Vamloset tabs 10mg + 160mg #90
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Vamloset instructionYou can buy Vamloset hereComposition1 tab .:- amlodipine (in the form of besylate) 10 mg- valsartan 160 mgpharmachologic effectCombined antihypertensive drug containing two active substances with the complement..
You can buy Vamloset here
1 tab .:
- amlodipine (in the form of besylate) 10 mg
- valsartan 160 mg
Combined antihypertensive drug containing two active substances with the complementary mechanism of blood pressure control. Amlodipine, a derivative of dihydropyridine, belongs to the class of BPC, valsartan - to the class of angiotensin II receptor antagonists (APA II). The combination of these components has a mutually complementary hypotensive effect, which leads to a more pronounced decrease in blood pressure compared with their separate use.
Amlodipine + valsartan
The combination of amlodipine and valsartan additively dose-dependently reduces blood pressure in the therapeutic dose range. When taking a single dose of the combination, amlodipine + valsartan hypotensive effect persists for 24 hours.
The clinical efficacy of the combination amlodipine + valsartan in patients with mild and moderate arterial hypertension has been proven (mean DBP ≥95 mmHg and the level of blood pressure reduction in the sitting position with hypertension with DBP ≥110 mmHg and the hypotensive effect lasts long. Sudden cessation of Vamloset is not accompanied by a sharp increase in blood pressure (no withdrawal syndrome).
Therapeutic efficacy does not depend on the age, gender, race of the patient and body mass index.
When combined therapy with amlodipine + valsartan is used, comparable blood pressure control is achieved with a lower probability of developing peripheral edema in patients with previously achieved blood pressure control and marked peripheral edema during amlodipine therapy.
Amlodipine - a derivative of dihydropyridine, BPC, has antianginal and hypotensive effects. Inhibits transmembrane entry of calcium ions into cardiomyocytes and vascular smooth muscle cells. The mechanism of the hypotensive effect of amlodipine is due to a direct relaxing effect on vascular smooth muscle, which leads to a decrease in OPSS and blood pressure.
Amlodipine in therapeutic doses in patients with arterial hypertension causes dilation of blood vessels, which leads to a decrease in blood pressure (in the lying and standing position). Reduction of blood pressure with prolonged use of amlodipine is not accompanied by a significant change in heart rate and catecholamine concentration in the blood plasma.
The concentration of amlodipine in plasma correlates with the clinical effect in both young patients and elderly patients.
In hypertension in patients with normal renal function, amlodipine at therapeutic doses leads to a decrease in renal vascular resistance and an increase in glomerular filtration rate and effective renal blood flow without changing the filtration fraction or proteinuria.
Amlodipine, like other BPCs, in patients with normal left ventricular function (LV) causes a change in the hemodynamic parameters of heart function at rest and during physical exertion (or stimulation): a slight increase in cardiac index, without significantly affecting the maximum pressure build-up rate in the LV ( dP / dt) or end LV diastolic pressure, or end LV diastolic volume. The use of amlodipine in the therapeutic dose range does not cause a negative inotropic effect, even when used simultaneously with beta-blockers.
Amlodipine does not change the function of the sinoatrial node or AV conduction in intact animals or humans. The use of amlodipine in combination with beta-blockers in patients with arterial hypertension or angina pectoris was not accompanied by unwanted ECG changes.
Clinical efficacy of amlodipine in patients with stable exertional angina, vasospastic angina, and angiographically confirmed coronary artery disease has been proven.
Valsartan is a selective ARA II (type AT1) for oral administration, non-protein nature.
Selectively blocks the AT1 subtype receptors, which are responsible for the effects of angiotensin II. Increasing the plasma concentration of angiotensin II due to blockade of AT1 receptors by valsartan can stimulate unblocked receptors of the AT2 subtype, which counteract the effects of stimulation of AT1 receptors. Valsartan does not have agonistic activity against AT1 receptors. The affinity of valsartan for the AT1 subtype receptors is about 20,000 times higher than for the AT2 receptor subtype.
Valsartan does not inhibit ACE, also known as kininase II, which converts angiotensin I to angiotensin II and destroys bradykinin. Due to the lack of influence on the ACE, the effects of bradykinin or substance P are not potentiated, therefore, when taking APA II, the development of dry cough is unlikely. It is proved that the incidence of dry cough in the treatment of valsartan is significantly lower compared with the use of ACE inhibitors. Valsartan does not interact and does not block the receptors of other hormones or ion channels involved in the regulation of the functions of the CAS.
