flatulence, inflammation of the salivary glands. Rarely: pancreatitis, acute cholecystitis, intrahepatic cholestatic jaundice. Very rare: paralytic ileus. From the genitourinary system Rarely: impaired renal function, interstitial nephritis, acute renal failure, impaired potency. From the musculoskeletal system Rarely: muscle cramps, muscle weakness, paresis. From the skin Uncommon: photosensitivity, skin rash, urticaria. Rarely: development of lupus-like syndrome (fever, arthralgia, myalgia, serositis, vasculitis, increased erythrocyte sedimentation rate (ESR), leukocytosis, eosinophilia), activation of the cutaneous form of systemic lupus erythematosus, anaphylactic reactions, toxic epidermal necrolysis. From laboratory parameters Often: hyperglycemia, glucosuria, hyperuricemia, increased serum creatinine concentrations, water and electrolyte imbalance (including hyponatremia, hypomagnesemia, hypochloremia, hypokalemia and hypercalcemia), increased concentrations of cholesterol and triglycerides in the blood. Other disorders Rare: fever. Contraindications for use - hereditary lactose intolerance, deficiency of lactase in the body or malabsorption syndrome of glucose and lactose; - severe liver dysfunction (more than 9 points on the Child-Pugh scale) (risk of developing hepatic coma), biliary obstruction and cholestasis; - severe renal dysfunction (creatinine clearance less than 30 ml/min.); - refractory hypokalemia, hyponatremia, hypercalcemia and symptomatic hyperuricemia; - pregnancy; - lactation period; - age under 18 years (the effectiveness and safety of the drug have not been studied); - hypersensitivity to olmesartan medoxomil, hydrochlorothiazide or other sulfonamide derivatives or to any of the excipients included in the drug (see section Composition). With caution: - bronchial asthma; — coronary heart disease (CHD); — chronic heart failure in the stage of decompensation; - severe cerebrovascular disorders; - stenosis of the aortic or mitral valve; — hypertrophic obstructive cardiomyopathy; - mild to moderate liver dysfunction (less than 9 points on the Child-Pugh scale); - impaired renal function (creatinine clearance more than 30 ml/min., but less than 60 ml/min.); - bilateral renal artery stenosis or stenosis of the artery of a single kidney; — condition after a recent kidney transplant (no experience with the drug); - primary aldosteronism; - diabetes mellitus, gout; - water-electrolyte imbalance, dehydration; — connective tissue diseases, including systemic lupus erythematosus; - patients on a salt-restricted diet or on hemodialysis; - when bone marrow hematopoiesis is suppressed; - conditions accompanied by a decrease in circulating blood volume; — (OTSK) incl. diarrhea, vomiting or previous diuretic therapy. Use during pregnancy and lactation There is no experience with the use of olmesartan medoxomil in pregnant women. However, due to existing reports of severe teratogenic effects of drugs acting on the RAAS, like any drug of this class, Cardosal® plus is contraindicated for use during pregnancy. If pregnancy is planned or occurs during therapy with Cardosal® plus, the drug should be discontinued as soon as possible. It is not known whether olmesartan medoxomil is excreted in breast milk, but thiazides are excreted in breast milk and may suppress lactation, therefore, if it is necessary to use the drug Cardosal® plus during lactation, breastfeeding should be discontinued while taking it. Use for liver dysfunction Contraindicated in severe liver dysfunction (more than 9 points on the Child-Pugh scale) (risk of developing hepatic coma), biliary obstruction and cholestasis. Use for impaired renal function Contraindicated in cases of severe impaired renal function (creatinine clearance less than 30 ml/min.). With caution: - impaired renal function (creatinine clearance more than 30 ml/min., but less than 60 ml/min.); - bilateral renal artery stenosis or stenosis of the artery of a single kidney; - condition after a recent kidney transplant (no experience with the drug). Patients with impaired