In the treatment of hypertension, valsartan lowers blood pressure without affecting heart rate. After ingestion of a single dose of valsartan, the hypotensive effect develops within 2 hours, and the maximum decrease in blood pressure is reached within 4–6 hours. The hypotensive effect of valsartan persists for 24 hours after taking it. With the repeated use of valsartan, the maximum reduction in blood pressure, regardless of the dose, is achieved in 2-4 weeks and is maintained at the achieved level during long-term therapy. Sudden cessation of valsartan is not accompanied by a significant increase in blood pressure or other adverse events (withdrawal syndrome).
Vamloset, indications for use
Arterial hypertension (patients for whom combination therapy is indicated).
Contraindications for Vamloset
Hypersensitivity to amlodipine, other derivatives of the dihydropyridine series, valsartan, or other components of the drug Vamloset;
severe liver failure (more than 9 points on the Child-Pugh scale), biliary cirrhosis and cholestasis;
severe renal failure (Cl creatinine less than 30 ml / min), patients on hemodialysis;
severe hypotension (SAD less than 90 mmHg), collapse, shock (including cardiogenic shock);
obstruction of the LV outflow tract (including hypertrophic obstructive cardiomyopathy and severe aortic stenosis);
hemodynamically unstable heart failure after acute myocardial infarction;
primary hyper aldosteronism;
simultaneous use with aliskiren in patients with diabetes mellitus or impaired renal function (Cl creatinine less than 60 ml / min);
The safety of the use of Vamloset drug in patients after kidney transplantation, as well as children and adolescents under 18 years of age has not been established.
With caution: impaired liver function easy (5-6 points on the Child-Pugh scale) and moderate (7-9 points on the Child-Pugh scale) severity; obstructive biliary tract diseases; impaired renal function of mild and moderate severity (Cl creatinine 30–50 ml / min); unilateral or bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney; chronic heart failure of the III – IV functional class according to the NYHA classification; hyperkalemia; hyponatremia; dietary restriction; reduced bcc (including diarrhea, vomiting); hereditary angioedema or edema in the background of previous therapy with APA II. Just as with the use of other vasodilators, special care should be taken when applying to patients with mitral and aortic stenosis of mild or moderate degree.
Dosage and administration
Inside, drinking down with a small amount of water, regardless of the meal time, 1 time per day.
The recommended daily dose - 1 table. Vamloset, containing a combination of amlodipine + valsartan at a dose of 5 + 80 mg, 5 + 160 mg, 10 + 160 mg, 5 + 320 mg or 10 + 320 mg.
It is recommended to start taking the drug Vamloset with a dose of 5 + 80 mg. Increase the dose can be 1-2 weeks after the start of therapy.
The maximum daily dose is 5 + 320 mg (in terms of valsartan) or 10 + 160 mg (in terms of amlodipine) or 10 + 320 mg.
Special patient groups:
Impaired renal function. Dose adjustment is not required.
Liver dysfunction. Use with caution.
Elderly patients. Dose adjustment and dosing regimen is not required.
Impaired renal function. In patients with impaired renal function (Cl creatinine ≥30 mL / min), an initial dose adjustment is not required.
Liver dysfunction. Valsartan is contraindicated in patients with severe liver failure, biliary cirrhosis and cholestasis. The maximum daily dose of valsartan for mild to moderate hepatic insufficiency is 80 mg. The drug Vamloset in a dose of 5 + 160 mg, 5 + 320 mg, 10 + 160 and 10 + 320 mg is contraindicated in these patients.
Elderly patients. Dose adjustment is not required.
Use during pregnancy and lactation
The drug Vamloset contraindicated in pregnancy.
Given the mechanism of action of APA II, the risk to the fetus cannot be excluded when using Vamloset in the first trimester of pregnancy.
Like any other drug that has a direct effect on the RAAS, you should not use the Vamloset drug during pregnancy, nor should women who are planning to become pregnant. When prescribing agents that affect the RAAS, it is necessary to inform women of childbearing age about the potential risk of adverse effects of these drugs on the fetus during pregnancy. When planning pregnancy, it is recommended to transfer the patient to alternative antihypertensive therapy with regard to the safety profile. If pregnancy is diagnosed, you should stop taking Vamloset and, if necessary, switch to alternative anti-hypertensive therapy.
Vamloset, as well as other drugs that have a direct effect on the RAAS, is contraindicated in the II – III trimesters of pregnancy, as it can cause fetotoxic effects (impaired renal function, delayed ossification of the fetal skull bones, oligohydramnion) and neonatal toxic effects (renal failure, arterial hypotension , hyperkalemia) and fetal death. If, nevertheless, Vamloset was used in the II – III trimesters of pregnancy, then an ultrasound of the kidneys and bones of the fetal skull must be performed. Newborns whose mothers took Vamloset during pregnancy should be supervised, as possible development of arterial hypotension in the newborn.
Do not use the drug Vamloset during breastfeeding. If necessary, drug therapy Vamloset during lactation, breastfeeding should be stopped.
Classification of the incidence of side effects WHO: very often - ≥1 / 10; often from ≥1 / 100 to
Infectious and parasitic diseases: often - nasopharyngitis, flu.
On the part of the immune system: rarely - hypersensitivity.
Metabolism and nutrition: often - hypokalemia; infrequently - anorexia, hypercalcemia, hyperlipidemia, hyperuricemia, hyponatremia.
Mental disorders: rarely - anxiety.
On the part of the nervous system: often - headache; infrequently - loss of coordination, dizziness, postural dizziness, paresthesia, drowsiness.
On the part of the organ of vision: infrequently - visual impairment; rarely - visual impairment.
On the part of the organ of hearing and labyrinth disturbances: infrequently - vertigo; rarely tinnitus.
From the side of the heart: infrequently - feeling of palpitations, tachycardia; rarely - fainting.
On the part of the vessels: infrequently - orthostatic hypotension; rarely - a pronounced decrease in blood pressure.
On the part of the respiratory system, organs of the chest and mediastinum: rarely - cough, sore throat and larynx.
On the part of the digestive system: rarely - diarrhea, nausea, abdominal discomfort, pain in the upper abdomen, constipation, dryness of the oral mucosa.
From the skin and subcutaneous tissues: infrequently - erythema, skin rash; rarely - rash, hyperhidrosis, pruritus.
On the part of the musculoskeletal and connective tissues: rarely - arthralgia, back pain, swelling of the joints; rarely, muscle spasms, a feeling of heaviness throughout the body.
On the part of the kidneys and urinary tract: rarely - pollakiuria, polyuria.
On the part of the genital organs and the breast: rarely - erectile dysfunction.
General disorders and disorders at the injection site: often - asthenia, fatigue, swelling of the face, feeling of a rush of blood to the skin of the face, edema, peripheral edema, pastosity.
In patients receiving the amlodipine / valsartan combination, peripheral edema was less common (5.8%) than in patients treated with amlodipine alone (9%).
On the part of the blood and lymphatic system: very rarely - leukopenia, thrombocytopenia, sometimes with purpura.
On the part of the immune system: very rarely - hypersensitivity.
On the part of metabolism and nutrition: very rarely - hyperglycemia.
Mental Disorders: Infrequently - depression, insomnia / sleep disorders, mood lability; rarely - confusion.
On the part of the nervous system: often - dizziness, headache, drowsiness; infrequently - a violation of taste, paresthesia, syncope, tremor, hypoesthesia; very rarely - muscle hypertonus, peripheral neuropathy, neuropathy; frequency unknown - extrapyramidal disorders.
On the part of the organ of vision: infrequently - visual impairment, visual impairment.
On the part of the organ of hearing and labyrinth disorders: infrequently - tinnitus.
From the side of the heart: often - a sensation of heartbeat; very rarely, arrhythmias (including bradycardia, ventricular tachycardia and atrial fibrillation), myocardial infarction.
From the side of blood vessels: often - a feeling of a rush of blood to the skin of the face, a pronounced decrease in blood pressure; very rarely - vasculitis.
On the part of the respiratory system, organs of the chest and mediastinum: infrequently - shortness of breath, rhinitis; very rarely - cough.
On the part of the digestive system: often - nausea, feeling of discomfort in the stomach, pain in the upper abdomen; infrequently - change of stool, diarrhea, dryness of the oral mucosa, dyspepsia, vomiting; rarely - gastritis, gingival hyperplasia, pancreatitis.