renal function (creatinine clearance = 30-60 ml/min.) do not require dose adjustment. Use in children Contraindicated in children under 18 years of age. Use in elderly patients Elderly patients (over 65 years of age) with normal renal function (creatinine clearance more than 90 ml/min) do not require dose adjustment. Special instructions Symptomatic arterial hypotension, especially after taking the first dose of the drug, may occur in patients with reduced blood volume and/or reduced sodium concentration due to intensive diuretic therapy, limited dietary salt intake during dietary nutrition, and also due to diarrhea or vomiting. Relevant factors should be eliminated before starting the use of Cardosal® plus. Thiazide diuretics, including hydrochlorothiazide, may cause disturbances in the blood volume or water-electrolyte balance of the blood serum (including hypokalemia, hyponatremia and hypochloremic alkalosis). Precursor symptoms are: dryness of the oral mucosa, thirst, weakness, drowsiness, anxiety, myalgia or cramps, muscle weakness, arterial hypotension, oliguria, tachycardia, nausea and vomiting (see section Side effects). The highest risk of developing hypokalemia exists in patients with liver cirrhosis, in patients undergoing forced diuresis, and in those patients who are simultaneously taking glucocorticosteroids or ACTT (see section Interaction with other drugs). Conversely, due to the antagonism of the angiotensin II (AT1) receptors contained in Cardosal plus olmesartan medoxomil, hyperkalemia may occur, especially in patients with decreased renal function and/or chronic heart failure, as well as patients with diabetes. In patients with risk factors, regular monitoring of serum potassium concentration is recommended. There are no data on whether olmesartan medoxomil can reduce or prevent diuretic-induced hyponatremia. In hot weather, dilution hyponatremia may occur in patients prone to edema. The decrease in chloride concentration is generally insignificant and usually does not require treatment. Thiazides can reduce the excretion of calcium ions by the kidneys and also lead to a transient slight increase in the concentration of calcium in the blood serum in the absence of a history of disturbances in its metabolism. Hyperkalygemia may indicate latent hyperparathyroidism. Before studying the function of the parathyroid glands, thiazides should be discontinued. It has been proven that thiazide diuretics increase the excretion of magnesium ions by the kidneys, which can lead to hypomagnesemia. In patients in whom vascular tone and renal function depend to a large extent on the activity of the RAAS (for example, in patients with severe chronic heart failure or impaired renal function, including renal artery stenosis), treatment with other drugs affecting the RAAS is associated with the possibility of developing acute arterial hypotension, azotemia, oliguria or, in rare cases, acute renal failure. The possibility of a similar effect cannot be excluded when using angiotensin P receptor antagonists. There is an increased risk of developing severe arterial hypotension and renal failure if a patient with bilateral renal artery stenosis or arterial stenosis of a single functioning kidney receives therapy with drugs that affect the RAAS. When using the drug Cardosal® plus in patients with impaired renal function, it is recommended to periodically monitor the concentration of potassium ions, creatinine and uric acid in the blood serum. There is no experience with the use of olmesartan medoxomil in patients with recent kidney transplantation or in patients with end-stage renal impairment. In patients with limited renal function, taking thiazide diuretics may be accompanied by azotemia. With obvious progression of renal failure, it is necessary to reconsider therapy and decide on the abolition of diuretics. As with any antihypertensive drug, excessive reduction of blood pressure in patients with coronary artery disease or cerebrovascular insufficiency can lead to myocardial infarction or stroke. Thiazide