On the part of the liver and biliary tract: very rarely - an increase in the activity of liver enzymes (more often with cholestasis), an increase in the concentration of bilirubin in the blood plasma, hepatitis, intrahepatic cholestasis, jaundice.
On the part of the skin and subcutaneous tissues: infrequently - alopecia, rash, erythema, photosensitivity reactions, pruritus, hyperhidrosis, purpura, skin rash, change in skin color; very rarely - erythema multiforme, urticaria, exfoliative dermatitis, Stevens-Johnson syndrome, angioedema.
From the musculoskeletal and connective tissues: often - ankle swelling; infrequently - arthralgia, back pain, muscle spasms, myalgia.
On the part of the kidneys and urinary tract: infrequently - a violation of urination, nocturia, pollakiuria.
On the part of the genitals and mammary gland: infrequently - erectile dysfunction, gynecomastia.
General disorders and disorders at the injection site: often - increased fatigue, peripheral edema; infrequently - asthenia, discomfort, malaise, non-cardiogenic pain in the heart, pain.
Laboratory and instrumental data: infrequently - weight loss / increase in body weight.
On the part of the blood and lymphatic system: the frequency is unknown - decrease in hemoglobin and hematocrit, leukopenia, neutropenia, thrombocytopenia, sometimes with purpura.
On the part of the immune system: very rarely - hypersensitivity.
On the part of the organ of hearing and labyrinth disturbances: infrequently - vertigo.
On the part of the vessels: the frequency is unknown - vasculitis.
On the part of the respiratory system, organs of the chest and mediastinum: infrequently - cough.
On the part of the digestive system: infrequently - a feeling of discomfort in the abdomen, pain in the upper abdomen.
On the part of the liver and biliary tract: the frequency is unknown - an increase in the activity of liver enzymes, an increase in plasma bilirubin concentration.
On the part of the skin and subcutaneous tissues: the frequency is unknown - pruritus, skin rash, angioedema.
From the musculoskeletal and connective tissue: the frequency is unknown - myalgia.
On the part of the kidneys and urinary tract: the frequency is unknown - increasing the concentration of creatinine in the blood plasma, impaired renal function, including acute renal failure.
General disorders and disorders at the injection site: infrequently - increased fatigue.
Laboratory and instrumental data: the frequency is unknown - an increase in the content of potassium in the serum.
Additional information about the components of Vamloset
The adverse events that were previously reported with each of the components used may occur with the use of the drug Vamloset, even if they were not observed in clinical studies.
Often - drowsiness, dizziness, palpitations, abdominal pain, nausea, ankle swelling.
Infrequently - insomnia, mood lability (including anxiety), depression, tremor, taste disturbance, syncope, hypoesthesia, visual disturbances (including diplopia), tinnitus, marked reduction in blood pressure, shortness of breath, rhinitis, vomiting , dyspepsia, alopecia, purpura, discoloration of the skin, hyperhidrosis, pruritus, exanthema, myalgia, muscle cramps, pain, impaired urination, increased urination, impotence, gynecomastia, chest pain, malaise, weight gain, weight loss.
Rarely - confusion.
Very rarely, leukopenia, thrombocytopenia, allergic reactions, hyperglycemia, muscular hypertonicus, an opticulist, anemia, anemia, anesthesia (most often due to cholestasis), angioedema, erythema multiforme, urticaria, exfoliative dermatitis, Stevens-Johnson syndrome, photosensitivity.
Separate cases of extrapyramidal syndrome have been described.
Frequency unknown - decrease in hemoglobin and hematocrit, neutropenia, thrombocytopenia, increase in serum potassium, increase in liver enzymes, increase in plasma bilirubin concentration, increase in plasma creatinine, renal dysfunction, including renal failure, angioedema, myalgia , vasculitis, hypersensitivity, including serum sickness.
Patients with hyponatremia and / or a decrease in BCC:
In patients with uncomplicated arterial hypertension, taking the amlodipine / valsartan combination, in 0.4% of cases severe arterial hypotension was observed.
In patients with activated RAAS (for example, in patients with dehydration and / or hyponatremia who take diuretics in high doses), while taking ARA II, symptomatic arterial hypotension may develop. Before starting treatment, it is recommended to restore the sodium content and / or replenish the BCC, in particular by reducing the doses of diuretics or initiate therapy under careful medical supervision.
With the development of a pronounced decrease in blood pressure: the patient should be placed in a horizontal position with raised legs and, if necessary, in / in the infusion of 0.9% sodium chloride solution. Therapy with Vamloset can be continued after stabilization of hemodynamic parameters.
With the simultaneous use of potassium-sparing diuretics, potassium preparations, dietary supplements containing potassium or other drugs that can increase the content of potassium in the blood plasma (for example, heparin), caution should be exercised. It is necessary to regularly monitor the content of potassium ions in the blood plasma.
Renal artery stenosis:
The drug Vamloset should be used with caution in patients with arterial hypertension on the background of unilateral or bilateral stenosis of the renal artery or stenosis of the artery of a single kidney, given the possibility of increasing serum concentrations of urea and creatinine.
Condition after kidney transplantation:
The safety of the combination of amlodipine + valsartan in patients who recently underwent kidney transplantation has not been established.
Valsartan is mainly excreted unchanged with bile. In patients, T1 / 2 is extended, and AUC is increased. Care should be taken when using the drug Vamloset in patients with a lung (5-6 points on the Child-Pugh scale) or moderate (7-8 points on the Child-Pugh scale) abnormal liver function or obstructive diseases of the biliary tract.
Dose adjustment of the drug Vamloset in patients with mild and moderate renal impairment is not required. In patients with moderate renal impairment, it is recommended that potassium and creatinine plasma levels be monitored. The simultaneous use of ARA II, including valsartan, or ACE inhibitors with aliskiren is contraindicated in patients with impaired renal function (Cl creatinine less than 60 ml / min).
Primary hyper aldosteronism:
Given the defeat of the RAAS in primary hyperaldosteronism, these patients should not be prescribed ARA II, incl. valsartan.
In patients with angioedema (including swelling of the larynx and vocal cords, causing airway obstruction and / or swelling of the face, lips, pharynx, and / or tongue) during therapy with Valsakor, there have been cases of angioedema in the history of including and ACE inhibitors. With the development of angioedema should immediately discontinue Vamloset and exclude the possibility of re-use.
Heart failure / myocardial infarction:
In patients whose renal function may depend on the activity of the RAAS (for example, in severe CHF), therapy with ACE inhibitors and ARA II is accompanied by oliguria and / or an increase in azotemia, and in rare cases, acute renal failure and / or death. Similar outcomes have been described with valsartan. In patients with CHF or myocardial infarction, renal function should always be evaluated.
In patients with CHF of the non-ischemic etiology of the III – IV functional class according to the NYHA classification, the use of amlodipine was accompanied by an increase in the incidence of pulmonary edema compared with placebo in the absence of a significant difference in the frequency of CHF deterioration between the two groups. BKK, incl. amlodipine should be used with caution in patients with CHF, because may increase the risk of cardiovascular complications and death.
Stenosis of the aortic valve of mild and moderate degree and mitral valve:
As with the use of any vasodilators, care should be taken in patients with mitral stenosis and mild to moderate aortic stenosis. The combination of amlodipine + valsartan was studied only in patients with arterial hypertension.
Influence on ability to steer vehicles and work with mechanisms. When using the drug Vamloset, care must be taken when driving vehicles and other technical devices that require high concentration of attention and speed of psychomotor reactions, since dizziness, fatigue, and nausea may occur.
- Vamloset (amlodipine + valsartan)
Simultaneous application requiring attention:
Other antihypertensive drugs (for example, alpha-blockers, diuretics) and drugs that have hypotensive effects (for example, tricyclic antidepressants, alpha-blockers for the treatment of benign prostatic hyperplasia) can enhance the hypotensive effect.
Unwanted simultaneous use:
Grapefruit or grapefruit juice: simultaneous use is not recommended, given the possibility of increasing bioavailability in some patients and enhancing the hypotensive effect.
Simultaneous use requiring caution:
CYP3A4 isoenzyme inhibitors: simultaneous use with strong or mild inhibitors of the CYP3A4 isoenzyme (protease inhibitors, verapamil or diltiazem, azole antifungal drugs, macrolides, such as erythromycin or clarithromycin) can lead to a significant increase in systemic exposure to amlodipine. In elderly patients, these changes are of clinical importance, therefore, medical supervision and dose adjustment are necessary.
Inductors of CYP3A4 isoenzyme (anticonvulsant drugs (for example, carbamazepine, phenobarbital, phenytoin, phosphenytoin, primidone), rifamycin, herbal preparations containing St. John's wort), should be used with caution, because with simultaneous use may reduce the concentration of amlodipine in the blood plasma.