diuretics may cause impaired glucose tolerance, as well as increased serum concentrations of cholesterol, triglycerides and uric acid. In patients with diabetes mellitus, it may be necessary to adjust the dose of insulin or oral hypoglycemic agent (see section Interactions with other drugs). When treated with thiazide diuretics, latent diabetes mellitus can manifest itself. There are reports that thiazide diuretics may precipitate an attack of gout and cause exacerbation of systemic lupus erythematosus. Hypersensitivity reactions to hydrochlorothiazide may be more likely to occur in patients with a history of allergies or bronchial asthma (history). Effect on the ability to drive vehicles and operate machinery The effect of the drug Cardosal® plus on the ability to drive vehicles and operate machinery has not been specifically studied, therefore, during treatment with Cardosal® plus, caution should be exercised when driving vehicles and engaging in potentially hazardous activities that require increased concentration attention and speed of psychomotor reactions. Overdose Symptoms: in case of an overdose of olmesartan medoxomil, a pronounced decrease in blood pressure is most likely, as well as tachycardia, bradycardia, nausea, drowsiness; in case of an overdose of hydrochlorothiazide - symptoms of electrolyte deficiency (hypokalemia, hypochloremia, hyponatremia) and dehydration due to excessive diuresis. Treatment: gastric lavage and/or intake of activated charcoal is recommended; therapy aimed at correcting dehydration and water-electrolyte imbalances. If there is a pronounced decrease in blood pressure, it is recommended to place the patient in a horizontal position, raising his legs, and carry out therapy aimed at replenishing blood volume. Hemodialysis is not effective. Drug interactions of Olmesartan medoxomil It is not recommended to use it together with potassium-sparing diuretics, potassium preparations, salt substitutes containing potassium, or other drugs that can increase the concentration of potassium in the blood serum (for example, heparin) - an increase in the concentration of potassium in the blood serum is possible. Nonsteroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid in doses greater than 3 g/day, as well as cyclooxygenase-2 (COX-2) inhibitors and angiotensin II receptor antagonists may act synergistically to reduce glomerular filtration. With the simultaneous use of NSAIDs and angiotensin II receptor antagonists, there may be a risk of developing acute renal failure, therefore monitoring of renal function at the beginning of treatment, as well as regular intake of sufficient fluids, is recommended. However, simultaneous treatment may reduce the antihypertensive effect of angiotensin II receptor antagonists, leading to a partial loss of their therapeutic effectiveness. When used simultaneously with antacids (magnesium and aluminum hydroxides), a moderate decrease in the bioavailability of olmesartan medoxomil is possible. There are reports of a reversible increase in serum lithium concentrations and toxicity during concomitant use of lithium preparations with angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists, therefore the use of olmesartan medoxomil in combination with lithium preparations is not recommended. If it is necessary to use appropriate combined therapy, regular control of the concentration of lithium in the blood serum is recommended. In rare cases, ACE inhibitors can enhance the hypoglycemic effect of insulin and hypoglycemic agents for oral administration (for example, sulfonyl gross derivatives) in patients with diabetes. In these cases, with the simultaneous use of ACE inhibitors, a decrease in the dose of the hypoglycemic agent for oral and insulin is required. Hylorotiazide glucocorticosteroids, adrenocorticotropic hormone (ACTH), amphotericin B (parenterally), carbenoksolon, penicillin G sodium salt, salicylic acid derivatives: while they are used with hydrochlorotiazide, an increase in electrolyte loss, especially the development of hypokalism. Simultaneous intake of ion -exchange drugs (steering wheel, rhinoma) reduces the absorption of hydrochlorotiazide. With the simultaneous use of hydrochlorotiazide with calcium salts, it is possible to increase the concentration of calcium in the blood serum, due to a decrease in its excretion. If it is necessary to prescribe calcium preparations, it should be controlled by its concentration in the blood serum and correctly adjust its dose. With the simultaneous use of hydrochlorotiazide with cardiac glycosides, arrhythmias are possible. Medicines capable of calling Ari (“Torsades des Pointes”) (a special form of polymorphic ventricular tachycardia with an excitement, spindle-shaped configuration of ventricular complexes in combination with an increase or decrease in the amplitude of the QRS complex, which can lead to ventricular fibrillation or asystole) : из-за риска развития гипокалиемии требуется осторожность при одновременном применении гидрохлоротиазида с некоторыми антиаритмическими средствами (хинидин, гидрохинидин, дизопирамид, амиодарон, соталол, дофетилид, ибутилид), нейролептиками (тиоридазин, хлорпромазин, левомепромазин, трифлуоперазин, циамемазин, сульпирид, сультоприд, амисульприд Tiapid, Pimoside, Haloperidol, Dropperidol) and others (Bephopal, Cisapride, Depemanil Methyl Sulfate, Erythromycin for intravenous administration, halophantrin, mizolastine, nantamidin, sparfloxacin, terphenin, vincamine for intravenous administration), which are known that they can cause Ari. With the joint use of hydrochlorotiazide with non -trapping muscle relaxants (including so chocoucurine chloride) - strengthening the action of muscle relaxants. Tiazids can increase the risk of side effects of Amantadine. Tiaside diuretics treatment can disrupt glucose tolerance. With the simultaneous use of M-cholin blockors (atropine) and thiazides, due to the decrease in the motility of the gastrointestinal tract, the bioavailability of thiazide diuretics may increase. It may be required to reduce the dose of hypoglycemic agents for oral and insulin. Contragric agents (probenecid, sulfinpirazone, allopurinol): It may be necessary to correct the dose of the hypouricemic agent (increasing the dose of probenecide or sulfinpirazone), since hydrochlorotiazide can increase the concentration of uric acid in the blood serum. Simultaneous use with thiazide diuretics can increase the frequency of development of increased sensitivity to allopurinol. The action of sympathomy meters with the simultaneous use of thiazide diuretics can be weakened. Tiazide diuretics can reduce the excretion of cytotoxic agents with the kidneys and strengthen their myelosupressive effect. When taking salicylates in high doses, hydrochlorotiazide can enhance their toxic effect on the central nervous system. There are reports of single cases of hemolytic anemia while taking methyldopa with hydrochlorotiazide. The simultaneous use of cyclosporine with hydrochlorotiazide can increase the risk of hyperuricemia and exacerbation of gout. The simultaneous use of tetracyclines with thiazide diuretics increases the risk of increasing the concentration of urea caused by tetracyclines. This interaction does not apply to doxycycline. Olmesartan Medoxomil/ hydrochlorotiazide in combination simultaneously using lithium preparations with thiazide diuretics can increase the already increased risk of lithium intoxication due to ACE inhibitors, therefore, the joint use of the drug Cardosal® Plus and lithium drugs are not recommended. If such a combination is still necessary, then careful control of the concentration of lithium in the blood serum is also necessary. With the simultaneous use of Cardosal* Plus with Baclofen and Amifostin, an increase in antihypertensive effect is possible. With the simultaneous use of other antihypertensive agents, the hypotensive effect of the drug Cardosal® plus may intensify. Ethanol, barbiturates, narcotic analgesics or antidepressants when used with Cardosal® Plus can lead to aggravation of orthostatic hypotension. Storage conditions and periods