Simvastatin: simultaneous repeated use of amlodipine at a dose of 10 mg and simvastatin at a dose of 80 mg increases the exposure of simvastatin by 77% compared to that with simvastatin monotherapy. Patients receiving amlodipine are recommended to use simvastatin in a dose of not more than 20 mg / day.
Dantrolene (on / in the introduction): in experiments on animals after oral administration of verapamil and on / in the administration of dantrolene, cases of fatal ventricular fibrillation and cardiovascular insufficiency associated with hyperkalemia were observed. Given the risk of developing hyperkalemia, the simultaneous use of CCL should be avoided, including amlodipine, in patients prone to the development of malignant hyperthermia.
Simultaneous application requiring attention:
Other: in clinical studies amlodipine no significant interaction with thiazide diuretics, alpha blockers, beta-blockers, ACE inhibitors, long-acting nitrates, nitroglycerin sublingual, digoxin, warfarin, atorvastatin, sildenafil, aluminum and / or magnesium-containing antacids, including maalox, simethicone, cimetidine, NSAIDs, antibiotics and hypoglycemic agents for oral administration.
Simultaneous use is contraindicated:
Simultaneous use of ARA II, including valsartan, or ACE inhibitors with aliskiren is contraindicated in patients with diabetes and kidney dysfunction (Cl creatinine less than 60 ml / min).
Unwanted simultaneous use:
Lithium: simultaneous use with lithium preparations is not recommended, since perhaps a reversible increase in the concentration of lithium in the blood plasma and the development of intoxication. If necessary, the simultaneous use of lithium preparations should be carefully monitored for the concentration of lithium in the blood plasma.
Potassium-sparing diuretics, potassium preparations, potassium-containing dietary supplements and other drugs and substances that can increase the serum potassium content (for example, heparin): if necessary, concurrent use with drugs affecting the potassium content is recommended to monitor plasma potassium.
Simultaneous use requiring caution:
NSAIDs, incl. selective inhibitors of COX-2, acetylsalicylic acid in a dose of more than 3 g / day and other non-selective NSAIDs: with simultaneous use, a decrease in the hypotensive effect, an increase in the risk of developing renal dysfunction and an increase in plasma potassium are possible. At the beginning of therapy, it is recommended to evaluate the function of the kidneys, as well as correct the impaired water-electrolyte balance.
Inhibitors of carrier proteins: according to the results of an in vitro study, valsartan is a substrate for the OATP1B1 and MRP2 carrier proteins. Simultaneous use of valsartan with inhibitors of the OATP1B1 carrier protein (for example rifampicin, cyclosporine) and inhibitor of the carrier protein MRP2 (for example, ritonavir) can increase the systemic exposure of valsartan (Cmax and AUC). This should be considered at the beginning and at the end of concurrent therapy.
Others: with monotherapy with valsartan, there were no clinically significant interactions with the following drugs: cimetidine, warfarin, furosemide, digoxin, atenolol, indomethacin, hydrochlorothiazide, amlodipine and glibenclamide.
Symptoms: data on cases of overdose are currently missing. With an overdose of valsartan, one can expect the development of a pronounced decrease in blood pressure and dizziness. An overdose of amlodipine can lead to a pronounced decrease in blood pressure with possible development of reflex tachycardia and excessive peripheral vasodilation (the risk of severe and persistent arterial hypotension, including the development of shock and death).
Treatment: symptomatic, the nature of which depends on the time elapsed since taking Vamloset, and on the severity of symptoms. In case of accidental overdose, it is necessary to induce vomiting (if the drug has been taken recently) or to perform a gastric lavage. The use of activated carbon in healthy volunteers immediately or within 2 hours after taking amlodipine resulted in a significant decrease in its absorption. With a pronounced decrease in blood pressure on the background of Vamloset taking the drug, it is necessary to transfer the patient to a supine position with raised legs, to take active measures to support CVS activity, including regular monitoring of heart function and respiratory system, BCC and urine volume.
In the absence of contraindications to restore vascular tone and blood pressure, it is possible to use (with caution) vasoconstrictor agents. To eliminate the blockade of calcium channels, it is possible to / in the administration of calcium gluconate solution. Removal of valsartan and amlodipine during hemodialysis is unlikely.
Terms of sell
The prescription is not required to buy Vamloset.