Store at a temperature not exceeding 30°C. Keep the medicine out of the reach of children! Shelf life: 3 years.

Instructions for use of Cardosal (Method and dosage)

Instructions for use of Cardosal prescribe taking the drug orally every day at the same time, once a day.

The recommended initial dose is 10 mg once daily. If the blood pressure reduction is not sufficient when taking 10 mg per day, it can be increased to 20 mg per day. If additional pressure reduction is required, the dosage is increased to a maximum of 40 mg per day or a diuretic (for example, hydrochlorothiazide ).

The highest daily dose is 40 mg.

Cardosal® 10

Olmesartan medoxomil, the active ingredient of Cardosal® 10, is a potent specific antagonist of angiotensin II receptors (type AT1).

Angiotensin II is the primary vasoactive hormone of the renin-angiotensin-aldosterone system and plays a significant role in the pathophysiology of arterial hypertension by acting on AT1 receptors. Olmesartan medoxomil is expected to block all AT1 receptor-mediated actions of angiotensin II, regardless of the source and route of angiotensin II synthesis. The specific antagonism of olmesartan medoxomil towards angiotensin II receptors (AT1 type) leads to an increase in the activity of renin, angiotensin I and II in the blood plasma, and also helps to reduce the plasma concentration of aldosterone.

The antihypertensive effect of olmesartan medoxomil usually develops within 2 weeks, and the maximum effect develops approximately 8 weeks after the start of therapy.

The effect of olmesartan medoxomil on mortality and complication rates has not been established. The ROADMAP trial, a randomized trial of 4447 patients with type 2 diabetes mellitus, normoalbuminuria, and at least one additional cardiovascular risk factor, assessed the ability of olmesartan medoxomil to prolong the time to onset of microalbuminuria. During the study period (median follow-up of 3.2 years), patients received olmesartan medoxomil or placebo in addition to other antihypertensive agents other than angiotensin-converting enzyme (ACE) inhibitors or other angiotensin II receptor antagonists.

The secondary composite cardiovascular endpoint was recorded in 40 patients in the olmesartan medoxomil group (14.2%) and in 53 patients in the placebo group (18.7%).

The composite cardiovascular endpoint included: death from cardiovascular causes in 10 (3.5%) patients in the olmesartan medoxomil group and in 3 (1.1%) patients in the placebo group; total mortality (19 (6.7%) cases in the olmesartan medoxomil group and 20 (7.0%) cases in the placebo group), non-fatal stroke (8 (2.8%) cases in the olmesartan medoxomil group and 11 (3.9 %) cases in the placebo group), non-fatal myocardial infarction (3 (1.1%) cases in the olmesartan medoxomil group and 7 (2.5%) cases in the placebo group).

Children and teenagers

In children and adolescents, treatment was effective for both primary and secondary arterial hypertension. As in adult patients, blood pressure in black patients decreased to a lesser extent.

Interaction

Concomitant use with potassium supplements, potassium-sparing diuretics or other drugs that can increase potassium in the blood is not recommended.

The antihypertensive effect of treatment with olmesartan is enhanced when used in combination with other antihypertensive drugs.

Nonsteroidal anti-inflammatory drugs, cyclooxygenase type 2 inhibitors, and angiotensin type 2 receptor blockers may interact synergistically to inhibit glomerular filtration. In this case, there is a possibility of acute renal failure . To avoid such phenomena, it is recommended to monitor kidney function at the beginning of therapy, as well as timely intake of a sufficient volume of fluid.

When used together with antacids , a moderate decrease in the bioavailability of olmesartan is possible.

The use of olmesartan together with lithium preparations is dangerous due to an increase in the concentration of the latter in the blood.

Interactions of the drug Cardosal

When used with other antihypertensive drugs, the effect of olmesartan medoxomil may be enhanced. When olmesartan medoxomil is used simultaneously with NSAIDs, its antihypertensive effect may be reduced and there may be a risk of acute renal failure. After therapy with antacids (magnesium-aluminum hydroxide), a decrease in the bioavailability of olmesartan medoxomil was noted. The combined use of warfarin and digoxin does not change the pharmacokinetics of olmesartan. It is not recommended to use olmesartan medoxomil with lithium preparations due to the increased toxicity of the latter. Due to the possibility of developing hyperkalemia, it is not recommended to use olmesartan medoxomil with potassium-sparing diuretics, drugs containing potassium, or with other drugs that can lead to an increase in serum potassium levels (for example, heparin). When using olmesartan medoxomil with pravastatin, no clinically significant interactions were observed. The interactions of olmesartan medoxomil with drugs that are metabolized by the cytochrome P450 enzyme have not been determined.

special instructions

When using the drug in people with impaired renal function, it is recommended to regularly monitor potassium and creatinine in the blood.

It should be remembered that an excessive decrease in pressure in patients with coronary artery disease or cerebrovascular changes can cause heart attack or stroke .

When driving a vehicle during treatment with this drug, you should be careful.

Features of application

Pregnant

The drug is contraindicated in pregnant women or women who are planning to become pregnant. If pregnancy is confirmed during treatment with a drug, its use must be stopped immediately and replaced with another drug approved for use in pregnant women.

Women who are breastfeeding should not use the drug due to lack of experience with its use during this period. Instead, you can use other antihypertensive drugs, the safety of which has been proven during breastfeeding, especially when feeding infants or premature infants.

Drivers

The drug has a slight or moderate effect on the ability to drive vehicles or use other machinery. Dizziness or fatigue may occasionally occur in patients taking antihypertensive therapy, which may impair responsiveness.

Cardosal's analogs

Level 4 ATC code matches:
Telmisartan

Irbesartan

Presartan

Nortivan

Candesartan

Kozaar

Aprovel

Teveten

Blocktran

Valsartan

Losartan

Atakand

Diovan

Valsacor

Mikardis

Vazar

Valz

Lorista

Lozap

Complete analogues of Cardosal: Olimestra, Olmesar.

Cardosal price, where to buy

In Russia, the price of Cardosal 10 No. 28 is 460-570 rubles, the price of Cardosal 20 No. 28 is 505-660 rubles, and Cardosal 40 with the same number is 670-715 rubles.

In Ukraine, prices for the drug in the same release forms are close to 248, 328 and 374 hryvnia, respectively.

Online pharmacies in RussiaRussia
Online pharmacies in UkraineUkraine

ZdravCity

Cardosal tablets p.p.o.
10 mg 28 pcs. Daichi Sankyo Europe GmbH RUR 582 order
Cardosal tablets p.p.o. 40 mg 28 pcs. Daichi Sankyo Europe GmbH
RUB 874 order
Cardosal Plus tablets p.p.o. 12.5mg+20mg 28pcs Daichi Sankyo Europe GmbH
RUR 796 order
Cardosal tablets p.p.o. 20 mg 28 pcs. Daichi Sankyo Europe GmbH
RUR 761 order

Pharmacy Dialogue

Cardosal plus (tab. p.pl/vol. 12.5 mg + 20 mg No. 28) Daiichi Sankyo
RUR 777 order
Cardosal (tab.p/vol.10mg No. 28)Berlin-Chemie AG/Menarini
RUR 576 order
Cardosal (tab.p/vol.40mg No. 28)Berlin-Chemie AG/Menarini
RUB 817 order
Cardosal (tablet p/o 20 mg No. 28)Berlin-Chemie AG/Menarini
RUR 738 order

Pharmacy24

Cardosal plus 20/12.5 No. 28 tablets Daichie Sankio Europe GmbH/Berlin Chemie AG (Menarini Group), Nimechchina/Nimechchina
380 UAH.order
Cardosal 40 mg No. 28 tablets Berlin Chemi AG, /Daichi Sankio Europe GmbH/Labor.Menarini S.A., Nimechchina
427 UAH. order
Cardosal plus 20/25 No. 28 tablets Berlin Chemi AG, Nimechchina
380 UAH. order
Cardosal 20 mg No. 28 tablets Berlin Chemi AG, /Daichi Sankio Europe GmbH/Labor.Menarini S.A., Nimechchina
388 UAH order
Cardosal 10 mg N28 tablets Berlin Chemi AG, /Daichi Sankio Europe GmbH/Labor.Menarini S.A., Nimechchina
312 UAH. order

Note!

Description of the drug Cardosal table. p/o 20 mg No. 28 on this page is a simplified author’s version of the apteka911 website, created on the basis of the instructions for use.
Before purchasing or using the drug, you should consult your doctor and read the manufacturer's original instructions (attached to each package of the drug). Information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. Only a doctor can decide to prescribe the drug, as well as determine the dose and methods of its use.